Arthroscopic Rotator Cuff Repair Using Modified Mason-Allen Medial Row Stitch: Knotless Versus Knot-Tying Suture Bridge Technique

• Published in: The American journal of sports medicine 2012-11, Vol.40 (11), p.2440-2447
• Main Authors: Rhee, Yong Girl, Cho, Nam Su, Parke, Chong Suck
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arthroscopy; Biological and medical sciences; Cohort Studies; Comparative analysis; Diseases of the osteoarticular system; Endoscopy; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Juxtaarticular diseases. Extraarticular rhumatism; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; NMR; Nuclear magnetic resonance; Rotator Cuff - surgery; Rotator Cuff Injuries; Surgical outcomes; Surgical techniques; Suture Techniques; Tendon Injuries - diagnosis; Tendon Injuries - surgery
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546512459170

Background: When using a method of suture bridge technique, there may be a possibility of strangulation of the rotator cuff tendon at the medial row. The style of knots chosen to secure the medial row might conceivably be a factor to reduce this possibility. Purpose: To compare the clinical results and repair integrity of arthroscopic rotator cuff repair between a knotless and a conventional knot-tying suture bridge technique for patients with full-thickness rotator cuff tears and to evaluate retear patterns in the cases with structural failure after arthroscopic repair by magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence, 2. Methods: After arthroscopic repair for medium-sized rotator cuff tears, 110 patients available for postoperative MRI evaluation at least 6 months were enrolled in this study. According to the repair technique, 51 shoulders were enrolled in a knotless suture bridge technique group (group A) and 59 shoulders in a conventional knot-tying suture bridge technique group (group B). The mean age at the time of the operation was 61.0 years (range, 44-68 years) in group A and 57.6 years (range, 45-70 years) in group B. The mean follow-up period was 21.2 months (range, 12-34 months) and 22.1 months (range, 13-32 months), respectively. Results: The Constant score of group A increased from the preoperative mean of 65.2 points to 79.1 points at the last follow-up (P < .001). The corresponding figures for group B improved from 66.6 points to 76.3 points (P < .001). The preoperative Shoulder Rating Scale of the University of California at Los Angeles (UCLA) score was 21.1 points in group A and 18.3 points in group B. The UCLA score at the last follow-up was 31.0 points in group A and 27.9 points in group B (P < .001, P < .001). Retear rate was significantly lower in group A (5.9%) than group B (18.6%) (P < .001). In group B, retear occurred at the musculotendinous junction in 72.7%, but group A had no medial cuff failure. Conclusion: In arthroscopic suture bridge repair of full-thickness rotator cuff tears, clinical results of both a knotless and a conventional knot-tying group showed improvement without significant difference between the 2 groups. However, the knotless group had a significantly lower retear rate compared with the conventional knot-tying group. A knotless suture bridge technique could be a new supplementary repair technique to conventional technique.