Chernchujit Bancha, Mendoza Christian Julius P, Samsuya Katreese Kimberly M
Thammasat University Hospital, Pathum Thani, Thailand.
Arthrosc Tech. 2023 Mar 27;12(4):e569-e574. doi: 10.1016/j.eats.2022.12.011. eCollection 2023 Apr.
Techniques in rotator cuff repair are constantly evolving, with the main goal of a biologic, stable, and tension-free construct. Significant controversy exists between various methods, and there is no gold standard surgical protocol. We demonstrate an alternative arthroscopic rotator cuff repair technique with 2 key components. First, we performed a transosseous equivalent, suture bridge technique with a combination of triple-loaded medial anchors and knotless lateral anchors. Second, we incorporated 2-strand and 3-strand suture shuttling through the torn rotator cuff and selective medial knot-tying. A total of 6 passes through the tendon are made, comprising 1-2-3-3-2-1 strands each pass. This minimizes the number of passes through the tendon and the overall number of medial knots. Our technique retains the known biomechanical advantages akin to a double-row repair, including less gap formation and wider footprint coverage. In addition, using fewer medial knots with efficient suture passing may result to decreased cuff strangulation and favorable biologic environment for tendon healing. We theorize that this technique may yield lower retear rates while maintaining immediate stability, translating to improved clinical results.
肩袖修复技术不断发展，其主要目标是构建生物性、稳定且无张力的结构。各种方法之间存在重大争议，尚无金标准手术方案。我们展示了一种具有两个关键组成部分的替代性关节镜下肩袖修复技术。首先，我们采用了一种经骨等效的缝合桥技术，结合使用三重加载的内侧锚钉和无结外侧锚钉。其次，我们将两线和三线缝线穿梭穿过撕裂的肩袖并在内侧选择性打结。总共穿过肌腱6次，每次穿过包括1-2-3-3-2-1股线。这将穿过肌腱的次数和内侧结的总数减至最少。我们的技术保留了类似于双排修复的已知生物力学优势，包括更少的间隙形成和更宽的足迹覆盖。此外，使用更少的内侧结并高效地穿线可能会减少肩袖绞窄，并为肌腱愈合创造良好的生物环境。我们推测，该技术可能会降低再撕裂率，同时保持即时稳定性，从而改善临床效果。
