Mid-term clinical outcomes after net-like bridging arthroscopic rotator cuff repair: a minimum 5-year follow-up study

This is the authors' abstract. We don't add key points for this paper.

Background The purpose of arthroscopic rotator cuff repair (ARCR) is to achieve pain reduction and functional improvement for rotator cuff tears. We have adopted the net-like bridging ARCR, a double-row suture-bridge technique. The technique has demonstrated biomechanical superiority in terms of footprint coverage and contract pressure, thereby supporting clinical application. The purpose of this study is to investigate mid-term clinical outcomes and cuff integrity on magnetic resonance imaging after net-like bridging ARCR. Methods Between 2013 and 2014, ARCR was performed on 44 patients with symptomatic full-thickness rotator cuff tears, specifically focusing on those with a maximum tear size of 20 mm or more. Of these patients, 22 patients who consented to participate and returned for follow-up evaluation at a minimum of five years post-operatively were included. The mean age at surgery was 65.8 years (range, 54.6-79.7 years). Active range of motion, clinical score, Cofield classification, and Sugaya classification were investigated. Retear was defined according to the Sugaya classification as types 4 and 5. A P value less than .05 was significant. Results Mean follow-up period was 71.3 months (range, 62.9-79.6 months). There were 20 males (91%) and 2 females. The Cofield classification was as follows: medium (6 cases), large (8 cases), and massive (8 cases). For active range of motion, flexion increased from pre-operative 131° ± 42° to final 159° ± 12° ( P < .05). The Japanese Orthopedic Association score also improved from a pre-operative value of 62.1 ± 11.5 points to 93.9 ± 5.1 points at final follow-up ( P < .01). The Constant score at final follow-up was 88.2 ± 11.9 points. Sugaya classification at 1 year and final follow-up are shown below, there was no significant difference: 1 year, type 1: 10; type 2: 3; type 3: 3; type 4: 5; type 5: 1; at final follow-up, type 1: 9; type 2: 3; type 3: 4; type 4: 2; type 5: 4. The retear rate was 27.3%, and no new retears occurred between 1 year post-operatively and the final follow-up. Conclusion Net-like bridging ARCR for medium-sized or larger full-thickness rotator cuff tears (≥20 mm) results in a retear rate of 27.3%, with no new retears beyond 1 year at a mean follow-up of 71.3 months (minimum 5 years), and sustained muscle strength in patients without retear. Despite the low follow-up rate, two-time-point evaluation in large tears (≥20 mm) provides clinically relevant mid-term outcomes.