Effectiveness analysis of “tail compression fixation+suture bridge” technology under shoulder arthroscopy for treating primary tear in medial enthesis of rotator cuff_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

Aikeremu·aierken ^1,2 , LI Qiangqiang ^1,2 , FU Kai ^1,2 , CHEN Dongyang ^1,2 , YAO Yao ^1,2 , SHEN Ying ^1,2 ,  JIANG Qing ^1,2 ,  QIN Jianghui ^1,2

1. Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, 210008, P. R. China;
2. Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing Jiangsu, 210008, P. R. China;

Corresponding?author：

JIANG Qing, Email: jiangqing112@hotmail.com; QIN Jianghui, Email: jianghui.qin@hotmail.com

Keywords：

Rotator cuff injury; tear in medial enthesis of rotator cuff; suture bridge; tail compression fixation; arthroscopy

DOI：

10.7507/1002-1892.202302030

Video：

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Objective To investigate the feasibility and effectiveness of “tail compression fixation+suture bridge” technology under shoulder arthroscopy for treating primary tear in medial enthesis of rotator cuff. Methods The clinical data of 11 patients with primary tear in medial enthesis of rotator cuff who met the selection criteria between October 2020 and October 2022 were retrospectively analyzed, including 3 males and 8 females, aged 39-79 years, with an average of 61.0 years. Rotator cuff injury was caused by traumatic fall in 8 cases, and the time from injury to admission was 1-4 months, with an average of 2.0 months; the remaining 3 cases had no obvious inducement. The active range of motion of the affected shoulder was limited, with an active forward flexion range of motion of (64.1±10.9)°, abduction of (78.1±6.4)°, internal rotation of (48.2±6.6)°, and external rotation of (41.8±10.5)°; 5 cases had shoulder stiffness. The preoperative visual analogue scale (VAS) score was 7.8±0.8 and the American Society of Shoulder and Elbow Surgeons (ASES) score was 23.9±6.4. The patients were treated with “tail compression fixation+suture bridge” technology under shoulder arthroscopy, and the pain and functional recovery were evaluated by VAS score, ASES score, and active range of motion of shoulder joint at last follow-up; MRI was performed after operation, and the integrity of rotator cuff was evaluated by Sugaya classification system. Results All the 11 patients were followed up 2-22 months, with an average of 13.5 months. All incisions healed by first intention, and there was no complication such as infection, rotator cuff re-tear, and anchor falling off. At last follow-up, the VAS score was 0.8±0.7 and the ASES score was 93.5±4.2, which significantly improved when compared with those before operation (P<0.05). All 11 patients had no significant swelling in the shoulders, and the active range of motion was (165.1±8.8)° in flexion, (75.3±8.4)° in abduction, (56.6±5.5)° in internal rotation, and (51.8±4.0)° in external rotation, which significantly improved when compared with those before operation (P<0.05). Shoulder MRI showed adequate tendon thickness and good continuity in 9 cases, including 4 cases with partial high signal area; and 2 cases with inadequate tendon thickness but high continuity and partial high signal area. According to Sugaya classification system, there were 4 cases of type 1 (36.4%), 5 cases of type 2 (45.5%), and 2 cases of type 3 (18.1%).Conclusion For the patients with primary tear in medial enthesis of rotator cuff, the “tail compression fixation+suture bridge” technology under shoulder arthroscopy is simple and effective.

Citation： Aikeremu·aierken, LI Qiangqiang, FU Kai, CHEN Dongyang, YAO Yao, SHEN Ying, JIANG Qing, QIN Jianghui. Effectiveness analysis of “tail compression fixation+suture bridge” technology under shoulder arthroscopy for treating primary tear in medial enthesis of rotator cuff. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(5): 561-565. doi: 10.7507/1002-1892.202302030 Copy

