The Use of a Suture Bridge Technique for Arthroscopic Rotator Cuff Repair in Patients Under 40 Years of Age Resulted in Successful Tendon Healing, Pain Relief, Improved Shoulder Function, and High Patient Satisfaction at a Minimum of 5-Year Follow-Up

Abstract

Purpose

To evaluate the long-term clinical and imaging outcomes after arthroscopic repair of rotator cuff tears (RCTs) using a suture bridge technique in patients under 40 years of age.

Methods

We retrospectively identified a consecutive series of patients who were treated arthroscopically for RCTs by a single surgeon between 2016 and 2018. Both full-thickness tears and partial tears were included. Arthroscopic cuff repair was performed with a double-row suture bridge technique using braided suture tapes. To assess clinical outcomes, we used the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, a strength score, and a visual analog scale score. Tendon healing was evaluated at 12 months on magnetic resonance imaging using the Sugaya classification.

Results

A total of 63 patients were included in the study. The mean age at the time of surgery was 33.6 years (range, 21-40 years), and the minimum follow-up duration was 5 years. Of the patients, 39 reported occasional sports activities and 8 were professional athletes whereas 16 reported no sportive activity prior to first symptoms. The mean follow-up duration was 66.8 months (range, 62.4-88.6 months). A significant improvement was observed in both the Constant score and the ASES score. The mean Constant score increased significantly from 39.8 points (range, 29-52 points) to 88.9 points (range, 34-100) postoperatively (P < .001). Similarly, the ASES score improved significantly from 41.8 points (range, 30-64 points) to 90.2 points (range, 35-100 points; P < .001). Mean anterior flexion improved from 86° (range, 60°-110°) to 137° (range, 90°-180°; P < .001). Pain significantly decreased after surgery, with the visual analog scale score descending from 6.3 (range, 3-10) to 1.3 (range, 0-9) postoperatively. The overall rate of return to previous activities in the cohort was 84% at an average of 10.1 months (range, 6-12 months) after surgery. Among the included patients, 85% who engaged in occasional sports activities and 67% of elite athletes returned to their preinjury sports levels after 9.8 months (range, 6-12 months) and 10.7 months (range, 6-12 months), respectively. Cuff rerupture occurred in 2 patients (3%), and tendon nonhealing (Sugaya stage 3 or 4) was observed in 5 patients (7%). At final follow-up, 95% of patients were satisfied or very satisfied with their functional results.

Conclusions

The use of a suture bridge technique in arthroscopic RCT repair for patients under 40 years of age resulted in excellent long-term outcomes, including successful tendon healing, pain relief, improved shoulder function, and high patient satisfaction. This result is of significant importance in this demanding population because it allows satisfactory high rate of return to the preinjury level of activity.

Level of Evidence

Level IV, therapeutic case series.