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Does Medial-Row Fixation Technique Affect the Retear Rate and Functional Outcomes After Double-Row Transosseous-Equivalent Rotator Cuff Repair?

Abstract

Background

Double-row transosseous-equivalent (TOE) rotator cuff repair techniques have been widely accepted because of their superior biomechanical properties when compared with arthroscopic single-row repair. Concerns regarding repair overtensioning with medial-row knot tying have led to increased interest in knotless repair techniques; however, there is a paucity of clinical data to guide the choice of technique.

Hypothesis

Arthroscopic TOE repair techniques using knotless medial-row fixation will demonstrate lower retear rates and greater improvements in the Constant score relative to conventional knot-tying TOE techniques.

Study Design

Systematic review; Level of evidence, 4.

Methods

A systematic review of 3 databases (PubMed, Cochrane, and Embase) was performed using PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. Inclusion criteria were English-language studies that examined repair integrity or Constant scores after arthroscopic rotator cuff repair with TOE techniques. Two investigators independently screened results for relevant articles. Data regarding the study design, surgical technique, retear rate, and Constant shoulder score were extracted from eligible studies. A quality assessment of all articles was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.

Results

The systematic review identified a total of 32 studies (level of evidence, 1-4) that met inclusion and exclusion criteria. Of the 32 studies, 5 reported on knotless TOE techniques, 25 reported on knot-tying TOE techniques, and 2 reported on both. In the knotless group, retear rates ranged from 6% to 36%, and Constant scores ranged from 38-65 (preoperative) to 73-83 (postoperative). In the knot-tying group, retear rates ranged from 0% to 48%, and Constant scores ranged from 42-64 (preoperative) to 55-96 (postoperative).

Conclusion

Despite several theoretical advantages of knotless TOE repair, both knotless and knot-tying techniques reported considerable improvement in functional outcomes after rotator cuff repair. Although tendon failure rates showed a downward trend in knotless studies, additional prospective studies are warranted to better understand the role of medial-row fixation on tendon repair integrity and postoperative clinical outcomes.

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  • Authors+Show Affiliations

    ,

    Hospital for Special Surgery, New York, New York, USA.

    ,

    Hospital for Special Surgery, New York, New York, USA.

    ,

    Hospital for Special Surgery, New York, New York, USA.

    ,

    Department of Orthopedic Surgery, NYU Langone Medical Center, New York, New York, USA.

    ,

    Department of Orthopedic Surgery, NYU Langone Medical Center, New York, New York, USA.

    Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA.

    Source

    Orthopaedic journal of sports medicine 7:5 2019 May pg 2325967119842881

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    31205960

    Citation

    Elbuluk, Ameer M., et al. "Does Medial-Row Fixation Technique Affect the Retear Rate and Functional Outcomes After Double-Row Transosseous-Equivalent Rotator Cuff Repair?" Orthopaedic Journal of Sports Medicine, vol. 7, no. 5, 2019, p. 2325967119842881.
    Elbuluk AM, Coxe FR, Fabricant PD, et al. Does Medial-Row Fixation Technique Affect the Retear Rate and Functional Outcomes After Double-Row Transosseous-Equivalent Rotator Cuff Repair? Orthop J Sports Med. 2019;7(5):2325967119842881.
    Elbuluk, A. M., Coxe, F. R., Fabricant, P. D., Ramos, N. L., Alaia, M. J., & Jones, K. J. (2019). Does Medial-Row Fixation Technique Affect the Retear Rate and Functional Outcomes After Double-Row Transosseous-Equivalent Rotator Cuff Repair? Orthopaedic Journal of Sports Medicine, 7(5), p. 2325967119842881. doi:10.1177/2325967119842881.
    Elbuluk AM, et al. Does Medial-Row Fixation Technique Affect the Retear Rate and Functional Outcomes After Double-Row Transosseous-Equivalent Rotator Cuff Repair. Orthop J Sports Med. 2019;7(5):2325967119842881. PubMed PMID: 31205960.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Does Medial-Row Fixation Technique Affect the Retear Rate and Functional Outcomes After Double-Row Transosseous-Equivalent Rotator Cuff Repair? AU - Elbuluk,Ameer M, AU - Coxe,Francesca R, AU - Fabricant,Peter D, AU - Ramos,Nicholas L, AU - Alaia,Michael J, AU - Jones,Kristofer J, Y1 - 2019/05/16/ PY - 2019/6/18/entrez PY - 2019/6/18/pubmed PY - 2019/6/18/medline KW - arthroscopic KW - knot KW - knotless KW - meta-analysis KW - shoulder KW - surgical techniques KW - systematic review SP - 2325967119842881 EP - 2325967119842881 JF - Orthopaedic journal of sports medicine JO - Orthop J Sports Med VL - 7 IS - 5 N2 - Background: Double-row transosseous-equivalent (TOE) rotator cuff repair techniques have been widely accepted because of their superior biomechanical properties when compared with arthroscopic single-row repair. Concerns regarding repair overtensioning with medial-row knot tying have led to increased interest in knotless repair techniques; however, there is a paucity of clinical data to guide the choice of technique. Hypothesis: Arthroscopic TOE repair techniques using knotless medial-row fixation will demonstrate lower retear rates and greater improvements in the Constant score relative to conventional knot-tying TOE techniques. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of 3 databases (PubMed, Cochrane, and Embase) was performed using PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. Inclusion criteria were English-language studies that examined repair integrity or Constant scores after arthroscopic rotator cuff repair with TOE techniques. Two investigators independently screened results for relevant articles. Data regarding the study design, surgical technique, retear rate, and Constant shoulder score were extracted from eligible studies. A quality assessment of all articles was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Results: The systematic review identified a total of 32 studies (level of evidence, 1-4) that met inclusion and exclusion criteria. Of the 32 studies, 5 reported on knotless TOE techniques, 25 reported on knot-tying TOE techniques, and 2 reported on both. In the knotless group, retear rates ranged from 6% to 36%, and Constant scores ranged from 38-65 (preoperative) to 73-83 (postoperative). In the knot-tying group, retear rates ranged from 0% to 48%, and Constant scores ranged from 42-64 (preoperative) to 55-96 (postoperative). Conclusion: Despite several theoretical advantages of knotless TOE repair, both knotless and knot-tying techniques reported considerable improvement in functional outcomes after rotator cuff repair. Although tendon failure rates showed a downward trend in knotless studies, additional prospective studies are warranted to better understand the role of medial-row fixation on tendon repair integrity and postoperative clinical outcomes. SN - 2325-9671 UR - https://www.unboundmedicine.com/medline/citation/31205960/Does_Medial-Row_Fixation_Technique_Affect_the_Retear_Rate_and_Functional_Outcomes_After_Double-Row_Transosseous-Equivalent_Rotator_Cuff_Repair L2 - http://journals.sagepub.com/doi/full/10.1177/2325967119842881?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -