Modified Double-Row Suture Bridge Technique With Double-Row Biceps Tenodesis for Massive Rotator Cuff Tear

Primary Cuff Repair Augmented With a Balloon Spacer in a Large and Massive Rotator Cuff Tear Series: A Technique and Short-term Outcome and Imaging Study

Massive rotator cuff tears are a challenge for patients and surgeons. We explored the outcomes of patients with massive rotator cuff tears primarily treated with primary cuff repair augmented with a subacromial balloon spacer. The mean age of the patients was 64.3 years, with 24 (71%) having massive cuff tears and the remaining 29% having large cuff tears. Most patients (61%) exhibited significant fatty atrophy (at least grade 3 Goutallier). At 6 months, patients showed improved Constant score, UCLA score, and Oxford Shoulder Score. Pain scores also significantly decreased. A phase 1 study of postoperative imaging indicated balloon disintegration in 50% of cases at 6 weeks. Augmenting primary cuff repair with a subacromial balloon spacer demonstrates promising short-term outcomes. Our postoperative images suggest that balloon disintegration may occur as early as 6 weeks. We recommend caution in using a balloon spacer as a standalone therapy. [Orthopedics. 2025;48(1):e56-e61.].

Improved patient reported outcomes with knotless double-row rotator cuff repair with and without lateral row biceps tenodesis at 2- and 5-years

Background

The purpose of this study is to report outcomes of an arthroscopic knotless double-row (DR) rotator cuff repair (RCR) technique at 2- and 5- years postoperatively, and to compare clinical outcomes in patients undergoing knotless DR RCR with incorporated lateral row biceps tenodesis (LRT) vs. those without LRT.

Methods

All primary RCR surgeries were performed by a single surgeon at a single institution using a knotless transosseous equivalent (TOE) technique. The postoperative rehabilitation protocol was standardized for all patients. The primary outcomes collected included American Shoulder and Elbow Surgeons (ASES) Function, ASES Index, Single Assessment Numeric Evaluation (SANE), Simple Shoulder Test (SST), Veterans RAND 12-Item Health Survey (VR-12) physical and mental, and Visual Analogue Scale (VAS) scores.

Results

Three hundred forty-two patients met inclusion criteria, of which 262 patients underwent isolated RCR and 61 underwent RCR with a concomitant LRT, 15 underwent RCR with concomitant tenotomy and 4 had RCR with débridement of the biceps. Significant improvements in VAS, ASES, SANE, SST, and VR-12 scores were observed at all-time points in all patient groups. No statistically significant differences in outcomes were noted in patients undergoing RCR with a lateral row tenodesis vs. those undergoing RCR alone. Similarly, no differences were seen when stratified by age, sex, body mass index, Worker's Compensation status, smoking, and diabetes mellitus. Based on ASES, 81% of patients met minimum clinically important difference, and 64% met maximal outcome improvement at 1-year postoperatively.

Conclusion

Knotless DR TOE arthroscopic RCR significantly improves patient-reported clinical outcomes at 1-, 2- and 5-year follow-ups. These results are reflected in clinical practice because 80% achieve minimum clinically important difference postoperatively. Patient-related factors, including body mass index, age, sex, Worker's Compensation, and diabetes mellitus do not significantly affect patient-reported outcomes in the first 5 years after surgery. Smokers have worse baseline scores which persist at 2-year follow-up. Lastly, adding an arthroscopic LRT in knotless DR TOE arthroscopic RCR provides similar clinical outcomes to knotless DR TOE arthroscopic RCR without biceps tenodesis.

Changes in the Lateral Acromion Angle in Rotator Cuff Tear Patients with Acromioplasty

BACKGROUND

Arthroscopic surgery has been established as an efficacious intervention for the treatment of rotator cuff tears. The primary aim of this study was to analyze the modifications in the lateral acromial angle (LAA) subsequent to rotator cuff repair surgery using single-row rivet fixation and double-row rivet fixation techniques. Furthermore, we sought to investigate the influence of LAA on the prognosis of rotator cuff repair surgery.

METHOD

This observational study retrospectively enrolled 105 patients diagnosed with degenerative rotator cuff tears who underwent arthroscopic rotator cuff repair between 2016 and 2019. Following the exclusion of two patients with subscapularis or superior labrum anterior and posterior (SLAP) tears, as well as three patients who were lost to follow-up, a cohort of 100 patients was included for clinical and imaging evaluation. Among these individuals, 50 were assigned to the double-row repair group, whereas the remaining 50 comprised the single-row repair group. Bilateral shoulder magnetic resonance imaging (MRI) scans were conducted no less than 24 months post-surgery. Experienced arthroscopic surgeons, blinded to the LAA measurements, assessed the rotator interval (RI) using a control MRI. Functional assessment was performed using the University of California, Los Angeles (UCLA) quick disability of the shoulder and arm, shoulder and hand (qDASH) score. The Wilcoxon signed-rank test for dependent samples was employed to compare data between the pre- and post-intervention groups. Pearson correlation coefficients were calculated to evaluate the relationship between different parameters.

RESULTS

The study population consisted of 73 female patients and 27 male patients, with a mean age of 58.32 ± 5.29 years and a mean follow-up duration of 25.88 ± 8.11 months. Preoperatively, the mean LAA was 75.81° ± 11.28°, RI was 4.78 ± 0.62, UCLA score was 17.54 ± 2.44, and qDASH score was 2.45 ± 0.25. The average tear size was 8.95 ± 2.11 mm. A statistically significant difference in LAA was observed between the preoperative and postoperative measurements, with the double-row repair group exhibiting a greater LAA than the single-row repair group. Finally, a significant correlation was identified between LAA, RI, and qDASH scores after a 24-month follow-up period.

CONCLUSION

According to our findings, the utilization of double-row rivet fixation has a greater LAA angle than single-row rivet fixation. Moreover, this preservation of LAA is significantly associated with the functional recovery of the shoulder joint.