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Functional outcomes of arthroscopic transosseous rotator cuff repair using a 2-mm tape suture in a 137-patient cohort

ABSTRACT:

Background

Although being the historical gold standard for rotator cuff repair, open transosseous (TO) repair was largely replaced by anchor-based methods with the advent of arthroscopic surgery owing to their comparative ease of use. However, suture anchors are at risk of dislodgement, especially among older patients, who have more osteopenic bone or those presenting large tears. Considering the ever-increasing active life expectancy and associated increased quality of life expectations by older generations, the need to offer safe and efficient surgical treatments to these patients imposes itself. Arthroscopic TO repairs would combine the best of both worlds and be well adapted to these populations. The primary objective of this study was to evaluate the functional outcome and complication rate of the TO arthroscopic repair technique when using a 2-mm braided suture tape. The secondary objective of this study was to assess functional outcome of TO repair in older patients and patients with >3-cm tears.

Methods

One hundred thirty-seven consecutive patients with full-thickness rotator cuff tear who underwent arthroscopic TO (anchorless) rotator cuff repair between January 2011 and December 2013 were reviewed. The surgery was performed by a single surgeon with a reusable curved suture passer and 2-mm braided tape suture. Follow-up was 3 to 5 years (mean = 50 months). All patients underwent preoperative and postoperative functional assessments (American Shoulder and Elbow Surgeons and Quick Dash) and were questioned with their overall satisfaction.

Results

Thirty-eight (28%) of the 137 patients were 65 years and older, and 62 (45%) had a large or massive tear. One patient (0.7%) had early retear at the suture-tendon interface after trauma 3 weeks postoperatively. The average Quick Dash score improved by 55.6 points and the average American Shoulder and Elbow Surgeons score improved by 69.7 points 3.5 and 6.3 times their minimal clinically important differences, respectively. There was no significant difference in final functional outcomes between patients 65 years and older and younger patients or between patients with large and massive (>3 cm) and smaller tears (≤3 cm). Mean operative time was 68 min ± 16.

Conclusions

Arthroscopic TO repair using a 2-mm tape material has achieved significant mid-term functional improvement, with results statistically unaffected by larger tear size (>3 cm) or older age (≥65 years).

SUBMITTER: Beauchamp J

PROVIDER: S-EPMC8568820 | biostudies-literature |

REPOSITORIES: biostudies-literature

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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.