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Rinaldi VG, Iacopo S, Coliva F, Favero A, Bazzocchi A, Miceli M, Di Paolo S, Zaffagnini S, Marcheggiani Muccioli GM. Double-row suture-bridge technique does not yield better clinical and radiological results than single-row technique in patients older than 55 years at 2 years minimum follow-up: A comparative study. J Exp Orthop 2025; 12:e70056. [PMID: 40330814 PMCID: PMC12053094 DOI: 10.1002/jeo2.70056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/02/2024] [Accepted: 08/07/2024] [Indexed: 05/08/2025] Open
Abstract
Purpose Arthroscopic rotator cuff repair has evolved, with suture anchor-based techniques like single-row (SR) and Double-row Suture-bridge (DRSB) gaining popularity. Despite improvements, early repair failures remain concerning, necessitating continued assessment of repair methods and devices' lasting impact. This study compares DRSB versus SR repairs at 24 months minimum follow-up, hypothesizing superior clinical outcomes and improved tendon healing with DRSB techniques. Methods Fifty patients with rotator cuff tears underwent either SR or DRSB repairs. Clinical evaluation included standardized scoring systems and strength testing. Magnetic Resonance Imaging (MRI) assessed tendon integrity. Partial cuff tears were evaluated according to Snyder's Southern California Orthopaedic Institute rotator cuff classification system, which classifies <2 cm lesions as C2 in its scoring system. Results Both groups showed comparable clinical outcomes, strength and MRI findings at 24 months minimum follow-up. No significant correlation was found between repair technique and clinical outcomes or retear rates. Preoperative Patte and Goutallier grades >1 were associated with lower postoperative Constant-Murley scores. Conclusion This study suggests that both SR and DRSB techniques offer comparable clinical outcomes and tendon healing rates for rotator cuff tears in patients over 55 at 24 months minimum follow-up. While limitations exist, our findings contribute to understanding optimal surgical approaches, emphasizing individualized treatment based on patient characteristics and surgeon expertise. Further research, including randomized controlled trials with long-term follow-up, is needed to refine treatment algorithms and improve patient outcomes in rotator cuff surgery. Level of Evidence Level III.
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Affiliation(s)
- Vito Gaetano Rinaldi
- II Clinica Ortopedica e Traumatologica—IRCCS Istituto Ortopedico RizzoliBolognaItaly
- DIBINEMUniversity of BolognaBolognaItaly
| | | | | | | | - Alberto Bazzocchi
- Radiologia Diagnostica ed Interventistica—IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Marco Miceli
- Radiologia Diagnostica ed Interventistica—IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Stefano Di Paolo
- II Clinica Ortopedica e Traumatologica—IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica—IRCCS Istituto Ortopedico RizzoliBolognaItaly
- DIBINEMUniversity of BolognaBolognaItaly
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2
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Kumar PV, Sugath S, Mohan V, Moharana AK, Angrish S, TS D. Assessing clinical and patient reported outcomes of Sironix suture anchors in rotator cuff and Bankart repair surgeries. World J Orthop 2024; 15:1183-1190. [DOI: 10.5312/wjo.v15.i12.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 11/05/2024] [Accepted: 12/05/2024] [Indexed: 12/17/2024] Open
Abstract
BACKGROUND Rotator cuff tears and Bankart lesions significantly affect shoulder function and quality of life. Arthroscopic rotator cuff repair and Bankart repair has become the standard treatment for restoring function and reducing pain. Recent advancements include new suture anchor technologies, such as the Sironix suture anchor known for its biomechanical strength and promising outcomes. However, there are limited real-world data on its effectiveness and safety, particularly in the Indian population.
AIM To evaluate the effectiveness and safety of Sironix suture anchors in rotator cuff and Bankart repair surgeries.
METHODS Sixty participants underwent surgery between January 2021 and December 2022, and demographic data and postoperative outcomes were collected through retrospective reviews and telephonic interviews. Validated scales, including the PENN Shoulder Score (PSS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Single Assessment Numeric Evaluation (SANE), were utilized for assessment.
