Summary

Early functional outcomes and repair technique in Musculotendinous Junction Rotator cuff tears

Abstract

Aim

To evaluate early post-operative outcomes post-arthroscopic rotator cuff repair of musculotendinous junction cuff tears and to assess efficacy of our arthroscopy repair technique .

Background

Musculotendinous junction rotator cuff tears pose a challenging surgical case in the realm of arthroscopic rotator cuff repair surgery. These cuff tears are rare injuries in which the tendon fails medially. There is difficulty in striking a balance between restoring the length -tension relation of the cuff tendon while avoiding high suture tension at the site of repair. A large focus of the repair is dependent on soft tissue- to – soft tissue fixation of medial and lateral margins of the tear. In view of the rare incidences of these tears, there is a paucity of literature on the functional outcomes and repair techniques. We seek to analyze the early post-operative outcomes in our patients with musculotendinous junction tears, and additionally share our novel surgical technique applied in a patient with a Type A musculotendinous junction tear.

Methods

A retrospective analysis of patients undergoing arthroscopic rotator cuff repair by a single-surgeon between August 2019 to December 2021 was performed. 6 patients had musculotendinous junction tears of the supraspinatus tendons, which were repaired using a suture bridging technique and double-row construct, with margin convergence sutures to compress down and oppose the lateral tendon stump and medial muscular portion. For 1 patient, we utilized mattress sutures in the lateral tendon stump, with the suture limbs then passed medially to engage the medial stump, before being fixed to a lateral row in a knotless fashion; Pulling on this particular suture will thus bring closer apposition of both medial and lateral tear margins in a dynamic convergence pattern.
Pre-operative and early post-operative outcomes were evaluated using Numerical Pain Rating Scale (NPRS), University of California Los Angeles Shoulder Score (UCLASS) and Oxford shoulder Score (OSS).

Results

Pre-operatively, average NPRS pain score was 5.7, which improved to 2.7 at 3 months. In terms of post-operative UCLASS and OSS scores, although no statistical significance was shown at this early post-operative stage, there was trend towards improvements for all 6 patients in both shoulder scores. UCLASS scores improved from a pre-operative mean of 18 to 25.83 (p = 0.07) while OSS scores improved from pre-operative mean of 28.67 to 20.67 ( p = 0.17).

Conclusions

Early functional outcomes highlight improvements following arthroscopic rotator cuff repair and we recommend surgical intervention in these injuries. We believe our applied surgical technique is a safe and effective method of repairing musculotendinous junction tears and we propose a hybrid suture bridging technique involving of a dynamic convergence with a double-row repair construct. Post-operative rehabilitation recovery may be gradual for these severe injuries and longer term outcome scores will need to be analyzed.