Skip to main content
SpringerLink
Log in

Serial clinical and MRI examinations after arthroscopic rotator cuff reconstruction using double-row technique

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Rotator cuff reconstruction using arthroscopic double-row technique enables a better repair of the anatomical footprint at the tendon insertion. Objective of this serial study was to illustrate structural and functional results during recovery following double-row reconstruction.

Methods

Forty-five patients with mid-sized ruptures of the supraspinatus tendon were assessed prospectively and underwent arthroscopic surgery using the double-row technique. Rupture localization, size, form, and extent of retraction were recorded intraoperatively. Clinical and MRI follow-up examinations were carried out for all patients after 6, 12, 26, and 52 weeks. A A standard protocol was used during the follow-up examinations to determine tendon integration, signal changes in the tendon, extent of bone marrow edema near the enclosed absorbable suture anchors, muscle changes. The clinical results were correlated with the MRI appearance.

Results

After 26 weeks, the Constant score (CS) showed a highly significant increase for the first time with a value of 78 (p < 0.001). Tendon integration according to Sugaya showed a left shift over time, with higher CS-values for lower Sugaya classifications. Significant improvements in strength were first measured between the 26-week and 52-week follow-ups (9−>19/p < 0.001). Highly significant improvement (p < 0.001) of the tendon signal and the fatty infiltration was found in the same time interval. The hypotrophy showed slight improvement, while a highly significant reduction of the bone marrow edema was found between weeks 12 and 26 (p < 0.001). There were no re-ruptures after week 26.

Conclusions

The present serial study showed that it took 26 weeks to reach a significant clinical improvement concerning CS. With regard to tendon healing, no further deterioration of the structural results occurred between week 26 and week 52 postoperative. There were slightly but not significant better clinical results according to the the Sugaya classification. However, parameter “strength” was significantly increased between weeks 26 and 52. This was consistent with a significant decrease in the signal intensity at the repaired tendon site, an additional improvement in the fatty infiltration, and the atrophy according to Thomazeau in the same time interval.

Level of evidence

I.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

Abbreviations

MRI:

Magnetic resonance imaging

CS:

Constant score

ADL:

Activities of daily living

m:

Male

f:

Female

mm:

Millimeter

ERO:

External rotation

IRO:

Internal rotation

ROI:

Region of interest

w:

Week

ROM:

Range of motion

VAS:

Visual analog scale

PLLA:

Poly-L-lactic-acid

FU:

Follow-up

References

  1. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG (2005) Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am 87:1229–1240

    PubMed  Google Scholar 

  2. Burkhart SS (2000) A stepwise approach to arthroscopic rotator cuff repair based on biomechanical principles. Arthroscopy 16:82–90

    Article  CAS  PubMed  Google Scholar 

  3. Burks RT, Crim J, Brown N, Fink B, Greis PE (2009) 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 37:674–682

    Article  PubMed  Google Scholar 

  4. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    Google Scholar 

  5. Crim J, Burks R, Manaster BJ, Hanrahan C, Hung M, Greis P (2010) Temporal evolution of MRI findings after arthroscopic rotator cuff repair. AJR Am J Roentgenol 195:1361–1366

    Article  PubMed  Google Scholar 

  6. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83

    Google Scholar 

  7. Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S (2003) Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg 12:550–554

    Article  PubMed  Google Scholar 

  8. Haneveld H, Hug K, Diederichs G, Scheibel M, Gerhardt C (2013) Arthroscopic double-row repair of the rotator cuff: a comparison of bio-absorbable and non-resorbable anchors regarding osseous reaction. Knee Surg Sports Traumatol Arthrosc 21:1647–1654

    Article  PubMed  Google Scholar 

  9. Huijsmans PE, Pritchard MP, Berghs BM, van Rooyen KS, Wallace AL, de Beer JF (2007) Arthroscopic rotator cuff repair with double-row fixation. J Bone Joint Surg Am 89:1248–1257

    Article  PubMed  Google Scholar 

  10. Iannotti JP, Deutsch A, Green A, Rudicel S, Christensen J, Marraffino S, Rodeo S (2013) Time to failure after rotator cuff repair: a prospective imaging study. J Bone Joint Surg Am 95:965–971

    Article  PubMed  Google Scholar 

  11. Jo CH, Park JW, Shin JS (2016) Changes of Muscle Atrophy According to the Immediate Postoperative Time Point in Magnetic Resonance Imaging After Arthroscopic Rotator Cuff Repair. Arthroscopy. doi:10.1016/j.arthro.2016.04.032

    Google Scholar 

  12. Jo CH, Shin JS (2013) Cross-sectional area of the supraspinatus muscle after rotator cuff repair: an anatomic measure of outcome. J Bone Joint Surg Am 95:1785–1791

    Article  PubMed  Google Scholar 

  13. Kim DH, Elattrache NS, Tibone JE, Jun BJ, DeLaMora SN, Kvitne RS, Lee TQ (2006) Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair. Am J Sports Med 34:407–414

