Summary

The arthroscopic margin convergence technique without the use of suture anchors may be a suitable option in patients with full thickness rotator cuff tears in the short term.

Abstract

Introduction

Although the arthroscopic margin convergence technique without suture anchors for rotator
cuff repair was developed and reported more than two decades ago, there is little data
available on patient outcomes. The transverse suture across the defect not only decreases the
strain at the repair site but also causes a margin convergence of the tear toward the greater
tuberosity. however, the mechanism of margin convergence effectiveness is not well
understood This can eliminate the need to use a suture anchor to keep the edge of tear at the
fresh bleeding bony insertion. The purpose of this study is to evaluate the efficacy of the margin
convergence technique, without the use of suture anchors, to repair different types of rotator
cuff tears. A secondary purpose of this study was to determine the prognostic factors that
affect the clinical outcome of this technique.
 
 

Methods

A retrospective analysis of 38 patients undergoing arthroscopic margin convergence
rotator cuff repair was performed. Outcomes were assessed using the American Shoulder and
Elbow Surgeons Shoulder Score (ASES), the UCLA Shoulder Score (UCLA SS) and a Visual Analog
Scale Score (VAS). A two-tailed distribution paired t-test was used to determine statistical significance (alpha<0.05) between pre-operative scores and scores at final follow-up. Correlation
tests and linear regression analysis were used to determine the correlation between various
clinical variables and clinical outcomes.
 

Results

The mean postoperative follow-up period was 33.9 (22.2-94.5) months, with a
minimum follow-up period of 22 months.  The mean age of the patients was 62±15.1. At the
time of final follow-up, patients reported a significant improvement in the ASES score from
preop 29.3 ±18.3 to 93.7±8.3 postop (p =0.001). The UCLA SS improved from (14.3 ± 6.2 to 32.8
± 2.6 (p = 0.001), and VAS improved from 7.37 ± 1.8 to 0.63 ± 1.02 (p= 0.001). Among the 38
patients there were 12 patients with partial tears: ASES 32.2 ± 18.4 to 95.4 ± 7.6 (p=0.002),
UCLA 17.6 ± 5.2 to 33.6 ± 1.9 (p=0.002) and 26 patients with complete tears: ASES 28.5 ± 18.5
to 92.9 ± 8.6 (p=0.001), UCLA 12.8 ± 6.1 to 32.5 ± 2.8 (p=0.001).
 
There was not any significant difference in outcome between the two groups in any clinical
scores. A few variables did relate to the functional outcome in the complete tear group. The
postoperative ASES and UCLA scores were significantly lower in patients with grades 3 and 4 of
retraction (ASES: p=.033; UCLA: p=.020) and the U-shaped tear vs non-U-shaped tears including
L-shaped and others (ASES: p=.047; UCLA: p=.050).
The age, gender, and associated pathology, including biceps tear and acromioclavicular arthritis
did not relate with the final functional outcome.
 
 

 

Conclusion

The arthroscopic margin convergence technique without the use of suture anchors
is a suitable option in patients with rotator cuff tears including partial or complete tears. The
retraction grade greater than 2 and U-shaped tearing was related to the lower clinical
outcome, however there was a reasonable improvement in the outcome of these patients.