Arthroscopic-modified transosseous rotator cuff repair using the giant needle technique and racking hitch knot

Hafez, Moustafa R.M.; El Shewy, Mohamed T.; El-Singergy, Abdel A.; Hashem, Moataz O.; Zawam, Sherif H.; Azzam, Ahmed H.

doi:10.4103/eoj.eoj_86_24

Arthroscopic-modified transosseous rotator cuff repair using the giant needle technique and racking hitch knot

Authors

Abstract

Background
While rotator cuff repairs yield a good outcome, arthroscopic repair using double-row anchors is expensive, especially in large and massive tears. Transosseous repair is a cost-effective way that can lead to excellent results, and modifying a previously described technique makes it reliable, easy to use, and feasible.
Purpose
This study analyzed the midterm functional outcomes of arthroscopic transosseous rotator cuff repair using special needles called giant needles. The aim of revisiting and modifying a previously described technique is to facilitate the passage of the giant needle, making it easier and more reliable. We also enhanced the repair construct by passing the sutures through the tendon in a separate step and applying a strong racking hitch knot.
Patients and methods
Sixty-two patients (41 females and 21 males, mean age 55.16 years) underwent arthroscopic transosseous rotator cuff repair for symptomatic full-thickness tears. Preoperative and postoperative pain severity, the constant shoulder score of the affected shoulders and the subjective value of the shoulders were recorded. Patients were followed up at 3, 6, 12, and 24 months after surgery.
Statistical analysis
Data were statistically described in terms of mean±SD, median and range, or frequencies (number of cases) and percentages when appropriate. IBM SPSS (Statistical Package for the Social Sciences) release 22 for Microsoft Windows was used for all statistical analyses.
Results
The mean pain severity improved from 8.61 preoperatively to 1.73 after 2 years of surgery. Similarly, the mean preoperative constant shoulder score and shoulder subjective value enhanced from 41.29 to 88.72 and 42.85 to 92.15%, respectively. We recorded two cases of postoperative stiffness, and two other cases underwent arthroscopic revision of rotator repair due to traumatic cuff retears.
Conclusion
The transosseous modified technique with a giant needle is reliable and safe, yielding satisfactory midterm outcome scores. This technique combines the minimally invasive advantage of arthroscopic procedures with the cost-effectiveness and biomechanical advantages of open transosseous procedures. Further comparative studies are recommended to support our results.

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