Skip to main content

Is the arthroscopic suture bridge technique suitable for full-thickness rotator cuff tears of any size?

Knee Surgery, Sports Traumatology, Arthroscopy volume 25, pages 2138–2146 (2017)Cite this article

Abstract

Purpose

The purpose of this study was to compare functional outcomes and tendon integrity between the suture bridge and modified tension band techniques for arthroscopic rotator cuff repair.

Methods

A consecutive series of 128 patients who underwent the modified tension band (MTB group; 69 patients) and suture bridge (SB group; 59 patients) techniques were enrolled. The pain visual analogue scale (VAS), Constant, and American Shoulder and Elbow Surgeons (ASES) scores were determined preoperatively and at the final follow-up. Rotator cuff hypotrophy was quantified by calculating the occupation ratio (OR). Rotator cuff integrity and the global fatty degeneration index were determined by using magnetic resonance imaging at 6 months postoperatively.

Results

The average VAS, Constant, and ASES scores improved significantly at the final follow-up in both groups (p < 0.05 for all scores). The retear rate of small-to-medium tears was similar in the modified tension band and suture bridge groups (7.0 vs. 6.8%, respectively; p = n.s.). The retear rate of large-to-massive tears was significantly lower in the suture bridge group than in the modified tension band group (33.3 vs. 70%; p = 0.035). Fatty infiltration (postoperative global fatty degeneration index, p = 0.022) and muscle hypotrophy (postoperative OR, p = 0.038) outcomes were significantly better with the suture bridge technique.

Conclusion

The retear rate was lower with the suture bridge technique in the case of large-to-massive rotator cuff tears. Additionally, significant improvements in hypotrophy and fatty infiltration of the rotator cuff were obtained with the suture bridge technique, possibly resulting in better anatomical outcomes. The suture bridge technique was a more effective method for the repair of rotator cuff tears of all sizes as compared to the modified tension band technique.

Level of evidence

Retrospective Cohort Design, Treatment Study, level III.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  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 Elb Surg 19(7):1018–1027

    Article  Google Scholar 

  2. Bae KH, Kim JW, Kim TK, Kweon SH, Kang HJ, Kim JY, Joo MS, Kim DM (2016) Is the arthroscopic modified tension band suture technique suitable for all full-thickness rotator cuff tears? J Shoulder Elb Surg. doi:10.1016/j.jse.2016.01.004

    Google Scholar 

  3. Behrens SB, Bruce B, Zonno AJ, Paller D, Green A (2012) Initial fixation strength of transosseous-equivalent suture bridge rotator cuff repair is comparable with transosseous repair. Am J Sports Med 40(1):133–140

    Article  PubMed  Google Scholar 

  4. Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL (2006) Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elb Surg 15(3):290–299

    Article  Google Scholar 

  5. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG (2005) Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am 87(6):1229–1240

    PubMed  Google Scholar 

  6. Boyer P, Bouthors C, Delcourt T, Stewart O, Hamida F, Mylle G, Massin P (2015) Arthroscopic double-row cuff repair with suture-bridging: a structural and functional comparison of two techniques. Knee Surg Sports Traumatol Arthrosc 23(2):478–486

    CAS  Article  PubMed  Google Scholar 

  7. Burkhart SS, Adams CR, Schoolfield JD (2009) A biomechanical comparison of 2 techniques of footprint reconstruction for rotator cuff repair: the SwiveLock-FiberChain construct versus standard double-row repair. Arthroscopy 25(3):274–281

    Article  PubMed  Google Scholar 

  8. Cho NS, Yi JW, Lee BG, Rhee YG (2010) Retear patterns after arthroscopic rotator cuff repair: single-row versus suture bridge technique. Am J Sports Med 38(4):664–671

    Article  PubMed  Google Scholar 

  9. Choi S, Kim MK, Kim GM, Roh YH, Hwang IK, Kang H (2014) Factors associated with clinical and structural outcomes after arthroscopic rotator cuff repair with a suture bridge technique in medium, large, and massive tears. J Shoulder Elb Surg 23(11):1675–1681

