Knot impingement after rotator cuff repair: is it real?

Abstract

The purpose of this study was to compare morphologic features of the acromion after 2 different repair methods (single-row [SR] repair with a minimum of 4 knots and suture-bridge [SB] repair with minimal knots) in medium to large rotator cuff tears. From May 2005 to July 2012, 1,693 rotator cuff repairs were performed, among them medium to large tears requiring more than 2 anchors for repair; those who had 6-month postoperative magnetic resonance imaging (MRI) scans were included (221 shoulders). They were divided into 2 groups; group A (SR repair) and group B (SB repair). Acromial morphologic characteristics were evaluated using MRI 6 months postoperatively. An acromial defect was defined as an irregular defect or erosion on the flat acromion. Clinical measurements were performed using the American Shoulder and Elbow Surgeons (ASES) score, Constant score, visual analogue scale (VAS) pain score, and range of motion (ROM). Erosion in the acromion was observed in 2 of 118 patients (1.7%) in group A and in 1 of 103 (1%) patients in group B. There was no statistically significant difference between the 2 groups (P = .796). A statistically significant improvement was observed in the clinical scores measured (P = .0043). ROM was not fully recovered to the preoperative level at 6 months postoperatively. Acromioplasty was performed in 2 of 3 patients with acromial erosion. There was acromial erosion in one patient in group A without performing subacromial decompression. Our study showed that there was no difference in acromial erosion in high-profile knots made by an SR compared with double-row (DR) SB low-profile repairs. Level III, retrospective comparative study.