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

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.

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.

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.

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.