Abstract：Background Rotator cuff tears is a important reason of shoulder pain.Single-row(SR) and suture bridge(SB) suture anchor technique are widely used in repairing rotator cuff tears.There are a lot of articles about SR and SB in the treatment of rotator cuff moderate damage (2-4 cm),but few literature of the comparision of their clinical effect in repairing rotator cuff moderate damage.The SR and SB in rotator cuff moderate tear treatment is controversial.The purpose of this study is to compare the short-term clinical outcomes and structural integrity after an all-arthroscopic repair in 2-4 cm rotator cuff tears with SR and SB suture anchor technique.Methods We adopted prospective randomized controlled method to compare the SR and operation effect of SB in mild cases of rotator cuff tear.With the symptoms,medical examination,preoperative MRI and arthroscopy in the verification results,11 cases who were conformd to the standard of moderate patients with rotator cuff tear were selected in the patients undergoing surgical repair of rotator cuff injury in our hospital from April 2012 to May 2013,and randomly assigned into the SR group and SB (SR group of 6 cases,5 cases SB group).Two groups respectively adopted corresponding operations. All patients were regularly followed-up postoperatively. Clinical data including patient’s general information, pre and postoperative clinical scores, the average operation time were collected. Comparison between SR and SB in the treatment of medium size (2-4 cm) rotator cuff tears was done by comparing the pre-and postoperative shoulder scores and patient’s satisfaction. t-test was used to compare the two groups. P<0.05 was set as statistical significance when comparing the clinical difference of the two groups.Results No significant difference showed between the SR and SB groups after comparison of demographic data,preoperative tear size,and global fatty degeneration index(t=0.923,P>0.05).The SR group average follow-up of 12.7 months,SB group were followed up for 14.6 months.Two groups of preoperative pain visual analog scale (PVAS),Constant,American shoulder and elbow surgeons scores (ASES) and University of California at LosAngeles (UCLA) score were 6.0,36.5,66.1 and 18.7,and the postoperative scores were 1.7,86.4,84.8 and 31.0,and the difference was statistically significant compared preoperatively and postoperatively (t=-2.64,P<0.001).No intergroup differences were detected at latest fellow-up(t=0.271,P>0.05),but the surgical time in SB group was obviously longer than that in SR group,the significant differences was observed.The operation time was (128.5±15) min in SR group and (168.9±24) min in SB group.Significant difference existed between the two groups when operation time was compared.Conclusion At a median follow-up of 11.2 months,the clinical scores and retear rate between SR group and SB group were no significant difference after arthroscopic repair in patients with medium size rotator cuff tear.
[1] Apreleva M,Ozbaydar M,Fitzgibbons PG,et al.Rotator cuff tears:the effect of the Reconstruction method on three-dimensional repair site area[J].Arthroscopy,2002,18(5):519-526. [2] Bishop J,Klepps S,Lo IK,et al.Cuff integrity after arthroscopic versus open rotator cuff repair.A prospective study[J].J shoulder Elbow Surg,2006,15(3):290-299. [3] Lo IK,Burkhart SS.Double-row arthroscopic rotator cuff repair:re-establishing the footprint of the rotator cuff[J].Arthroscopy,2003,19(9):1035-1042. [4] Kim KC,Shin HD,LEE WY.Repair integrity and functional outcomes after arthroscopic suture-bridge rotator cuff repair[J].J Bone Joint Surg Am,2012,94(8):e48. [5] Chen M,Xu W,Dong Q,et al.Outcomes of single-row versus double-row arthroscopic rotator cuff repair:A systemic review and meta-analysis of current evidence[J].Arthroscopy,2013,29(8):1437-1439. [6] Kim KC,Rhee KJ,Shin HD.Deformities associated with the suture-bridge technique for full-thickness rotator cuff tears[J].Arthroscopy,2008,24(11):1251-1257. [7] Sugaya H,Maeda K,Matsuki K,et al.Functional and structural outcome after arthroscopic full-thickness rotator cuff repair:single-row versus dual-row fixation[J].Arthroscopy,2005,21(11):1307-1316. [8] Cho NS,Lee BG,Rhee YG.Arthroscopic rotator cuff repair using a suture bridge technique:is the repair