The use of the anterior tendinous portion of the supraspinatus muscle as a central point for rotator cuff repair - 03/04/25

Doi : 10.1016/j.otsr.2025.104236

Thomas Cuinet ^a,^b,⁎ , Lucie Schnedecker ^c, Bouchra Assabah ^d,^e, Nguyen Tran ^f, François Sirveaux ^a,^f, Adrien Jacquot ^b,^g
^a Chirurgie Orthopédique et Traumatologique, Centre Chirurgical Émile Gallé, CHRU de Nancy, 54000 Nancy, France
^b Clinique Louis Pasteur, 54270 Essey-lès-Nancy, France
^c Service d’anatomopathologie, CHRU de Nancy, 54000 Nancy, France
^d Médecine Physique et de Réadaptation, CHRU de Nancy, 54000 Nancy, France
^e Institut d’Anatomie Normale, Faculté de médecine de Nancy, 54000 Nancy, France
^f École de Chirurgie, Faculté de Médecine de Nancy, Université de Lorraine, 54000 Nancy, France
^g ARTICS - Chirurgie des Articulations et du Sport, 54000 Nancy, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 03 April 2025

Abstract

Introduction

Double-row repairs with knots on the medial row carry a risk of secondary lesions at the myotendinous junction. Knotless double-row repairs imply dependence between rows, sometimes resulting in a failure to properly apply the medial row, and the systematic use of 4 anchors. The anterior tendinous portion of the supraspinatus muscle appears to be a promising anatomical landmark and support point for the medial row in an optimized independent double-row technique.

Hypothesis

This technique provides results equivalent to those published about rotator cuff repair and reduces the risk of medial secondary rupture and the number of implants used.

Materials and methods

This study includes an initial histopathological analysis of the supraspinatus muscle, complemented by an in vivo arthroscopic observation of its anterior tendinous portion in a consecutive series of arthroscopy procedures on shoulders with intact rotator cuffs. We present a technique for independent double-row repair using 2 (or 3) anchors, with a single knot on the medial row relying on the anterior tendinous portion of the supraspinatus muscle, and lateral tension-band sutures. In this study, we report the clinical and ultrasound outcomes from a preliminary prospective series of 20 patients with distal supraspinatus tears at a 2-year follow-up.

Results

The anterior tendinous portion of the supraspinatus was found in 100% of patients in our arthroscopic analysis. Regarding the surgical technique, the median number of anchors was 2. At 2-year follow-ups, the median Constant score was 84.5, and the Subjective Shoulder Value score was 93%. No complications were recorded. Tendon healing was achieved in 100% of cases (Sugaya stage I or II).

Conclusion

This independent double-row repair technique relying on the anterior tendinous portion of the supraspinatus muscle provides a solid medial row fixation, minimizing the risk of secondary myotendinous injury, and an appropriate anatomical landmark, allowing for a more anatomic repair. It is a simple and reproducible technique requiring a limited number of implants and demonstrating satisfactory clinical outcomes and tendon healing rate.