Arthroscopic side-to-side repair of massive and contracted rotator cuff tears using a single uninterrupted suture: the shoestring bridge technique.

Purpose: This study was performed to evaluate the clinical effectiveness of a new side-to-side repair technique for massive rotator cuff tears using a single uninterrupted suture in the configuration of a shoestring in a medial-to-lateral progression.

Methods: Thirty-one consecutive patients with a mean age of 59 years (SD, 4.7 years) had primary arthroscopic repair of their massive, U-shaped, contracted supraspinatus and infraspinatus tear by the shoestring bridge technique. Preoperatively and postoperatively, we measured active forward flexion and determined the visual analog scale score for pain, Simple Shoulder Test score, and Disabilities of the Arm, Shoulder and Hand (DASH) score. Repair integrity was evaluated by ultrasonography.

Results: At a mean follow-up of 26.5 months, all scores had significantly improved: active forward flexion, mean of 70° (SD, 29°) preoperatively to 139° (SD, 39°) postoperatively (P < .001); visual analog scale score for pain, 8.0 ± 1.4 points to 2.5 ± 1.8 points (P < .001); Simple Shoulder Test score, 15% ± 19% to 72% ± 23% (P < .001); and Disabilities of the Arm, Shoulder and Hand score, 62 ± 17 points to 21 ± 14 points (P < .001). Ultrasound evaluation showed that 25 of 31 patients (81%) had heeled tendons. Of 31 patients, 6 (19%) had a complete retear. Only 3 of these 6 patients were not satisfied with the result.

Conclusions: Arthroscopic side-to-side repair by the shoestring bridge technique is effective in the treatment of massive, U-shaped, contracted supraspinatus and infraspinatus tears. It provides the shoulder surgeon a treatment modality with significant improvement in pain and function, high patient satisfaction, and a low retear rate.

Level Of Evidence: Level IV, therapeutic case series.