2017 ISAKOS Biennial Congress ePoster #2248

 

A Transtendon Suture Technique To Treat Partial-Thickness Articular Surface Supraspinatus Tears

Xudong Liu, MD, Shanghai CHINA
Chongyang Wang, MD, Shanghai, shanghai CHINA

Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, CHINA

FDA Status Cleared

Summary

The trans-tendon repair technique can preserve the normal tissue of the rotator cuff, reconstruct rotator cuff footprint anatomically and have a stable fixed tendon-bone interface.

Abstract

Purpose

To evaluate the functional outcomes of arthroscopic trans-tendon suture-bridge repair for partial-thickness articular-side rotator cuff tears.

Method

From April 2014 to January 2016, 25 patients (male 11 cases; female 14 cases; mean age 54.6±12.7 years) with partial-thickness articular surface supraspinatus tears received arthroscopic trans-tendon suture-bridge repair. Following debridement of the articular-sided tears, a spinal needle was inserted percutaneously to locate the proper point, then mark the location with a PDS for suture anchor insertion on the greater tuberosity. The arthroscope is reintroduced into subacromial space to conduct bursectomy , acromioplasty and assessment of the integrity of the bursal side rotator cuff. After that, insert the arthroscope into the glenohumeral joint, polish the greater tuberosity of the rotator cuff using the burr to make the inner side rotator cuff footprints fresh, one or two bio-absorbable suture anchors(4.5-mm Bio-Corkscrew; Arthrex, Naples, FL, USA) were inserted at the articular margin to create a medial row through the intact cuff, then use a NO.18 spinal needle to insert from anterior to posterior through the inferior of the tear position and a NO. 2 polydioxanone (PDS) suture was advanced through each spinal needle, a grasper was used to shuttle these sutures out of the anterior cannula. The anchor sutures were tied to the PDS and pulled into the joint, and the knots were shuttled externally by pulling on the percutaneously located PDS sutures. The strands of the anchor were tied with a sliding knot under subacromial space. Pilot holes for a PushLock anchor(Arthrex) were prepared directly in line with the medial anchors and approximately 1cm distal to the lateral edge of the greater tuberosity. The PushLock anchor was advanced into the pilot hole completely to form a suture bridge. The follow-up time was of 12-24 months (mean 16.9±5.4 months). MRI, a visual analog scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Rating Scale of the University of California at Los Angeles (UCLA), the Constant–Murley score and range of motion (ROM) were conducted before surgery and the final follow-up.

Result: Mean VAS, ASES, UCLA and Constant–Murley scores improved from 5.9±1.8, 44.8±15.6, 19.3±5.2, 58.2±19.9 preoperatively to 2.7±2.1, 80.3±14.9, 36.0±8.1, 78.4±12.5 at final follow-up, respectively (all p<0.001); ROM improves from 133±34.7 to 167.4±26.3(P=0.001)

Conclusions

Arthroscopic trans-tendon suture-bridge repair for partial-thickness articular-side rotator cuff tears resulted in significant improvement in function compared with that before the operation while preserving the normal tissue of the rotator cuff,reconstructing rotator cuff footprint anatomically.