Advertisement

Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 7, pp 2129–2137 | Cite as

Arthroscopic modified Mason-Allen technique for large U- or L-shaped rotator cuff tears

  • Sung-Weon JungEmail author
  • Dong-Hee Kim
  • Seung-Hoon Kang
  • Ji-Heon Lee
Shoulder

Abstract

Purpose

While a conventional single- or double-row repair technique could be applied for repair of C-shaped tears, a different surgical strategy should be considered for repair of U- or L-shaped tears because they typically have complex patterns with anterior, posterior, or both mobile leaves. This study was performed to examine the outcomes of the modified Mason-Allen technique for footprint restoration in the treatment of large U- or L-shaped rotator cuff tears.

Methods

Thirty-two patients who underwent an arthroscopic modified Mason-Allen technique for large U- or L-shaped rotator cuff tears between January 2012 and December 2013 were included in this study. Margin convergence was first performed to reduce the tear gap and tension, and then, an arthroscopic Mason-Allen technique was performed to restore the rotator cuff footprint in a side-to-end repair fashion. All patients were evaluated preoperatively and for a minimum of 2 years of follow-up with a visual analog scale (VAS) for pain, Constant score, and ultrasonography.

Results

There was significant improvement in all VAS and Constant scores compared with the preoperative values (P < 0.001). Functional results by Constant scores included 9 cases that were classified as excellent, 11 cases as good, 8 cases as fair, and 2 cases as poor. Binary logistic regression analysis revealed that heavy work, pseudoparalysis, joint space narrowing, fatty degeneration of the SST and IST, and a positive tangent sign were found to significantly correlate with functional outcomes. Multivariable logistic regression analysis revealed that only fatty degeneration of the SST was a risk factor for fair/poor clinical outcomes. Complications occurred in 5 of the 32 patients (15.6 %), and the reoperation rate due to complications was 6.3 % (2 of 32 patients).

Conclusions

An arthroscopic modified Mason-Allen technique was sufficient to restore the footprint of the rotator cuff in our data. Overall satisfactory results were achieved in most patients, with the exception of those with severe fatty degeneration. An arthroscopic modified Mason-Allen technique could be an effective and reliable alternative for patients with large U- or L-shaped rotator cuff tears.

Level of evidence

Case Series, Therapeutic Level IV.

Keywords

Rotator cuff tear Large size Mason-Allen technique Margin convergence Shoulder 

Notes

Acknowledgments

This study was approved by the IRB committee of Samsung Medical Center.

Compliance with ethical standards

Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Supplementary material

Supplementary material 1 (AVI 9669 kb)

References

  1. 1.
    Arce G, Bak K, Bain G, Calvo E, Ejnisman B, Di Giacomo G et al (2013) Management of disorders of the rotator cuff: proceedings of the ISAKOS upper extremity committee consensus meeting. Arthroscopy 29:1840–1850CrossRefPubMedGoogle Scholar
  2. 2.
    Baums MH, Spahn G, Steckel H, Fischer A, Schultz W, Klinger HM (2009) Comparative evaluation of the tendon–bone interface contact pressure in different single- versus double-row suture anchor repair techniques. Knee Surg Sports Traumatol Arthrosc 17:1466–1472CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Bedi A, Dines J, Warren RF, Dines DM (2010) Massive tears of the rotator cuff. J Bone Joint Surg Am 92:1894–1908CrossRefPubMedGoogle Scholar
  4. 4.
    Burkhart SS, Athanasiou KA, Wirth MA (1996) Margin convergence: a method of reducing strain in massive rotator cuff tears. Arthroscopy 12:335–338CrossRefPubMedGoogle Scholar
  5. 5.
    Burkhart SS, Danaceau SM, Pearce CE Jr (2001) Arthroscopic rotator cuff repair: analysis of results by tear size and by repair technique-margin convergence versus direct tendon-to-bone repair. Arthroscopy 17:905–912CrossRefPubMedGoogle Scholar
  6. 6.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164Google Scholar
  7. 7.
    Curtis AS, Burbank KM, Tierney JJ, Scheller AD, Curran AR (2006) The insertional footprint of the rotator cuff: an anatomic study. Arthroscopy 22:603–609CrossRefGoogle Scholar
  8. 8.
    Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S (2003) Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg 12:550–554CrossRefPubMedGoogle Scholar
  9. 9.
    Harryman DT, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA (1991) Repairs of the rotator cuff: correlation of functional results with integrity of the cuff. J Bone Joint Surg Am 73:982–989CrossRefPubMedGoogle Scholar
  10. 10.
    Iannotti JP, Deutsch A, Green A, Rudicel S, Christensen J, Marraffino S (2013) Time to failure after rotator cuff repair: a prospective imaging study. J Bone Joint Surg Am 95:965–971CrossRefPubMedGoogle Scholar
  11. 11.
    Jones CK, Savoie FH III (2003) Arthroscopic repair of large and massive rotator cuff tears. Arthroscopy 19:564–571CrossRefPubMedGoogle Scholar
  12. 12.
    Lapner PL, Sabri E, Rakhra K, McRae S, Leiter J, Bell K et al (2012) A multicenter randomized controlled trial comparing single-row with double-row fixation in arthroscopic rotator cuff repair. J Bone Joint Surg Am 94:1249–1257CrossRefPubMedGoogle Scholar
  13. 13.
    Lee BG, Cho NS, Rhee YG (2012) Modified Mason-Allen suture bridge technique: a new suture bridge technique with improved tissue holding by the modified Mason-Allen stitch. Clin Orthop Surg 4:242–245CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Mochizuki T, Sugaya H, Uomizu M, Maeda K, Matsuki K et al (2009) Humeral insertion of the supraspinatus and infraspinatus: new anatomical findings regarding the footprint of the rotator cuff—surgical technique. J Bone Joint Surg Am 91:1–7CrossRefPubMedGoogle Scholar
  15. 15.
    Naqvi GA, Jadaan M, Harrington P (2009) Accuracy of ultrasonography and magnetic resonance imaging for detection of full thickness rotator cuff tears. Int J Shoulder Surg 3:94–97CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Parsons BO, Gruson KI, Chen DD, Harrison AK, Gladstone J, Flatow EL (2010) Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness. J Shoulder Elbow Surg 19:1034–1039CrossRefPubMedGoogle Scholar
  17. 17.
    Rhee YG, Cho NS, Park CS (2012) Arthroscopic rotator cuff repair using modified Mason-Allen medial row stitch: knotless versus knot-tying suture bridge technique. Am J Sports Med 40:2440–2447CrossRefPubMedGoogle Scholar
  18. 18.
    Scheibel MT, Habermeyer P (2003) A modified Mason-Allen technique for rotator cuff repair using suture anchors. Arthroscopy 19:330–333CrossRefPubMedGoogle Scholar
  19. 19.
    Schmidt CC, Jarrett CD, Brown BT (2014) Management of rotator cuff tears. J Hand Surg Am 40:399–408CrossRefGoogle Scholar
  20. 20.
    Thes A, Hardy P, Bak K (2015) Decision-making in massive rotator cuff tear. Knee Surg Sports Traumatol Arthrosc 23:449–459CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • Sung-Weon Jung
    • 1
    Email author
  • Dong-Hee Kim
    • 1
  • Seung-Hoon Kang
    • 1
  • Ji-Heon Lee
    • 1
  1. 1.Department of Orthopedic Surgery, Samsung Changwon HospitalSungkyunkwan University School of MedicineChangwon-siKorea

Personalised recommendations