Tendonbone contact pressure and biomechanical evaluation. Maintain a soft tissue bridge of one to two centimeters between the mattress stitches. The level of muscle atrophy of supraspinatus was not changed significantly after surgery. Minimal tying technique with suture configuration of fourbyfour strand doublerow suturebridge yielded a lower retear rate 6. To compare arthroscopic suture bridge sb techniques with medial tying to those without tying, considering clinical and structural outcomes. Arthroscopic singlerow versus doublerow suture bridge. Most important, it touches on some of the critical decisions which must be made on a daily basis to help ensure proper wound closure.
A suturebridge technique has been introduced to facilitate fixation procedures and to achieve increased holding strength in posterosuperior rotator cuff. The sutures are then anchored on the lateral cortex of the. The doublerow technique is believed to more effectively recreate the anatomic footprint of the tendon, as well as increase tendon to bone surface area, and apposition for healing. A modified suture bridge technique to prevent a marginal dogear deformity provided better structural outcomes than a conventional suture bridge technique for mediumsized to massive rotator cuff tears. Avulsion fracture of the ischial tuberosity treated with. Observation of arthroscopic suture bridge technique 5829 int j clin exp med 2019. In addition, doublerow repair eliminates the need for knot tying, minimizing foreign body material in the glenohumeral joint. However, a new suture bridge technique using the arthrex speedbridgetm system arthrex, inc. A biomechanical and histological comparison of the suture. We included 124 patients with rotator cuff tears after arthroscopic rotator cuff repair arcr. Arthroscopic rotator cuff repair arthroscopy techniques. Pdf minimal medialrow tie with suturebridge technique. Traditional fixation techniques using running, locking sutures through the tendon secured through bone tunnels have been shown to poorly restore the anatomic. This technique may ultimately provide better functional outcomes by decreasing the retear rate.
The suture bridge technique is used to uniformly tension the torn tissue to the rotator cuff footprint. It was hypothesized that the suture bridge technique shows lower elongation and higher load to failure force compared to a transtibial pullout fixation. The needle holder should be held with the palm grip as illustrated in figure 1. The authors concluded that the suturebridge technique could protect the biological environment of tendontobone healing over a shortterm period.
However, the clinical outcomes have been mixed and little direct evidence has been. Ultrabutton adjustable fixation device is uniquely designed for graft protection while also featuring leading fixation strength and less displacement compared to other leading options with a simple onehanded reduction technique requiring minimal force. We presented a surgical technique including a suture bridge technique with relatively small incision for the reduction and fixation of posterior ligament avulsion fractures. Consider suture removal children, location of wound, type of suture. To compare the biomechanical properties of 3 suturebridge techniques for rotator cuff repair. Therefore, further studies are required to clarify the biomechanical advantage of.
We present our technique in managing highgrade bursalsided rotator cuff tears. To request a price quote andor surgical evaluation of products, please add all products of interest to your cart by selecting the respective product checkboxes in the quote 1 andor surgical evaluation 2 column of the products view 3. Arthroscopic fixation for displaced greater tuberosity. Suturebridge rotator cuff repair university of washington. Whilst sutures create conditions for primary healing, inappropriate selection and technique can have an adverse effect by increasing infection risk, impairing local circulation or causing further tissue injury. Research article biomechanical comparison of modified. This article introduces a new method of suture bridge technique, which occupies the modified masonallen stitch in medial row fixation. Sutures and wound closure techniques introduction this booklet is intended as an introductory guide to sutures and suturing techniques. The doublerow technique is believed to more effectively recreate the anatomic footprint of the tendon, as well as increase tendon to.
Biomechanical comparison of modified suture bridge using. The suturebridge and speedbridge are novel concepts in achilles. Although there are some limitations in these studies including. Flying swan arthroscopic labral repair using a tensioned. Doublerow transosseous equivalent suture bridge technique. First, the followup time of 46 months is not sufficient to determine long. A modified suturebridge technique to prevent a marginal dogear deformity provided better structural outcomes than a conventional suturebridge technique for mediumsized to massive rotator cuff tears. The purpose of this study was to evaluate clinical and structural outcomes of this technique. Subscapularis tendon repair using suture bridge technique. Biomechanical testing revealed a statistically significant higher failure load in comparison to. We here describe our treatment technique for patients with chronic and persistent calcific tendinitis in which we use an arthroscopic suture bridge technique for repairing bursal side tears with deep intratendinous extensions that develop consequent on removal of calcific deposits.
We present a new method of suture bridge technique for medial row fixation using a modified masonallen stitch instead of a horizontal mattress. The second part of the chapter describes the authors preferred technique of arthroscopic transosseousequivalent suture bridge rotator cuff repair. The novel pcl suturebridge technique provides a significant lower construct elongation during cyclic loading and a trend towards higher load to failure in comparison to cortical suspension button fixation. We describe an arthroscopic doublerow labral repair technique using a knotless suture bridge. The arthroscopic suture bridge repair technique for rotator cuff tears may be an operative method for which a patient can expect to achieve clinical improvement regardless of the preoperative tear size and the extent of fatty degeneration. A new approach to improving the tissue grip of the medial. The boy felt pain in the left gluteal area while running. Comparison of arthroscopic suturebridge technique and. Clinical outcomes and repair integrity of arthroscopic. There have been few studies comparing clinical and radiological outcomes between the conventional and knotless suturebridge techniques. Suture bridge and transosseous techniques request pdf.
