Comparison of clinical and biomechanical results of arthroscopic rotator cuff repair using conventional and triple-row suture-bridge techniques

Background The suture-bridge technique (SBT), with its various modifications, is frequently utilized in rotator cuff tear repairs. This study aimed to assess and compare the clinical and radiological tendon integrity outcomes of conventional and triple-row SBTs in patients with full-thickness rotator cuff tears (RCTs). Additionally, it evaluated the construct strength of each technique through biomechanical experiments. We hypothesized that the triple-row SBT would yield better clinical and radiological outcomes, as well as superior biomechanical properties, compared to the conventional SBT. Methods A retrospective evaluation was conducted on 62 patients who underwent arthroscopic rotator cuff repair using either conventional or triple-row SBT from January to December 2019. The conventional SBT was performed on 26 patients, while the triple-row SBT was used on 36 patients. Clinical evaluations were conducted preoperatively, and at 1 and 2 years post-surgery using the ASES; UCLA; Constant scores; and VAS scores. Magnetic resonance imaging was performed before surgery, and the postoperative rotator cuff integrity was evaluated 6 months after surgery. Mechanical testing on seven pairs of sawbone and allodermal patch models was also performed. These specimens underwent horizontal and vertical axial load tests on a material testing machine, and the ultimate failure load was measured. Results Both techniques significantly improved the clinical outcomes at postoperative 1 and 2 years ( p < .001), with no significant difference between-group ( p > .05). The retear rate was 19.2% in the conventional group and 11.1% in the triple-row group, but the difference was not statistically significant ( p = .379). The failure load of the triple-row suture-bridge technique was higher than that of conventional suture-bridge technique. Conclusion Both the conventional and triple-row SBT techniques were effective in achieving favorable clinical outcomes in patients with full-thickness rotator cuff tears, with no statistically significant differences between the two groups. Although the triple-row technique suggested a potential for a reduced retear rate, the difference was not statistically significant. However, in our biomechanical study, the triple-row SBT demonstrated superior mechanical stability compared to the conventional technique. Specifically, the triple-row configuration showed greater resistance to displacement under cyclic loading and improved load distribution across the repair site. These findings suggest that the triple-row SBT may offer biomechanical advantages that could contribute to enhanced structural integrity of the repair, especially in challenging cases.