By: 4 October 2013


Masafumi Gotoh et al study the use of a modified stitch technique to treat massive cuff tears

 

Abstract

ShoulderBackground

The massive cuff stitch (MCS) is known to be a strong suture, suitable for rotator cuff repair. We modified this technique for massive cuff tears by employing a horizontal medial mattress suture from an anchor as well as a vertically crossing transosseous suture.

Methods

We included 42 patients with massive cuff tears suitable for repair: 22 were treated with the modified MCS (MCS group), and 20 with a simple transosseous suture (STS group). The range of motion (ROM), muscle strength, visual analogue scale, and the Japanese Orthopaedic Association (JOA) scores were evaluated pre-operatively and 12 and 24 months post-operatively. The incidence of post-operative re-tears was examined at least one year post-operatively using Sugaya’s classification.

Results

The ROM, muscle strength, degree of pain, and the JOA scores were much improved after surgery in both groups, and there was no significant intergroup difference throughout the pre- and postoperative periods. In contrast, post-operative MRI revealed a significantly lower re-tear rate in the MCS group than in the STS group (9.1% vs. 40%, P = 0.0296).

Conclusions

The techniques tested were comparable in terms of functional outcome after surgical repair of massive cuff tears; however, the modified MCS repair technique produced superior structural outcomes with a significantly lower re-tear rate.

Keywords

Massive cuff tear; Massive cuff stitch; Transosseous suture; Magnetic resonance imaging; Post-operative re-tear…

 

For the full article, please contact us and ask about subscription:

Jordan Yates
T: 0844 858 2890
E: jordan.yates@barkerbrooks.co.uk

 

Author

Masafumi Gotoh1*, Yasuhiro Mitsui,1 Kazuhiro Yoshimitsu,2 Kenjiro Nakama,2 Takahiro Okawa,1 Fujio Higuchi1 and Kensei Nagata.2

* Corresponding author: Masafumi Gotoh gomasa@med.kurume-u.ac.jp

1 Department of Orthopaedic Surgery, Kurume University Medical Center Kurume, 155-1 Kokubu-machi, Kurume, Fukuoka 839-0863, Japan

2 Department of Orthopaedic Surgery, Kurume University, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan

Journal of Orthopaedic Surgery and Research 2013, 8:26 | doi:10.1186/1749-799X-8-26

www.josr-online.com/content/8/1/26
© 2013 Gotoh et al.; licensee BioMed Central Ltd.

 

References

  1. Liu SH, Baker CL: Arthroscopically assisted rotator cuff repair: correlation of functional results with integrity of the cuff. Arthroscopy 1994, 10:54-60.
  2. Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K: The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 2004, 86:219-224.
  3. Ko SH, Friedman D, Seo DK, Jun HM, Warner JJ: A prospective therapeutic comparison of simple suture repairs to massive cuff stitch repairs for treatment of small- and medium-sized rotator cuff tears. Arthroscopy 2009, 25:583-589.
  4. Kim JR, Cho YS, Ryu KJ, Kim JH: Clinical and radiographic outcomes after arthroscopic repair of massive rotator cuff tears using a suture bridge technique: assessment of repair integrity on magnetic resonance imaging. Am J Sports Med 2012, 40:786-793.
  5. Bigliani LU, Cordasco FA, McLlveen SJ, Musso ES: Operative repair of massive rotator cuff tears: long-term results. J Shoulder Elbow Surg 1992, 1:120-30.
  6. Gerber C, Fuchs B, Hodler J: The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am 2000, 82:505-515.
  7. Yamaguchi H, Suenaga N, Oizumi N, Hosokawa Y, Kanaya F: Open repair for massive rotator cuff tear with a modified transosseous-equivalent procedure: preliminary results at short-term follow-up. J Orthop Sci 2011, 16:398-404.
  8. Waltrip RL, Zheng N, Dugas JR, Andrews JR: Rotator cuff repair. A biomechanical comparison of three techniques. Am J Sports Med 2003, 31:493-497.
  9. Sileo MJ, Ruotolo CR, Nelson CO, Serra-Hsu F, Panchal AP: A biomechanical comparison of the modified Mason-Allen stitch and massive cuff stitch in vitro. Arthroscopy 2007, 23:235-240.
  10. Ma CB, MacGillivray JD, Clabeaux J, Lee S, Otis JC: Biomechanical evaluation of arthroscopic rotator cuff stitches. J Bone Joint Surg Am 2004, 86:1211-1216.
  11. Shirachi I, Gotoh M, Mitsui Y, Yamada T, Nakama K, Kojima K, Okawa T, Higuchi F, Nagata K: Collagen production at the edge of ruptured rotator cuff tendon is correlated with postoperative cuff integrity. Arthroscopy 2011, 27:1173-1179.
  12. Gotoh M, Hamada K, Yamakawa H, Nakamura M, Yamazaki H, Ueyama Y, Tamaoki N, Inoue A, Fukuda H: Perforation of rotator cuff increases interleukin 1beta production in the synovium of glenohumeral joint in rotator cuff diseases. J Rheumatol 2000, 27:2886-2892.
  13. Sugaya H, Maeda K, Matsuki K, Moriishi J: Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthroscopy 2005, 21:1307-16.
  14. R Development Core Team: R: A Language and Environment for Statistical Computing. Vienna, Austria: R oundation for Statistical Computing; 2011.  
  15. Kai Y, Gotoh M, Nagata K, Shiba N: Infraspinatus fatigue during resisted arm elevation with isometric contraction: an electromyographic study. J Shoulder Elbow Surg 2012, 21:1104-1109.
  16. Sugaya H, Maeda K, Matsuki K, Moriishi J: Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study. J Bone Joint Surg Am 2007, 89:953-60.
  17. Harryman DT 2nd, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA 3rd: Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am 1991, 73:982-989.
  18. Rokito AS, Cuomo F, Gallagher MA, Zuckerman JD: Long-term functional outcome of repair of large and massive chronic tears of the rotator cuff. J Bone Joint Surg Am 1999, 81:991-997.
  19. Scheibel MT, Habermeyer P: A modified Mason-Allen technique for rotator cuff repair using suture anchors. Arthroscopy 2003, 19:330-333.
  20. Bisson LJ, Manohar LM: A biomechanical comparison of transosseous-suture anchor and suture bridge rotator cuff repairs in cadavers. Am J Sports Med 2009, 37:1991-1995.