RESULTS Treatment with Sironix suture anchor devices, including Ceptre Knotted UHMWPE Suture Titanium Anchor, Spyke Knotted UHMWPE Suture Peek Anchor, Stativ Knotted UHMWPE Suture Anchor, and Viplok Knotless Peek Screw Anchor with Titanium Tip, revealed no repair failures. Participants demonstrated high satisfaction and functional improvement, as evidenced by the mean Quick DASH score (32.01) and PSS (71.65) and the satisfactory SANE scores for both injured joints (74.33) and non-injured (83.67) shoulder joints.
CONCLUSION The study yielded favorable outcomes for rotator cuff tear repair and Bankart repair. No repair failures were observed, supporting the safety and efficacy of these devices in shoulder injury management.
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Affiliation(s)
| | - Subin Sugath
- Department of Orthopedic Oncology, Aster Medcity, Kochi 682027, Kerala, India
| | - Vijay Mohan
- Department of Orthopedics, Aster Medcity, Kochi 682027, Kerala, India
| | - Ashok Kumar Moharana
- Department of Clinical Affairs, Healthium Medtech Limited, Bangalore 560058, Karnātaka, India
| | - Sachin Angrish
- Department of Clinical Affairs, Healthium Medtech Limited, Bangalore 560058, Karnātaka, India
| | - Deepak TS
- Department of Clinical Affairs, Healthium Medtech Limited, Bangalore 560058, Karnātaka, India
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3
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Gumina S, Song HS, Kim H, Candela V. Arthroscopic evaluation of the rotator cuff vasculature: inferences into the pathogenesis of cuff tear and re-tear. Clin Shoulder Elb 2024; 27:203-211. [PMID: 38863404 PMCID: PMC11181063 DOI: 10.5397/cise.2024.00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/15/2024] [Accepted: 03/28/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Little is known about alterations of the rotator cuff (RC) macroscopic vasculature associated with medical conditions and/or habits that predispose a person to diseases of the peripheral microcirculation. The high frequency of cuff tear and re-tear in patients with diabetes, hypercholesterolemia, uncontrolled arterial hypertension, or metabolic syndrome may be due to tissue hypovascularity. METHODS The macroscopic vasculature of both the articular and bursal sides of the posterosuperior RC was evaluated arthroscopically in 107 patients (mean age, 58.2 years) with no RC tear. Patients were divided into three groups according to medical comorbidities and lifestyle factors (group I, none; group II, smokers and/or drinkers and one comorbidity; and group III, two or more comorbidities). Pulsating vessels originating from both the myotendinous and osteotendinous junctions were assessed as "clearly evident," "poorly evident," or "not evident." RESULTS Groups I, II, and III comprised 36, 45, and 26 patients, respectively. Within the myotendinous junction, vessels were visualized in 22 group I patients (61%), 25 group II patients (55%), and 6 group III patients (23%) (P=0.007). Pulsating arterial vessels originating from the osteotendinous junction were seen in 42%, 36%, and 0% of patients, respectively (P<0.001). Within the bursal side of the RC, a dense anastomotic network was visualized (either clearly or poorly) in 94% (34), 80% (36), and 35% (9) of patients, respectively (P<0.001). CONCLUSIONS The macroscopic vasculature of the RC is influenced by pre-existing diseases and lifestyle factors, which may impair peripheral microcirculation. Level of evidence: III.
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Affiliation(s)
- Steafano Gumina
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
- Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - Hyun Seok Song
- Department of Orthopaedics Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyungsuk Kim
- Department of Orthopaedics Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Vittorio Candela
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy
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Chernchujit B, Mendoza CJP, Samsuya KKM. Blended Suture-bridge Technique for Arthroscopic Rotator Cuff Repair. Arthrosc Tech 2023; 12:e569-e574. [PMID: 37138682 PMCID: PMC10150159 DOI: 10.1016/j.eats.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/28/2022] [Accepted: 12/10/2022] [Indexed: 05/05/2023] Open
Abstract
Techniques in rotator cuff repair are constantly evolving, with the main goal of a biologic, stable, and tension-free construct. Significant controversy exists between various methods, and there is no gold standard surgical protocol. We demonstrate an alternative arthroscopic rotator cuff repair technique with 2 key components. First, we performed a transosseous equivalent, suture bridge technique with a combination of triple-loaded medial anchors and knotless lateral anchors. Second, we incorporated 2-strand and 3-strand suture shuttling through the torn rotator cuff and selective medial knot-tying. A total of 6 passes through the tendon are made, comprising 1-2-3-3-2-1 strands each pass. This minimizes the number of passes through the tendon and the overall number of medial knots. Our technique retains the known biomechanical advantages akin to a double-row repair, including less gap formation and wider footprint coverage. In addition, using fewer medial knots with efficient suture passing may result to decreased cuff strangulation and favorable biologic environment for tendon healing. We theorize that this technique may yield lower retear rates while maintaining immediate stability, translating to improved clinical results.
