Abstract:

Background

A large rotator cuff tear is when a tendon in the rotator cuff muscle group breaks or falls offaround the shoulder joint. At least one of the tendons is involved. Common large rotator cufftears involve tendons in the rotator cuff muscle group， including supraspinatus， infraspinatus， teres minor， and subscapularis tendons. Large rotator cufftear has a great impact on patients'daily life. It weakens the stability of the shoulder joint， which increases the risk of shoulder dislocation. In recent years， the arthroscopic repair technique in the treatment of rotator cufftears has received more and more attention from doctors and patients. Among them，the arthroscopic modified load-sharing rip-stop technique （mLSRS） and the double-row suture bridge technique are two commonly used methods for the treatment of large rotator cufftears. mLSRS technology is a repair method that combines arthroscopy and traditional surgery. Through arthroscopic joint surface preparation， the torn edge of the rotator cuffcan be cleaned up， which can reduce surgical trauma and postoperative pain and help promote the early functional recovery of the shoulder joint. The double-row suture bridge technique crosses the suture lines in the tendons on both sides of the rotator cufftear to form a stable structure similar to a "bridge"， thus achieving the repair of the rotator cufftear. The advantage of this technique is that it can provide a more stable repair and reduce the risk of retearing after surgery. However， the efficacy of the two kinds of surgery is still controversial in the academic circle， and the research reports on the treatment mechanism of the two kinds of surgery are rarely studied.

Objective

To investigate the effect of modified barrier line tension （mLSRS） and double-row suture bridge under arthroscopy in treating large rotator cuff tears and to analyze its prognosis.

Methods

A total of 84 patients with large rotator cuff tears diagnosed and treated in our hospital from January 2019 to December 2021. According to the different treatment methods， 41 cases were divided into the mLSRS group， and the double-row suture bridge group （43 cases）. The mLSRS group was treated with the arthroscopic mLSRS technique， while the double-row suture bridge group was treated with the double-row suture bridge technique. The VAS score， Constant Murley score， UCLA score， ASES score， shoulder range of motion， prognosis， and complications were compared between the two groups before and 1 year after surgery.

Results

One year after surgery， the VAS scores in both groups were decreased compared with those before surgery （P＜0.05）， and the Constant-Murley score， UCLA score， and ASES score in both groups were increased compared with those before surgery （P＜0.05）. However， the VAS score， Constant-Murley score， UCLA score， and ASES score in the mLSRS group were compared with those in the double-row suture bridge group， and there was no statistical significance （P＞0.05）. One year after surgery， the lateral pronation decreased in both groups compared with that before surgery （P＜0.05）. The anterior flexion， abduction，and lateral pronation increased in both groups than before surgery （P＜0.05）. Still， there was no statistical significance in the ranges of anterior flexion， abduction， lateral pronation， and lateral pronation in the mLSRS group compared with those in the double-row suture bridge group （P＞0.05）.The healing rate in the mLSRS group was 95.12%， which was significantly higher than that in the double-row suture bridge group （79.07%）（P＜0.05）. The retear rate in the mLSRS group was 4.88%， which was significantly lower than that in the double-row suture bridge group （20.93%） （P＜0.05）. The incidence of complications in the mLSRS group was 9.76%， which was not statistically significant compared with 6.98% in the double-row suture bridge group （P＞0.05）.

Conclusion

The arthroscopic mLSRS and double-row suture bridge techniques in treating large rotator cufftears can effectively relieve pain and improve shoulder function and motion with high safety. However， the arthroscopic mLSRS technique can improve the healing rate of the rotator cuffmore effectively， reduce the retear rate， and improve the prognosis.

Key words: Arthroscopy, Improved barrier line tension reduction, Double-row suture bridge technique, Large rotator cufftear, Prognosis