Arthroscopic Knotless-Anchor Rotator Cuff Repair

SCOI Row Technique Versus Double-Row Suture Bridge Technique for Repairing Rotator Cuff Tears: A Biomechanical and Histological Study in Rabbits

BACKGROUND

The double-row suture bridge (SB) is an effective technique for rotator cuff repair. However, because of high-tension sutures and tendon vascular insufficiency, nonunion or retearing of the rotator cuff after SB repair is common. The low-tension suture and microfracture features of the SCOI Row (SR) technique may help address these issues.

PURPOSE

To compare the biomechanical and histological outcomes of SR and SB techniques in treating rotator cuff tears in rabbits.

STUDY DESIGN

Controlled laboratory study.

METHODS

The study utilized a model of acute bilateral supraspinatus tendon tears in the shoulders of 42 New Zealand rabbits. The tear was randomly repaired using either the SR or SB technique on the left or right shoulder. Twelve rabbits were euthanized at 2, 4, and 8 weeks after surgery. Six rabbits were assigned for histological evaluation, while the other 6 were designated for biomechanical testing. Six of the original 42 animals were exclusively allocated for preliminary biomechanical testing at the 0-week time point.

RESULTS

At 8 weeks after surgery, all mended tendons were successfully attached to the footprint region of the greater tubercle without any postoperative complications. In comparison with the SB group, the SR group exhibited superior histological tendon-bone healing characterized by enhanced fibrocartilage regeneration, collagen composition, and fibrous tissue structure. The biomechanical results of the SR group exhibited superior performance compared with the SB group at both the 0- and 8-week postoperative assessments.

CONCLUSIONS

Both repair techniques have demonstrated effectiveness in the rabbit rotator cuff tear model. Nevertheless, when compared with SB, SR demonstrates superior advantages in enhancing biomechanical properties and histological tendon-bone healing.

CLINICAL RELEVANCE

This study proposes that the SR technique could serve as a viable treatment alternative for rotator cuff tears in humans, as it can improve tendon-bone healing and decrease the incidence of failed healing.

Does Reusable Instrumentation for Four-Anchor Rotator Cuff Repair Offer Decreased Waste Disposal Costs and Lower Waste-Related Carbon Emissions?

INTRODUCTION

Orthopaedic surgery is culpable, in part, for the excessive carbon emissions in health care partly due to the utilization of disposable instrumentation in most procedures, such as rotator cuff repair (RCR). To address growing concerns about hospital waste, some have considered replacing disposable instrumentation with reusable instrumentation. The purpose of this study was to estimate the cost and carbon footprint of waste disposal of RCR kits that use disposable instrumentation compared with reusable instrumentation.

METHODS

The mass of the necessary materials and their packaging to complete a four-anchor RCR from four medical device companies that use disposable instrumentation and one that uses reusable instrumentation were recorded. Using the cost of medical waste disposal at our institution ($0.14 per kilogram) and reported values from the literature for carbon emissions produced from the low-temperature incineration of noninfectious waste (249 kgCO 2 e/t) and infectious waste (569 kgCO 2 e/t), we estimated the waste management cost and carbon footprint of waste disposal produced per RCR kit.

RESULTS

The disposable systems of four commercial medical device companies had 783%, 570%, 1,051%, and 478%, respectively, greater mass and waste costs when compared with the reusable system. The cost of waste disposal for the reusable instrumentation system costs on average $0.14 less than the disposable instrumentation systems. The estimated contribution to the overall carbon footprint produced from the disposal of a RCR kit that uses reusable instrumentation was on average 0.37 kg CO2e less than the disposable instrumentation systems.

CONCLUSION

According to our analysis, reusable instrumentation in four-anchor RCR leads to decreased waste and waste disposal costs and lower carbon emissions from waste disposal. Additional research should be done to assess the net benefit reusable systems may have on hospitals and the effect this may have on a long-term decrease in carbon footprint.

LEVEL OF EVIDENCE

Level II.

Association of obesity with high retears and complication rates, and low functional scores after rotator cuff repair: a systematic review and meta-analysis

BACKGROUND

Obesity influences the outcomes of orthopedic surgeries such as total knee arthroplasty and spinal surgery. However, the effect of obesity on the outcomes of rotator cuff repair is unknown. This systematic review and meta-analysis aimed to examine the effect of obesity on rotator cuff repair outcomes.

METHODS

PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched to identify relevant studies published from their inception till July 2022. Two reviewers independently screened titles and abstracts using the specified criteria. Articles were included if they indicated the effect of obesity on rotator cuff repair and the related outcomes after surgery. Review Manager 5.4.1 software was used to perform statistical analysis.

RESULTS

Thirteen articles involving 85,497 patients were included. Obese patients had higher retear rates than nonobese patients (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.23-5.41, P = .01), lower American Shoulder and Elbow Surgeons scores (mean difference [MD]: -3.59, 95% CI: -5.45 to [-1.74]; P = .0001), higher visual analog scale for pain (mean difference: 0.73, 95% CI: 0.29-1.17; P = .001), higher reoperation rates (OR 1.31, 95% CI 1.21-1.42, P < .00001), and higher rates of complications (OR 1.57, 95% CI 1.31-1.87, P = .000). Obesity did not affect the duration of surgery (MD: 6.03, 95% CI: -7.63 to 19.69; P = .39) or external rotation of the shoulder (MD: -1.79, 95% CI: -5.30 to 1.72; P = .32).

CONCLUSION

Obesity is a significant risk factor for retear and reoperation after rotator cuff repair. Furthermore, obesity increases the risk of postoperative complications and leads to lower postoperative American Shoulder and Elbow Surgeons scores and higher shoulder visual analog scale for pain.

Knotless Tendoscopic Peroneal Retinaculum Repair Technique for Recurrent Peroneal Tendon Dislocation

Peroneal tendon dislocation (PTD) is sometimes diagnosed as a sports-related injury, of which many cases lead to recurrent PTD (RPTD). Superior retinaculum repair is the major operative treatment of RPTD. The technique described herein comprises 8 steps: (1) Standard tendoscopic examination, (2) debridement of the pseudo-pouch base, (3) first anchor insertion, (4) suture relay, (5) second anchor insertion and suture relay, (6) third anchor insertion and suture relay, (7) suture tightening, and (8) suture bridge. Although this tendoscopic peroneal retinaculum repair technique is complicated, expensive, and requires a longer operation time, it incorporates a double-row suture bridge. Therefore, it has a wider contact surface between the superior retinaculum repair and fibula bone and tighter fixation than does a single-row technique. Moreover, our technique is knotless and thereby avoids knot-related complications. Tendoscopy has additional advantages in terms of less postoperative pain, fewer complications, and better cosmesis. In conclusion, this knotless tendoscopic peroneal retinaculum repair technique for RPTD is a patient-friendly surgery compared with previous procedures.