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Affiliation(s)
| | - Christian Julius P. Mendoza
- Address correspondence to Christian Julius P. Mendoza, M.D., Thammasat University Hospital, Pathum Thani, Thailand 12120.
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Lapner P, Henry P, Athwal GS, Moktar J, McNeil D, MacDonald P. Treatment of rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:e120-e129. [PMID: 34906681 DOI: 10.1016/j.jse.2021.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is ongoing controversy regarding optimal treatment for full-thickness rotator cuff tears. Given that the evidence surrounding the use of various treatment options has expanded, an overall assessment is required. OBJECTIVES The following were compared to determine which resulted in improved patient-reported function, pain, and reoperation rates for each: (1) double-row (DR) fixation and single-row (SR) fixation in arthroscopic cuff repair; (2) latissimus dorsi transfer (LDT) with lower trapezius transfer (LTT), partial rotator cuff repair, and superior capsular reconstruction (SCR); and (3) early and late surgical intervention. METHODS Medline, Embase, and Cochrane were searched through to April 20, 2021. Additional studies were identified from reviews. The following were included: (1) All English-language randomized controlled trials (RCTs) in patients ≥18 years of age comparing SR and DR fixation, (2) observational studies comparing LDT with LTT, partial repair, and SCR, and (3) observational studies comparing early vs. late treatment of full-thickness rotator cuff tears. RESULTS A total of 15 RCTs (n = 1096 randomized patients) were included in the meta-analysis of SR vs. DR fixation. No significant standardized mean differences in function (0.08, 95% confidence interval [CI] -0.09, 0.24) or pain (-0.01, 95% CI -0.52, 0.49) were observed. There was a difference in retear rates in favor of DR compared with SR fixation (RR 1.56, 95% CI 1.06, 2.29). Four studies were included in the systematic review of LDT compared with a surgical control. LDT and partial repair did not reveal any differences in function (-1.12, 95% CI -4.02, 1.78) on comparison. A single study compared arthroscopically assisted LDT to LTT and observed a nonstatistical difference in the Constant score of 14.7 (95% CI -4.06, 33.46). A single RCT compared LDT with SCR and revealed a trend toward superiority for the Constant score with SCR with a mean difference of -9.6 (95% CI -19.82, 0.62). Comparison of early vs. late treatment revealed a paucity of comparative studies with varying definitions of "early" and "late" treatment, which made meaningful interpretation of the results difficult. CONCLUSION DR fixation leads to similar improvement in function and pain compared with SR fixation and results in a higher healing rate. LDT transfer yields results similar to those from partial repair, LTT, and SCR in functional outcomes. Further study is required to determine the optimal timing of treatment and to increase confidence in these findings. Future trials of high methodologic quality comparing LDT with LTT and SCR are required.
