The Application of H-Loop in Arthroscopic Knotless Double-Row Rotator Cuff Repairs

Objective To determine the functional outcomes after a novel method of H-loop knotless double-row technique in patients with rotator cuff tears. Method From June 2020 to September 2020, a total of six patients (five women, one man) with arthroscopic rotator cuff repair using the H-loop knotless double-row technique were enrolled in our study. The average age is 54 years (range: 50-61 years). The preoperative and final follow-up clinical outcome were evaluated using the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS), University of California Los Angeles (UCLA) score, and Constant-Murley score. The active shoulder range of motion (ROM) was also collected preoperatively and postoperatively at the final follow-up (forward flexion and abduction). Accordingly, intraoperative and postoperative complications were observed as well. Result There were six patients that underwent arthroscopic rotator cuff repair using the H-loop knotless double-row technique. The average follow-up period was 7.52 +/- 0.70 months. The VAS, UCLA, ASES, and Constant-Murley scores improved from 5 +/- 2.45, 15.67 +/- 3.44, 47.67 +/- 17.41 and 49.17 +/- 8.98 preoperatively, to 0.83 +/- 0.75, 36.27 +/- 3.83, 91.67 +/- 10.76 and 85.83 +/- 4.31 at the final follow-up, with statistical significances of P = 0.009, P < 0.001, P = 0.006, and P = 0.001, respectively. Meanwhile, the active shoulder ROM (forward flexion and abduction) improved from 135.00 +/- 46.80 and 125 +/- 56.48 preoperatively, to 173.67 +/- 4.13 and 172 +/- 3.27 at final follow-up, respectively (P = 0.082, P = 0.088). During the follow-up, there were no postoperative complications such as wound-site infection, nerve or vessel damage, subcutaneous hematoma, and suture anchor problems. Conclusion With the benefit of reducing the possibility of strangulation and blood supply affection for the rotator cuff, The H-loop knotless double row technique may be an alternative method to significantly improve subjective functional outcomes and increase the healing rate of medium-sized rotator cuff tears with degeneration issues and poor tissue quality.