Dataset Information

The Simple Cow Hitch Stitch Technique for Arthroscopic Rotator Cuff Repair and Stabilization Using Knotless Suture Anchors.

ABSTRACT: The tissue-suture interface is the most vulnerable and challenging part of adequate restoration and fixation in rotator cuff repair. We describe a simple stitch technique for arthroscopic rotator cuff repair using knotless suture anchors based on the cow hitch. The simple cow hitch stitch technique is easy to perform, especially under difficult conditions, and provides excellent initial fixation strength as required for integration of the reinserted cuff and for shoulder stabilization.

SUBMITTER: Hawi N

PROVIDER: S-EPMC4523664 | biostudies-literature | 2015 Jun

REPOSITORIES: biostudies-literature

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The Simple Cow Hitch Stitch Technique for Arthroscopic Rotator Cuff Repair and Stabilization Using Knotless Suture Anchors.

Hawi Nael N Krettek Christian C Hawi Ahmed A Meller Rupert R

Arthroscopy techniques 20150504 3

The tissue-suture interface is the most vulnerable and challenging part of adequate restoration and fixation in rotator cuff repair. We describe a simple stitch technique for arthroscopic rotator cuff repair using knotless suture anchors based on the cow hitch. The simple cow hitch stitch technique is easy to perform, especially under difficult conditions, and provides excellent initial fixation strength as required for integration of the reinserted cuff and for shoulder stabilization. ...[more]

PMID: 26258030

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Project description:Incomplete healing and/or functional failure following rotator cuff tear repair remains a challenging problem for both patients and surgeons. Augmentation strategies are growing to increase healing through biologic and mechanical mechanisms to improve functional results after arthroscopic rotator cuff repair. The majority of currently described augmentation techniques use allograft tissue. An alternative, low-cost, autograft option for augmentation is the use of the long head of biceps tendon autograft as a free functional graft. Here, we describe the use of autograft biceps tendon as a viable option for augmentation of double-row rotator cuff repair with knotless all-suture suture anchors. Technique Video Video 1 Arthroscopic repair of a right shoulder rotator cuff repair, subpectoral open biceps tenodesis, and autograft biceps graft augmentation is performed in a beach-chair position. We begin with a diagnostic arthroscopy viewing the subacromial space through the posterolateral portal. The rotator cuff tear is evaluated using a grasper through the lateral portal. The rotator cuff is repaired using a knotless configuration double row transosseous-equivalent beginning with all-suture anchors being placed, creating a medial row. These sutures are then passed through the rotator cuff tear and brought to a lateral row where the final construct is visualized. Next, we perform a mini-open subpectoral biceps tenodesis using a low axillary incision. The proximal biceps tendon is harvested and placed on the back table to be measured for autograft augmentation. The biceps autograft is placed in a compression plate and loaded into the press, where it is “smashed.” Sutures are put into all 4 corners of the graft and loaded onto the delivery device. The patch is inserted into the shoulder through a cannulated lateral portal into the subacromial space and deployed over the rotator cuff repair. The patch is fixated medially using a PLGA tissue tack device and laterally with two anchors. The final repair construct is demonstrated by the autograft patch augmentation lying flush over the rotator cuff repair.

Project description:BackgroundAlthough arthroscopic anchor suturing is commonly used for rotator cuff repair and achieves good results, certain shortcomings remain, including difficulty with reoperation in cases of retear, anchor dislodgement, knot impingement, and financial cost. In 2005, we developed an anchorless technique for arthroscopic transosseous suture rotator cuff repair.Description of techniqueAfter acromioplasty and adequate footprint decortication, three K-wires with perforated tips are inserted through the inferior margin of the greater tuberosity into the medial edge of the footprint using a customized aiming guide. After pulling the rotator cuff stump laterally with a grasper, three K-wires are threaded through the rotator cuff and skin. Thereafter, five Number 2 polyester sutures are passed through three bone tunnels using the perforated tips of the K-wires. The surgery is completed by inserting two pairs of mattress sutures and three bridging sutures.MethodsWe investigated the retear rate (based on MR images at least 1 year after the procedure), total score on the UCLA Shoulder Rating Scale, axillary nerve preservation, and issues concerning bone tunnels with this technique in 384 shoulders in 380 patients (174 women [175 shoulders] and 206 men [209 shoulders]). Minimum followup was 2 years (mean, 3.3 years; range, 2-7 years). Complete followup was achieved by 380 patients (384 of 475 [81%] of the procedures performed during the period in question). The remaining 91 patients (91 shoulders) do not have 1-year postsurgical MR images, 2-year UCLA evaluation or intraoperative tear measurement, or they have previous fracture, retear of the rotator cuff, preoperative cervical radiculopathy or axillary nerve palsy, or were lost to followup.ResultsRetears occurred in 24 patients (24 shoulders) (6%). The mean overall UCLA score improved from a preoperative mean of 19.1 to a score of 32.7 at last followup (maximum possible score 35, higher scores being better). Postoperative EMG and clinical examination showed no axillary nerve palsies. Bone tunnel-related issues were encountered in only one shoulder.ConclusionsOur technique has the following advantages: (1) reoperation is easy in patients with retears; (2) surgical materials used are inexpensive polyester sutures; and (3) no knots are tied onto the rotator cuff. This low-cost method achieves a low retear rate and few bone tunnel problems, the mean postoperative UCLA score being comparable to that obtained by using an arthroscopic anchor suture technique.

Dataset Information

The Simple Cow Hitch Stitch Technique for Arthroscopic Rotator Cuff Repair and Stabilization Using Knotless Suture Anchors.

Publications

The Simple Cow Hitch Stitch Technique for Arthroscopic Rotator Cuff Repair and Stabilization Using Knotless Suture Anchors.

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