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Knotted and knotless double row transosseous equivalent repair techniques for arthroscopic rotator cuff repair demonstrate comparable post-operative outcomes

  • SHOULDER
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To compare failure rates and outcomes after transosseous equivalent (TOE) double row (DR) knotted suture bridge versus knotless suture tape bridge repair techniques for rotator cuff tears.

Methods

A consecutive series of 272 shoulders in 256 patients who underwent arthroscopic, double row, TOE repair for full-thickness tears of the supraspinatus tendon were reviewed. Eighty-four shoulders were repaired using knotted suture bridge (KSB) technique, and 188 shoulders were repaired using all knotless suture tape bridge (KTB) technique. Revision procedures and concomitant subscapularis tendon repairs were excluded from analysis. The minimum follow-up was 12 months. Primary outcome was failure of surgical repair, defined as either confirmed retear on MRI and/or need for revision surgery. Secondary clinical outcome measures were assessed including range of motion, strength, visual analog scale (VAS), operative time, subjective shoulder value (SSV), Patient-Reported Outcomes Measurement Information System (PROMIS) mental and physical health, American Shoulder and Elbow Surgeons Shoulder Score (ASES), Brophy shoulder activity scores, and need for manipulation under anesthesia (MUA).

Results

A total of 127 shoulders (38 KSB and 89 KTB) met inclusion criteria for the study. No significant difference in demographic variables were present between the groups at baseline. Supraspinatus tear size and average follow-up time did not differ significantly between groups. Failure rates were similar between the KSB and KTB repairs (13.1 vs 7.9%, n.s.). There was no significant difference in functional outcomes including strength, range of motion in forward flexion and external rotation, as well as patient reported outcomes including VAS, SSV, PROMIS, ASES, and Brophy scores between the groups. There was also no difference in post-operative stiffness requiring MUA.

Conclusion

Both KSB and KTB repair techniques demonstrate low retear rates with excellent functional outcomes when compared to pre-operative examination. Both KSB and KTB techniques are viable options for achieving a successful rotator cuff repair.

Level of evidence

Level III

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Funding

No funding was disclosed by the author(s).

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Pittsburgh Shoulder Institute, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 1010, Pittsburgh, PA, 15213, USA

    Michael A. Fox, Jonathan D. Hughes, Nicholas P. Drain, Nyaluma Wagala, Neel Patel, Ehab Nazzal, Bryson P. Lesniak & Albert Lin

  2. Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA

    Adam Popchak & Soheil Sabsevari

Authors
  1. Michael A. Fox
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  2. Jonathan D. Hughes
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  4. Nyaluma Wagala
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  5. Neel Patel
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  6. Ehab Nazzal
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  7. Adam Popchak
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Contributions

MAF: significant contribution to data collection, manuscript preparation, statistical analysis, and conception of design. Reviewed and provided final approval for version to be published, and is agreeable to be accountable for all aspects of the work. JDH: significant contribution to manuscript preparation, and intellectual content. Reviewed and provided final approval for version to be published, and is agreeable to be accountable for all aspects of the work. NPD: significant contribution to data collection and manuscript preparation. Reviewed and provided final approval for version to be published, and is agreeable to be accountable for all aspects of the work. NW: significant contribution to data collection. Reviewed and provided final approval for version to be published, and is agreeable to be accountable for all aspects of the work. NP: significant contribution to manuscript preparation, and intellectual content. Reviewed and provided final approval for version to be published, and is agreeable to be accountable for all aspects of the work. EN: significant contribution to data collection. Reviewed and provided final approval for version to be published, and is agreeable to be accountable for all aspects of the work. AP: significant contribution to manuscript preparation, and intellectual content. Reviewed and provided final approval for version to be published, and is agreeable to be accountable for all aspects of the work. SS: significant contribution to manuscript preparation, statistical analysis, and intellectual content. Reviewed and provided final approval for version to be published, and is agreeable to be accountable for all aspects of the work. BPL: significant contribution to conception of design, manuscript preparation, statistical analysis, and intellectual content. Reviewed and provided final approval for version to be published, and is agreeable to be accountable for all aspects of the work. AL: significant contribution to conception of design, manuscript preparation, statistical analysis, and intellectual content. Reviewed and provided final approval for version to be published, and is agreeable to be accountable for all aspects of the work.

Corresponding author

Correspondence to Michael A. Fox.

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Conflict of interest

The authors, their immediate families, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.

Ethical approval

This study was approved by the local ethical committee (University of Pittsburgh Institutional Review Board; STUDY20030061).

Informed consent

Not applicable for this retrospective study.

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Fox, M.A., Hughes, J.D., Drain, N.P. et al. Knotted and knotless double row transosseous equivalent repair techniques for arthroscopic rotator cuff repair demonstrate comparable post-operative outcomes. Knee Surg Sports Traumatol Arthrosc 31, 1919–1924 (2023). https://doi.org/10.1007/s00167-022-07121-0

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