Is there a clinical difference between suture bridge and speed bridge (arthroscopic rotator cuff repair techniques) in terms of outcomes for rotator cuff repair?

From the Guidelines

Both the suture bridge and speed bridge techniques are effective for arthroscopic rotator cuff repair, with no significant clinical differences in outcomes. The speed bridge technique is essentially a modification of the suture bridge that allows for faster procedure time while maintaining similar biomechanical properties. Both techniques create a double-row repair with a compression footprint that maximizes tendon-to-bone contact area and initial fixation strength. The speed bridge uses fewer suture passes and knots, which can reduce operative time by approximately 15-20 minutes.

Key Points

• Both approaches demonstrate comparable healing rates, functional outcomes, and re-tear rates in clinical studies, with reported healing rates of 70-90% and similar improvements in pain and range of motion 1.
• The choice between techniques often depends on surgeon preference, experience, and specific patient factors rather than clear clinical superiority of one method over the other.
• For surgeons learning arthroscopic rotator cuff repair, the traditional suture bridge may provide better visualization of the repair process, while experienced surgeons may prefer the speed bridge for its efficiency.

Considerations

• An arthroscopic approach is recommended as it reduces postoperative pain 1.
• The use of platelet-rich plasma supplementation in the rotator cuff repair setting has inconsistent procedure-specific evidence and is therefore not recommended 1.
• Interscalene brachial plexus blockade is recommended as the first-choice regional analgesic technique, and a single dose of intravenous dexamethasone is recommended for its ability to increase the analgesic duration of interscalene brachial plexus block, decrease analgesic use and anti-emetic effects 1.

From the Research

Clinical Outcomes

• The study 2 compared the clinical outcomes and cuff integrity of the triple-row and suture-bridge techniques in arthroscopic rotator cuff repair for Fosbury flop tears, and found that the triple-row technique demonstrated a significantly higher 24-month postoperative JOA score and significantly lower retear rate.
• Another study 3 compared clinical outcome between the Speed-Bridge technique and single-row techniques in patients with full-thickness rotator cuff tears, and found that there were no significant differences in clinical outcome between the 2 groups.
• The study 4 evaluated the functional outcome of arthroscopic rotator cuff repair with double-row knotless vs knot-tying anchors, and found that the scores in both treatment groups improved at twelve months follow-up, but there was no statistical difference between both groups.

Repair Integrity

• The study 2 found that the triple-row technique demonstrated a significantly lower retear rate compared to the suture-bridge technique.
• The study 3 found that the retear rates of medium and large-sized rotator cuff tear groups were higher in the single-row repair group than in the Speed-Bridge repair group.
• The study 5 reported a low retear rate of 4.9% using a triple-row modified suture bridge technique for the treatment of full-thickness rotator cuff tears with medium and high grades of retraction.

Comparison of Techniques

• The study 2 compared the triple-row and suture-bridge techniques, and found that the triple-row technique was an effective method compared with the suture-bridge technique in cases with Fosbury flop tears.
• The study 3 compared the Speed-Bridge technique and single-row techniques, and found that the Speed-Bridge technique may be a considerable alternative method for treating full-thickness rotator cuff-tears.
• The study 5 reported good to excellent clinical results using a triple-row modified suture bridge technique for the treatment of full-thickness rotator cuff tears with medium and high grades of retraction.