A Modified Mac Suture Bridge Technique: Clinical and Radiological Outcomes of the Treatment of Rotator Cuff Tear with Poor Tissue Quality

Sang Jin Cheon; Hyo Yeol Lee; Sung Jin Ahn

doi:10.4055/jkoa.2017.52.5.392

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Cheon, Lee, and Ahn: A Modified Mac Suture Bridge Technique: Clinical and Radiological Outcomes of the Treatment of Rotator Cuff Tear with Poor Tissue Quality

Original Article

Journal of the Korean Orthopaedic Association 2017; 52(5): 392-402.

Published online: 30 October 2017

DOI: https://doi.org/10.4055/jkoa.2017.52.5.392

A Modified Mac Suture Bridge Technique: Clinical and Radiological Outcomes of the Treatment of Rotator Cuff Tear with Poor Tissue Quality

Sang Jin Cheon, M.D., Ph.D., Hyo Yeol Lee, M.D., Sung Jin Ahn, M.D.

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

Correspondence to: Sang Jin Cheon, M.D., Ph.D. Department of Orthopedic Surgery, Pusan National University School of Medicine, 179 Guduk-ro, Seo-gu, Busan 49241, Korea. TEL: +82-51-240-7248, FAX: +82-51-247-8395, scheon@pusan.ac.kr

Received 19 September 2016 Revised 30 December 2016 Accepted 29 March 2017

The Korean Orthopaedic Association

(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/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Base on the concept of the Mac stitch, we designed the modified Mac-suture bridge technique to improve the outcome of arthroscopic repair of rotator cuff tear with poor tissue quality. Moreover, we evaluated both the radiological and clinical outcomes of the surgery to assess the effectiveness of the newly designed technique.

Materials and Methods

From January 2010 to December 2014, a total of 52 patients (25 males, 27 females) with rotator cuff tear, with poor tissue quality according to both radiological and intraoperative findings, who underwent arthroscopic rotator cuff repair using the modified Mac-suture bridge technique and followed-up for at least 1 year were included in this study. The mean patient age at the time of surgery was 60 years. The average follow-up period was 20 months. We evaluated the clinical outcomes by checking the range of motion and compared the following, both preoperatively and postoperatively: American Shoulder and Elbow Surgeon (ASES) score, University of California, Los Angeles (UCLA) score, Constant shoulder score (CSS), visual analogue scale (VAS). In addition, we analyzed 42 series of postoperative magnetic resonance imaging by using the Sugaya's classification for the evaluation of the repair integrity.

Results

All clinical scores showed significant improvement (ASES score improved from 56.75 to 83.44, UCLA score from 20.52 to 29.23, CSS from 64.04 to 80.90, and VAS from 6.17 to 1.62; p<0.001). The range of motion was also improved; forward flexion improved from 108° to 158°, abduction from 109° to 160°, external rotation from 27° to 50°, and internal rotation from 31° to 57° (p<0.001). Satisfactory radiologic results were noted on postoperative magnetic resonance imaging, consisting of 15 cases (35.7%) type I, 22 cases (52.4%) type II, 3 cases (7.1%) type III, 2 cases (4.8%) type IV, and no type V, according to the Sugaya's method.

Conclusion

The modified Mac-suture bridge technique provided satisfactory results both radiologically and clinically for the treatment of rotator cuff tear with poor tendon tissue quality. It could possibly be a good alternative to previous techniques of arthroscopic repair.

Keywords: rotator cuff tear, poor tissue quality, modified Mac suture bridge technique, Massive cuff stitch, suture bridge repair

Figures and Tables

Figure 1

Manipulating tendon to evaluate the quality of tendon tissue. Edematous torn tendon is grasped with a retriever, which is oversusceptible to the tension due to severe tendinopathy.

Figure 2

Schematic illustration of modified Mac-suture bridge technique. (A) Penetrate suture fiber in appropriate site. (B) Rip-stop stitch. (C) Anchor-lock fixation. (D) Final outcome.

Figure 3

Modified Mac-suture bridge technique. (A) Rip-stop stitches at the medial row (black arrow: rip stop stitch, white arrow: traction fiber for suture bridging, SSp: supraspinatus tendon, HH: humeral head). (B) Lateral migration of two pairs of suture fibers. (C) Suture anchor fixation at the medial row. Note that one pair is consisted of one green fiber and one white fiber. (D) Grand canyon view at the end of the repair.

Figure 4

Preoperative and postoperative outcomes on magnetic resonance imaging findings.

Table 1

Inclusion and Exclusion Criteria

Table 2

Clinical Results of Modified Mac-Suture Bridge Technique

Values are presented as mean±standard deviation. ^*Wilcoxon signed rank test. Diff., difference; ASES, American Shoulder and Elbow Surgeon; UCLA, University of California, Los Angeles; CSS, Constant shoulder score; VAS, visual analogue scale; FF, forward flexion; ABD, abduction; ER, external rotation; IR, internal rotation; Group A, isolated rotator cuff lesion; Group B, rotator cuff lesion with associated shoulder lesion.

Table 3

Comparison of Clinical Results Depending on the Existence of Other Shoulder Lesions

Values are presented as mean±standard deviation. ^*Wilcoxon signed rank test. Diff., difference; Group A, isolated rotator cuff lesion; Group B, rotator cuff lesion with associated shoulder lesion; ASES, American Shoulder and Elbow Surgeon; UCLA, University of California, Los Angeles; CSS, Constant shoulder score; VAS, visual analogue scale; FF, forward flexion; ABD, abduction; ER, external rotation; IR, internal rotation.

Table 4

Criteria Used for the Subjective Evaluation of Intraoperative Findings

Table 5

Comparison of Postoperative Cuff Integrities

Retear rates of each technique are subdivided by preoperative tear size. Values are presented as percent (number/total number). SB, suture bridge; TOE/SB, Transosseous-equivalent suture bridge; N/A, not available.

ACKNOWLEDGEMENTS

The authors acknowledge Mrs. Seong Eun Kim for preparation of the illustrations.

Notes

This study was supported by a 2016 research grant from Pusan National University Hospital.

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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