The arthroscopic bone needle. A new, safe and cost-effective technique for rotator cuff repair

Background. Reconstruction of a rotator cuff tendon tear using transosseous sutures was the gold standard when surgery was still done open or mini-open and has the advantage of no implants and cost-effectiveness. Arthroscopic rotator cuff repair is less invasive but suture anchors are expensive. This abstract will introduce a novel technique for treatment of arthroscopic rotator cuff repair combining the advantages of an arthroscopic procedure and transosseous sutures. The purpose of the study was to evaluate the clinical results, patient satisfaction, short-term rerupture rates with magnetic resonance imaging (MRI) and hardware costs of this procedure. Material and Methods. From August 2008 to November 2009 a total of 66 patients with a tear of the supraspinatus tendon were treated using an arthroscopic bone needle. Patients were evaluated with the constant score (CS), patient satisfaction and complications. The hardware costs of a supraspinatus reconstruction using the arthroscopic bone needle were documented and compared in each case to the hardware costs using the estimated number of suture anchors that would have been necessary. A separate study was performed to evaluate the rerupture rate after supraspinatus reconstruction whereby 20 consecutive patientstreated from July 2010 to January 2011 had an MRI 3 months postoperatively and were evaluated by independent radiologists using the criteria of Sugaya. The arthroscopic bone needle technique is based on the Giant Needle (R) method but changes in the design, material and in the surgical technique were made to allow multiple usage of the needle and (in contrast to the Giant Needle (R) method) the sutures were first made in the bone and not in the tendon, which allows the surgeon to decide how and where the sutures penetrate the tendon and what configuration of sutures and knots should be made. Results. The 60 patients (including 25 women, mean age 61 years) were examined approximately 1 year postoperatively at follow-up and 6 patients had an additional infraspinatus rupture and 16 a subscapularis rupture. The acromioclavicular (AC) joint was resected in 41 and the long head of the biceps was treated in 45 patients. The average CS was 73 (SD 12) which equals a CS normalized for age and gender of 92% (SD 15) and 56 patients (93%) were satisfied or very satisfied with the surgery. No axillary nerve injuries or fractures of the greater tuberosity occurred. The hardware costs of a supraspinatus reconstruction were reduced by 80% using the arthroscopic bone needle technique compared to suture anchors (121 EUR versus 600 EUR) and 2 patients (10%) suffered a rerupture of the reconstructed tendon in the MRI. Conclusion. The arthroscopic bone needle technique proved to be a new, safe and cost-effective method with good clinical results and low rerupture rate for the repair of rotator cuff ruptures.