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Affiliation(s)
- Peter Lapner
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
| | - Patrick Henry
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - George S Athwal
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, Western University, London, ON, Canada
| | - Joel Moktar
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Daniel McNeil
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, Western University, London, ON, Canada
| | - Peter MacDonald
- Section of Orthopaedic Surgery & The Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada
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Hackl M, Nacov J, Kammerlohr S, Staat M, Buess E, Leschinger T, Müller LP, Wegmann K. Intratendinous Strain Variations of the Supraspinatus Tendon Depending on Repair Technique: A Biomechanical Analysis Regarding the Cause of Medial Cuff Failure. Am J Sports Med 2021; 49:1847-1853. [PMID: 33872064 DOI: 10.1177/03635465211006138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Double-row (DR) and transosseous-equivalent (TOE) techniques for rotator cuff repair offer more stability and promote better tendon healing compared with single-row (SR) repairs and are preferred by many surgeons. However, they can lead to more disastrous retear patterns with failure at the medial anchor row or the musculotendinous junction. The biomechanics of medial cuff failure have not been thoroughly investigated thus far. PURPOSE To investigate the intratendinous strain distribution within the supraspinatus tendon depending on repair technique. STUDY DESIGN Controlled laboratory study. METHODS Twelve fresh-frozen cadaveric shoulders were used. The intratendinous strain within the supraspinatus tendon was analyzed in 2 regions-(1) at the footprint at the greater tuberosity and (2) medial to the footprint up to the musculotendinous junction-using a high-resolution 3-dimensional camera system. Testing was performed at submaximal loads of 40 N, 60 N, and 80 N for intact tendons, after SR repair, after DR repair, and after TOE repair. RESULTS The tendon strain of the SR group differed significantly in both regions from that of the intact tendons and the TOE group at 40 N (P≤ .043) and from the intact tendons, the DR group, and the TOE group at 60 N and 80 N (P≤ .048). SR repairs showed more tendon elongation at the footprint and less elongation medial to the footprint. DR and TOE repairs did not provide significant differences in tendon strain when compared with the intact tendons. However, the increase in tendon strain medial to the footprint from 40 N to 80 N was significantly more pronounced in the DR and TOE group (P≤ .029). CONCLUSION While DR and TOE repair techniques more closely reproduced the strains of the supraspinatus tendon than did SR repair in a cadaveric model, they showed a significantly increased tendon strain at the musculotendinous junction with higher loads in comparison with the intact tendon. CLINICAL RELEVANCE DR and TOE rotator cuff reconstructions lead to a more anatomic tendon repair. However, their use has to be carefully evaluated whenever tendon quality is diminished, as they lead to a more drastic increase in tendon strain medial to the footprint, putting these repairs at risk of medial cuff failure.
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Affiliation(s)
- Michael Hackl
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Julia Nacov
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Sandra Kammerlohr
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Manfred Staat
- Institute of Bioengineering, FH Aachen University of Applied Sciences, Jülich, Germany
| | | | - Tim Leschinger
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Lars P Müller
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
| | - Kilian Wegmann
- University of Cologne, Faculty of Medicine, Cologne, Germany.,University Hospital Cologne, Center of Orthopedic and Trauma Surgery, Cologne, Germany
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7
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Sakha S, Erdogan S, Shanmugaraj A, Betsch M, Leroux T, Khan M. Update on all-arthroscopic vs. mini-open rotator cuff repair: A systematic review and meta-analysis. J Orthop 2021; 24:254-263. [PMID: 33867750 DOI: 10.1016/j.jor.2021.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/23/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose To provide an updated comparison between modern arthroscopic and mini-open repairs for treating rotator cuff tears. Methods Multiple online databases were searched from 2010 to October 1st, 2020. A meta-analysis was conducted for patient-reported outcomes and complications. Results Eleven studies were included. Majority of patients underwent mini-open repair (MOR) compared to arthroscopic repair (AR) (57.4% vs 42.6%). A meta-analysis found statistically significant differences (p < 0.05) in patient-reported outcomes favouring AR. While retear rates were higher in AR (p = 0.03) analysis of retear rates for arthroscopic double row and mini-open repairs, yielded no differences between groups (p = 0.48). Conclusion Patients undergoing AR for rotator cuff tears had improved post-operative clinical outcomes in some functional outcomes compared to MOR. Modern arthroscopic double row repair result in similar failure rates to open repair techniques. Level of evidence Level III, Systematic Review of Level I-III studies.
