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Arthroscopic Rotator Cuff Repair: Outcomes After Knotted Verses Knotless Double Row Transosseous Equivalent Repair Techniques

Arthroscopic Rotator Cuff Repair: Outcomes After Knotted Verses Knotless Double Row Transosseous Equivalent Repair Techniques

Michael Andrew Fox, MD, UNITED STATES Jonathan D Hughes, MD, UNITED STATES Nyaluma N. Wagala, MD, UNITED STATES Neel K. Patel, MD, UNITED STATES Adam Popchak, DPT, PhD, UNITED STATES Bryson P. Lesniak, MD, UNITED STATES Albert Lin, MD, UNITED STATES

University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, UNITED STATES


2021 Congress   ePoster Presentation     rating (1)

 

Anatomic Location

Anatomic Structure

Diagnosis / Condition

Sports Medicine

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Summary: A comparison of failure rates and functional outcomes after transosseous equivalent (TOE) double-row (DR) knotted suture bridge versus knotless suture tape bridge repair techniques for rotator cuff tears


Purpose

To compare failure rates and functional outcomes after transosseous equivalent (TOE) double-row (DR) knotted suture bridge versus knotless suture tape bridge repair techniques for rotator cuff tears.

Methods

A consecutive series of 133 shoulders in 124 patients (60 men, 73 women, mean age 61.7 years ± 11.9 years) underwent arthroscopic, DR TOE repairs of the supraspinatus tendon with and without involvement of the infraspinatus tendon. A total of 84 shoulders, 14 using knotted suture bridging (KSB) technique and 70 using knotless tape bridging (KTB) configuration, met inclusion criteria for the study. Patients who underwent concomitant subscapularis tendon repairs were excluded. The minimum follow-up was 12 months. Primary outcome was failure of surgical repair, defined as either confirmed retear on MRI and/or need for revision repair. Secondary clinical outcome measures were assessed including range of motion, strength, Visual Analog Scale (VAS), PROMIS mental and physical health, American Shoulder and Elbow Surgeons Shoulder Score (ASES), Brophy shoulder activity scores, and need for manipulation under anesthesia (MUA).

Results

Average follow-up after surgery was 15 (12–55) months for the KSB group and 26 (12-70) months for the KTB group (p < 0.01). Although failure rate was higher in the KSB repairs (4/14, 28.6%) compared to the KTB group (7/70, 10%), this did not reach statistical significance (p=0.09). ASES scores (p = 0.03) and range of motion in forward flexion (FF) (p < 0.01) were significantly higher in the KSB group. There was no significant difference in strength, external rotation range of motion, VAS, PROMIS, and Brophy scores between the groups, as well as no difference in stiffness requiring MUA.

Conclusion

Both knotted KSB and KTB DR TOE repair techniques demonstrate low retear rates with excellent functional outcomes when compared to preoperative baseline at a minimum of 12 months follow-up after surgery, though KSB repairs performed significantly higher on ASES reported outcomes. There are no significant differences in retear rates; however, the findings may indicate a clinically significant trend towards increased failure rate with KSB repair.


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