    Article  Google Scholar 

  10. Chung SK, Kim SH, Tae SK, Yoon JP, Choi JA, Oh JH (2013) Is the supraspinatus muscle hypotrophy truly irreversible after surgical repair of rotator cuff tears? Clin Orthop Surg 5(1):55–65

    Article  PubMed  PubMed Central  Google Scholar 

  11. Chung SW, Kim JY, Kim MH, Kim SH, Oh JH (2013) Arthroscopic repair of massive rotator cuff tears: outcome and analysis of factors associated with healing failure or poor postoperative function. Am J Sports Med 41(7):1674–1683

    Article  PubMed  Google Scholar 

  12. Cole BJ, ElAttrache NS, Anbari A (2007) Arthroscopic rotator cuff repairs: an anatomic and biomechanical rationale for different suture-anchor repair configurations. Arthroscopy 23(6):662–669

    Article  PubMed  Google Scholar 

  13. Deniz G, Kose O, Tugay A, Guler F, Turan A (2014) Fatty degeneration and hypotrophy of the rotator cuff muscles after arthroscopic repair: does it improve, halt or deteriorate? Arch Orthop Trauma Surg 134(7):985–990

    Article  PubMed  Google Scholar 

  14. Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elb Surg 8(6):599–605

    CAS  Article  Google Scholar 

  15. Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K (2004) The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 86(A(2)):219–224

    Article  PubMed  Google Scholar 

  16. Gerber C, Schneeberger AG, Hoppeler H, Meyer DC (2007) Correlation of hypotrophy and fatty infiltration on strength and integrity of rotator cuff repairs: a study in thirteen patients. J Shoulder Elb Surg 16(6):691–696

    Article  Google Scholar 

  17. Gerhardt C, Hug K, Pauly S, Marnitz T, Scheibel M (2012) Arthroscopic single-row modified Mason-Allen repair versus double-row suture bridge reconstruction for supraspinatus tendon tears: a matched pair analysis. Am J Sports Med 40(12):2777–2785

    Article  PubMed  Google Scholar 

  18. Gladstone JN, Bishop JY, Lo IK, Flatow EL (2007) Fatty infiltration and hypotrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med 35(5):719–728

    Article  PubMed  Google Scholar 

  19. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures: pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83

    Google Scholar 

  20. 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 Elb Surg 12(16):550–554

    Article  Google Scholar 

  21. Gramstad DG, Yamaguchi K (2011) Anatomy, pathogenesis, natural history, and nonsurgical treatment of rotator cuff disorders. In: Galatz LM (ed) Orthopaedic knowledge update: shoulder and elbow, vol 3. AAOS, Rosemont, pp 149–159

    Google Scholar 

  22. Jost B, Pfirrmann CW, Gerber C (2000) Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am 82(3):304–314

    CAS  Article  PubMed  Google Scholar 

  23. Kim DH, Elattrache NS, Tibone JE, Jun BJ, DeLaMora SN, Kvitne RS, Lee TQ (2006) Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair. Am J Sports Med 34(3):407–414

    CAS  Article  PubMed  Google Scholar 

  24. Kim JR, Cho YS, Ryu KJ, Kim JH (2012) Clinical and radiographic outcomes after arthroscopic repair of massive rotator cuff tears using a suture bridge technique: assessment of repair integrity on magnetic resonance imaging. Am J Sports Med 40(4):786–793

    Article  PubMed  Google Scholar 

  25. Kim KC, Shin HD, Lee WY (2012) Repair integrity and functional outcomes after arthroscopic suture-bridge rotator cuff repair. J Bone Joint Surg Am 94(8):e48

    Article  PubMed  Google Scholar 

  26. Kluger R, Bock P, Mittlböck M, Krampla W, Engel A (2011) Long term survivorship of rotator cuff repairs using ultrasound and magnetic resonance imaging analysis. Am J Sport Med 39(10):2071–2081

