Purpose
To compare clinical outcomes between 2 suturing procedures, conventional en masse
suture bridging (EMSB) and dual-layer suture bridging (DLSB), for delaminated rotator
cuff tears.
Methods
From January 2011 through December 2015, 98 consecutive cases with delaminated rotator
cuff tears were included in this study (52 with EMSB and 46 with DLSB). The mean age
was 65.0 ± 8.9 years (range, 38-85 years). The mean follow-up period was 28.0 ± 6.3 months
(range, 24-40 months). The cases included 78 medium tears (1-3 cm) and 20 large tears
(3-5 cm). The University of California, Los Angeles (UCLA) rating scale, the Simple
Shoulder Test (SST), a visual analog scale for pain, and active range of motion of
the shoulder preoperatively and 2 years after surgery were evaluated. Postoperative
magnetic resonance imaging was obtained at 12 months after surgery.
Results
Both the EMSB and DLSB groups showed improved clinical outcomes. Postoperative UCLA
and SST scores were higher in the DLSB group than in the EMSB group (UCLA score, 33.2
± 2.3 vs 32.0 ± 3.3 [P = .027]; SST score, 10.0 ± 1.0 vs 9.5 ± 1.2 [P = .014]). Postoperative abduction and external rotation of the shoulder were greater
in the DLSB group than in the EMSB group (abduction, 160.1° ± 9.1° vs 154.8° ± 19.8°
[P = .030]; external rotation, 53.7° ± 8.5° vs 46.1° ± 9.4° [P = .023]). Postoperative magnetic resonance imaging showed a retear in 7 of 52 cases
in the EMSB group and 3 of 46 cases in the DLSB group, with no significant difference
between groups.
Conclusions
The DLSB and EMSB procedures for delaminated rotator cuff tears improved clinical
and radiographic outcomes, and the DLSB group achieved better postoperative range
of motion of the shoulder than the EMSB group. The DLSB procedure is useful for repairing
delaminated rotator cuff tears.
Level of Evidence
Level III, retrospective, case-control, comparative study.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic and PersonalCorporate R&D ProfessionalsOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Arthroscopic repair of full-thickness tears of the supraspinatus: Does the tendon really heal?.J Bone Joint Surg Am. 2005; 87: 1229-1240
- Arthroscopic repair of full-thickness cuff tears: A multicentric retrospective study of 576 cases with anatomical assessment.Rev Chir Orthop Reparatrice Appar Mot. 2005; 91 ([in French]): 31-42
- Is posterior delamination in arthroscopic rotator cuff repair hidden to the posterior viewing portal?.Arthroscopy. 2013; 29: 1740-1747
- The effect of dynamic external rotation comparing 2 footprint-restoring rotator cuff repair techniques.Am J Sports Med. 2008; 36: 893-900
- Initial fixation strength of transosseous-equivalent suture bridge rotator cuff repair is comparable with transosseous repair.Am J Sports Med. 2012; 40: 133-140
- Knotless anatomic double-layer double-row rotator cuff repair: A novel technique re-establishing footprint and shape of full-thickness tears.Arch Orthop Trauma Surg. 2009; 129: 1031-1036
- Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. a prospective outcome study.J Bone Joint Surg Am. 2007; 89: 953-960
- Results of a second attempt at surgical repair of a failed initial rotator-cuff repair.J Bone Joint Surg Am. 1984; 66: 563-567
- Arthroscopy of the shoulder.Orthop Clin North Am. 1987; 18: 361-372
- Classification and clinical significance of acromial spur in rotator cuff tear. Heel-type spur and rotator cuff tear.Clin Orthop Relat Res. 2010; 468: 1542-1550
- Repair of rotator cuff tear with delamination: Independent repairs of the infraspinatus and articular capsule.Arthrosc Tech. 2016; 5: e1129-e1134
- Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: Single-row versus dual-row fixation.Arthroscopy. 2005; 21: 1307-1316
- Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics.Bone Marrow Transplant. 2013; 48: 452-458
- Laminated tears of the human rotator cuff: A histologic and immunochemical study.J Shoulder Elbow Surg. 2001; 10: 109-115
- Delamination tearing of the rotator cuff: Prospective analysis of the influence of delamination tearing on the outcome of arthroscopically assisted mini open rotator cuff repair.J Shoulder Elbow Surg. 2010; 19: 1063-1069
- Delamination observed in full-thickness rotator cuff tears.Shoulder Joint (Katakansetsu). 2005; 29: 603-606
- Structural factors affecting the outcome of rotator cuff repair.J Shoulder Elbow Surg. 2002; 11: 212-218
- Delaminated rotator cuff tear: Extension of delamination and cuff integrity after arthroscopic rotator cuff repair.J Shoulder Elbow Surg. 2015; 24: 719-726
- The superior capsule of the shoulder joint complements the insertion of the rotator cuff.J Shoulder Elbow Surg. 2012; 21: 867-872
- Role of the superior shoulder capsule in passive stability of the glenohumeral joint.J Shoulder Elbow Surg. 2014; 23: 642-648
- Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: A biomechanical cadaveric study.Am J Sports Med. 2012; 40: 2248-2255
- Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears.Arthroscopy. 2013; 29: 459-470
- Arthroscopic lamina-specific double-row fixation for large delaminated rotator cuff tears.Arthrosc Tech. 2014; 3: e667-e671
- Conventional en masse repair versus separate double-layer double-row repair for the treatment of delaminated rotator cuff tears.Am J Sports Med. 2016; 44: 1146-1152
- Retraction pattern of delaminated rotator cuff tears: Dual-layer rotator cuff repair.J Orthop Surg Res. 2016; 11: 75
- Comparison of histologic healing and biomechanical characteristics between repair techniques for a delaminated rotator cuff tear in rabbits.J Shoulder Elbow Surg. 2017; 26: 838-845
- Responsiveness of self-report scales in patients recovering from rotator cuff surgery.J Shoulder Elbow Surg. 2006; 15: 407-414
- Measuring shoulder function: A systematic review of four questionnaires.Arthritis Rheum. 2009; 61: 623-632
Article Info
Publication History
Published online: November 01, 2018
Accepted:
June 26,
2018
Received:
January 23,
2018
Footnotes
See commentary on page 3157
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2018 by the Arthroscopy Association of North America
