Single-row vs. double-row arthroscopic rotator cuff repair: clinical and 3 Tesla MR arthrography results

BMC Musculoskeletal Disorders

Giovanni Simonetti¹  Salvatore Masala¹  Dario A Bartolucci¹  Roberto Fiori¹  Eugenio Savarese²  Salvatore Bisicchia²  Cosimo Tudisco² 

[1] Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, University of Rome “Tor Vergata”, 81 Oxford Street, Rome, 00133, Italy;Department of Orthopaedic Surgery, University of Rome “Tor Vergata”, 81 Oxford Street, Rome, 00133, Italy

关键词: Clinical result;    MR arthrography;    Arthroscopic repair;    Rotator cuff tear;    Shoulder;   

Others  :  1134096
DOI  :  10.1186/1471-2474-14-43

 received in 2012-01-24, accepted in 2013-01-10,  发布年份 2013

【 摘 要 】

Background

Arthroscopic rotator cuff repair has become popular in the last few years because it avoids large skin incisions and deltoid detachment and dysfunction. Earlier arthroscopic single-row (SR) repair methods achieved only partial restoration of the original footprint of the tendons of the rotator cuff, while double-row (DR) repair methods presented many biomechanical advantages and higher rates of tendon-to-bone healing. However, DR repair failed to demonstrate better clinical results than SR repair in clinical trials. MR imaging at 3 Tesla, especially with intra-articular contrast medium (MRA), showed a better diagnostic performance than 1.5 Tesla in the musculoskeletal setting. The objective of this study was to retrospectively evaluate the clinical and 3 Tesla MRA results in two groups of patients operated on for a medium-sized full-thickness rotator cuff tear with two different techniques.

Methods

The first group consisted of 20 patients operated on with the SR technique; the second group consisted of 20 patients operated on with the DR technique. All patients were evaluated at a minimum of 3 years after surgery. The primary end point was the re-tear rate at 3 Tesla MRA. The secondary end points were the Constant-Murley Scale (CMS), the Simple Shoulder Test (SST) scores, surgical time and implant expense.

Results

The mean follow-up was 40 months in the SR group and 38.9 months in the DR group. The mean postoperative CMS was 70 in the SR group and 68 in the DR group. The mean SST score was 9.4 in the SR group and 10.1 in the DR group. The re-tear rate was 60% in the SR group and 25% in the DR group. Leakage of the contrast medium was observed in all patients.

Conclusions

To the best of our knowledge, this is the first report on 3 Tesla MRA in the evaluation of two different techniques of rotator cuff repair. DR repair resulted in a statistically significant lower re-tear rate, with longer surgical time and higher implant expense, despite no difference in clinical outcomes. We think that leakage of the contrast medium is due to an incomplete tendon-to-bone sealing, which is not a re-tear. This phenomenon could have important medicolegal implications.

Level of evidence III. Treatment study: Case–control study.

