Gatot Cheryl, Lie Hannah Mei En, Tijauw Tjoen Denny Lie
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
Arthrosc Tech. 2023 Nov 6;12(12):e2117-e2126. doi: 10.1016/j.eats.2023.07.036. eCollection 2023 Dec.
Musculotendinous junction (MTJ) rotator cuff tears in the shoulder are rare injuries in which the tendon fails medial to its tuberosity attachment. There is difficulty in striking a balance between restoring the length-tension relationship of the tendon while avoiding high suture tension at the repair site. In view of the rare incidences of these tears, there is a paucity of literature on their repair techniques. We seek to share our surgical technique in addressing type A MTJ tears-where the medial muscular tear margin is short but remains adequate for suture bridge repair, whereas the lateral tendon remains on the footprint. We used mattress sutures from the medial row of anchors, threaded through the lateral tendon stump, then passed medially to engage the medial stump, before being fixed to a lateral row in a knotless fashion. Pulling on this pair of sutures will thus bring into closer apposition of both medial and lateral tear margins in a dynamic convergence pattern. Our surgical technique is a safe and effective method of repairing type A MTJ tear that confers improved biological and biomechanical advantage via the formation of a dynamic convergence suture bridging technique in addition to a double-row repair construct.
肩部的肌腱-肌肉交界处（MTJ）肩袖撕裂是一种罕见的损伤，即肌腱在其结节附着点内侧发生断裂。在恢复肌腱的长度-张力关系与避免修复部位出现高缝合张力之间难以取得平衡。鉴于这些撕裂的发生率很低，关于其修复技术的文献也很少。我们旨在分享我们处理A型MTJ撕裂的手术技术——内侧肌肉撕裂边缘短但仍足以进行缝合桥接修复，而外侧肌腱仍附着在骨床。我们使用来自内侧排锚钉的褥式缝线，穿过外侧肌腱残端，然后向内侧穿过以接合内侧残端，最后以无结方式固定到外侧排。拉动这对缝线将使内侧和外侧撕裂边缘以动态汇聚模式更紧密地对合。我们的手术技术是修复A型MTJ撕裂的一种安全有效的方法，除了双排修复结构外，还通过形成动态汇聚缝合桥接技术赋予了更好的生物学和生物力学优势。
