Arthroscopic Rotator Cuff Repair with a Knotless Suture Bridge Technique: Functional and Radiological Outcomes after a Minimum Follow-Up of 5 Years

Purpose: To evaluate clinical and radiological outcomes of knotless suture bridge repair after a minimum of 5 years of follow-up. Methods: A prospective consecutive series of full-thickness supraspinatus atraumatic chronic tears was evaluated in the study. Tears were medium or large. Further inclusion criteria were minimum clinical follow-up of 5 years with magnetic resonance imaging (MRI) at 24 months and fatty infiltration < 2. Patients with shoulder stiffness, arthritis, or rotator cuff tear involving the subscapularis tendon were excluded. An arthroscopic cuff repair was performed using a knotless double-row suture bridge technique with braided suture tapes. Clinical outcomes were evaluated using the Constant score, the American Shoulder and Elbow Surgeons score, strength score, and a visual analog scale. Tendon healing was analyzed according to Sugaya MRI classification at 24 months. A Sugaya score of 1 or 2 was considered as tendon healing. Statistical analysis was performed with the Student's t-test. P = .05 were considered statistically significant. Results: Sixty-eight patients were included in this series. Mean follow-up was equal to 68.8 +/- 7 months. At last follow-up, the mean visual analog scale, American Shoulder and Elbow Surgeons score, and Constant scores improved significantly from 5.5 +/- 1.6, 48.2 +/- 13.1, 37.8 +/- 8.3, to 2.1 +/- 2.1 (P = 5.43 E-14), 87.4 +/- 15.8 (P = 7.15 E-27), and 82.8 +/- 14.7 (P = 1.01 E-33), respectively. Anteflexion improved from 99.3 degrees +/- 13.4 degrees preoperatively to 136.6 degrees +/- 15.9 degrees at last follow-up (P = 3.08 E-21). Strength score was significantly higher postoperatively (18.4 +/- 6.7 vs 8.3 +/- 3.5). MRI showed 88% (n = 57) of Sugaya 1-2 repairs. Patients with unhealed rotator cuffs showed significantly lower functional results than the Sugaya 1-2 group. No correlation between degree of retraction and rate of healing was observed. Four symptomatic patients (6%) required revision for failed rotator cuff repair. Conclusions: Despite potential confounding factors, arthroscopic knotless suture bridge repair of rotator cuff tears with acromioplasty demonstrated excellent long-term results of tendon healing, pain relief, and improvement of shoulder function.