Background
For rotator cuff injury, transoseous suture repair is the main method in open surgery, and suture anchor repair is the main method in arthroscopic surgery. However, in case of severe regional osteoporosis, suture-cutting through the bone or anchor pull-out may occur and result in mechanical failure, which may contribute to the failure of rotator cuff healing and functional impairment. We developed a special technique, the fixing-to-suture-base (F2SB) technique, which can be used as a salvaging or planned procedure, to deal with this special condition. However, the clinical results of the application of this technique are unknown.
Hypothesis
The application of F2SB technique in rotator cuff repair with regional osteoporosis can result in satisfactory rotator cuff healing and functional restoration.
Study Design: Case series; Level of evidence, 4.
Methods
This was a retrospective study of prospectively collected data. From 2003 through 2011, 125 patients underwent rotator cuff repair with the application of the F2SB technique. The F2SB technique included the creation of suture loops at the proximal humeral shaft and the fixation of all the sutures from the cuff side to the suture loops. The F2SB technique was used in three ways: Simple stich F2SB repair (all sutures), transosseous equivalent (TOE) F2SB repair, in which suture anchors were used for the medial row fixation and F2SB technique were applied as a lateral row fixation, and trans-osseous F2SB repairs (all sutures). The patients were followed up at 3, 6, 12 and 24 months postoperatively. X-ray film and MRI examination were taken before operation, and MRI examination was taken at each time of follow-up. Shoulder function was evaluated using the ASES scale and through the degree of forward elevation before operation and at the 24 month time point.
Results
Finally, 93 patients, with 27 undergoing simple-stich F2SB repair, 38 undergoing TOE F2SB repair and 28 undergoing TO F2SB repair were followed up for more than two years and took complete serial examination. Through the final MRI examination, rotator cuff retear was found in 4 patients (14.8%) in the simple-stich F2SB repair group, 3 patients (7.9%) in the TOE F2SB group, and 2 patients (7.1%) in the TE F2SB group. The average ASES scores improved significantly in all three groups, with 45.4 versus 85.1 in the simple stitch group, 47.9 versus 91.9 in the TOE group and 44.8 versus 92.2 in the TO group. The mean forward flexion improved from 114.3° to 169.7°, 109.3° to 173.1°, 101.4° to 170.9°, respectively in the three groups.
Conclusion
F2SB technique can be used as a salvaging or planned procedure in rotator cuff repair with regional osteoporosis.