integrity actually maintained? [J].Am J Sports Med,2011,39(10):2108-2116. [9] Duquin TR,Buyea C,Bisson LJ.Which method of rotator cuff repair leads to the highest rate of structural healing? A systematic review[J].Am J Sports Med,2010,38(4):835-841. [10] Mall NA,Lee AS,Chahal J,et al.Transosseous-equivalent rotator cuff repair:a systematic review on the biomechanical importance of tying the medial row[J].Arthroscopy,2013,29(2):377-386. [11] Lorbach O,Kieb M,Raber F,et al.Comparable biomechanical results for a modified single-row rotator cuff Reconstruction using triple-loaded suture anchors versus a suture-bridging double-row repair[J].Arthroscopy,2012,28(2):178-187. [12] Harryman DT II,Mack LA,Wang KY,et al.Repairs of the rotator cuff.Correlation of functional results with integrity of the cuff[J].J Bone Joint Surg Am,1991,73(7):982-989. [13] Thomazeau H,Boukobza E,Morcet N,et al.Prediction of rotator cuff repair results by magnetic resonance imaging[J].Clin Orthop Relat Res,1997,11(344):275-283. [14] Toussaint B,Schnaser E,Lafosse L,et al.A new approach to improving the tissue grip of the medial-row repair in the suture-bridge technique:the “modified lasso-loop stitch”[J].Arthroscopy,2009,25(6):691-695. [15] Nho SJ,Slabaugh MA,Seroyer ST,et al.Does the literature support double-row suture anchor fixation for arthroscopic rotator cuff repair? A systematic review comparing double-row and single-row suture anchor configuration[J].Arthroscopy,2009,25(11):1319-1328. [16] Wall LB,Keener JD,Brophy RH.Clinical outcomes of double-row versus single-row rotator cuff repairs[J].Arthroscopy,2009,25(11):1312-1318. [17] Mihata T,Watanabe C,Fukunishi K,et al.Functional and structural outcomes of single-row versus double-row versus combined double-row and suture-bridge repair for rotator cuff tears[J].Am J Sports Med,2011,39(10):2091-2098. [18] Burks RT,Crim J,Brown N,et al.A prospective randomized clinical trial comparing arthroscopic single- and Double-Row rotator cuff repair magnetic resonance imaging and early clinical evaluation[J].American Journal of Sports Medicine,2009,37(4):674-682. [19] Christoforetti JJ,Krupp RJ,Singleton SB,et al.Arthroscopic suture bridge transosseus equivalent fixation of rotator cuff tendon preserves intratendinous blood flow at the time of initial fixation[J].J Shoulder Elbow Surg,2012,21(4):523-530. [20] Cho NS,Lee BG,Rhee YG.Arthroscopic rotator cuff repair using a suture bridge technique:is the repair integrity actually maintained?[J].Am J Sports Med,2011,39(10):2108-2116. [21] Park JY,Lhee SH,Choi JH,et al.Comparison of the clinical outcomes of single- and double-row repairs in rotator cuff tears[J].Am J Sports Med,2008,36(7):1310-1316. [22] Kim YK,Moon SH,Cho SH.Treatment outcomes of single- versus double-row repair for larger than medium-sized rotator cuff tears:the effect of preoperative remnant tendon length[J].Am J Sports Med,2013,41(10):2270-2277. [23] Franceschi F,Ruzzini L,Longo UG,et al.Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears:a randomized controlled trial[J].Am J Sports Med,2007,35(8):1254-1260. [24] Charousset C,Grimberg J,Duranthon LD,et al.Can a double-row Anchorage technique improve tendon healing in arthroscopic rotator cuff repair?:A prospective,nonrandomized,comparative study of double-row and single-row Anchorage techniques with computed tomographic arthrography tendon healing assessment[J].Am J Sports Med,2007,35(8):1247-1253. [25] Park JY,Lhee SH,Oh KS,et al.Clinical and ultrasonographic outcomes of arthroscopic suture bridge repair for massive rotator cuff tear[J].Arthroscopy,2013,29(2):280-289. [26] Park JY,Siti HT,Keum JS,et al.Does an arthroscopic suture bridge technique maintain repair integrity?:a serial evaluation by ultrasonography[J].Clin Orthop Relat Res,2010,468(6):1578-1587. [27] Goutallier D,Postel JM,Gleyze P,et al.Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears[J].J Shoulder Elbow Surg,2003,12(6):550-554. [28] Flury MP,John M,Goldhahn J,et al.Rupture of the subscapularis tendon (isolated or in combination with supraspinatus tear):when is a repair indicated? [J].J Shoulder Elbow Surg,2006,15(6):659-664. [29] Williams MD,Ldermann A,Melis B,et al.Fatty infiltration of the supraspinatus:a reliability study[J].J Shoulder Elbow Surg,2009,18(4):581-587.
