Summary

our technique of repairing U shaped tears in which only margin convergence is done using a single triple loaded suture anchor reduces the strain and also allows repair of seemingly irreparable tears.

Abstract

The rotator cuff tears have been classified as a crescent, U shaped, L shaped and massive contracted, immobile tears. U shaped tears have greater medial extent when compared to crescent-shaped tears, with the apex adjacent or medial to the glenoidal rim. Recognizing the tear pattern is crucial because medial to the lateral mobilization of U shaped tears tend to create extreme tensile forces at the middle of the repaired cuff margin, causing tensile overload and subsequent failure. The “margin convergence“ refers to the technique of side to side suturing from medial to lateral of the anterior and posterior leaves of the tear causing the free margin to converge towards the bone bed on the humerus. It reduces the strain and also allows the repair of seemingly irreparable tears. This retrospective study included 20 patients with U-shaped rotator cuff tears. Patients had chronic degenerative tears. The age ranged between 50 and 70 years, with a male predominance of 2:1 and a clearly documented rotator cuff tear on MRI. The UCLA score increased from an average of 9 pre-operatively (range 8 – 12) to an average of 29.5 (range 27 – 31) at final follow-up. All patients had good/excellent outcomes. It increased from an average of 280 pre-operatively (range 200 – 350) to an average of 1300 (range 1250 – 1400) at final follow-up (unpaired t-test; p-value 0.0001). Modified margin convergence achieves a low tension repair with anatomical footprint reconstruction with good clinical outcomes using a single anchor.