The Integrity after Arthroscopically Repairing the Rotator Cuff Tendon Using the Suture Bridge Technique

Sang Jin Cheon; Joon Oh Hur; Jeung Tak Suh; Chong Il Yoo

doi:10.4055/jkoa.2011.46.1.1

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Cheon, Hur, Suh, and Yoo: The Integrity after Arthroscopically Repairing the Rotator Cuff Tendon Using the Suture Bridge Technique

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2011; 46(1): 1-9.

Published online: 22 February 2011

DOI: https://doi.org/10.4055/jkoa.2011.46.1.1

The Integrity after Arthroscopically Repairing the Rotator Cuff Tendon Using the Suture Bridge Technique

Sang Jin Cheon, M.D., Joon Oh Hur, M.D., Jeung Tak Suh, M.D., Chong Il Yoo, M.D.

Department of Orthopedic Surgery, Pusan National University School of Medicine, Pusan, Korea.

Correspondence to: Sang Jin Cheon, M.D. Department of Orthopedic Surgery, Pusan National University School of Medicine, 1 Ga-10, Ami-dong, Seo-gu, Busan 602-739, Korea. TEL: +82-51-240-7248, FAX: +82-51-247-8395, scheon@pusan.ac.kr

Received 1 July 2010 Accepted 3 December 2010

(open-access):

"This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited."

Abstract

Purpose

We evaluated the integrity after repairing the arthroscopic rotator cuff tendon using the suture-bridge technique in patients with full thickness rotator cuff tendon tears.

Materials and Methods

Forty two (males: 14, females: 28) consecutive shoulders that were treated with this index procedure and that had magnetic resonance imaging (MRI) taken at a mean of 9 months postoperatively were enrolled to estimate the postoperative intregrity of the repair. The mean age was 57 years (range: 44-75 years) and the mean follow-up period was 14 months (range: 12-16 months). The follow up MRI was evaluated using the Sugaya classification for postoperative cuff integrity. The clinical outcomes were evaluated by using the University of California Los Angeles (UCLA) score, the Korean Shoulder Scoring System (KSS) and Visual Analogue Scale (VAS). Significance was set at p values < 0.05

Results

In the 42 cases with follow up MRI, the cuff integrity was graded as type I in 10 cases, type II in 28, type III in 2, type IV in 1 and type V in 1 case. Out of the 39 cases having a medium to large tear, the type I and II cuff integrity was 92.3% and two patients had type III cuff integrity postoperatively, while the rate of retear was 33.3% (1 of 3) in the cases with massive tear. The overall rate of retear was 4.8%. For the intact postoperative repair rate, the precent of cases with fatty degeneration of grade 3 or less seen on preoperative MRI was 92.7%. For 41 patients, except for 1 case of type V retear, the UCLA score and the KSS score were significantly improved (p < 0.05) from 17.2 to 31.4 and from 58.2 to 90.8 on average, respectively, which showed satisfactory clinical outcomes regardless of the type of repair integrity.

Conclusion

The arthroscopic suture-bridge technique resulted in intact repair integrity in 90.4% of the cases and improved clinical outcomes, so we think this technique is one of the reliable procedures for treating full-thickness rotator cuff tear.

Keywords: full thickness rotator cuff tendon tears, arthroscopic rotator cuff tendon repair, suture-bridge technique, repair integrity

Figures and Tables

Figure 1

A 64-year-old female had painful limitation of motion of right shoulder preoperatively. (A) Preoperative massive tear of rotator cuff tendons: Black arrow head denotes full-thickness massive tear of rotator cuff tendons in preoperative MRA. (B) Repair integrity: White arrow head indicates Sugaya classification type I in follow-up MRA taken 7 months postoperatively.

Figure 2

A 56-year-old male had right shoulder pain preoperatively. (A) Preoperative large tear of rotator cuff tendons: White arrow head denotes full-thickness large tear of rotator cuff tendons in preoperative MRA. (B) Repair integrity: White arrow head indicates Sugaya classification type II in follow-up MRA taken 8 months postoperatively.

Figure 3

A 55-year-old male was presented with retear of rotator cuff tendons. (A) Preoperative large retear of rotator cuff tendons: Black arrow head denotes full-thickness large retear of rotator cuff tendons in preoperative MRA. (B) Repair integrity: White arrow head indicates Sugaya classification type III in follow-up MRA taken 6 months postoperatively.

Table 1

Repair Integrity according to Tear Size of Rotator Cuff

^*Sugaya classification: Type I (Sufficient thickness with homogeneous low intensity), Type II (Sufficient thickness with partial high intensity), Type III (Insufficient thickness without discontinuity), Type IV (Presence of a minor discontinuity), Type V (Presence of a major discontinuity).

Table 2

Repair Integrity according to Fatty Degeneration of Rotator Cuff

^*Sugaya classification of rotator cuff after repair of the rotator cuff; ^†Goutallier classification of fatty degeneration: Grade 0 (No fatty deposits), Grade 1 (Some fatty streaks), Grade 2 (More muscle than fat), Grade 3 (As much muscle as fat), Grade 4 (Less muscle than fat).

Table 3

Functional Outcomes according to Repair Integrity of Rotator Cuff

The University of California Los Angeles (UCLA) score: Maximum scores are 10 points for pain and function; 5 points for motion, strength, and satisfaction; and 35 points total. The Korean Shoulder Scoring System (KSS) includes 5 domains totalling 100 points: function, 30 points; pain, 20; satisfaction, 10; range of motion, 20; and muscle power, consisting of strength, 10; and endurance, 10. ^*p<0.05.

Table 4

Changes between Preoperative and Last Follow-up UCLA Score, KSS Score and VAS Score

^*p<0.05.

Table 5

Changes in Range of Motion of the Affected Shoulder

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