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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 12, pp 3989–3996 | Cite as

Medialization of medial row anchor via the Nevasier portal yield enhanced footprint and outcomes in medium-to-large rotator cuff tears

  • Seung-bae Oh
  • Jae-Jung Jeong
  • Jong-Hun JiEmail author
  • Kaushal Patel
  • Won-Ha Hwang
  • Joon-Hyung Cho
SHOULDER
  • 61 Downloads

Abstract

Purpose

To evaluate clinical and radiological outcomes of medial row anchor insertion between 90° or 45° (deadman) angle in the suture-bridge rotator cuff repair of medium-to-large rotator cuff tears.

Methods

This retrospective analysis included 113 consecutive patients undergoing arthroscopic suture-bridge repair for medium-to-large rotator cuff tears (mean tear size: 2.8 × 2.3 cm) between 2010 and 2013. The patients were divided into two groups: group I (53 patients) and group II (60 patients) involving 90° and 45° medial row anchors, respectively. The conventional lateral row anchors were inserted in the suture-bridge repair. The clinical outcomes at 2 years and radiological outcomes including re-tear or footprint coverage (anteroposterior length and mediolateral width) of the repaired tendon using postoperative MRI were evaluated.

Results

Clinical outcome scores were significantly improved in both groups. However, Group I (90° anchor insertion group) showed better clinical scores without the difference of range of motion. The postoperative MRI revealed enlarged footprint coverage with 90° medial row anchor. The repaired footprint cuff size (mediolateral width) in the coronal plane MRI showed a statistically significant difference (45°: 19 mm vs. 90°: 24 mm) (p < 0.05).

Conclusions

Enhanced clinical outcomes and additional anatomical footprint coverage (coronal width of repaired tendon) in the suture-bridge repair are obtained with the 90° medial row anchors compared with the 45° medial row anchors. These findings would guide clinical application of 90° medial row anchor insertion for further medialization in the medium-to-large rotator cuff tears.

Level of evidence: Level III (retrospective comparative trial).

Keywords

Suture-bridge rotator cuff repair Medial row anchor 90° anchor insertion 45° anchor insertion 

Notes

Funding

No author or related institute has received any financial benefit from research in this study.

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest.

Ethical approval

The study was approved by our local institutional review board and informed consent was obtained from all patients before surgery. All studies have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

