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BACKGROUND: In clinic, there are various fixation methods for greater tuberosity avulsion fractures of the humerus. If the fixation of the greater tubercle is unsatisfactory, it will lead to the absorption of the greater tubercle as the mechanical core of the shoulder joint, resulting in serious shoulder joint dysfunction. OBJECTIVE: To explore the curative effect of the treatment of anterior dislocation of shoulder joint with greater tuberosity avulsion fractures of the humerus by double-row suture anchors under shoulder arthroscope. METHODS: A retrospective study was conducted in 20 patients with anterior dislocation of the shoulder and avulsion fracture of the greater tuberosity of the humerus in Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University who underwent arthroscopic double-row suture anchors from January 2016 to October 2018. After operation, systematic shoulder joint function exercise was performed, and joint function evaluation and pain score were regularly followed up. The functional recovery was compared before and after operation. RESULTS AND CONCLUSION: (1) The incisions of all patients healed in stage I, without complications such as infection, loosening of anchor pin, or nerve injury. After one-year follow-up, there was no significant subacromial impact in all patients. (2) At 1, 3, 6 and 12 months postoperatively, the Constant-Murley score and the University of California at Los Angeles shoulder rating scale score were significantly different (P < 0.05); and the score of each time point was better than that of the previous time point (P < 0.05). (3) At 1 month after surgery, the resting and activity visual analogue scale scores were significantly lower than before surgery (P < 0.05); the displacement distance of greater tuberosity fracture was significantly less than that before operation (P < 0.05). (4) One year after operation, the range of motion of shoulder joint such as flexion, abduction, external rotation and adduction recovered well. (5) It is indicated that arthroscopic double-row suture anchors can effectively restore the displacement of the greater tuberosity fractures, and achieve a good fixation of the rotator cuff tendon injury, promote healing, and relieve patients’ pain, which is conductive to early shoulder functional exercise.
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Objective To compare the suture bridge (SB) and conventional double-row (DR) suture in the repair of full-thickness rotator cuff tear.Methods From May 2013 through July 2016,48 patients with full-thickness rotator cuff tear were randomly divided into 2 even groups (n =24).SB group was repaired using the SB technique while DR group using conventional DR technique.The 2 groups were compared in terms of operation time,postoperative shoulder function scoring and incidence of re-tear.Results All the patients were followed up for 8 to 24 months (average,15.3 months).In DR group,the visual analogue scale (VAS) scores decreased from preoperative 6.3 ± 2.3 to 1.0 ± 0.4 at the last follow-up,the America Shoulder and Elbow Surgeons (ASES) scores increased from preoperative 49.3 ± 8.5 to 90.0 ± 2.5 at the last follow-up,and the Constant scores increased from preoperative 58.7 ± 12.5 to 88.1 ± 4.0 at the last follow-up.In SB group,the VAS scores decreased from preoperative 6.0 ± 1.9 to 0.9 ± 0.8 at the last follow-up,the ASES scores increased from preoperative 50.2 ± 6.2 to 89.5 ± 3.4 at the last follow-up,and the Constant scores increased from preoperative 57.3 ± 7.5 to 90.0 ± 3.2 at the last follow-up.All the comparisons showed a significant difference between preoperation and the last follow-up (P ＜ 0.05),but an insignificant difference between the 2 groups (P ＞ 0.05).SB group used significantly less operation time (74.5 ± 19.0 min) than DR group (86.5 ± 21.0 min),and reported significantly lower incidence of re-tear (4.2％) than DR group (25.0％) (P ＜ 0.05).Conclusions In arthroscopic repair of full-thickness rotator cuff tear,SB technique shows few therapeutic advantages over conventional DR technique,but the former needs less operation time and leads to lower incidence of re-tear.
