Low-Tension Triple-Row Repair Preserves Medial Cuff Perfusion After Lateral Fixation: A Prospective Intraoperative Study
Satoshi Miyake, Terufumi Shibata, Shunsuke Kobayashi, Kotaro Miyazaki, Kei Matsunaga, Naofumi Hata, Masahiko Sakai, Teruaki Izaki, Takuaki YamamotoBackground:
Medial cuff failure has been recognized as a characteristic structural failure pattern after arthroscopic rotator cuff repair, particularly in association with transosseous-equivalent (suture-bridge) constructs. Previous biomechanical and clinical studies have suggested that stress concentration at the medial row and excessive repair tension may contribute to this failure pattern. In addition, recent intraoperative studies have demonstrated that increased repair tension can reduce intratendinous microvascular perfusion, suggesting that the mechanical environment at the time of repair may influence tendon biology and healing.
Purpose:
To evaluate intraoperative changes in medial cuff microvascular perfusion immediately before and after lateral fixation during low-tension staged bridge repair.
Study Design:
Descriptive laboratory study.
Methods:
A total of 30 consecutive patients with full-thickness rotator cuff tears underwent arthroscopic repair using a triple-row (staged bridge) technique under controlled low-tension conditions (≤10 N). Intraoperative microvascular blood flow at the medial cuff was measured using a contact laser Doppler flowmeter immediately before and after lateral fixation. Pre- and postfixation perfusion values were compared within patients, and the post-/prefixation ratio was calculated to express the relative change. Clinical outcomes, including visual analog scale score, Japanese Orthopaedic Association score, University of California Los Angeles score, Simple Shoulder Test score, and range of motion, were evaluated preoperatively and at final follow-up. Structural integrity was assessed by magnetic resonance imaging at 1 year.
Results:
Perfusion measurements were obtained in all patients. Median absolute perfusion was 2.15 mL/min/100 g (IQR, 1.58-3.55) before lateral fixation and 2.20 mL/min/100 g (IQR, 1.20-4.53) after lateral fixation, with no significant difference between time points (
Conclusion:
Medial cuff perfusion remained stable after lateral fixation under controlled low-tension conditions in predominantly small- to medium-sized rotator cuff tears. These findings suggest that intraoperative tension management may be an important factor influencing the local biologic environment during rotator cuff repair.
Clinical Relevance:
Low-tension repair may preserve medial cuff perfusion.