Purpose

The purpose was to evaluate the clinical and radiological results of knotless repair with flat-braided suture in full small-sized supraspinatus tendon tears (< 1 cm).

Methods

A consecutive series of 54 patients with isolated small supraspinatus tendon tear (< 1 cm and Goutallier index < 2) was evaluated in the study. Patients underwent a knotless arthroscopic repair using flat-braided suture (2 mm wide). Minimal follow-up required was 5 years. Changes in Murley–Constant score, ASES score, strength, and pain relief were assessed. The Sugaya score was used to confirm the tendon repair on MRI. Data were analyzed in two subgroups: technique with additional U point for dog ear deformity (group 1) and technique without additional U point (group 2). The immobilization period was 3 weeks long. Passive mobilization was immediate.

Results

Fifty-four patients were included. Mean age was 57 ± 4 years. The average follow-up was 68 ± 10 months. Average preoperative score of Constant was 51.2 ± 8.5 and 83.1 ± 14.6 at the end of the follow-up (p < 0.001). Mean VAS went from 5.8 ± 1.8 to 1.9 ± 2.1 (p < 0.001). Average forward elevation of the shoulder went from 86.3° ± 9 preoperatively to 169.6° ± 15.9 at the end of the follow-up (p < 0.001). The strength score was significantly higher post-operatively (18.4 vs. 8.3, p < 0.001.). The ASES score was significantly improved 49.1 ± 13.1 vs. 88.6 ± 15.8, p < 0.001). The MRI assessment revealed 94% of Sugaya 1–2. No significant difference was observed between group 1 and 2 regarding all clinical outcomes. Two complex regional pain syndromes were described with a favorable evolution. Three patients presented a retear requiring an iterative arthroscopic repair.

Conclusion

The use of a knotless arthroscopic construct with flat-braided suture for small supraspinatus repair achieved excellent structural and clinical results. This technique is fully adequate for the arthroscopic treatment of such tears, enabling early mobilization.

Level of evidence

Level III.

中文翻译：

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关节镜无节修复：一种有效的技术，用于小型脊柱上肌腱撕裂。

目的

目的是评估用扁平编织缝线对全小上棘上肌腱撕裂（<1 cm）进行无结修复的临床和放射学结果。

方法

在该研究中，对连续54例孤立的小上棘上肌腱撕裂（<1 cm和Goutallier指数<2）的患者进行了评估。使用扁平编织缝线（2毫米宽）对患者进行无节关节镜修复。所需的最少随访时间为5年。评估了Murley-Constant评分，ASES评分，强度和缓解疼痛的变化。Sugaya评分用于确认MRI上的肌腱修复。对数据进行了两个子组的分析：带附加U点的犬耳畸形技术（第1组）和无附加U点的技术（第2组）。固定期为3周。被动动员是立即的。

结果

包括54名患者。平均年龄为57±4岁。平均随访时间为68±10个月。随访结束时，Constant的平均术前评分为51.2±8.5和83.1±14.6（p  <0.001）。平均VAS从5.8±1.8降至1.9±2.1（p  <0.001）。术后平均肩关节前抬高从术前的86.3°±9升高至术后的169.6°±15.9（p  <0.001）。术后强度得分显着更高（18.4 vs. 8.3，p  <0.001。）。ASES分数显着提高了49.1±13.1，而88.6±15.8，p <0.001）。MRI评估显示Sugaya 1-2中有94％。关于所有临床结果，第1组和第2组之间没有观察到显着差异。描述了两个复杂的区域性疼痛综合征，并得到了有利的发展。三名患者出现了需要进行反复关节镜修复的后眼。

结论

使用平结缝合线的无结关节镜构造进行小型上棘突修复，可获得出色的结构和临床效果。这项技术完全适用于这种泪液的关节镜治疗，能够尽早动员。

证据水平

第三级。