【 授权许可】

   
2013 Tudisco et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL: Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elbow Surg 2006, 15:290-299.
• [2]Kang L, Henn RF, Tashjian RZ, Green A: Early outcome of arthroscopic rotator cuff repair: a matched comparison with mini-open rotator cuff repair. Arthroscopy 2007, 23:573-582. e1-2
• [3]Nho SJ, Shindle MK, Sherman SL, Freedman KB, Lyman S, MacGil-livray JD: Systematic review of arthroscopic rotator cuff repair and mini-open rotator cuff repair. J Bone Joint Surg Am 2007, 89(Suppl 3):127-136.
• [4]Kasten P, Keil C, Grieser T, Raiss P, Streich N, Loew M: Prospective randomised comparison of arthroscopic versus mini-open rotator cuff repair of the supraspinatus tendon. Int Orthop 2011, 35:1663-1670.
• [5]Ropiak RR, Zmistowski BM, Ciccotti MC, Rynning R, Williams GR Jr, Fenlin JM Jr: Postoperative Pain after Open versus Arthroscopic Rotator Cuff Repair. Scottsdale, AZ: ASES 2010 closed meeting; 2010.
• [6]Ma CB, Comerford L, Wilson J, Puttlitz CM: Biomechanical evaluation of arthroscopic rotator cuff repairs: double-row compared with single-row fixation. J Bone Joint Surg Am 2006, 88:403-410.
• [7]Meier SW, Meier JD: The effect of double-row fixation on initial repair strength in rotator cuff repair: a biomechanical study. Arthroscopy 2006, 22:493-497.
• [8]Milano G, Grasso A, Zarelli D, Deriu L, Cillo M, Fabbriciani C: Comparison between single-row and double-row rotator cuff repair: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 2008, 16:75-80.
• [9]Saridakis P, Jones G: Outcomes of single-row and double-row arthroscopic rotator cuff repair: a systematic review. J Bone Joint Surg Am 2010, 92:732-742.
• [10]Smith CD, Alexander S, Hill AM, Huijsmans PE, Bull AM, Amis AA, De Beer JF, Wallace AL: A biomechanical comparison of single and double-row fixation in arthroscopic rotator cuff repair. J Bone Joint Surg Am 2006, 88:2425-2431.
• [11]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.
• [12]Apreleva M, Ozbaydar M, Fitzgibbons PG, Warner JJ: Rotator cuff tears: the effect of the reconstruction method on three-dimensional repair site area. Arthroscopy 2002, 18:519-526.
• [13]Brady PC, Arrigoni P, Burkhart SS: Evaluation of residual rotator cuff defects after in vivo single- versus double-row rotator cuff repairs. Arthroscopy 2006, 22:1070-1075.
• [14]Mazzocca AD, Millett PJ, Guanche CA, Santangelo SA, Arciero RA: Arthroscopic single-row versus double-row suture anchor rotator cuff repair. Am J Sports Med 2005, 33:1861-1868.
• [15]Nelson CO, Sileo MJ, Grossman MG, Serra-Hsu F: Single-row modified mason-allen versus double-row arthroscopic rotator cuff repair: a biomechanical and surface area comparison. Arthroscopy 2008, 24:941-948.
• [16]Park MC, ElAttrache NS, Tibone JE, Ahmad CS, Jun BJ, Lee TQ: Part I: Footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elbow Surg 2007, 16:461-468.
• [17]Tuoheti Y, Itoi E, Yamamoto N, Seki N, Abe H, Minagawa H, Okada K, Shimada Y: Contact area, contact pressure, and pressure patterns of the tendon-bone interface after rotator cuff repair. Am J Sports Med 2005, 33:1869-1874.
• [18]Ahmad CS, Stewart AM, Izquierdo R, Bigliani LU: Tendon-bone interface motion in transosseous suture and suture anchor rotator cuff repair techniques. Am J Sports Med 2005, 33:1667-1671.
• [19]Park MC, Cadet ER, Levine WN, Bigliani LU, Ahmad CS: Tendon-to-bone pressure distributions at a repaired rotator cuff footprint using transosseous suture and suture anchor fixation techniques. Am J Sports Med 2005, 33:1154-1159.
• [20]Charousset C, Grimberg J, Duranthon LD, Bellaiche L, Petrover D: Can a double row anchorage technique improve tendon healing in arthroscopic rotator cuff repair? A prospective, nonrandomized, comparative study of double-row and single-row anchorage techniques with computed tomographic arthrography tendon healing assessment. Am J Sports Med 2007, 35:1247-1253.
• [21]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.
• [22]Lafosse L, Brozska R, Toussaint B, Gobezie R: The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique. J Bone Joint Surg Am 2007, 89:1533-1541.
• [23]Pennington WT, Gibbons DJ, Bartz BA, Dodd M, Daun J, Klinger J, Popovich M, Butler B: Comparative analysis of single-row versus double-row repair of rotator cuff tears. Arthroscopy 2010, 26:1419-1426.
• [24]Burks RT, Crim J, Brown N, Fink B, Greis PE: A prospective randomized clinical trial comparing arthroscopic single- and double-row rotator cuff repair: magnetic resonance imaging and early clinical evaluation. Am J Sports Med 2009, 37:674-682.
