Elsevier

Journal of Shoulder and Elbow Surgery

Volume 13, Issue 6, November–December 2004, Pages 664-667
Journal of Shoulder and Elbow Surgery

Original articles
Passive tension and gap formation of rotator cuff repairs

https://doi.org/10.1016/j.jse.2004.03.011Get rights and content

Abstract

The objectives of this study were to quantify the relationship between passive tension of rotator cuff repairs and arm position and to examine the effect of this tension on repair gap formation. Five patients undergoing open surgical rotator cuff repair of the supraspinatus tendon were recruited. Tendon tension was recorded as the supraspinatus was advanced into a bone trough and secured. The relationship between arm position and repair tension was then measured. Standardized rotator cuff tears were created in 3 cadaveric shoulders and repaired by use of the intraoperative technique. The difference in tension measured between 0° and 30° abduction was statically applied for 24 hours and the gap formation measured. Repair tension increased with advancement of the supraspinatus tendon into the bone trough. Abduction reduced the repair load. The mean reduction in load by 30° abduction was 34 N. Twenty-four hours of 34-N loading caused gap formation of 9 mm in cadaveric rotator cuff repairs. Passive tension in surgically repaired rotator cuffs may contribute to repair failure and can be modified by arm positioning.

Section snippets

Materials and methods

We recruited 5 patients (mean age, 58 years; age range, 43–67 years; 3 women and 2 men) all undergoing open surgical repair of the right rotator cuff. The indication for surgery was pain and weakness. Exclusion criteria were previous rotator cuff repair, glenohumeral arthritis, and tears considered irreparable by the senior surgeon. A combination of general anesthetic and interscalene block was used.

A single surgeon using a standardized technique performed the operations. First, an

Intraoperative findings

At surgery, it was found that two tears were small (<2 cm in length) and three were large (2–4 cm in length). Two of the large tears included some tears of the superior fibers of the subscapularis. The infraspinatus was intact in all patients; thus, the repairs were considered isolated repairs of the supraspinatus. There were no complications resulting from the additional measurement, which added 19 minutes to the length of the procedure (range, 7–37 minutes).

Data were lost from one patient

Discussion

The first hypothesis for this study was that passive tension in a supraspinatus tendon repair could be modified by changing the position of the arm. The second hypothesis was that the change in tension measured with passive alteration in arm position would be sufficient to affect postoperative gap formation.

This study found that 30° abduction of the arm after a rotator cuff repair reduced the tension at the point of measurement by a mean of 34 N compared with that measured at 0° abduction. The

References (14)

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    All these growth factors return to near physiological levels 16 weeks post-injury, establishing a connection between their in vivo upregulation and tissue repair (Chen et al., 2008; Würgler-Hauri et al., 2007). Despite this response by the body to heal, gaps often form between the tendon and bone after surgical repair of large rotator cuff tears (Reilly et al., 2004), which impair tendon structural and mechanical outcomes (Killian et al., 2014). Growth factors, being potent morphogens, can reduce the gap formation by promoting new tissue formation at the interphase by increasing cellular migration, proliferation, differentiation, and matrix synthesis (Oliva et al., 2011).

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This project was funded in part by the Royal College of Surgeons of England, the Wishbone Trust, and the Arthritis Research Campaign.

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