Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleA Biomechanical Comparison of 2 Transosseous-Equivalent Double-Row Rotator Cuff Repair Techniques Using Bioabsorbable Anchors: Cyclic Loading and Failure Behavior
Section snippets
Methods
In this study 20 Merino sheep shoulders (10 pairs; mean age, 1 year) were harvested and frozen at −20°C before testing. Each specimen was allowed to thaw before dissection, surgical site preparation, and testing. The infraspinatus muscle is the most developed rotator cuff muscle in the sheep and has been used in prior studies for evaluation of anchoring constructs.18, 22, 23 The infraspinatus tendon and humeral attachment were carefully dissected and isolated, and the remaining rotator cuff
Cyclic Loading
There were no statistically significant differences noted between group A and group B during the cyclic loading test (Table 1). Gap formation was not significantly different between the 2 groups in either the first or last cycle. Strain recorded over the repair area was also not significantly different between the 2 groups in either the first or last cycle. For both group A and group B, all specimens survived the cyclic loading testing without obvious defect or deformity.
Tensile Testing to Failure
Overall, the results
Discussion
There were no major statistical differences between the novel stitch configuration using 4 insertion anchors and the conventional TOE double-row construct using 2 suture anchors and 2 insertion anchors. Therefore our initial hypothesis must be rejected.
It has been suggested that the suture-tendon interface remains the most likely site of failure of rotator cuff repair.26 Indeed, in our study 19 of 20 specimens failed at the tendon-suture interface. Multiple studies have concluded that
Conclusions
Both tested rotator cuff repair techniques had high failure loads, limited gap formation, and acceptable strain patterns. No significant difference was found between the novel and conventional double-row repair types.
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Cited by (48)
Triple-Row Technique Confers a Lower Retear Rate Than Standard Suture Bridge Technique in Arthroscopic Rotator Cuff Repairs
2021, Arthroscopy - Journal of Arthroscopic and Related SurgeryEditorial Commentary: Anterior Cable Reconstruction for the Shoulder Superior Capsule: Time for “Indication Rounds”
2021, Arthroscopy - Journal of Arthroscopic and Related SurgeryDoes the Anchor Eye Alignment Affect the Performance of the Rotator Cuff Repair? A Biomechanical Study
2021, Arthroscopy, Sports Medicine, and RehabilitationCitation Excerpt :Immediately after anchor fixation, each humeral shaft was clamped to a custom device (fixture) with bone cement (polymethyl methacrylate). This device was then placed in the servo-hydraulic testing machine (MTS Bionix model 370.02; MTS Systems, Minneapolis, MN) ensuring an angulation of 135° between the humeral axis and loading direction, re-creating the vector of force that would occur after a rotator cuff repair.7 The free end of the wire was fixed with a surgeon’s knot in the load cell, leaving a gage length of 30 mm between the knot and the anchor, as shown in Fig 1.
Comparison of clinical outcomes between knotted and knotless double-row arthroscopic rotator cuff repairs: a meta-analysis
2021, JSES InternationalCitation Excerpt :Studies have suggested that theoretically, knotted techniques, compared with knotless techniques, allow for superior biomechanical stability of repairs but are inferior biologically as they potentially can result in strangulation of tissue and thus inadequate blood flow for long-term healing. However, studies have revealed no significant difference in biomechanical stability of both repair techniques.24 Some of the more likely causes of medial rotator cuff failure after arthroscopic double-row repair are tension overload at the suture-tendon interface and over-tensioning of the medial repair.25
Biomechanical analysis of four different medial row configurations of suture bridge rotator cuff repair
2019, Clinical BiomechanicsArthroscopic Rotator Cuff Repair With a Knotless Suture Bridge Technique: Functional and Radiological Outcomes After a Minimum Follow-Up of 5 Years
2019, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :Furthermore, the use of suture tapes enhances the apposition of the tendon on the footprint.12,29 The tension is distributed more evenly with less risk of “cut-through resistance” on the medial part of the suture as has been described with knot-tyed sutures on the medial row.13,16 This may also explain why we did not observe any iterative tear on the medial part.
Supported by Arthrex, Naples, Florida. The authors report no conflict of interest.