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Affiliation(s)
- Seaher Sakha
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Safiya Erdogan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ajaykumar Shanmugaraj
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marcel Betsch
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Center of Orthopaedics and Trauma Surgery, University Hospital Mannheim, Medical Faculty University Heidelberg, Mannheim, Germany
| | - Timothy Leroux
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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8
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Wang Z, Long Z, Li H, Lu H, Gingery A, Amadio PC, Moran SL, Zhao C. A biomechanical comparison of a mesh suture to a polyblend suture in a porcine tendon model. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:450. [PMID: 33850847 PMCID: PMC8039690 DOI: 10.21037/atm-20-1065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background The suture-tendon interface turned out to be the weak point of a repaired rotator cuff. A double rip-stop (DRS) technique was developed to enhance the strength of the suture-tendon interface. The first aim of this study was to compare the suture-tendon interface strength between mesh suture and the No. 2 FiberWire (FW), which is commonly used in the clinic. The second aim was to compare the biomechanical properties of rotator cuff repair between mesh suture and No. 2 FiberWire using a typical suture-bridge (SB) and DRS techniques. Methods Eighteen porcine subscapularis tendon (SST) was randomly assigned to the Mesh-tendon group and FiberWire-tendon group. A single suture loop was passed through the SST with a Mesh suture or FiberWire. Thirty-two infraspinatus tendons (ISTs) were randomly assigned to four groups: SB-Mesh group: SB technique with Mesh suture, SB-FW group: SB technique with FiberWire, DRS-Mesh group: DRS technique with Mesh suture, and DRS-FW group: DRS technique with FiberWire. All repaired specimens were underwent failure testing. Failure modes, load to create a 3-mm gap, failure load, and stiffness were compared. Results There were no significant differences between the Mesh-tendon group and FiberWire-tendon group regarding the failure load, stiffness, and ultimate stress. When the same technique was used, the rotator cuff repaired with a mesh suture had the similar load to create a 3-mm gap, failure load, and stiffness compared with FiberWire. When the same suture was used, the DRS technique had a significantly higher load to create a 3-mm gap formation and failure load compared with the SB technique. Conclusions The repair failure strength and stiffness using the mesh suture were similar to the FiberWire suture regardless of the repair techniques. However, the repair strength in the DRS technique was significantly stronger than the SB technique when the same suture material was used.
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Affiliation(s)
- Zhanwen Wang
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Zeling Long
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hong Li
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hongbin Lu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Anne Gingery
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Peter C Amadio
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Steven L Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Chunfeng Zhao
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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9
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Tan KG, Lie DT, Yew AK, Chou SM. Gap formation after single lateral row versus dual-row suture bridge cuff repair: An ovine biomechanical model. J Orthop Sci 2020; 25:115-121. [PMID: 30914150 DOI: 10.1016/j.jos.2019.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/09/2019] [Accepted: 03/01/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study is to compare two types of suture bridging constructs; a laterally based bridging single row (SR) construct and a classic dual row (DR) suture bridge construct. The hypothesis is that the DR construct will demonstrate superior biomechanical properties. METHODS Six matched pairs of sheep infraspinatus tendon tears repaired with these two different types of suture bridging techniques were tested for gap formation, ultimate failure load and mode of failure. The specimens were pre-cycled for 10 cycles before they were subjected to a constant pre-load of 10N. The specimens were then subjected to cyclic loading at a speed of 8.33 mm/s. The test was stopped after every 500 cycles for a total of 3000 cycles. RESULTS Mean gap formation after 3000 cycles was lower in the DR group (0.81 ± 0.2 mm versus 2.44 ± 0.27 mm; p = 0.002). Mean change in gap (with every 500 cycles) was also lesser for the DR group after 1500 cycles. DR repairs failed at a higher load (523.4 ± 80.4 N) compared to the SR repairs (452.3 ± 66.3 N) but this did not reach significance. All repairs failed with sutures pulling through the tendon during load to failure testing. CONCLUSIONS Gap formation is significantly lower with a dual row suture bridge construct than a laterally based bridging single row construct. LEVEL OF EVIDENCE Biomechanical study.
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Affiliation(s)
- Kelvin G Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, 169608, Singapore.
| | - Denny Tt Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, 169608, Singapore.
| | - Andy Ks Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, 169608, Singapore.
| | - Siaw Meng Chou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Ave, 639798, Singapore.
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Rossi LA, Rodeo SA, Chahla J, Ranalletta M. Current Concepts in Rotator Cuff Repair Techniques: Biomechanical, Functional, and Structural Outcomes. Orthop J Sports Med 2019; 7:2325967119868674. [PMID: 31565664 PMCID: PMC6755640 DOI: 10.1177/2325967119868674] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
There is substantial evidence indicating that double-row (DR) repair restores
more of the anatomic rotator cuff footprint and is biomechanically superior to
single-row (SR) repair. Transosseous-equivalent (TOE) techniques have shown
biomechanical advantages when compared with traditional DR, including increased
contact at the rotator cuff footprint, higher pressure at the tendon-bone
interface, and increased failure strength. Several meta-analyses of evidence
level 1 and 2 studies have shown a lower rate of failed/incomplete healing when
DR repair was compared with SR repair types. There is some limited evidence that
TOE techniques improve healing rates in large and massive tears as compared with
SR and DR. Overall, most level 1 and 2 studies have failed to prove a
significant difference between SR and DR repairs in terms of clinical outcomes.
