Illustration comparing two arthroscopic rotator cuff repair techniques: one with medial knot tying and one without.

Shoulder Pain After Surgery? Unveiling the Truth About Rotator Cuff Repair Techniques

Lena Voss in Health & Wellness December 2025 • 6 min read.

"Discover the latest research on arthroscopic rotator cuff repair and how different methods affect your recovery and long-term shoulder health."

Shoulder pain can be debilitating, significantly impacting your quality of life. For those suffering from rotator cuff tears, arthroscopic rotator cuff repair (ARCR) offers a promising solution. But with various surgical techniques available, understanding which approach is best is essential for a successful outcome. This article breaks down a recent study comparing two popular methods: suture bridge techniques with and without medial knot tying. We'll explore the findings and discuss how these techniques influence your recovery and long-term shoulder health.

ARCR is a minimally invasive procedure that aims to repair the torn tendons of the rotator cuff, a group of muscles and tendons that surround the shoulder joint. While the surgery itself is crucial, the specific technique used can have a significant impact on healing, pain levels, and overall function. The choice of technique can affect factors like initial fixation strength and the potential for re-tears, making it a key consideration for both surgeons and patients.

This article examines the outcomes of patients who underwent ARCR using different suture bridge techniques. Suture bridge techniques are designed to provide robust initial fixation. However, the addition of medial knot tying, while intended to enhance the repair, has raised questions. By comparing these two approaches, we aim to provide clarity on which method may offer the best chance for a full recovery and a return to pain-free shoulder function.

Suture Bridge Techniques: A Closer Look

Illustration comparing two arthroscopic rotator cuff repair techniques: one with medial knot tying and one without.

The study focused on two variations of the suture bridge technique, both commonly used in ARCR. These methods involve using sutures to bridge the torn tendon back to the bone. The critical difference lies in the presence or absence of medial knot tying. In the technique with medial knot tying, surgeons tie knots in a medial row, theoretically enhancing the repair's biomechanical strength. The technique without medial knot tying, on the other hand, relies on the suture bridge alone for fixation.

The study included 124 patients who underwent ARCR. They were divided into two groups: one with medial knot tying (WMT) and one without (WOMT). The researchers then meticulously assessed clinical and structural outcomes over 3, 12, and 24 months post-surgery. The clinical evaluations included the University of California Los Angeles (UCLA) and Japanese Orthopaedic Association (JOA) scores, which measure shoulder function and pain. Structural outcomes were evaluated using magnetic resonance imaging (MRI) to assess the integrity of the repair and identify any re-tears.

Clinical Outcomes: Both WMT and WOMT groups showed significant improvements in JOA and UCLA scores over time, indicating improvements in function and pain reduction. There were no significant differences between the two groups in terms of these clinical outcomes.
Re-tear Rates: The study found no significant difference in the rates of re-tears (Sugaya types 4 and 5) between the two groups at any of the follow-up points (3, 12, and 24 months).
Healing: While complete healing (Sugaya type 1) rates were similar between the groups at 3 and 12 months, the WOMT group showed significantly better complete healing at 24 months. Conversely, the WMT group had a significantly higher number of incomplete healing cases (Sugaya types 2 and 3) at 24 months.

The findings suggest that both techniques can improve shoulder function and reduce pain. However, the study highlights a potential concern with medial knot tying. While re-tear rates were similar, the increased incidence of incomplete healing in the WMT group at 24 months raises questions about the long-term structural integrity of the repair. This suggests that, while medial knot tying may not impact clinical outcomes in the short term, it could potentially affect the durability of the repair over time.

Key Takeaways and Implications for Patients

This research provides valuable insights for both patients and surgeons. It emphasizes the importance of considering the long-term structural outcomes when choosing a surgical technique. For patients, this means having an informed discussion with your surgeon about the potential benefits and drawbacks of each approach. While both techniques can provide pain relief and improved function, the study suggests that the technique without medial knot tying may offer a better chance for complete healing and long-term durability. As always, individual results may vary, and the best approach depends on various factors, including the size and type of tear, patient age, and activity level. Consulting with your surgeon to determine the most appropriate treatment plan for your specific needs is always recommended.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1186/s13018-018-0990-z, Alternate LINK

Title: Clinical And Structural Outcomes After Arthroscopic Rotator Cuff Repair: A Comparison Between Suture Bridge Techniques With Or Without Medial Knot Tying

Subject: Orthopedics and Sports Medicine

Journal: Journal of Orthopaedic Surgery and Research

Publisher: Springer Science and Business Media LLC

Authors: Hirokazu Honda, Masafumi Gotoh, Yasuhiro Mitsui, Hidehiro Nakamura, Ryo Tanesue, Hisao Shimokobe, Naoto Shiba

Published: 2018-11-22

Everything You Need To Know

What is arthroscopic rotator cuff repair (ARCR), and why is it important?

Arthroscopic rotator cuff repair (ARCR) is a minimally invasive surgical procedure designed to mend torn tendons of the rotator cuff. This is crucial because the rotator cuff, comprising muscles and tendons around the shoulder joint, is vital for shoulder movement and stability. When these tendons tear, ARCR becomes necessary to restore function and alleviate pain, significantly improving a patient's quality of life.

What are suture bridge techniques in ARCR, and how do they work?

Suture bridge techniques in ARCR use sutures to reconnect the torn tendon of the rotator cuff back to the bone. The main goal of these techniques is to establish a robust initial fixation, ensuring the tendon is securely anchored. There are variations, with and without medial knot tying. The technique without medial knot tying depends on the suture bridge alone for fixation, while the one with medial knot tying, adds knots in a medial row to potentially enhance biomechanical strength.

What is the difference between the suture bridge technique with and without medial knot tying?

The key difference lies in how the sutures are secured. In the suture bridge technique with medial knot tying (WMT), surgeons add knots in a medial row to the sutures, aiming to boost the repair's strength. The technique without medial knot tying (WOMT), on the other hand, relies solely on the suture bridge for fixation. The study examines the effects of these distinct methods on patient outcomes post-ARCR.

How do the clinical outcomes of the suture bridge techniques with and without medial knot tying compare?

Both the suture bridge technique with medial knot tying (WMT) and the technique without medial knot tying (WOMT) demonstrated significant improvements in shoulder function and pain reduction, as measured by UCLA and JOA scores. However, the study found no significant difference in these clinical outcomes between the two groups. This indicates that both methods can effectively improve patient function and decrease pain in the short term after arthroscopic rotator cuff repair (ARCR).

What do the study findings suggest about the long-term outcomes of the two suture bridge techniques, and what does this mean for patients?

The study revealed similar re-tear rates between the suture bridge technique with medial knot tying (WMT) and the technique without medial knot tying (WOMT) at all follow-up points. However, the WOMT group showed significantly better complete healing at 24 months. The WMT group had a significantly higher incidence of incomplete healing (Sugaya types 2 and 3) at 24 months. This suggests that while WMT may not impact initial clinical outcomes, it might affect the repair's durability over time. For patients, this means discussing the potential for complete healing and long-term durability with their surgeon, and understanding that the WOMT technique may offer better long-term structural integrity.