    Article  CAS  PubMed  Google Scholar 

  14. Koh KH, Laddha MS, Lim TK, Park JH, Yoo JC (2012) Serial structural and functional assessments of rotator cuff repairs: do they differ at 6 and 19 months postoperatively? J Shoulder Elbow Surg 21:859–866

    Article  PubMed  Google Scholar 

  15. Lafosse L, Brzoska R, Toussaint B, Gobezie R (2008) The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique. Surgical technique. J Bone Joint Surg Am 90 Suppl 2 Pt 2:275–286

    Article  Google Scholar 

  16. Liem D, Lichtenberg S, Magosch P, Habermeyer P (2007) Magnetic resonance imaging of arthroscopic supraspinatus tendon repair. J Bone Joint Surg Am 89:1770–1776

    PubMed  Google Scholar 

  17. Lo IK, Burkhart SS (2003) Double-row arthroscopic rotator cuff repair: re-establishing the footprint of the rotator cuff. Arthroscopy 19:1035–1042

    Article  PubMed  Google Scholar 

  18. Ma HL, Chiang ER, Wu HT, Hung SC, Wang ST, Liu CL, Chen TH (2012) Clinical outcome and imaging of arthroscopic single-row and double-row rotator cuff repair: a prospective randomized trial. Arthroscopy 28:16–24

    Article  CAS  PubMed  Google Scholar 

  19. Malavolta EA, Assuncao JH, Ramos FF, Ferreira TC, Gracitelli ME, Bordalo-Rodrigues M, Ferreira Neto AA (2016) Serial structural MRI evaluation of arthroscopy rotator cuff repair: does Sugaya’s classification correlate with the postoperative clinical outcomes? Arch Orthop Trauma Surg 136:791–797

    Article  PubMed  Google Scholar 

  20. Mazzocca AD, Millett PJ, Guanche CA, Santangelo SA, Arciero RA (2005) Arthroscopic single-row versus double-row suture anchor rotator cuff repair. Am J Sports Med 33:1861–1868

    Article  PubMed  Google Scholar 

  21. Meier SW, Meier JD (2006) The effect of double-row fixation on initial repair strength in rotator cuff repair: a biomechanical study. Arthroscopy 22:1168–1173

    Article  PubMed  Google Scholar 

  22. Patte D (1990) Classification of rotator cuff lesions. Clin Orthop Relat Res 254:81–86

    Google Scholar 

  23. Pawaskar AC, Kekatpure A, Cho NS, Rhee YG, Jeon IH (2015) Magnetic resonance appearance of bioabsorbable anchor screws for double row arthroscopic rotator cuff repairs. Indian J Orthop 49:164–170

    Article  PubMed  PubMed Central  Google Scholar 

  24. Saridakis P, Jones G (2010) Outcomes of single-row and double-row arthroscopic rotator cuff repair: a systematic review. J Bone Joint Surg Am 92:732–742

    Article  PubMed  Google Scholar 

  25. Snyder SJ (1993) Evaluation and treatment of the rotator cuff. Orthop Clin North Am 24:173–192

    CAS  PubMed  Google Scholar 

  26. Stahnke K, Nikulka C, Diederichs G, Haneveld H, Scheibel M, Gerhardt C (2016) Serial MRI evaluation following arthroscopic rotator cuff repair in double-row technique. Arch Orthop Trauma Surg 136:665–672

    Article  PubMed  Google Scholar 

  27. Sugaya H, Maeda K, Matsuki K, Moriishi J (2005) Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthroscopy 21:1307–1316

    Article  PubMed  Google Scholar 

  28. Thomazeau H, Rolland Y, Lucas C, Duval JM, Langlais F (1996) Atrophy of the supraspinatus belly. Assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand 67:264–268

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sportklinik Stuttgart, 70372, Stuttgart, Germany

    F. Pfalzer, J. Huth, D. Endele & F. Mauch

  2. Klinikum Stuttgart, 70174, Stuttgart, Germany

    E. Stürmer & B. Kniesel

Authors
  1. F. Pfalzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Huth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Stürmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Endele
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B. Kniesel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. Mauch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Huth.

Ethics declarations

Conflict of interest

The authors declare that there are no conflicts of interest.

Funding

The study was approved by the ethics committee of the State Medical Association of Baden-Württemberg (Landesärztekammer Baden-Württemberg; F-2013-098).

Ethical approval

The Authors declare that no third-party funds were used to accomplish the study.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pfalzer, F., Huth, J., Stürmer, E. et al. Serial clinical and MRI examinations after arthroscopic rotator cuff reconstruction using double-row technique. Knee Surg Sports Traumatol Arthrosc 25, 2174–2181 (2017). https://doi.org/10.1007/s00167-017-4437-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-017-4437-6

Keywords

Search

Navigation