However, most studies include only short-term follow-up, minimizing the impact
that the higher rate of retears/failed healing seen with SR repairs can have in
the long term. There are no high-quality clinical studies comparing different DR
configurations, and there are currently not enough clinical data to determine
the functional advantages of various DR technique modifications over one
another. Although numerous biomechanical and clinical studies comparing
different rotator cuff repair techniques have been published in the past decade,
none has achieved universal acceptance. It is essential for the orthopaedic
surgeon to know in detail the available literature to be able to apply the most
appropriate and cost-effective technique in terms of healing and functional
outcomes. This review provides a critical analysis of the comparative
biomechanical and clinical studies among SR, DR, and TOE techniques reported in
the literature in the past decade.
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Affiliation(s)
| | - Scott A Rodeo
- Hospital for Special Surgery, New York, New York, USA
| | - Jorge Chahla
- Rush University Medical Center, Chicago, Illinois, USA
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11
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Dukan R, Ledinot P, Donadio J, Boyer P. Arthroscopic Rotator Cuff Repair With a Knotless Suture Bridge Technique: Functional and Radiological Outcomes After a Minimum Follow-Up of 5 Years. Arthroscopy 2019; 35:2003-2011. [PMID: 31147110 DOI: 10.1016/j.arthro.2019.02.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 02/11/2019] [Accepted: 02/17/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate clinical and radiological outcomes of knotless suture bridge repair after a minimum of 5 years of follow-up. METHODS A prospective consecutive series of full-thickness supraspinatus atraumatic chronic tears was evaluated in the study. Tears were medium or large. Further inclusion criteria were minimum clinical follow-up of 5 years with magnetic resonance imaging (MRI) at 24 months and fatty infiltration <2. Patients with shoulder stiffness, arthritis, or rotator cuff tear involving the subscapularis tendon were excluded. An arthroscopic cuff repair was performed using a knotless double-row suture bridge technique with braided suture tapes. Clinical outcomes were evaluated using the Constant score, the American Shoulder and Elbow Surgeons score, strength score, and a visual analog scale. Tendon healing was analyzed according to Sugaya MRI classification at 24 months. A Sugaya score of 1 or 2 was considered as tendon healing. Statistical analysis was performed with the Student's t-test. P = .05 were considered statistically significant. RESULTS Sixty-eight patients were included in this series. Mean follow-up was equal to 68.8 ± 7 months. At last follow-up, the mean visual analog scale, American Shoulder and Elbow Surgeons score, and Constant scores improved significantly from 5.5 ± 1.6, 48.2 ± 13.1, 37.8 ± 8.3, to 2.1 ± 2.1 (P = 5.43 E-14), 87.4 ± 15.8 (P = 7.15 E-27), and 82.8 ± 14.7 (P = 1.01 E-33), respectively. Anteflexion improved from 99.3° ± 13.4° preoperatively to 136.6° ± 15.9° at last follow-up (P = 3.08 E-21). Strength score was significantly higher postoperatively (18.4 ± 6.7 vs 8.3 ± 3.5). MRI showed 88% (n = 57) of Sugaya 1-2 repairs. Patients with unhealed rotator cuffs showed significantly lower functional results than the Sugaya 1-2 group. No correlation between degree of retraction and rate of healing was observed. Four symptomatic patients (6%) required revision for failed rotator cuff repair. CONCLUSIONS Despite potential confounding factors, arthroscopic knotless suture bridge repair of rotator cuff tears with acromioplasty demonstrated excellent long-term results of tendon healing, pain relief, and improvement of shoulder function. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Ruben Dukan
- Orthopaedic Department, Bichat-Claude Bernard Hospital, Paris Diderot University, Paris, France.
