Sang-Jin Shin1, Seung-Hwan Kook2, Nandan Rao2, Myeong-Jae Seo2. 1. Global Top 5 Research Program, Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea sjshin622@ewha.ac.kr. 2. Global Top 5 Research Program, Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea.
Abstract
BACKGROUND: Various repair techniques have been reported for the operative treatment of bursal-sided partial-thickness rotator cuff tears. Recently, arthroscopic single-row repair using a modified Mason-Allen technique has been introduced. HYPOTHESIS: The arthroscopic, modified Mason-Allen single-row technique with preservation of the articular-sided tendon provides satisfactory clinical outcomes and similar results to the double-row suture-bridge technique after conversion of a partial-thickness tear to a full-thickness tear. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A retrospective study was conducted on 84 consecutive patients with symptomatic, bursal-sided partial-thickness rotator cuff tears involving more than 50% thickness of the tendon. A total of 47 patients were treated by the modified Mason-Allen single-row repair technique, preserving the articular-sided tendon, and 37 patients were treated by the double-row suture-bridge repair technique after conversion to a full-thickness tear. The clinical and functional outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) and Constant scores and a visual analog scale (VAS) for pain and satisfaction of patients. Magnetic resonance imaging (MRI) was used to analyze the integrity of tendons at 6-month follow-up. Patients were followed up for a mean of 32.5 months. RESULTS: In the 47 patients treated with the modified Mason-Allen suture technique, the VAS score decreased from a preoperative mean of 5.3 ± 0.3 to 0.9 ± 0.5 at the time of final follow-up. There was a statistically significant increase in the mean ASES score (from 45.4 ± 2.9 to 88.6 ± 4.5) and mean Constant score (from 66.9 ± 2.6 to 88.1 ± 2.4) (P < .001). Four of 47 patients (8.5%) demonstrated retears at 6-month postoperative MRI. There was no statistical difference in terms of functional outcomes and the retear rate compared with those of patients with the suture-bridge repair technique (3 patients, 8.1%). However, the mean number of suture anchors used in the patients with modified Mason-Allen suture repair (1.2 ± 0.4) was significantly fewer than that in the patients with suture-bridge repair (3.2 ± 0.4) (P < .01). CONCLUSION: The modified Mason-Allen single-row repair technique that preserved the articular-sided tendon provided satisfactory clinical outcomes in patients with symptomatic, bursal-sided partial-thickness rotator cuff tears. Despite a fewer number of suture anchors, the shoulder functional outcomes and retear rate in patients after modified Mason-Allen repair were comparable with those of patients who underwent double-row suture-bridge repair. Therefore, the modified Mason-Allen single-row repair technique using a triple-loaded suture anchor can be considered as an effective treatment in patients with bursal-sided partial-thickness rotator cuff tears.
BACKGROUND: Various repair techniques have been reported for the operative treatment of bursal-sided partial-thickness rotator cuff tears. Recently, arthroscopic single-row repair using a modified Mason-Allen technique has been introduced. HYPOTHESIS: The arthroscopic, modified Mason-Allen single-row technique with preservation of the articular-sided tendon provides satisfactory clinical outcomes and similar results to the double-row suture-bridge technique after conversion of a partial-thickness tear to a full-thickness tear. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A retrospective study was conducted on 84 consecutive patients with symptomatic, bursal-sided partial-thickness rotator cuff tears involving more than 50% thickness of the tendon. A total of 47 patients were treated by the modified Mason-Allen single-row repair technique, preserving the articular-sided tendon, and 37 patients were treated by the double-row suture-bridge repair technique after conversion to a full-thickness tear. The clinical and functional outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) and Constant scores and a visual analog scale (VAS) for pain and satisfaction of patients. Magnetic resonance imaging (MRI) was used to analyze the integrity of tendons at 6-month follow-up. Patients were followed up for a mean of 32.5 months. RESULTS: In the 47 patients treated with the modified Mason-Allen suture technique, the VAS score decreased from a preoperative mean of 5.3 ± 0.3 to 0.9 ± 0.5 at the time of final follow-up. There was a statistically significant increase in the mean ASES score (from 45.4 ± 2.9 to 88.6 ± 4.5) and mean Constant score (from 66.9 ± 2.6 to 88.1 ± 2.4) (P < .001). Four of 47 patients (8.5%) demonstrated retears at 6-month postoperative MRI. There was no statistical difference in terms of functional outcomes and the retear rate compared with those of patients with the suture-bridge repair technique (3 patients, 8.1%). However, the mean number of suture anchors used in the patients with modified Mason-Allen suture repair (1.2 ± 0.4) was significantly fewer than that in the patients with suture-bridge repair (3.2 ± 0.4) (P < .01). CONCLUSION: The modified Mason-Allen single-row repair technique that preserved the articular-sided tendon provided satisfactory clinical outcomes in patients with symptomatic, bursal-sided partial-thickness rotator cuff tears. Despite a fewer number of suture anchors, the shoulder functional outcomes and retear rate in patients after modified Mason-Allen repair were comparable with those of patients who underwent double-row suture-bridge repair. Therefore, the modified Mason-Allen single-row repair technique using a triple-loaded suture anchor can be considered as an effective treatment in patients with bursal-sided partial-thickness rotator cuff tears.
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