Hombro/Shoulder/Schulter: Puentear el manguito sin nudos con buenos resultados

Arthroscopic knotless-anchor rotator cuff repair: a clinical and radiological evaluation.

Hug K, Gerhardt C, Haneveld H, Scheibel M.

Knee Surg Sports Traumatol Arthrosc 2014 May 4.

The goal of this study was to evaluate the clinical and radiological results of the arthroscopic knotless-anchor Speed-Bridge technique, in particular the pattern and the rate of retears. The results were compared with a modified Suture-Bridge knot-tying technique (mDR). The hypothesis is that arthroscopic knotless-anchor Speed-Bridge rotator cuff repair is a sufficient technique to address supraspinatus tears and differs in pattern of retears when compared to mDR.

METHODS

This study includes twenty-two consecutive patients (8f/14m ø 63.3 ± 7.2 years) undergoing knotless-anchor Speed-Bridge repair. The subjective shoulder value (SSV), Constant score (CS) and Western Ontario Rotator Cuff (WORC) Score were used for clinical follow-up. MRI scans were conducted within 3 weeks post-operatively, after 1 and after 2 years for analysis of (a) tendon integrity (according to Sugaya), (b) muscle atrophy according to Thomazeau and (c) fatty infiltration. Results were compared with 20 patients operated in mDR (ø 61.2 ± 7.5 years).

RESULTS

The mean follow-up was 24.4 ± 4.7 months. The average SSV was 88.7 ± 14.9 %, the CS was 78.2 ± 13.2 points (contralateral side 78.5 ± 16.6) and the WORC Score averaged 87.1 ± 18.2 %. On magnetic resonance imaging, the integrity failure rate was 22.7 % (n = 5). The pattern of retear was a medial cuff failure in 2/5 cases (mDR 4/5, n.s.). Muscular atrophy or fatty degeneration did not increase between surgery and follow-up (n.s.). Compared with mDR (25 %) reconstruction, no significant differences were obtained regarding integrity failure rate and muscular atrophy (n.s.).

CONCLUSION

The modified knotless-anchor Speed-Bridge technique shows good to excellent clinical results as well as acceptable retear rates. This technique eliminates medial and lateral knot impingement. Concerning the potential reduction in the medial strangulation of the tendon, there is a need for further clinical research. 

LEVEL OF EVIDENCE: III