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Objective To compare the suture bridge (SB) and conventional double-row (DR) suture in the repair of full-thickness rotator cuff tear.Methods From May 2013 through July 2016,48 patients with full-thickness rotator cuff tear were randomly divided into 2 even groups (n =24).SB group was repaired using the SB technique while DR group using conventional DR technique.The 2 groups were compared in terms of operation time,postoperative shoulder function scoring and incidence of re-tear.Results All the patients were followed up for 8 to 24 months (average,15.3 months).In DR group,the visual analogue scale (VAS) scores decreased from preoperative 6.3 ± 2.3 to 1.0 ± 0.4 at the last follow-up,the America Shoulder and Elbow Surgeons (ASES) scores increased from preoperative 49.3 ± 8.5 to 90.0 ± 2.5 at the last follow-up,and the Constant scores increased from preoperative 58.7 ± 12.5 to 88.1 ± 4.0 at the last follow-up.In SB group,the VAS scores decreased from preoperative 6.0 ± 1.9 to 0.9 ± 0.8 at the last follow-up,the ASES scores increased from preoperative 50.2 ± 6.2 to 89.5 ± 3.4 at the last follow-up,and the Constant scores increased from preoperative 57.3 ± 7.5 to 90.0 ± 3.2 at the last follow-up.All the comparisons showed a significant difference between preoperation and the last follow-up (P ＜ 0.05),but an insignificant difference between the 2 groups (P ＞ 0.05).SB group used significantly less operation time (74.5 ± 19.0 min) than DR group (86.5 ± 21.0 min),and reported significantly lower incidence of re-tear (4.2％) than DR group (25.0％) (P ＜ 0.05).Conclusions In arthroscopic repair of full-thickness rotator cuff tear,SB technique shows few therapeutic advantages over conventional DR technique,but the former needs less operation time and leads to lower incidence of re-tear.
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Objective To investigate the clinical outcomes of arthroscopic rotator cuff repair using improved-press-ift double-row technique for patients of large rotator cuff tear.Methods From December 2013 to November 2014, 52 patients (20 males, 32 females) with a full-thickness large rotator cuff tear underwent arthroscopic improved-press-ift double-row repair were retrospectively analyzed. The mean age of the patients was 65.6 years (range 51 to 76 years). The visual analog pain scale scores (VAS), the range of motion (ROM), University of California at Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) were used for clinical and functional evaluations before surgery and at the time of 6 months after arthroscopy.Results The mean duration of follow-up was 10.9 months (range 6 to 17 months). At the time of 6 months after arthroscopy, the mean subjective pain score (VAS) was (1.6 ± 0.9), the mean active forward flexion was (145.6 ± 10.7)°, whereas the mean external rotation at the side was (30.8 ± 8.5)°. The mean UCLA score improved to (32.3 ± 3.5), the mean ASES score improved to (81.8 ± 8.7). There was significant difference postoperatively (P < 0.05). No re-tear occurred.Conclusion The improved-press-ift DR technique is effective in arthroscopic large rotator cuff repairing. Compared with suture-bridge technique, this technique can decrease operation time, costs, and is much easier to process.
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Resumen: Objetivo: Analizar si existen diferencias clínicas entre las técnicas "hilera simple" versus "suture bridge" en la reparación artroscópica de roturas de espesor completo del supraespinoso. Material y métodos: Estudio retrospectivo de 123 pacientes con rotura de espesor completo del supraespinoso, intervenidos entre Enero de 2009 y Enero de 2013 (60 hilera simple y 63 suture bridge). La edad media en el grupo suture bridge fue 63.3 años y en el grupo hilera simple, 62.9. Predominio de mujeres (67%) en ambos grupos. En todos los casos, se reparó la hilera medial con anclajes Bio-Corkscrew y la hilera lateral con implantes Bio-PushLock (Arthrex, Naples, FL). Resultados: El valor del test de Constant medio en individuos intervenidos mediante suture bridge fue 76.7 (ponderado 96.5). En hilera simple, fue 72.4 (ponderado 92.8). Se realizó también un análisis estadístico comparativo de cada ítem del test de Constant por separado. La fuerza es el único parámetro del test de Constant estadísticamente significativo y es mayor en el grupo suture bridge. Conclusiones: La reparación de las roturas de espesor completo del supraespinoso mediante suture bridge proporciona resultados clínicos superiores a la reparación en hilera simple, sin existir diferencias estadísticamente significativas (p = 0.298).
Abstract: Purpose: The purpose of this study is to analyze if there is any difference between the arthroscopic reparation of full-thickness supraspinatus tears with simple row technique versus suture bridge technique. Material and methods: We accomplished a retrospective study of 123 patients with full-thickness supraspinatus tears between January 2009 and January 2013 in our hospital. There were 60 simple row reparations, and 63 suture bridge ones. Results: The mean age in the simple row group was 62.9, and in the suture bridge group was 63.3 years old. There were more women than men in both groups (67%). All patients were studied using the Constant test. The mean Constant test in the suture bridge group was 76.7, and in the simple row group was 72.4. We have also accomplished a statistical analysis of each Constant item. Strength was higher in the suture bridge group, with a significant statistical difference (p < 0.04). The range of movement was also greater in the suture bridge group, but was not statistically significant. Conclusions: Suture bridge technique has better clinical results than single row reparations, but the difference is not statistically significant (p = 0.298).
