Does an arthroscopic suture bridge technique maintain repair integrity?: a serial evaluation by ultrasonography

Abstract

Biomechanical studies suggest a suture bridge technique enhances rotator cuff tendon footprint contact area, holding strength, and mean contact pressure. Based on these studies, we asked whether (1) the suture bridge technique would provide a high rate of cuff integrity after surgery, (2) the status of the repaired cuff would change with time, (3) preoperative factors could predict postoperative cuff integrity, and (4) patients with retears had less favorable pain, functional scores, range of motion (ROM), and muscle strength compared with those with intact repairs. We prospectively followed 78 patients with arthroscopic repairs in whom we used the suture bridge technique. The integrity of the rotator cuff repair was determined using ultrasonographic evaluation at 4.5 and 12 months after surgery. Ultrasonography revealed intact cuffs in 91% at 4.5 months postoperatively, all of which were maintained at the 12-month followup. Failure rates were 17.6% (three of 17) for massive tears, 11.1% (two of 18) for large tears, 6.3% (two of 32) for medium tears, and no failures for small tears. Preoperative fatty degeneration of the supraspinatus muscle was a strong predictor of cuff integrity. We found no correlation between the integrity and clinical outcomes except for a temporary decrease of abduction strength at 6 months. Arthroscopic repair using suture bridge technique can achieve a low retear rate in shoulders treated for rotator cuff tears, but the occurrence of retear did not influence the outcome.

Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Fig. 1A–B

(A) An arthroscopic view shows a massive rotator cuff tear involving the upper border of the subscapularis, supraspinatus, and infraspinatus, with medial retraction and subluxation of the long head of the biceps tendon. (B) An arthroscopic view from the lateral portal shows a completed repair of a massive rotator cuff tear with three suture anchors and three push-lock devices, resulting in 10 suture bridges.

Fig. 2A–B

(A) Ultrasonography shows failed repair of the supraspinatus tendon with multiple droplets (black arrow) in the rotator cuff defect. A long-axis view shows medial retraction of the supraspinatus (SS) tendon (white arrows). (B) The anterior-to-posterior dimension of the retear is noted on the short-axis view with the shadow of the inserted suture anchors (white arrows) observed on the humeral head (HH). The posterior part of the remaining tendon is also noted (black arrows). D = deltoid muscle; GT = greater tuberosity.