Two Techniques for Treating Medium-Sized Supraspinatus Tears: The Medially Based Single-Row Technique and the Suture Bridge Technique.

backgroundArthroscopic rotator cuff repair emerged in the early 1990s, and the single-row repair technique (i.e., suture anchor[s] set at the center or laterally on the greater tuberosity) has shown promising outcomes; however, the healing rate of the repaired cuff is suboptimal. Although small to medium-sized rotator cuff tears have shown better clinical outcomes and structural healing than larger tears, healing failure still occurs DESCRIPTION: Arthroscopic subacromial decompression is performed in both techniques.For suture bridge fixation, the suture anchor is placed at the articular margin of the humeral head as the medial row, and both limbs of each suture are passed through the tendon approximately 5 mm lateral to the muscle-tendon junction of the rotator cuff in a mattress fashion. After the medial-row knots are tied, the suture limbs are brought into 2 lateral push-in anchors.For the medially based single-row repair, suture anchors are placed lateral to the articular margin. Each suture limb is passed through the tendon approximately 1 cm medial to the torn edge of the cuff. All sutures are tied with 7 half-hitches, avoiding a sliding knot. ALTERNATIVES: Open or mini-open rotator cuff repair RATIONALE: The suture bridge technique has achieved better mechanical properties and footprint coverage, and the medially based single-row technique has achieved lower tension on the repaired construct with neotendon regeneration. These techniques are the opposite concept as coverage-oriented and tension-oriented techniques, respectively. To our knowledge, there is presently no study showing that either of these 2 techniques is better than the other EXPECTED OUTCOMES: Published data have not shown significant differences in the clinical outcomes and cuff integrity between these 2 techniques, with no decisive superiority when treating small to medium-sized supraspinatus tears. The choice between these techniques is solely the decision of the surgeon; however, medial cuff failure has been reported only when using the suture bridge technique, and incomplete healing was more frequent among medially based single-row techniques. One should consider the risks of medial cuff failure and incomplete healing of the repaired cuff before choosing the repair technique for medium-sized supraspinatus tears. IMPORTANT TIPS: The proposed risk factors for medial cuff failure in the suture bridge technique include:○ A mattress suture configuration placed at the muscle-tendon junction○ Aggressive rehabilitation○ Use of a large-diameter suture passer○ Application of a sliding knot○ High-stress concentration around the medial knotsThe proposed risk factors for incomplete healing in the medially based single-row techniqueare:○ Lower mechanical properties (initial stiffness and strength, gap formation resistance) in the repaired site○ Lower number of sutures.