Purpose The purpose of this study was to investigate the rate at which antegrade suture passers successfully passed through both the articular and bursal layers of the rotator cuff in partial- and full-thickness tears at the anterior, middle, and posterior portions of the rotator cuff during arthroscopic repair of rotator cuff tears. Methods A consecutive series of arthroscopic rotator cuff repairs performed by a single surgeon were evaluated. An antegrade suture passer was used to pass sutures through the rotator cuff in each procedure. Successful suture placement was assessed intraoperatively by the surgeon as the ability to capture both bursal (superficial) and articular (deep) tendon layers, categorized as either a “successful” or “missed” suture placement, and success rates were calculated for each rotator cuff. Success rates were compared by tear size (<20 mm vs. ≥20 mm), tear morphology (partial-thickness vs. full-thickness), and suture position (anterior, middle, posterior). Statistical analyses were performed using the Kruskal-Wallis Test and Mann-Whitney U Test with significance set at p<0.05. Results 102 shoulders were included in the study. The overall success rate of the suture passer was 60.56%. The mean age at operation was 61.04 ± 8.3 years (40-75 years), with a mean tear size of 20.0 ± 6.8mm (10-55mm). Although no significant difference was determined between partial-thickness (64.83%, n=29) and full-thickness tears (58.86%, n=73) (p=0.517), tears ≥ 20mm in the posterior portion of the tendon had a significantly lower success rate (45.61%, n=57) compared to the anterior and middle portions (p=0.037). Conclusion The antegrade suture passer demonstrated an overall moderate success rate, with reduced efficacy in larger tears and in the posterior part of the tendon where delamination and deep retraction are more prevalent. Surgeons should exercise caution when using this device in complex tear morphologies with delamination of the tendon layers and in tears ≥ 20mm involving the posterior aspect of the tendon.
Moon et al. (Sun,) studied this question.