References

  1. 1.
    Andres BM, Lam PH, Murrell GA (2010) Tension, abduction, and surgical technique affect footprint compression after rotator cuff repair in an ovine model. J Shoulder Elbow Surg 19(7):1018–1027CrossRefGoogle Scholar
  2. 2.
    Burkhart SS (1995) The deadman theory of suture anchors: observations along a south Texas fence line. Arthroscopy 11(1):119–123CrossRefGoogle Scholar
  3. 3.
    Burkhart SS (2014) Reprint of: the deadman theory of suture anchors: observations along a south Texas fence line. Arthroscopy 30(8):895–899CrossRefGoogle Scholar
  4. 4.
    Clevenger TA, Beebe MJ, Strauss EJ, Kubiak EN (2014) The effect of insertion angle on the pullout strength of threaded suture anchors: a validation of the deadman theory. Arthroscopy 30(8):900–905CrossRefGoogle Scholar
  5. 5.
    Cummins CA, Murrell GA (2003) Mode of failure for rotator cuff repair with suture anchors identified at revision surgery. J Shoulder Elbow Surg 12(2):128–133CrossRefGoogle Scholar
  6. 6.
    Davidson J, Burkhart SS (2010) The geometric classification of rotator cuff tears: a system linking tear pattern to treatment and prognosis. Arthroscopy 26(3):417–424CrossRefGoogle Scholar
  7. 7.
    Day M, Westermann R, Duchman K, Gao Y, Pugely A, Bollier M, Wolf B (2018) Comparison of Short-term complications after rotator cuff repair: open versus arthroscopic. Arthroscopy 34(4):1130–1136CrossRefGoogle Scholar
  8. 8.
    Duquin TR, Buyea C, Bisson LJ (2010) Which method of rotator cuff repair leads to the highest rate of structural healing? A systematic review. Am J Sports Med 38(4):835–841CrossRefGoogle Scholar
  9. 9.
    Elia F, Azoulay V, Lebon J, Faraud A, Bonnevialle N, Mansat P (2017) Clinical and anatomic results of surgical repair of chronic rotator cuff tears at ten-year minimum follow-up. Int Orthop 41(6):1219–1226CrossRefGoogle Scholar
  10. 10.
    Green RN, Donaldson OW, Dafydd M, Evans SL, Kulkarni R (2014) Biomechanical study: determining the optimum insertion angle for screw-in suture anchors-is deadman's angle correct? Arthroscopy 30(12):1535–1539CrossRefGoogle Scholar
  11. 11.
    Hein J, Reilly JM, Chae J, Maerz T, Anderson K (2015) Retear rates after arthroscopic single-row, double-row, and suture bridge rotator cuff repair at a minimum of 1 year of imaging follow-up: a systematic review. Arthroscopy 31(11):2274–2281CrossRefGoogle Scholar
  12. 12.
    Hurley ET, Maye AB, Mullett H (2019) Arthroscopic Rotator cuff repair: a systematic review of overlapping meta-analyses. JBJS Rev 7:1CrossRefGoogle Scholar
  13. 13.
    Ide J, Karasugi T, Okamoto N, Taniwaki T, Oka K, Mizuta H (2015) Functional and structural comparisons of the arthroscopic knotless double-row suture bridge and single-row repair for anterosuperior rotator cuff tears. J Shoulder Elbow Surg 24(10):1544–1554CrossRefGoogle Scholar
  14. 14.
    Kirchhoff C, Braunstein V, Milz S, Sprecher CM, Fischer F, Tami A, Ahrens P, Imhoff AB, Hinterwimmer S (2010) Assessment of bone quality within the tuberosities of the osteoporotic humeral head: relevance for anchor positioning in rotator cuff repair. Am J Sports Med 38(3):564–569CrossRefGoogle Scholar
  15. 15.
    Koh KH, Lim TK, Park YE, Lee SW, Park WH, Yoo JC (2014) Preoperative factors affecting footprint coverage in rotator cuff repair. Am J Sports Med 42(4):869–876CrossRefGoogle Scholar
  16. 16.
    Kulwicki KJ, Kwon YW, Kummer FJ (2010) Suture anchor loading after rotator cuff repair: effects of an additional lateral row. J Shoulder Elbow Surg 19(1):81–85CrossRefGoogle Scholar
  17. 17.
    Lee SH, Kim JW, Kim TK, Kweon SH, Kang HJ, Kim SJ, Park JS (2017) Is the arthroscopic suture bridge technique suitable for full-thickness rotator cuff tears of any size? Knee Surg Sports Traumatol Arthrosc 25(7):2138–2146CrossRefGoogle Scholar
  18. 18.
    Liporace FA, Bono CM, Caruso SA, Weiner B, Penny K, Feldman AJ, Grossman MG, Haher TR (2002) The mechanical effects of suture anchor insertion angle for rotator cuff repair. Orthopedics 25(4):399–402PubMedGoogle Scholar
