Does the technique of rotator cuff repair matter?

Clinical outcomes and repair integrity after arthroscopic full-thickness rotator cuff repair: suture-bridge versus double-row modified Mason-Allen technique

These authors compared the clinical and radiologic outcomes of patients who underwent arthroscopic rotator cuff repairs by the suture-bridge and double-row modified Mason-Allen techniques.
76 consecutive cases of full-thickness rotator cuff tear, 1 to 4 cm in the sagittal plane, for which arthroscopic rotator cuff repair was performed, were included. The suture-bridge technique was used in 37 consecutive shoulders; and the double-row modified Mason- Allen technique, in 39 consecutive shoulders. 

Clinical outcomes at a minimum of 2 years (mean, 35.7 months) were not different between the two groups. Postoperative cuff integrity at a mean of 17.7 months by magnetic resonance imaging showed a retear rate of 18.9% in the shoulders having suture-bridge repair and 12.8% in those having double-row modified Mason-Allen repair.

Comment: Unfortunately, this paper does not present the clinical outcomes of the failed repairs, which, in other studies have been shown to be comparable to those of intact repairs.

In their discussion the authors reference papers showing rehear rates approaching 60% in some settings. Thus the clinical significance of a retear needs careful investigation.

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Rotator cuff repair - the use of grasping suture in a sheep model

Medial grasping sutures significantly improve load to failure of the rotator cuff suture bridge repair.

The authors point out that the failure rates of cuff repair continue to be high, especially in large and massive tears.

They studied 7 matched pairs of sheep infraspinatus tendons were randomly repaired with either a suture bridge or suture bridge with grasping suture. 

They found that the rotator cuff footprint displacement was less during tensile loading with the addition of the medial grasping suture. 

The ultimate load to failure was significantly greater with the addition of the grasping suture.

Interestingly, in all cases the mode of failure was the tendon pulling off the footprint with suture cutting through the tendon.

Comment: It is not surprising that the addition of more sutures increases the load to failure, see the post linked here..

It is important to note that cuff repairs fail by suture tension overload. This study was performed using healthy sheep tendons. Poor quality of tendon or insufficient quantity of tendon can be expected to increase the risk of failure with any repair technique. It remains to be seen whether the addition of another stitch improves the success rate in chronic large tears.

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