| | - Pauline Ledinot
- Orthopaedic Department, Bichat-Claude Bernard Hospital, Paris Diderot University, Paris, France
| | - Julia Donadio
- Orthopaedic Department, Bichat-Claude Bernard Hospital, Paris Diderot University, Paris, France
| | - Patrick Boyer
- Orthopaedic Department, Bichat-Claude Bernard Hospital, Paris Diderot University, Paris, France
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Technique for a Novel Arthroscopic Transosseous Rotator Cuff Repair. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2019. [DOI: 10.1097/bte.0000000000000159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aydin N, Karaismailoglu B, Gurcan M, Ozsahin MK. Arthroscopic double-row rotator cuff repair: a comprehensive review of the literature. SICOT J 2018; 4:57. [PMID: 30547879 PMCID: PMC6294008 DOI: 10.1051/sicotj/2018048] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/22/2018] [Indexed: 12/14/2022] Open
Abstract
Rotator cuff repairs seek to achieve adequate tendon fixation and to secure the fixation during the process of biological healing. Currently, arthroscopic rotator cuff repair has become the gold standard. One of the earliest defined techniques is single-row repair but the inadequacy of single-row repair to precisely restore the anatomical footprint as well as the significant rates of retear especially in large tears have led surgeons to seek other techniques. Double-row repair techniques, which have been developed in response to these concerns, have various modifications like the number and placement of anchors and suture configurations. When the literature is reviewed, it is possible to say that double-row repairs demonstrate superior biomechanical properties. In regard to retear rates, both double row and transosseous equivalent (TOE) techniques have also yielded more favorable outcomes compared to single-row repair. But the clinical results are conflicting and more studies have to be conducted. However, it is more probable that superior structural integrity will yield better structural and functional results in the long run. TOE repair technique is regarded as promising in terms of better biomechanics and healing since it provides better footprint contact. Knotless TOE structures are believed to reduce impingement on the medial side of tendons and thus aid in tendon nutrition; however, there are not enough studies about its effectiveness. It is important to optimize the costs without endangering the treatment of the patients. We believe that the arthroscopic TOE repair technique will yield superior results in regard to both repair integrity and functionality, especially with tears larger than 3 cm. Although defining the pattern of the tear is one of the most important guiding steps when selecting the repair technique, the surgeon should not forget to evaluate every patient individually for tendon healing capacity and functional expectations.
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Affiliation(s)
- Nuri Aydin
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | | | - Mert Gurcan
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Jeong JJ, Ji JH, Park SJ. Delayed Lateral Row Anchor Failure in Suture Bridge Rotator Cuff Repair: A Report of 3 Cases. Clin Shoulder Elb 2018; 21:246-251. [PMID: 33330184 PMCID: PMC7726407 DOI: 10.5397/cise.2018.21.4.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/08/2018] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
Compared to single row repair, use of lateral row anchors in suture bridge rotator cuff repair enhances repair strength and increases footprint contact area. If a lateral knotless anchor (push-in design) is inserted into osteoporotic bone, pull-out of the lateral row anchor can developed. However, failures of lateral row anchors have been reported at several months after surgery. In our cases, even though complete cuff healing occurred, delayed pull-out of the lateral row anchor in the suture bridge repair occurred. In comparison to a conventional medial anchor, further biomechanical evaluation of the pull-out force, design, and insertion angle of the lateral anchor is needed in future studies. We report three cases with delayed pull-out of lateral row anchor in suture bridge rotator cuff repair with a literature review.
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Affiliation(s)
- Jae-Jung Jeong
- Department of Orthopedic Surgery, Daejoen St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejoen, Korea
| | - Jong-Hun Ji
- Department of Orthopedic Surgery, Daejoen St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejoen, Korea
| | - Seok-Jae Park
- Department of Orthopedic Surgery, Daejoen St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejoen, Korea
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Tradonsky S. Editorial Commentary: Delaminated Rotator Cuff Tears-Does the Suture Pattern Matter? Arthroscopy 2018; 34:2952-2953. [PMID: 30392679 DOI: 10.1016/j.arthro.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/04/2018] [Indexed: 02/02/2023]
Abstract
The configuration of the suture placed in the rotator cuff tendon in the presence of a delaminated tear may be an important determinant of outcome. Delaminated rotator cuff tears are difficult to repair and probably occur more frequently than appreciated. The goal of anatomic reduction of the tendon to the footprint, attaching the deep tendon layer to the medial aspect of the footprint while approximating the superior tendon layer to the more lateral aspect of the footprint, may best result in complete healing.
