Imai Shinji
Department of Orthopaedic Surgery, University Hospital, Shiga University of Medical Science, Shiga, Japan.
JB JS Open Access. 2025 Jan 23;10(1). doi: 10.2106/JBJS.OA.24.00031. eCollection 2025 Jan-Mar.
Although a certain degree of tension in bridging sutures is required for proper tendon healing following suture-bridge rotator cuff repair, excessive suture tension may be detrimental to tendon healing. This study aimed to investigate the effects of bridging suture tension on clinical outcomes and tendon healing. We hypothesized that fixed, low tension of the bridging sutures would improve the tendon healing rate and clinical outcomes compared with maximum manual tensioning.
A group of 39 patients with a rotator cuff tear were treated with arthroscopic suture-bridge rotator cuff repair, in which the bridging sutures were uniformly tensioned to 20 N (group A). A separate group of 37 patients was treated with the same suture construct, but the sutures were tensioned by maximum manual pulling (mean tension, 36.1 N; group B). The visual analog scale (VAS) score for pain, active anterior elevation, external and internal rotation, and Constant score were compared between the groups preoperatively and at 1, 3, and 6 months and 1 and 2 years postoperatively. Anatomical healing was evaluated using magnetic resonance imaging (MRI) at 1 year after surgery.
At 6 months postoperatively, all clinical values had improved in both groups. The Constant score (p < 0.001), VAS pain score (p < 0.001), and anterior elevation (p = 0.004) were significantly better in group A than in group B. Two years postoperatively, there was no significant difference between groups A and B in the Constant score (p = 0.847), VAS pain score (p = 0.991), and anterior elevation (p = 0.855). Group A demonstrated a significantly lower retear rate (3 of 39, 7.7%) than group B (9 of 37, 24.3%) (p = 0.0467).
Double-row suture-bridge repairs with fixed, low tension led to superior clinical outcomes at 6 months and a superior tendon healing rate at 1 year compared with repairs with higher suture tension. However, the clinical outcomes did not differ significantly at 2 years between the 2 tensioning methods.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
尽管在缝线桥接修复肩袖后，适当的肌腱愈合需要桥接缝线有一定程度的张力，但过高的缝线张力可能对肌腱愈合不利。本研究旨在探讨桥接缝线张力对临床疗效和肌腱愈合的影响。我们假设，与最大手动张紧相比，固定的低张力桥接缝线将提高肌腱愈合率和临床疗效。
一组39例肩袖撕裂患者接受关节镜下缝线桥接修复肩袖，其中桥接缝线均匀张紧至20 N（A组）。另一组37例患者采用相同的缝线结构，但缝线通过最大手动牵拉张紧（平均张力36.1 N；B组）。比较两组术前、术后1、3、6个月以及1年和2年时的视觉模拟评分（VAS）疼痛评分、主动前举、外旋和内旋以及Constant评分。术后1年采用磁共振成像（MRI）评估解剖愈合情况。
术后6个月，两组所有临床指标均有所改善。A组的Constant评分（p < 0.001）、VAS疼痛评分（p < 0.001）和前举（p = 0.004）均显著优于B组。术后2年，A组和B组在Constant评分（p = 0.847）、VAS疼痛评分（p = 0.991）和前举（p = 0.855）方面无显著差异。A组的再撕裂率（39例中的3例，7.7%）显著低于B组（37例中的9例，24.3%）（p = 0.0467）。
与较高缝线张力的修复相比，固定低张力的双排缝线桥接修复在6个月时临床疗效更佳，1年时肌腱愈合率更高。然而，两种张紧方法在2年时的临床疗效无显著差异。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
