Arthroscopic double-locked stitch: a new technique for suturing rotator cuff tears.

There are a number of reasons for failed rotator cuff tear repair. In such cases the suture-tendon interface seems to be the most vulnerable area, especially when tendon degeneration is present. We describe a new technique, the arthroscopic double-locked suture, that increases the tendon fixation and has the added benefit of being placed parallel to the blood vessels, therefore avoiding damage to the tendon vascularization. The suture may be achieved by use of knots or knotless anchors and suture passers, without the need for any additional instrumentation. The new technique is especially helpful in cases in which the tendon is retracted and degeneration is present, impeding the use of the double-row technique or its transosseous equivalents.

Comparison between the acromion index and rotator cuff tears in the Brazilian and Japanese populations.

BACKGROUND: We compared the acromion index, a lateral tilt of the acromion described by Nyffeler et al as a possible cause of rotator cuff tears (RCTs), in 2 different populations: Brazilian and Japanese. METHODS: Patients with full-thickness RCTs diagnosed by magnetic resonance imaging and corroborated by intraoperative findings were included in this study. Controls were patients with shoulder radiographs that indicated instability or adhesive capsulitis. The studied population was subdivided into 2 major racial groups: Brazilian and Japanese. We compared 83 Brazilian adults (mean age, 54 years) with RCTs with 28 individuals with intact rotator cuffs matched by sex, age, and race. Similarly, 112 Japanese individuals (mean age, 59 years) with RCTs were compared with 56 controls. The radiographic images were digitally scanned (HP DeskJet F4180; Hewlett-Packard, Palo Alto, CA, USA) and analyzed. RESULTS: The mean acromion index of the Brazilian patients with RCTs was 0.72; 0.68 was the result for the Japanese patients. When patients with RCTs were compared with those with intact rotator cuffs, a statistically significant difference was found in the Brazilian population (P = .001) but not in the Japanese population (P = .18). Therefore, Brazilian subjects with RCTs were found to have a greater lateral extension of the acromion than those with intact rotator cuffs. Such a difference, however, was not observed in the Japanese population. CONCLUSION: The acromion index can be used as a predictive factor for RCTs in the Brazilian population but not in the Japanese population.