Arthroscopic single-row fixation and knotless suture bridge fixation for rotator cuff injuries combined with osteoporosis

doi:10.12307/2025.142

Abstract

Abstract: BACKGROUND: Arthroscopic single-row fixation with knotless suture bridge fixation techniques have been commonly used in the treatment of rotator cuff injuries, but the clinical efficacy in rotator cuff injuries combined with osteoporosis is unclear.
OBJECTIVE: To investigate the clinical efficacy of arthroscopic single-row fixation versus knotless suture bridge fixation in the treatment of rotator cuff injuries combined with osteoporosis.
METHODS: One hundred and twenty-two patients with rotator cuff injuries combined with osteoporosis who underwent arthroscopic treatment admitted to Affiliated Hospital of Xuzhou Medical University between January 2018 and August 2022 were retrospectively analyzed. They were divided into two groups according to the treatment plan. There were 63 patients with single-row fixation (single-row group) and 59 patients with knotless suture-bridge fixation (suture-bridge group). The visual analog scale scores for pain, University of California Los Angeles Shoulder Score, American Shoulder and Elbow Surgeons Score, Constant-Murley score, and shoulder range of motion were compared between the two groups at the preoperative and 1 year postoperative periods. Rotator cuff re-tears were evaluated at 1 year postoperatively using the Sugaya staging criteria. The occurrence of complications was recorded in both groups.
RESULTS AND CONCLUSION: (1) All patients received more than 1-year follow-up. No complications such as incision infection and nerve injury occurred in both groups after surgery. (2) Postoperative visual analog scale scores, University of California Los Angeles Shoulder Score, American Shoulder and Elbow Surgeons Score, Constant-Murley scores, and shoulder range of motion were significantly improved 1 year postoperatively in both groups compared with the preoperative period (P < 0.05). Visual analog scale scores, University of California Los Angeles Shoulder Score, American Shoulder and Elbow Surgeons Score, Constant-Murley scores, and shoulder range of motion were better in the suture-bridge group than in the single-row group 1 year postoperatively (P < 0.05). (3) At 1 year postoperatively, the re-tear rate in the single-row group [22% (14/63)] was significantly higher than that in the suture-bridge group [7% (4/59)], and the difference between the two groups was statistically significant (χ2=5.777, P=0.016). (4) It is indicated that arthroscopic single-row fixation and knotless suture bridge fixation for rotator cuff injuries combined with osteoporosis both yielded satisfactory clinical outcomes, but knotless suture bridge fixation was more clinically effective, with a lower rate of postoperative retear.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: rotator cuff tear, single-row fixation, knotless suture bridge technique, osteoporosis, arthroscopy

CLC Number:

Zhang Haoliang, Xia Sijia, Zhan Bingzhen, Feng Shuo, Zha Guochun, Li Cheng. Arthroscopic single-row fixation and knotless suture bridge fixation for rotator cuff injuries combined with osteoporosis[J]. Chinese Journal of Tissue Engineering Research, 2025, 29(15): 3188-3192.

