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The modified massive cuff stitch: functional and structural outcome in massive cuff tears.

Gotoh M, Mitsui Y, Yoshimitsu K, Nakama K, Okawa T, Higuchi F, Nagata K - J Orthop Surg Res (2013)

Bottom Line: The ROM, muscle strength, degree of pain, and the JOA scores were much improved after surgery in both groups, and there was no significant intergroup difference throughout the pre- and post-operative periods.In contrast, post-operative MRI revealed a significantly lower re-tear rate in the MCS group than in the STS group (9.1% vs. 40%, P = 0.0296).The techniques tested were comparable in terms of functional outcome after surgical repair of massive cuff tears; however, the modified MCS repair technique produced superior structural outcomes with a significantly lower re-tear rate.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedic Surgery, Kurume University Medical Center Kurume, Kurume, Fukuoka, Japan. gomasa@med.kurume-u.ac.jp

ABSTRACT

Background: The massive cuff stitch (MCS) is known to be a strong suture, suitable for rotator cuff repair. We modified this technique for massive cuff tears by employing a horizontal medial mattress suture from an anchor as well as a vertically crossing transosseous suture.

Methods: We included 42 patients with massive cuff tears suitable for repair: 22 were treated with the modified MCS (MCS group), and 20 with a simple transosseous suture (STS group). The range of motion (ROM), muscle strength, visual analog scale, and the Japanese Orthopaedic Association (JOA) scores were evaluated pre-operatively and 12 and 24 months post-operatively. The incidence of post-operative re-tears was examined at least 1 year post-operatively using Sugaya's classification.

Results: The ROM, muscle strength, degree of pain, and the JOA scores were much improved after surgery in both groups, and there was no significant intergroup difference throughout the pre- and post-operative periods. In contrast, post-operative MRI revealed a significantly lower re-tear rate in the MCS group than in the STS group (9.1% vs. 40%, P = 0.0296).

Conclusions: The techniques tested were comparable in terms of functional outcome after surgical repair of massive cuff tears; however, the modified MCS repair technique produced superior structural outcomes with a significantly lower re-tear rate.

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Related in: MedlinePlus

Schema of the procedure tested. Modified massive cuff stitch (MCS) (A); simple transosseous suture (STS) (B).
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Figure 1: Schema of the procedure tested. Modified massive cuff stitch (MCS) (A); simple transosseous suture (STS) (B).

Mentions: For the modified MCS repair, a horizontal mattress stitch was made on the inside 10–15 mm of the ruptured rotator cuff using a single-loaded bioabsorbable suture anchor (PANALOCK RC, DePuy Mitek Inc., Raynham, MA, USA) placed just medial to the rotator cuff footprint. Next, a vertical simple transosseous suture was made to cross over the horizontal suture proximally after medial tying (Figure 1A). The vertical transosseous suture was then tied. For the STS repair, simple transosseous sutures were placed on the inside 10–15 mm of the ruptured rotator cuff and sutured to the bone tunnel prepared in the greater tuberosity (Figure 1B). Watertight repairs were completed in all patients without excessive tension at the repair site; once repaired, the deltoid was re-attached with non-absorbable braided sutures to its previous anatomical position.


The modified massive cuff stitch: functional and structural outcome in massive cuff tears.

Gotoh M, Mitsui Y, Yoshimitsu K, Nakama K, Okawa T, Higuchi F, Nagata K - J Orthop Surg Res (2013)

Schema of the procedure tested. Modified massive cuff stitch (MCS) (A); simple transosseous suture (STS) (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750386&req=5

Figure 1: Schema of the procedure tested. Modified massive cuff stitch (MCS) (A); simple transosseous suture (STS) (B).
Mentions: For the modified MCS repair, a horizontal mattress stitch was made on the inside 10–15 mm of the ruptured rotator cuff using a single-loaded bioabsorbable suture anchor (PANALOCK RC, DePuy Mitek Inc., Raynham, MA, USA) placed just medial to the rotator cuff footprint. Next, a vertical simple transosseous suture was made to cross over the horizontal suture proximally after medial tying (Figure 1A). The vertical transosseous suture was then tied. For the STS repair, simple transosseous sutures were placed on the inside 10–15 mm of the ruptured rotator cuff and sutured to the bone tunnel prepared in the greater tuberosity (Figure 1B). Watertight repairs were completed in all patients without excessive tension at the repair site; once repaired, the deltoid was re-attached with non-absorbable braided sutures to its previous anatomical position.

Bottom Line: The ROM, muscle strength, degree of pain, and the JOA scores were much improved after surgery in both groups, and there was no significant intergroup difference throughout the pre- and post-operative periods.In contrast, post-operative MRI revealed a significantly lower re-tear rate in the MCS group than in the STS group (9.1% vs. 40%, P = 0.0296).The techniques tested were comparable in terms of functional outcome after surgical repair of massive cuff tears; however, the modified MCS repair technique produced superior structural outcomes with a significantly lower re-tear rate.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedic Surgery, Kurume University Medical Center Kurume, Kurume, Fukuoka, Japan. gomasa@med.kurume-u.ac.jp

ABSTRACT

Background: The massive cuff stitch (MCS) is known to be a strong suture, suitable for rotator cuff repair. We modified this technique for massive cuff tears by employing a horizontal medial mattress suture from an anchor as well as a vertically crossing transosseous suture.

Methods: We included 42 patients with massive cuff tears suitable for repair: 22 were treated with the modified MCS (MCS group), and 20 with a simple transosseous suture (STS group). The range of motion (ROM), muscle strength, visual analog scale, and the Japanese Orthopaedic Association (JOA) scores were evaluated pre-operatively and 12 and 24 months post-operatively. The incidence of post-operative re-tears was examined at least 1 year post-operatively using Sugaya's classification.

Results: The ROM, muscle strength, degree of pain, and the JOA scores were much improved after surgery in both groups, and there was no significant intergroup difference throughout the pre- and post-operative periods. In contrast, post-operative MRI revealed a significantly lower re-tear rate in the MCS group than in the STS group (9.1% vs. 40%, P = 0.0296).

Conclusions: The techniques tested were comparable in terms of functional outcome after surgical repair of massive cuff tears; however, the modified MCS repair technique produced superior structural outcomes with a significantly lower re-tear rate.

Show MeSH
Related in: MedlinePlus