Suture de coiffe sous arthroscopie : meilleurs résultats de l’IRM pour la suture transosseuse comparé avec une technique ancrée standard

Aim To compare the outcome of patients operated using either suture anchors vs a new anchorless transosseous (TO) technique for rotator cuff (RC) repair. We hypothesize that healing at the footprint (FP) as observed on MRI might be better with the anchorless approach. Background The former gold standard of open TO RC repair can now be mimicked arthroscopically. Since 5 years we use the Arthrotunneler (AT) system with 2 bone tunnels and 4-5 high strength sutures in an X-Box configuration for medium to large tears of supra- and infraspinatus, which would otherwise require a four anchor construct. Our impression was that the TO technique provides excellent outcomes and high healing rates. Methods We compared 2 cohorts: Cohort A prospectively includes 50 consecutive patients operated since 12/13 with the AT-device (Tornier, Wright); cohort B entails a retrospective series of 35 patients operated earlier. Included were non-retracted tears with a sagittal extension of 2.5 to 4 cm. Group A was operated without, group B with 4 anchors (Speed-bridge, Arthrex). Groups A and B were comparable in regards to age, sex and tear size. After a minimum of 2 years clinical outcome scores and a native MRI were obtained. Tendon quality and FP integration were evaluated using the Sugaya classification by an independent radiologist. Statistics: ANOVA and Wilcoxon test. Results Excluding 9 patients who declined, FU data are available from 44 patients in group A and 32 in B. Constant Score improved from 49 to 89P in group A vs. 46 to 86P in B (p = 0.66). The SSV rose from 45 to 95 % in group A vs from 44 to 93 % in B (p = 0.84). MRI showed no retears in group A vs 3 retears (= 9 %) in B. Comparing the Sugaya types we observed a significant (p = 0.002) shift to the more favorable Sugaya types I and II (normal & near normal) with 82 % in group A vs 50 % in B. Conclusions The study confirms that anchorless TO RC repair is a good alternative to established suture anchor techniques. The technique can easily be learned by the experienced arthroscopist. Clinical outcome data show equivalent results for both techniques. With EUR 700 vs 1100 material costs are lower for the anchorless technique. The healing results as observed on MRI are superior, maybe due to enhanced blood flow at the FP provided by the bone tunnels.