Comparison of arthroscopic knot-tying and knotless suture-bridge rotator cuff repair techniques: Randomized prospective clinical trial

Objective: Arthroscopic rotator cuff repair (RCR) is one of the most commonly performed procedures in routine practice. Recently, new techniques such as suture-bridge (SB) RCR have been developed in an attempt to improve the results. However, one of the most serious matters after surgery is still the retear rate. In recent studies; knot-tying and knotless SB RCR techniques have been evaluated but the results are controversial; each technique has its own advantages and shortcomings. Besides that, there have been few studies comparing clinical and structural outcomes of these two techniques. The aim of this study is to compare clinical and structural outcomes of two arthroscopic SB RCR techniques which are medial knot-tying and knotless SB RCR Patients and Methods: This study is a randomized controlled single-blinded prospective clinical trial. We enrolled 75 patients who underwent arthroscopic SB RCR with a diagnosis of full thickness rotator cuff tear. Regarding the repair technique, 37 shoulders were enrolled in a conventional knot-tying SBT group (group A) and 38 shoulders in a knotless SBT group (group b). The mean age at the time of operation was 53.84±9.89 in group A and 55.63±7.70 in group B. The mean follow-up period was 21.54±7.71 months in group A and 19,91±6,26 months in group B. Clinical outcomes comprised pain scores (visual analogue scale – VAS), range of motion (ROM) values and Constant scores. Structural outcomes were evaluated with postoperative magnetic resonance images (MRI) according to the Sugaya's classification after a mean of 9.4±2.15 months. Results: There were no differences between two groups regarding age, gender, body mass index, preoperative pain scores, fonctional scores and ROM values as well as anteroposterior extension and retraction size of tear on preoperative MRIs. Mean VAS score decreased from 7.29±1.85 to 1.15±2 in group A and from 7.38±1.77 to 0.95±1.78 in group B (p<0.01). Mean Constant score increased from 52.32±13.25 to 87.27±10.87 in group A and from 49.29±19.51 to 87.29±15.47 in group B (p<0.01). According to the postoperative MRIs, the retear rate was 18.9% (7/37) in group A and 31.6% (12/38) in group B. Medial cuff failure rate in the retorn shoulders was 71.4% (5/7) in group A and 25% (3/12) in group B. No statistical difference was found regarding clinical outcomes, retear rates and retear patterns between two groups (p>0,05). Conclusion: Both SB RCR techniques achieved succesful clinical outcomes without significant difference between two groups. A higher retear rate was seen in the knotless SB technique, however the difference was not significant.