1.	Graham P. Rotator cuff tear. Orthop Nurs, 2018, 37(2): 154-156.
2.	Reilly P, Macleod I, Macfarlane R, et al. Dead men and radiologists don’t lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence. Ann R Coll Surg Engl, 2006, 88(2): 116-121.
3.	Nyffeler RW, Schenk N, Bissig P. Can a simple fall cause a rotator cuff tear? Literature review and biomechanical considerations. Int Orthop, 2021, 45(6): 1573-1582.
4.	Rothman RH, Parke WW. The vascular anatomy of the rotator cuff. Clin Orthop Relat Res, 1965, 41: 176-186.
5.	Brumitt J, Hutchison MK, Kang D, et al. Blood flow restriction training for the rotator cuff: A randomized controlled trial. Int J Sports Physiol Perform, 2020, 15(8): 1175-1180.
6.	Zhao J. Editorial commentary: Make use of the native insertion structure in rotator cuff repair. Arthroscopy, 2020, 36(7): 1843-1844.
7.	Keener JD, Patterson BM, Orvets N, et al. Degenerative rotator cuff tears: Refining surgical indications based on natural history data. J Am Acad Orthop Surg, 2019, 27(5): 156-165.
8.	Greenspoon JA, Petri M, Warth RJ, et al. Massive rotator cuff tears: pathomechanics, current treatment options, and clinical outcomes. J Shoulder Elbow Surg, 2015, 24(9): 1493-1505.
9.	Cheon SJ, Lee HY, Jeon WK. Arthroscopic treatment for intratendinous rotator cuff tear results in satisfactory clinical outcomes and structural integrity. Knee Surg Sports Traumatol Arthrosc, 2018, 26(12): 3797-3803.
10.	韓寧. 肩袖全層撕裂的治療選擇. 復旦學報 (醫學版), 2010, 37(5): 608-611.
11.	戴金良, 馬健, 杜庚衡, 等. 經肌腱修補法和轉化為全層后修補法治療Ellman 3度岡上肌腱關節側部分撕裂的臨床研究. 中國運動醫學雜志, 2021, 40(1): 7-11.
12.	Collin P, Yoshida M, Delarue A, et al. Evaluating postoperative rotator cuff healing: Prospective comparison of MRI and ultrasound. Orthop Traumatol Surg Res, 2015, 101(6 Suppl): S265-268.
13.	Benazzo F, Marullo M, Pietrobono L. Supraspinatus rupture at the musculotendinous junction in a young woman. J Orthop Traumatol, 2014, 15(3): 231-234.
14.	Hertel R, Lambert SM. Supraspinatus rupture at the musculoten-dinous junction. J Shoulder Elbow Surg, 1998, 7(4): 432-435.
15.	L?dermann A, Christophe FK, Denard PJ, et al. Supraspinatus rupture at the musclotendinous junction: an uncommonly recognized phenomenon. J Shoulder Elbow Surg, 2012, 21(1): 72-76.
16.	Huegel J, Williams AA, Soslowsky LJ. Rotator cuff biology and biomechanics: a review of normal and pathological conditions. Curr Rheumatol Rep, 2015, 17(1): 476. doi: 10.1007/s11926-014-0476-x.
17.	Millett PJ, Hussain ZB, Fritz EM, et al. Rotator cuff tears at the musculotendinous junction: Classification and surgical options for repair and reconstruction. Arthrosc Tech, 2017, 6(4): e1075-e1085.
18.	Barber FA. Editorial commentary: Musculotendinous junction mattress sutures are inefficient. Arthroscopy, 2017, 33(2): 251-253.
19.	Leung KS, Chong WS, Chow DH, et al. A comparative study on the biomechanical and histological properties of bone-to-bone, bone-to-tendon, and tendon-to-tendon healing: An Achilles tendon calcaneus model in goats. Am J Sports Med, 2015, 43(6): 1413-1421.
20.	Sun Y, Kwak JM, Qi C, et al. Remnant tendon preservation enhances rotator cuff healing: Remnant preserving versus removal in a rabbit model. Arthroscopy, 2020, 36(7): 1834-1842.
21.	Urch E, Taylor SA, Ramkumar PN, et al. Biceps tenodesis: A comparison of tendon-to-bone and tendon-to-tendon healing in a rat model. Am J Orthop (Belle Mead NJ), 2017, 46(6): E388-E395.
22.	Hackl M, Nacov J, Kammerlohr S, et al. Intratendinous strain variations of the supraspinatus tendon depending on repair technique: A biomechanical analysis regarding the cause of medial cuff failure. Am J Sports Med, 2021, 49(7): 1847-1853.