Tendon repair with pars using the knotless midsubstance speedbridge technique. When compared with double row technique, suture bridge repair has been thought to lead to improved contact area 19, 20, increased yield load, and reduced operative time. No knots are tied on the rotator cuff to minimize the tension on the cuff. The purpose of this study was to compare the biomechanical properties of a recently established modified suture bridge technique to a wellestablished transtibial pullout technique. Clinical and structural outcomes after arthroscopic. Once passed through the medial row, the sutures are then tied in a. Suture bridge technique has been achieving popularity in rotator cuff repair for the last few years. The suturebridge technique, a tendontobone repair, has become a popular method for arthroscopic rotator cuff repair.
Distal triceps speed bridge repair arthroscopy techniques. The suture bridge sb technique and conventional doublerow dr are both effective in repair of fullthickness rotator cuff tears. A suture anchor was used to hold the avulsed fragment and a knotless anchor was. Article pdf available in arthroscopy techniques 56. As a clinical consequence, suturebridge technique should be considered to fix small pcl avulsion fractures at the tibial insertion site. An increase in the suture tension caused by swelling of the wound may be released by turning the capstan in the reverse direction. Even though the study of biomechanical properties of masonallen suture bridge technique was not performed, we have commonly used the masonallen suture bridge repair technique for rotafig. Shoulder, arthroscopy, rotator cuff, suture bridge repair technique. In this technique, the remaining intact cuff tissue is not sacrificed. Fiftythree patients with clinical and structural evaluations 3, 12, and 24 months postoperatively were included and divided into 29 patients with medial. This technique is used to suture tubular structures such as blood vessels in order to stop bleeding or reestablish blood flow horizontal continuous mattress sutures. Knotless suture bridge technique in highgrade bursal.
Modified suturebridge technique for tibial avulsion. The sb technique has greater ultimate failure load and less gap formation than the dr technique. Triplerow modification of the suturebridge technique for. Suture bridge fixation technique for posterior cruciate. Identify proper suture material as indicated by wound. Pdf we present a new method of suture bridge technique for medial row fixation using a modified masonallen stitch instead of a horizontal. To analyze the clinical efficacy of arthroscopic suture bridge in the treatment of traumatic shoulder dislocation and rotator cuff injuries, the present study analyzed 150. Repeat for the three remaining sutures to create a horizontal mattress configuration. Arthroscopic suture bridge repair technique for full. We present a method for repairing an rc tear using doublerow suture anchors in a transosseous equivalent suture bridge technique.
However, increasing numbers of scholars believe that the sb technique produces better results than conventional dr because of the higher bonetendon contact area and pressure. The patients with rotator cuff tears, who were treated by suture bridge technique under arthroscopy, were followed for more than 6 months, and assessed for the clinical results by joa score and repair condition by mri. Flying swan arthroscopic labral repair using a tensioned suture bridge construct. Arthroscopic suture bridge fixation of tibial eminence. This technique may ultimately provide better functional outcomes by. Subscapularis tendon repair using suture bridge technique article pdf available in arthroscopy techniques 42 march 2015 with 125 reads how we measure reads. Basic suturing skills and techniques boston college. Suturebridge technique for tibial avulsion fractures of. However, it requires longer operating times and is costlier. Clinical results of arthroscopic rotator cuff repair with.
Evaluation of the functional results after rotator cuff arthroscopic. All specimens were operated on by use of the suturebridge technique, only differing in terms of the medialrow suturegrasping configuration. Various surgical procedures have been reported, but achieving sufficient fixation strength is difficult. The purpose of this study was to evaluate and compare the functional outcomes and repair integrity of arthroscopic conventional and knotless suturebridge technique for fullthickness rotator cuff tears. Certain anatomical areas like the retroauricular skin, are prone to wound inversion, and this is an indication for placing horizontal continuous mattress sutures. Original article observation of arthroscopic suture bridge. Suturebridge subscapularis tendon repair technique using. Research article biomechanical comparison of modified suture bridge using ripstop versus traditional suture bridge for rotator cuff repair ziyingwu, 1 chongzhang, 2,3 pengzhang, 1 tianwuchen, 1 shiyichen, 1 andjiwuchen 1 department of sports medicine. The needle should be grasped between to 12 of the distance between the suture attachment and. Suture bridge fixation technique for posterior cruciate ligament avulsion fracture kwang won lee, md, dae suk yang, md, gyu sang lee, md, and won sik choy, md department of orthopedic surgery, eulji university school of medicine, daejeon, korea. Arthroscopic reduction and internal fixation of displaced greater tuberosity fractures with the suturebridge technique described by us provide adequate fixation with improvement of the pressurized contact area of the fracture and can be used as an additional modality of arthroscopic treatment.
Thus far, there are no established surgical techniques for removing the calcific materials while ensuring cuff integrity. Based on biomechanical studies, this technique has been suggested as an effective method that could optimize rotator cuff tendonfootprint contact area and mean pressure, as well as holding strength. Preloaded suture anchors are placed medially on the glenoid neck, and. Good clinical results for rotator cuff repair were achieved by using an arthroscopic suture bridge technique in patients with longstanding calcific tendinitis. Pdf biomechanical comparison of modified suture bridge using. This allows superior wrist mobility than if the fingers are placed in the handle loops. In brief, sliding stitches are placed in the medial row. Disclosures there has been no commercial support or sponsorship for this program. We treated a 12yearold male trackandfield athlete with avulsion fracture of the ischial tuberosity by suture anchor fixation using the suture bridge technique. The suture bridge technique tended to better preserve the cuff tissue repaired to the insertion site of the rotator cuff than a singlerow technique did. However, barber et al showed tripleloaded suture anchors perform in a superior fashion to sb technology. Under this subheading, youll find links to some of the more advanced suturing techniques employed for wound closure in emergency medicine practice.