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Objective To compare the clinical effect of single-row (SR) and double-row (DR)rotator cuff injury repair.Methods Twenty-three patients with rotator cuff injury were randomized into SR group(12 patients) and DR group (11 patients) by ranom digits table.Two anchors and simple sutures were applied in SR group,three anchors and medial mattress sutures were applied in DR group.Clinical function were compared after operation 24 months,included pain visual analogue scale (VAS) scores,Constant scores,American Shoulder and Elbow Surgeons (ASES) scores,University of California at Los Angeles (UCLA) scores,range of shoulder motion (anteflexion,adtorsion conclination,external rotation),operation time and patient's satisfaction were compared.Re-tear rate and clinical function were also analyzed.Results The operation time in SR group was shorter than that in DR group [(115.8 t25.0) min vs.(124.5 ± 19.7)min,P =0.033].The scores of VAS,Constant,ASES,UCLA in two groups had no significant difference (P ＞ 0.05).The full-thickness re-tear in SR group was 2 patients,in DR group was 2 patients,there was no significant difference (P ＞ 0.05).The full-thickness re-tear and part-thickness re-tear in SR group was 7 patients,in DR group was 2 patients,there was significant difference(P=0.041).Furthermore,the scores of VAS,Constant,ASES,UCLA had no significant difference (P＞ 0.05).Conclusion Compared with SR,2-5 cm rotator cuff injury repaired by DR has no obviously advantage.
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PURPOSE: Our goal for this study was to prospectively evaluate the functional & structural outcomes, by means of CT arthroscopy, of arthroscopic double-row fixation for treating rotator cuff tear. We also attempted to determine the variants that affect the functional & structural outcomes. MATERIALS AND METHODS: Twenty seven consecutive patients underwent arthroscopic rotator cuff repair with double-row fixation. The average age at the time of the operation was fifty six years. The preoperative and postoperative examinations consisted of determining the Constant score, the score for the visual analogue scale for pain, the UCLA score, the American Shoulder and Elbow Surgeons (ASES) score, as well as a full physical examination of the shoulder. Preoperative MR arthrography was used to evaluate the integrity and atrophy of the rotator cuff. We measured the intraoperative tear size in the sagittal and coronal planes. Postoperative CT arthrography was used at one year postoperatively to evaluate the integrity and atrophy of the repaired tendons and muscles. RESULTS: Preoperative MR arthrography revealed an average 29.22 mm tear size in the sagittal plane and an average 22.72 mm tear size in the coronal plane. Twelve cases of supraspinatus muscle atrophy and two cases of infraspinatus atrophy were observed on the preoperative MR arthrography. The average clinical outcome scores all significantly improved at the time of follow-up. At a mean of one year postoperatively, CT arthrography revealed 48.1% of the shoulders had healed, 11.1% showed incomplete healing and 40.7% showed retear of the repaired tendon. CONCLUSION: Arthroscopic double-row repair can result in improved clinical outcomes and good patient satisfaction. However, the problems about how to enhance healing of the repaired tendon still remain.
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Humans , Arthrography , Arthroscopy , Atrophy , Elbow , Follow-Up Studies , Muscular Atrophy , Patient Satisfaction , Physical Examination , Prospective Studies , Rotator Cuff , Shoulder , TendonsABSTRACT
Ideal rotator cuff repair is to maintain high fixation strength and minimize gap formation for optimizing the environment of biologic healing of tendon to bone. Among the current repair techniques, the suture bridge technique is superior to single- or double-row repair in ultimate load to failure, gap formation, restoring anatomical footprint and achieving pressurized contact area. The suture bridge technique also minimizes gap formation and has rotational and torsional resistances allowing early rehabilitation. However, despite superior biomechanical characteristics of the suture bridge technique, there is no evidence that these mechanical advantages result in better clinical outcomes. Furthermore, there is no difference in failure rates between the double-row repair and suture bridge techniques. An appropriate repair technique should be determined based on tear size and pattern and tendon quality.