Arthroscopic rotator cuff repair with and without medial knot tying.

Rotator Cuff Repair: Is Knot Tying Necessary?

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Avery Sinclair in Health & Wellness August 2025 • 4 min read.

"A new study examines if arthroscopic rotator cuff repair techniques with or without medial knot tying impacts clinical and structural outcomes."


Rotator cuff tears are a common issue, affecting a significant portion of the adult population, especially as we age. When conservative treatments don't provide relief, surgery becomes a viable option. Arthroscopic rotator cuff repair (ARCR) is well-regarded for restoring function and alleviating pain, but the risk of re-tears remains a concern despite advancements in surgical techniques.

The suture bridge technique has become increasingly popular in ARCR as surgeons seek to improve initial fixation, maximize the contact area between the tendon and bone, and enhance mechanical stability during healing. This method often involves knot tying in the medial row due to its perceived biomechanical advantages. However, some research suggests that medial tying might lead to strangulation and other complications.

A recent study has explored and compared clinical results of suture bridge techniques, considering both functional and structural outcomes. The aim was to determine whether knot tying in the ARCR impacts structural integrity and overall success rates. By examining these factors, healthcare professionals and patients can make more informed decisions about rotator cuff repair strategies.

Knot Tying in Rotator Cuff Repair: Does It Really Matter?

Arthroscopic rotator cuff repair with and without medial knot tying.

A study published in the Journal of Orthopaedic Surgery and Research investigated the impact of medial knot tying in arthroscopic suture bridge rotator cuff repair. The researchers compared outcomes in patients who underwent ARCR using suture bridge techniques with medial knot tying (WMT group) to those without medial knot tying (WOMT group).

The study included 124 patients with rotator cuff tears who underwent ARCR. Fifty-three patients with both clinical and structural evaluations at 3, 12, and 24 months postoperatively were divided into two groups: 29 patients with medial tying (WMT group) and 24 patients without medial tying (WOMT group). Researchers assessed clinical outcomes using the University of California Los Angeles (UCLA) and Japanese Orthopaedic Association (JOA) scores. Structural outcomes were evaluated using magnetic resonance images (MRI) based on the Sugaya classification system.

The key findings from the study are:
  • Clinical Improvements: Both WMT and WOMT groups showed significant improvements in JOA and UCLA scores from before surgery to 24 months post-surgery.
  • No Significant Clinical Difference: There was no significant difference in clinical outcomes between the two groups at any point during the 24-month follow-up.
  • Similar Retear Rates: The incidence of postoperative retears (Sugaya types 4 and 5) was similar between the WMT and WOMT groups at 3, 12, and 24 months.
  • Healing Differences: Complete healing (Sugaya type 1) was observed more frequently in the WOMT group at 24 months postoperatively (P = 0.024).
  • Incomplete Healing: Incomplete healing (Sugaya types 2 and 3) was more common in the WMT group at 24 months (P = 0.024).
These results suggest that while both techniques lead to comparable clinical improvements, the structural outcomes differ. Specifically, medial knot tying may hinder complete tendon healing over the long term.

Implications for Rotator Cuff Repair Techniques

While both suture bridge techniques provide similar clinical benefits, the study indicates that medial knot tying may lead to less complete tendon healing at 24 months post-surgery. Surgeons should consider these findings when selecting a repair technique, especially for patients where long-term structural integrity is a major concern. Further research may explore alternative methods to enhance tendon healing and improve patient outcomes.

About this Article -

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Everything You Need To Know

1

What is the primary focus of the study on arthroscopic rotator cuff repair (ARCR)?

The study focuses on comparing arthroscopic rotator cuff repair techniques, specifically evaluating the impact of medial knot tying on clinical and structural outcomes. It investigates whether the use of medial knot tying in the suture bridge technique affects the success of the repair in terms of both function and tendon healing. The aim is to inform decisions about the best approach for patients undergoing ARCR.

2

What are the key differences in outcomes between patients who had medial knot tying (WMT) and those who did not (WOMT) during ARCR?

Both the WMT and WOMT groups showed significant improvements in clinical scores (UCLA and JOA) over 24 months, with no significant clinical differences between them. However, structural outcomes differed. The WOMT group showed more frequent complete healing (Sugaya type 1) at 24 months. Conversely, incomplete healing (Sugaya types 2 and 3) was more common in the WMT group at 24 months, suggesting that medial knot tying might hinder complete tendon healing.

3

How does the study define and measure 'clinical outcomes' in arthroscopic rotator cuff repair?

Clinical outcomes in the study were evaluated using the University of California Los Angeles (UCLA) and Japanese Orthopaedic Association (JOA) scores. These scores likely assess a range of factors like pain levels, range of motion, and overall function of the shoulder. By using these standardized scoring systems, researchers could systematically compare the recovery and functional improvement of patients in the WMT and WOMT groups.

4

Can you explain the role of the suture bridge technique and why knot tying is used in arthroscopic rotator cuff repair?

The suture bridge technique is a method used in arthroscopic rotator cuff repair to improve initial fixation of the tendon to the bone, maximize the contact area for healing, and enhance mechanical stability. Medial knot tying is often employed in this technique because it is thought to offer biomechanical advantages. However, the study suggests that this method may potentially hinder complete tendon healing over time, which is a concern due to the possibility of strangulation and other complications.

5

What are the implications of these findings for surgeons and patients considering arthroscopic rotator cuff repair?

The study's findings suggest that while both techniques (with and without medial knot tying) provide similar clinical benefits, the structural outcomes may differ. Surgeons should consider these results when choosing a repair technique, especially if long-term tendon integrity is a priority. The study emphasizes the importance of evaluating structural outcomes and their impact on healing. Patients and surgeons should discuss the potential trade-offs between different techniques, considering factors like the patient's age, activity level, and the severity of the tear to optimize the repair strategy.

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