  19. 19.
    Meier SW, Meier JD (2006) The effect of double-row fixation on initial repair strength in rotator cuff repair: a biomechanical study. Arthroscopy 22(11):1168–1173CrossRefGoogle Scholar
  20. 20.
    Meier SW, Meier JD (2006) Rotator cuff repair: the effect of double-row fixation on three-dimensional repair site. J Shoulder Elbow Surg 15(6):691–696CrossRefGoogle Scholar
  21. 21.
    Mihata T, Watanabe C, Fukunishi K, Ohue M, Tsujimura T, Fujiwara K, Kinoshita M (2011) Functional and structural outcomes of single-row versus double-row versus combined double-row and suture-bridge repair for rotator cuff tears. Am J Sports Med 39(10):2091–2098CrossRefGoogle Scholar
  22. 22.
    Millett PJ, Warth RJ, Dornan GJ, Lee JT, Spiegl UJ (2014) Clinical and structural outcomes after arthroscopic single-row versus double-row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials. J Shoulder Elbow Surg 23(4):586–597CrossRefGoogle Scholar
  23. 23.
    Monrad NG, Kallemose A, Barfod T, K. W. (2018) Alarming increase in the registration of degenerative rotator cuff-related lesions a nationwide epidemiological study investigating 244,519 patients. Knee Surg Sports Traumatol Arthrosc 26(1):188–194CrossRefGoogle Scholar
  24. 24.
    Park JY, Lhee SH, Choi JH, Park HK, Yu JW, Seo JB (2008) Comparison of the clinical outcomes of single- and double-row repairs in rotator cuff tears. Am J Sports Med 36(7):1310–1316CrossRefGoogle Scholar
  25. 25.
    Pietschmann MF, Frohlich V, Ficklscherer A, Gulecyuz MF, Wegener B, Jansson V, Muller PE (2009) Suture anchor fixation strength in osteopenic versus non-osteopenic bone for rotator cuff repair. Arch Orthop Trauma Surg 129(3):373–379CrossRefGoogle Scholar
  26. 26.
    Prasathaporn N, Kuptniratsaikul S, Kongrukgreatiyos K (2011) Single-row repair versus double-row repair of full-thickness rotator cuff tears. Arthroscopy 27(7):978–985CrossRefGoogle Scholar
  27. 27.
    Sano H, Takahashi A, Chiba D, Hatta T, Yamamoto N, Itoi E (2013) Stress distribution inside bone after suture anchor insertion: simulation using a three-dimensional finite element method. Knee Surg Sports Traumatol Arthrosc 21(8):1777–1782CrossRefGoogle Scholar
  28. 28.
    Saridakis P, Jones G (2010) Outcomes of single-row and double-row arthroscopic rotator cuff repair: a systematic review. J Bone Joint Surg Am 92(3):732–742CrossRefGoogle Scholar
  29. 29.
    Shin JJ, Popchak AJ, Musahl V, Irrgang JJ, Lin A (2018) Complications After arthroscopic shoulder surgery: a review of the American Board of Orthopaedic Surgery Database. J Am Acad Orthop Surg Glob Res Rev 2(12):e093PubMedPubMedCentralGoogle Scholar
  30. 30.
    Stahnke K, Nikulka C, Diederichs G, Haneveld H, Scheibel M, Gerhardt C (2016) Serial MRI evaluation following arthroscopic rotator cuff repair in double-row technique. Arch Orthop Trauma Surg 136(5):665–672CrossRefGoogle Scholar
  31. 31.
    Strauss E, Frank D, Kubiak E, Kummer F, Rokito A (2009) The effect of the angle of suture anchor insertion on fixation failure at the tendon-suture interface after rotator cuff repair: deadman's angle revisited. Arthroscopy 25(6):597–602CrossRefGoogle Scholar
  32. 32.
    Tingart MJ, Apreleva M, Lehtinen J, Zurakowski D, Warner JJ (2004) Anchor design and bone mineral density affect the pull-out strength of suture anchors in rotator cuff repair: which anchors are best to use in patients with low bone quality? Am J Sports Med 32(6):1466–1473CrossRefGoogle Scholar
  33. 33.
    Xu B, Chen L, Zou J, Gu Y, Hao L, Peng K (2019) The Clinical effect of arthroscopic rotator cuff repair techniques: a network meta-analysis and systematic review. Sci Rep 9(1):4143CrossRefGoogle Scholar
  34. 34.
    Zhang Q, Ge H, Zhou J, Yuan C, Chen K, Cheng B (2013) Single-row or double-row fixation technique for full-thickness rotator cuff tears: a meta-analysis. PLoS ONE 8(7):e68515CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, Daejeon St.Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea

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