title: Modified suture-bridge technique to prevent a marginal dog-ear deformity improves structural integrity after rotator cuff repair.
abstract: BACKGROUND
  The arthroscopic suture-bridge technique has proved to provide biomechanically firm fixation of the torn rotator cuff to the tuberosity by increasing the footprint contact area and pressure. However, a marginal dog-ear deformity is encountered not infrequently when this technique is used, impeding full restoration of the torn cuff.
  
  
  OBJECTIVE
  To evaluate the structural and functional outcomes of the use of a modified suture-bridge technique to prevent a marginal dog-ear deformity compared with a conventional suture-bridge method in rotator cuff repair.
  
  
  METHODS
  Cohort study; Level of evidence 2.
  
  
  METHODS
  A consecutive series of 71 patients aged 50 to 65 years who underwent arthroscopic rotator cuff repair for full-thickness medium-sized to massive tears was evaluated. Patients were divided into 2 groups according to repair technique: a conventional suture-bridge technique (34 patients; group A) versus a modified suture-bridge technique to prevent a marginal dog-ear deformity (37 patients; group B). Radiographic evaluations included postoperative cuff integrity using MRI. Functional evaluations included pre- and postoperative range of motion (ROM), pain visual analog scale (VAS), the University of California, Los Angeles (UCLA) shoulder rating scale, the Constant score, and the American Shoulder and Elbow Surgeons (ASES) score. All patients were followed up clinically at a minimum of 1 year.
  
  
  RESULTS
  When the 2 surgical techniques were compared, postoperative structural integrity by Sugaya classification showed the distribution of types I:II:III:IV:V to be 4:20:2:4:4 in group A and 20:12:4:0:1 in group B. More subjects in group B had a favorable Sugaya type compared with group A (P < .001). The postoperative healed:retear rate was 26:8 in group A and 36:1 in group B, with a significantly lower retear rate in group B (P = .011). However, there were no significant differences in ROM and all functional outcome scores between the 2 groups postoperatively. When surgical techniques were compared across healed (n = 62) and retear (n = 9) groups, significantly fewer modified suture-bridge technique repairs were found in the retear group (P = .03). There were significant differences between healed and retear groups in functional outcome scores, with worse results in the retear group.
  
  
  CONCLUSIONS
  A modified suture-bridge technique to prevent a marginal dog-ear deformity provided better structural outcomes than a conventional suture-bridge technique for medium-sized to massive rotator cuff tears. This technique may ultimately provide better functional outcomes by decreasing the retear rate.
authors.affiliation: Department of Orthopaedic Surgery, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam-si, Kyeonggi-do, Korea.
authors.forename: Keun Jung
authors.initials: KJ
authors.lastname: Ryu
authors.affiliation: Department of Orthopaedic Surgery, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam-si, Kyeonggi-do, Korea.
authors.forename: Bang Hyun
authors.initials: BH
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam-si, Kyeonggi-do, Korea.
authors.forename: Yohan
authors.initials: Y
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, CHA Gumi Medical Center, School of Medicine, CHA University, Gumi-si, Kyungsangbuk-do, Korea.
authors.forename: Yoon Seok
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam-si, Kyeonggi-do, Korea drjkim@cha.ac.kr.
authors.forename: Jae Hwa
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000368:Aged; D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D016059:Range of Motion, Articular; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D013536:Suture Techniques; D013708:Tendon Injuries / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing
keywords: cuff healing; modified suture bridge; retear; rotator cuff; suture bridge