2015 ISAKOS Biennial Congress ePoster #2429

A Modified Suture Bridge Technique for a Marginal Dog Ear Deformity Improves Structural Integrity After Rotator Cuff Repair

Keun-Jung Ryu, MD, Seongnam-Si, Kyeonggi-do KOREA, REPUBLIC OF
Jae-Hwa Kim, PhD, Prof., Seung Nam, Kyenggi KOREA, REPUBLIC OF
Bang Hyun Kim, MD, Seongnam-Si, Kyeonggi-do KOREA, REPUBLIC OF

Department of Orthopaedic Surgery, CHA Bundang Medical Center,School of Medicine, CHA University, Seongnam-si, Kyeonggi-do, KOREA

FDA Status Not Applicable

Summary: A modified suture bridge technique for a marginal dog ear deformity provided superior structural outcomes than a conventional suture bridge technique for medium-sized to massive rotator cuff tears

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Abstract:

Background

Arthroscopic suture bridge technique has been proved to provide biomechanically firm fixation of the torn rotator cuff to the tuberosity by increasing footprint contract area and pressure. However, a marginal dog ear deformity is not infrequently encountered during this technique, impeding full restoration of it. Only one technical report was introduced on a modified suture bridge technique for a marginal dog ear deformity in 2007, and the incidence of this deformity was reported to be as high as 47 percent in the subsequent year. However, its structural and functional outcomes compared to other techniques have never been reported.

Purpose

To evaluate the structural and functional outcomes of a modified suture bridge technique for a marginal dog ear deformity compared with a conventional suture bridge method in rotator cuff repair.
Study Design: Cohort study; Level of evidence II

Methods

A consecutive series of 71 patients with age from 50 to 65 who underwent arthroscopic rotator cuff repair for full-thickness medium-sized to massive tears were evaluated. Patients were divided into two groups according to their repair techniques – group A: a conventional suture bridge technique (34 patients) versus group B: a modified suture bridge technique for a marginal dog ear deformity (37 patients). Radiographic evaluations included postoperative cuff integrity using MRI. Functional evaluations included range of motion (ROM), pain visual analog scale (VAS), the University of California, Los Angeles (UCLA) shoulder rating scale, Constant score, American Shoulder and Elbow Surgeons (ASES) scores, both pre- and post-operatively. All patients were followed up clinically at a minimum of one year.
Result: Postoperative structural integrity by Sugaya classification showed that I:II:III:IV:V = 4:20:2:4:4 in group A, and 20:12:4:0:1 in group B. It was significant (p<.001) having lower Sugaya stages in group B. The postoperative healed:retear rate was 26:8 in group A, and 36:1 in group B, with significantly (p=.011) lower retear rate in group B. However, the ROM and all functional outcome scores showed no significant differences between the two groups postoperatively. When healed and retear groups were compared, the ratio of two surgical techniques showed significant difference (p=.03) with lesser ratio of a modified suture bridge technique in retear group. The functional outcome scores showed significant differences between healed and retear groups, showing worse results in retear group.

Conclusion

A modified suture bridge technique for a marginal dog ear deformity provided superior structural outcomes than a conventional suture bridge technique for medium-sized to massive rotator cuff tears. This technique seems to provide better functional outcomes by decreasing a retear rate.