A MULTICENTRE RETROSPECTIVE COHORT STUDY COMPARING CONVENTIONAL DOUBLE-ROW WITH SUTURE BRIDGE FIXATION IN ARTHROSCOPIC ROTATOR CUFF REPAIRS

Double-row and suture bridge techniques have emerged as effective methods for arthroscopic rotator cuff repair (ARCR). Biomechanical studies have shown that suture bridge technique improves contact areas and mean pressure between the tendon and footprint, which may facilitate healing. However, few studies have directly compared both techniques. Our primary objective was to compare the functional outcomes of double-row versus suture bridge fixation in patients undergoing ARCR. The secondary objectives were to compare healing rates between the two groups as well as investigate any factors associated with healing. This was a secondary analysis of previous randomized controlled trials. Two hundred and ten patients underwent ARCR at one of three tertiary-level university hospitals. A total of 42 patients underwent conventional double-row fixation and 168 underwent suture bridge repair. Functional outcomes measures included the Western Ontario Rotator Cuff Index, the American Shoulder and Elbow Surgeons score, and the Constant score measured at baseline as well as at 3-, 6-, 12- and 24-months post-operatively. Healing rates were determined by ultrasound at 24-months post-operatively. No statistically significant differences were found between outcomes at any of the follow-up times, except a significant difference observed in Constant total score at 24-months in favor for the double-row group (85.5 and 80.5 for double row and suture bridge respectively, p=0.04). The changes from baseline were statistically significant for all outcomes in both groups (p<0.0001). Healing rates were 77.8% for double row and 82.5% for suture bridge (OR, 95% CI:1.34 (0.53,3.38), p=0.53). Multivariable regression analysis showed a strong positive correlation between non-healing rates and size of rotator cuff tear in the sagittal plane (OR, 95% CI:1.97 (1.02,3.78) p=0.043). A statistically significant, but not clinically relevant difference was observed in Constant score at 24-months in favor of double-row fixation. The remaining outcomes measures and healing rates were similar between group. An association was found between non-healing rates and the size of the rotator cuff tear in the sagittal plane.