Figures/Tables 4

References

[1] BEDEIR YH, SCHUMAIER AP, ABU-SHEASHA G, et al. Type 2 retear after arthroscopic single-row, double-row and suture bridge rotator cuff repair: A systematic review. Eur J Orthop Surg Traumatol. 2019;29(2):373-382.
[2] LAPNER P, HENRY P, ATHWAL GS, et al. Treatment of rotator cuff tears: A systematic review and meta-analysis. J Shoulder Elbow Surg. 2022;31(3): e120-e129.
[3] LAPNER P, LI A, POLLOCK JW, et al. A multicenter randomized controlled trial comparing single-row with double-row fixation in arthroscopic rotator cuff repair: Long-term follow-up. Am J Sports Med. 2021;49(11):3021-3029.
[4] MOON N, LEE SJ, KWAK SH, et al. Clinical and radiologic outcomes after arthroscopic rotator cuff repair: Single-row versus speed-bridge technique. Acta Orthopaedica Belgica. 2018;84(4):516-525.
[5] ŞAHIN K, ŞENTÜRK F, ERSIN M, et al. Repair integrity and functional outcomes between knot-tying and knotless suture-bridge arthroscopic rotator cuff repair: A prospective randomized clinical trial. Orthop J Sports Med. 2021;9(4):23259671211002482.
[6] HARRIS K, ZAGAR CA, LAWRENCE KV. Osteoporosis: Common questions and answers. Am Fam Physician. 2023;107(3):238-246.
[7] ENTEZARI V, LAZARUS M. Surgical considerations in managing osteoporosis, osteopenia, and vitamin d deficiency during arthroscopic rotator cuff repair. Orthop Clin North Am. 2019;50(2):233-243.
[8] HONG JP, HUANG SW, LEE CH, et al. Osteoporosis increases the risk of rotator cuff tears: A population-based cohort study. J Bone Miner Metab. 2022;40(2):348-356.
[9] JUNG SW, KIM DH, PARK TH, et al. Humeral head coverage in arthroscopic partial repair of massive rotator cuff tears improves functional outcomes: An analysis of influential factors. J Shoulder Elbow Surg. 2022;31(11):2233-2241.
[10] VECCHINI E, RICCI M, ELENA N, et al. Rotator cuff repair with single row technique provides satisfying clinical results despite consistent mri retear rate. J Orthop Traumatol. 2022;23(1):23.
[11] SANDOW MJ, SCHUTZ CR. Arthroscopic rotator cuff repair using a transosseous knotless anchor (atok). J Shoulder Elbow Surg. 2020;29(3): 527-533.
[12] NARVANI AA, IMAM MA, GODENÈCHE A, et al. Degenerative rotator cuff tear, repair or not repair? A review of current evidence. Ann Royal Coll Surg Eng. 2020;102(4):248-255.
[13] PARIKH N, MARTINEZ DJ, WINER I, et al. Direct and indirect economic burden associated with rotator cuff tears and repairs in the us. Curr Med Res Opin. 2021;37(7):1199-1211.
[14] FITZPATRICK LA, ATINGA A, WHITE L, et al. Rotator Cuff Injury and Repair. Semin Musculoskelet Radiol. 2022;26(5):585-596.
[15] PATEL M, AMINI MH. Management of Acute Rotator Cuff Tears. Orthop Clin North Am. 2022;53(1):69-76.
[16] CASTRO-CONTRERAS E, VALDEZ-PARDO ME. Rotator cuff injuries with nighttime pain and sleep quality before and after treatment. Acta Ortop Mex. 2022;36(1):33-38.
[17] LI C, ZHANG H, BO X, et al. Arthroscopic release combined with single-row fixation or double-row suture bridge fixation in patients with traumatic supraspinatus tear and adhesive capsulitis non-responsive to conservative management: A prospective randomized trial. Orthop Traumatol Surg Res. 2021;107(4):102828.
[18] DUKAN R, LEDINOT P, DONADIO J, et al. Arthroscopic rotator cuff repair with a knotless suture bridge technique: Functional and radiological outcomes after a minimum follow-up of 5 years. Arthroscopy. 2019;35(7):2003-2011.
[19] FREISLEDERER F, SCHEIBEL M. Arthroscopic knotless-anchor rotator cuff repair. JBJS Essent Surg Tech. 2020;10(3):e19.00021.
[20] MAZZOCCA AD, BOLLIER MJ, CIMINIELLO AM, et al. Biomechanical evaluation of arthroscopic rotator cuff repairs over time. Arthroscopy. 2010; 26(5):592-599.
[21] HEIN J, REILLY JM, CHAE J, et al. Retear rates after arthroscopic single-row, double-row, and suture bridge rotator cuff repair at a minimum of 1 year of imaging follow-up: A systematic review. Arthroscopy. 2015;31(11):2274-2281.
[22] LEE JB, KHOLINNE E, BEN H, et al. Clinical and Radiological Outcomes of Arthroscopic Superior Capsular Reconstruction Versus Primary Rotator Cuff Repair in Massive Rotator Cuff Tears: A Propensity Score-Matched Study. Am J Sports Med. 2023;51(8):1971-1978.
[23] ROSSI LA, CHAHLA J, VERMA NN, et al. Rotator Cuff Retears. JBJS Rev. 2020; 8(1):e0039.
[24] O’DONNELL EA, FU MC, WHITE AE, et al. The Effect of Patient Characteristics and Comorbidities on the Rate of Revision Rotator Cuff Repair. Arthroscopy. 2020;36(9):2380-2388.
[25] COTTER EJ, KLOSTERMAN EL, WINZENRIED AE, et al. Osteoporosis screening is often indicated but overlooked prior to rotator cuff repair. Arthroscopy. 2021;3(3):e659-e665.
[26] CHUNG SW, OH JH, GONG HS, et al. Factors affecting rotator cuff healing after arthroscopic repair: Osteoporosis as one of the independent risk factors. Am J Sports Med. 2011;39(10):2099-2107.
[27] PIETSCHMANN MF, FRÖHLICH V, FICKLSCHERER A, et al. Suture anchor fixation strength in osteopenic versus non-osteopenic bone for rotator cuff repair. Arch Orthop Trauma Surg. 2009;129(3):373-379.
[28] APRELEVA M, OZBAYDAR M, FITZGIBBONS PG, et al. Rotator cuff tears: The effect of the reconstruction method on three-dimensional repair site area. Arthroscopy. 2002;18(5):519-526.
[29] PAPALIA R, FRANCESCHI F, VASTA S, et al. Single- and double-row repair for rotator cuff tears - biology and mechanics. Med Sport Sci. 2012;57:122-141.
[30] LI X, XIAO Y, SHU H, et al. Risk factors and corresponding management for suture anchor pullout during arthroscopic rotator cuff repair. J Clin Med. 2022;11(22):6870.
[31] RO K, RHEE SM, KIM JY, et al. All-Suture Anchor Settling After Arthroscopic Repair of Small and Medium Rotator Cuff Tears. Am J Sports Med. 2019; 47(14):3483-3490.