Monday, October 21, 2013

Single-row versus double-row suture bridge repair of supraspinatus tears - a randomized study

Ultrasound evaluation of arthroscopic full-thickness supraspinatus rotator cuff repair: single-row versus double-row suture bridge (transosseous equivalent) fixation. Results of a prospective, randomized study

The authors are to be complemented in their conduction of a well-randomized clinical trial.

The purpose of this study was to compare the structural outcomes of a single-row rotator cuff repair and double-row suture bridge fixation after arthroscopic repair of a full-thickness supraspinatus rotator cuff tear (tear size less than 25 mm in their anterior to posterior dimension). Specifically the goal was to test the null hypothesis that an arthroscopic double-row repair would not produce an improvement in the tendon healing rate as determined by diagnostic ultrasound.

Randomization took place in the operating room. After the operative findings confirmed patient eligibility, the circulating nurse consulted a random number table and the patient was then assigned to one of the two study groups. Forty-three shoulders were repaired with single-row technique and 47 shoulders with double-row suture bridge technique. Postoperative rehabilitation was identical for both groups. Shoulders were immobilized in an abduction sling for 6 weeks, being allowed out of the sling for bathing, dressing, and pendulum circumduction. At 6 weeks after the operation. The sling was discontinued and the shoulder started on supine active assisted elevation.
Ultrasound criteria for healed repair included visualization of a tendon with normal thickness and length, and a negative compression test. Eighty-three patients were available for ultrasound examination (40 single-row and 43 suture-bridge). Thirty of 40 patients (75%) with single-row repair demonstrated a healed rotator cuff repair compared to 40/43 (93%) patients with suture-bridge repair (P = .024)

In their sample size estimation, the authors were seeking a 15% to 20% difference in supraspinatus integrity rates - a difference not quite achieved in this study.

It would have been of interest to know the age, gender, and tear size of the two groups so we could see how comparable they were. There were no clinical results presented for these patients so we do not know if the shoulders with retears fared worse and those with intact repairs or whether the suture-bridge shoulders had more comfort and function at followup than those having single row repairs.

The authors are to be again complemented on yet another randomized study - all too rare in our field.

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