Study identifies new complication linked to rotator cuff repairs using suture bridge technique

Cho NS. Am J Sports Med. 38(4):664-671. April 2010.

Korean investigators found that the suture bridge technique for arthroscopic rotator cuff repair yielded good tendon-to-bone healing; however, retears were common in the muscle-tendon junction.

In their cohort study, Nam Su Cho, MD, from the Kyung Hee University School of Medicine in Seoul, Korea, and colleagues compared retear patterns after arthroscopic rotator cuff repair using either a single-row or a suture bridge technique. They evaluated 46 cases that were identified via an MRI performed at least 6 months after arthroscopic repair for a full-thickness rotator cuff tear. The single-row technique was used in 19 cases and the suture bridge was used in 27 cases, according to the abstract.

Based on retear patterns visible on postoperative MRIs, the investigators divided the cases into the following two groups:

those with cuff tissue repaired at the rotator cuff insertion site that was not observed on the greater tuberosity (type 1); and
those with remnant cuff tissue that remained at the insertion site despite retear (type 2).

There were 14 type 1 (73.7%) and five type 2 cases (26.3%) in the single-row group. There were seven type 1 cases (25.9%) and 20 type 2 cases (74.1%) in the suture bridge group.

The results showed that in the single-row group, neither the extent of fatty degeneration of the rotator cuff nor the extent of muscle atrophy affected retear patterns. In the suture bridge group, however, the percentage of type 1 retears increased with the severity fatty degeneration (P=.030) and the extent of muscle atrophy (P .029).

The most commonly asked question raised following the introduction of the double-row suture bridge rotator cuff repair technique at meetings around the world was, “Is this type of repair going to strangulate the tissue and compromise the vascular supply?” This is an interesting study investigating failures of single- vs. double-row repairs. They found what I have found as well: In some of the double row repairs, the tendon has in fact healed to the bone, but now the weak link seems to be the muscle-tendon junction (perhaps due to a compromised vascular supply — we do not know). This is concerning because there is no simple solution to a muscle-tendon disruption. In fact, there really is no good surgical option for this failure type.

This study is significant because it the first to highlight, specifically, a new complication associated with the double-row suture bridge rotator cuff repair — this is not a mode of failure previously experienced with open, mini-open or arthroscopic single-row repairs. Further research will be necessary to determine the cause of this type of failure and possible preventative measures.

– William N. Levine, MD
Professor of clinical orthopedics
Columbia University
New York