• [25]Franceschi F, Ruzzini L, Longo UG, Martina FM, Zobel BB, Maffulli N, Denaro V: Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: a randomized controlled trial. Am J Sports Med 2007, 35:1254-1260.
• [26]Grasso A, Milano G, Salvatore M, Falcone G, Deriu L, Fabbriciani C: Single-row versus double-row arthroscopic rotator cuff repair: a prospective randomized clinical study. Arthroscopy 2009, 25:4-12.
• [27]Park JY, Lhee SH, Choi JH, Park HK, Yu JW, Seo JB: Comparison of the clinical outcomes of single- and double-row repairs in rotator cuff tears. Am J Sports Med 2008, 36:1310-1316.
• [28]Bauer JS, Banerjee S, Henning TD, Krug R, Majumdar S, Link TM: Fast high-spatial-resolution MRI of the ankle with parallel imaging using GRAPPA at 3 T. AJR Am J Roentgenol 2007, 189:240-245.
• [29]Duc SR, Mengiardi B, Pfirrmann CW, Jost B, Hodler J, Zanetti M: Diagnostic performance of MR arthrography after rotator cuff repair. AJR Am J Roentgenol 2006, 186:237-241.
• [30]Gold GE, Han E, Stainsby J, Wright G, Brittain J, Beaulieu C: Musculoskeletal MRI at 3.0 T: relaxation times and image contrast. AJR Am J Roentgenol 2004, 183:343-351.
• [31]Jung JY, Yoon YC, Choi SH, Kwon JW, Yoo J, Choe BK: Three-dimensional isotropic shoulder MR arthrography: comparison with two-dimensional MR arthrography for the diagnosis of labral lesions at 3.0 T. Radiology 2009, 250:498-505.
• [32]Lambert A, Loffroy R, Guiu B, Mejean N, Lerais JM, Cercueil JP, Krausé D: Rotator cuff tears: value of 3.0T MRI. J Radiol 2009, 90:583-588.
• [33]Magee T: 3-T MRI of the shoulder: is MR arthrography necessary? AJR Am J Roentgenol 2009, 192:86-92.
• [34]Magee T, Williams D: 3.0-T MRI of the supraspinatus tendon. AJR Am J Roentgenol 2006, 187:881-886.
• [35]Major NM, Browne J, Domzalski T, Cothran RL, Helms CA: Evaluation of the glenoid labrum with 3-T MRI: is intraarticular contrast necessary? AJR Am J Roentgenol 2011, 196:1139-1144.
• [36]Masi JN, Sell CA, Phan C, Han E, Newitt D, Steinbach L, Majumdar S, Link TM: Cartilage MR imaging at 3.0 versus that at 1.5 T: preliminary results in a porcine model. Radiology 2005, 236:140-150.
• [37]Murray PJ, Shaffer BS: Clinical update: MR imaging of the shoulder. Sports Med Arthrosc 2009, 17:40-48.
• [38]Trattnig S, Mamisch TC, Noebauer I: High-field and ultrahigh-field magnetic resonance imaging: new possibilities for imaging joints. Z Rheumatol 2006, 65:681-687.
• [39]DeOrio JK, Cofield RH: Results of a second attempt at surgical repair of a failed initial rotator cuff repair. J Bone Joint Surg Am 1984, 66:563-567.
• [40]Constant CR, Murley AH: A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987, 214:160-164.
• [41]Matsen FA III, Lippitt SB, Sidles JA, Harryman DT II: Practical Evaluation and Management of the Shoulder. Philadelphia: Saunders C; 1996.
• [42]Arrigoni P, Brady PC, Burkhart SS: The double-pulley technique for double-row rotator cuff repair. Arthroscopy 2007, 23:675. e1-4
• [43]Cho NS, Yi JW, Lee BG, Rhee YG: Retear patterns after arthroscopic rotator cuff repair: single-row versus suture bridge technique. Am J Sports Med 2010, 38:664-671.
• [44]Koh KH, Kang KC, Lim TK, Shon MS, Yoo JC: Prospective randomized clinical trial of single- versus double-row suture anchor repair in 2- to 4-cm rotator cuff tears: clinical and magnetic resonance imaging results. Arthroscopy 2011, 27:453-462.
• [45]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, 21:1307-1316.
• [46]Burkhart SS, Morgan CD, Kibler WB: The disabled throwing shoulder: spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy 2003, 19:641-661.
• [47]Lake SP, Miller KS, Elliott DM, Soslowsky LJ: Effect of fiber distribution and realignment on the nonlinear and inhomogeneous mechanical properties of human supraspinatus tendon under longitudinal tensile loading. J Orthop Res 2009, 27:1596-1602.
• [48]Wang VM, Wang FC, McNickle AG, Friel NA, Yanke AB, Chubinskaya S, Romeo AA, Verma NN, Cole BJ: Medial versus lateral supraspinatus tendon properties: implications for double-row rotator cuff repair. Am J Sports Med 2010, 38:2456-2463.
• [49]Oh JH, Kim SH, Kang JY, Oh CH, Gong HS: Effect of age on functional and structural outcome after rotator cuff repair. Am J Sports Med 2010, 38:672-678.
• [50]Tashjian RZ, Hollins AM, Kim HM, Teefey SA, Middleton WD, Steger-May K, Galatz LM, Yamaguchi K: Factors affecting healing rates after arthroscopic double-row rotator cuff repair. Am J Sports Med 2010, 38:2435-2442.
• [51]Duquin TR, Buyea C, Bisson LJ: Which method of rotator cuff repair leads to the highest rate of structural healing? A systematic review. Am J Sports Med 2010, 38:835-841.