Rotator cuff repair with ultrasonic suture welding (SS-46)

      Rotator cuff repair techniques traditionally employ suture fixation of the tendon to both soft and bony tissues. The suture is tied by hand or arthroscopic knot pusher to provide secure loops to fix tissue to facilitate healing. A new technology allows the creation of secure loops with ultrasonic energy welding. This study was conducted to assess the clinical results of mini-open rotator cuff repair employing ultrasonic suture welding. Fifty consecutive patients treated by one surgeon were retrospectively evaluated with an average follow-up of 26 months. These patients were then compared to 55 patients treated by the same surgeon with a technique employing standard knot-tying with nonabsorbable suture with similar follow-up. The groups were similar in regard to age, sex, hand dominance and preoperative duration of symptoms. All procedures were performed in a hospital ambulatory surgery center in a lateral decubitus position. A glenohumeral arthroscopy and arthroscopic acromioplasty were performed in all cases. All patients were evaluated by an independent examiner using the UCLA scale; 47 of the 50 suture weld patients were available for evaluation. Preoperative UCLA score averaged 21.5 and postoperative 29.8. There were four failures in this group but two of the patients who failed had a significant postoperative traumatic events; a dislocation in one and a car accident in another. Both patients underwent revision cuff repair. At revision. both repairs had pulled through tendon without failure of the weld. 40 of the 55 patients treated with tied sutures were available for evaluation. Preoperative UCLA score averaged 13.2 and postoperative 31.6. There was one failure in this group of patients and none with postoperative trauma. Postoperative scores for the two groups did not differ significantly according to Student t test. An Analysis of Covariance (ANCOVA) of postoperative UCLA scores was also not statistically significant. Suture welding produces secure loops that allow for cuff repair with results similar to traditional knot-tying techniques. Welding technology may facilitate arthroscopic cuff repair by obviating the need to tie arthroscopic knots.