    Article  Google Scholar 

  27. Liu X, Manzano G, Kim HT, Feeley BT (2011) A rat model of massive rotator cuff tears. J Orthop Res 29(4):588–595

    Article  PubMed  Google Scholar 

  28. Maguire M, Goldberg J, Bokor D, Bertollo N, Pelletier MH, Harper W, Walsh WR (2011) Biomechanical evaluation of four different transosseous-equivalent/suture bridge rota-tor cuff repairs. Knee Surg Sports Traumatol Arthrosc 19(9):1582–1587

    Article  PubMed  Google Scholar 

  29. 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 Elb Surg 23(4):586–597

    Article  Google Scholar 

  30. Park MC, ElAttrache NS, Tibone JE, Ahmad CS, Jun BJ, Lee TQ (2007) Part I: footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elb Surg 16(4):461–468

    Article  Google Scholar 

  31. Park MC, Tibone JE, ElAttrache NS, Ahmad CS, Jun BJ, Lee TQ (2007) Part II: biomechanical assessment for a footprint-restoring transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elb Surg 16(4):469–476

    Article  Google Scholar 

  32. Pauly S, Kieser B, Schill A, Gerhardt C, Scheibel M (2010) Biomechanical comparison of 4 double-row suture-bridging rotator cuff repair techniques using different medial-row configurations. Arthroscopy 26(10):1281–1288

    Article  PubMed  Google Scholar 

  33. 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):732–742

    Article  PubMed  Google Scholar 

  34. Sugaya H, Maeda K, Matsuki K, Moriishi J (2007) Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair: a prospective outcome study. J Bone Joint Surg Am 89(5):953–960

    PubMed  Google Scholar 

  35. Tae SK, Oh JH, Kim SH, Chung SW, Yang JY, Back YW (2011) Evaluation of fatty degeneration of the supraspinatus muscle using a new measuring tool and its correlation between multidetector computed tomography and magnetic resonance imaging. Am J Sports Med 39(3):599–606

    Article  PubMed  Google Scholar 

  36. Thomazeau H, Boukobza E, Morcet N, Chaperon J, Langlais F (1997) Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res 344:275–283

    Article  Google Scholar 

  37. van de Sande MA, Stoel BC, Obermann WR, a Lieng JGT, Rozing PM (2005) Quantitative assessment of fatty degeneration in rotator cuff muscles determined with computed tomography. Invest Radiol 40(5):313–319

    Article  PubMed  Google Scholar 

  38. Zanetti M, Gerber C, Hodler J (1998) Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging. Invest Radiol 33(3):163–170

    CAS  Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Orthopaedic Surgery, Wonkwang University Hospital, 344-2 Shinyong-dong, Iksan, Jeollabuk-do, Korea

    Sung Hyun Lee, Jeong Woo Kim, Tae Kyun Kim, Seok Hyun Kweon, Hong Je Kang, Se Jin Kim & Jin Sung Park

Authors
  1. Sung Hyun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeong Woo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tae Kyun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seok Hyun Kweon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hong Je Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Se Jin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jin Sung Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeong Woo Kim.

Ethics declarations

Conflict of interest

The authors delcare that they have no conflict of interest.

Funding

This paper will be supported by Wonkwang University in 2017.

Ethical approval

This study was approved by the Institutional Review Board of Wonkwang University Hospital (WKUHIRB 201607-HR-081).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lee, S.H., Kim, J.W., Kim, T.K. et al. Is the arthroscopic suture bridge technique suitable for full-thickness rotator cuff tears of any size?. Knee Surg Sports Traumatol Arthrosc 25, 2138–2146 (2017). https://doi.org/10.1007/s00167-016-4415-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-016-4415-4

Keywords

  • Rotator cuff tear
  • Suture bridge
  • Modified tension band
  • Tear size
  • Retear rate