1. Graham P. Rotator cuff tear. Orthop Nurs, 2018, 37(2): 154-156.
2. Reilly P, Macleod I, Macfarlane R, et al. Dead men and radiologists don’t lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence. Ann R Coll Surg Engl, 2006, 88(2): 116-121.
3. Nyffeler RW, Schenk N, Bissig P. Can a simple fall cause a rotator cuff tear? Literature review and biomechanical considerations. Int Orthop, 2021, 45(6): 1573-1582.
4. Rothman RH, Parke WW. The vascular anatomy of the rotator cuff. Clin Orthop Relat Res, 1965, 41: 176-186.
5. Brumitt J, Hutchison MK, Kang D, et al. Blood flow restriction training for the rotator cuff: A randomized controlled trial. Int J Sports Physiol Perform, 2020, 15(8): 1175-1180.
6. Zhao J. Editorial commentary: Make use of the native insertion structure in rotator cuff repair. Arthroscopy, 2020, 36(7): 1843-1844.
7. Keener JD, Patterson BM, Orvets N, et al. Degenerative rotator cuff tears: Refining surgical indications based on natural history data. J Am Acad Orthop Surg, 2019, 27(5): 156-165.
8. Greenspoon JA, Petri M, Warth RJ, et al. Massive rotator cuff tears: pathomechanics, current treatment options, and clinical outcomes. J Shoulder Elbow Surg, 2015, 24(9): 1493-1505.
9. Cheon SJ, Lee HY, Jeon WK. Arthroscopic treatment for intratendinous rotator cuff tear results in satisfactory clinical outcomes and structural integrity. Knee Surg Sports Traumatol Arthrosc, 2018, 26(12): 3797-3803.
10. 韓寧. 肩袖全層撕裂的治療選擇. 復旦學報 (醫學版), 2010, 37(5): 608-611.
11. 戴金良, 馬健, 杜庚衡, 等. 經肌腱修補法和轉化為全層后修補法治療Ellman 3度岡上肌腱關節側部分撕裂的臨床研究. 中國運動醫學雜志, 2021, 40(1): 7-11.
12. Collin P, Yoshida M, Delarue A, et al. Evaluating postoperative rotator cuff healing: Prospective comparison of MRI and ultrasound. Orthop Traumatol Surg Res, 2015, 101(6 Suppl): S265-268.
13. Benazzo F, Marullo M, Pietrobono L. Supraspinatus rupture at the musculotendinous junction in a young woman. J Orthop Traumatol, 2014, 15(3): 231-234.
14. Hertel R, Lambert SM. Supraspinatus rupture at the musculoten-dinous junction. J Shoulder Elbow Surg, 1998, 7(4): 432-435.
15. L?dermann A, Christophe FK, Denard PJ, et al. Supraspinatus rupture at the musclotendinous junction: an uncommonly recognized phenomenon. J Shoulder Elbow Surg, 2012, 21(1): 72-76.
16. Huegel J, Williams AA, Soslowsky LJ. Rotator cuff biology and biomechanics: a review of normal and pathological conditions. Curr Rheumatol Rep, 2015, 17(1): 476. doi: 10.1007/s11926-014-0476-x.
17. Millett PJ, Hussain ZB, Fritz EM, et al. Rotator cuff tears at the musculotendinous junction: Classification and surgical options for repair and reconstruction. Arthrosc Tech, 2017, 6(4): e1075-e1085.
18. Barber FA. Editorial commentary: Musculotendinous junction mattress sutures are inefficient. Arthroscopy, 2017, 33(2): 251-253.
19. Leung KS, Chong WS, Chow DH, et al. A comparative study on the biomechanical and histological properties of bone-to-bone, bone-to-tendon, and tendon-to-tendon healing: An Achilles tendon calcaneus model in goats. Am J Sports Med, 2015, 43(6): 1413-1421.
20. Sun Y, Kwak JM, Qi C, et al. Remnant tendon preservation enhances rotator cuff healing: Remnant preserving versus removal in a rabbit model. Arthroscopy, 2020, 36(7): 1834-1842.
21. Urch E, Taylor SA, Ramkumar PN, et al. Biceps tenodesis: A comparison of tendon-to-bone and tendon-to-tendon healing in a rat model. Am J Orthop (Belle Mead NJ), 2017, 46(6): E388-E395.
22. Hackl M, Nacov J, Kammerlohr S, et al. Intratendinous strain variations of the supraspinatus tendon depending on repair technique: A biomechanical analysis regarding the cause of medial cuff failure. Am J Sports Med, 2021, 49(7): 1847-1853.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of “tail compression fixation+suture bridge” technology under shoulder arthroscopy for treating primary tear in medial enthesis of rotator cuff

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