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Robinson S, Krigbaum H, Kramer J, Purviance C, Parrish R, Donahue J. Double row equivalent for rotator cuff repair: A biomechanical analysis of a new technique. J Orthop 2018; 15:426-431. [PMID: 29881170 DOI: 10.1016/j.jor.2018.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/16/2018] [Indexed: 01/09/2023] Open
Abstract
Introduction There are numerous configurations of double row fixation for rotator cuff tears however, there remains to be a consensus on the best method. In this study, we evaluated three different double-row configurations, including a new method. Our primary question is whether the new anchor and technique compares in biomechanical strength to standard double row techniques. Methods Eighteen prepared fresh frozen bovine infraspinatus tendons were randomized to one of three groups including the New Double Row Equivalent, Arthrex Speedbridge and a transosseous equivalent using standard Stabilynx anchors. Biomechanical testing was performed on humeri sawbones and ultimate load, strain, yield strength, contact area, contact pressure, and a survival plots were evaluated. Results The new double row equivalent method demonstrated increased survival as well as ultimate strength at 415N compared to the remainder testing groups as well as equivalent contact area and pressure to standard double row techniques. Conclusions This new anchor system and technique demonstrated higher survival rates and loads to failure than standard double row techniques. This data provides us with a new method of rotator cuff fixation which should be further evaluated in the clinical setting. Level of Evidence Basic science biomechanical study.
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Affiliation(s)
- Sean Robinson
- San Francisco Orthopaedic Residency Program, 450 Stanyan St, San Francisco CA 94117, United States
| | | | - Jon Kramer
- San Francisco Orthopaedic Residency Program, 450 Stanyan St, San Francisco CA 94117, United States
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Baums MH, Kostuj T, Klinger HM, Papalia R. [Rotator cuff repair: single- vs double-row. Clinical and biomechanical results]. DER ORTHOPADE 2016; 45:118-24. [PMID: 26694067 DOI: 10.1007/s00132-015-3210-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The goal of rotator cuff repair is a high initial mechanical stability as a requirement for adequate biological recovery of the tendon-to-bone complex. Notwithstanding the significant increase in publications concerning the topic of rotator cuff repair, there are still controversies regarding surgical technique. OBJECTIVES The aim of this work is to present an overview of the recently published results of biomechanical and clinical studies on rotator cuff repair using single- and double-row techniques. MATERIALS AND METHODS The review is based on a selective literature research of PubMed, Embase, and the Cochrane Database on the subject of the clinical and biomechanical results of single- and double-row repair. RESULTS In general, neither the biomechanical nor the clinical evidence can recommend the use of a double-row concept for the treatment for every rotator cuff tear. Only tears of more than 3 cm seem to benefit from better results on both imaging and in clinical outcome studies compared with the use of single-row techniques. CONCLUSIONS Despite a significant increase in publications on the surgical treatment of rotator cuff tears in recent years, the clinical results were not significantly improved in the literature so far. Unique information and algorithms, from which the optimal treatment of this entity can be derived, are still inadequate. Because of the cost-effectiveness and the currently vague evidence, the double-row techniques cannot be generally recommended for the repair of all rotator cuff tears.
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Affiliation(s)
- M H Baums
- Orthopädie Aukamm-Klinik Wiesbaden, Leibnizstr. 21, 65191, Wiesbaden, Deutschland.
- Abteilung Orthopädie, Universitätsmedizin Göttingen (UMG), Georg-August-Universität, Göttingen, Deutschland.
| | - T Kostuj
- Klinik für Orthopädie und Unfallchirurgie, St. Josef-Hospital im Katholischen Klinikum Bochum, Ruhr-Universität-Bochum (RUB), Bochum, Deutschland
| | - H-M Klinger
- Abteilung Orthopädie, Universitätsmedizin Göttingen (UMG), Georg-August-Universität, Göttingen, Deutschland
| | - R Papalia
- UOC Ortopedia e Traumatologia, Policlinico Universitario Campus Bio-Medico, Rom, Italien
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Roth KM, Warth RJ, Lee JT, Millett PJ, ElAttrache NS. Arthroscopic Single-Row Versus Double-Row Repair for Full-Thickness Posterosuperior Rotator Cuff Tears: A Critical Analysis Review. JBJS Rev 2016; 2:01874474-201407000-00006. [PMID: 27490063 DOI: 10.2106/jbjs.rvw.m.00081] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Kevin M Roth
- Webster Orthopedic Medical Group, 3010 Colby Street, Suite 118, Berkeley, CA 94705
| | - Ryan J Warth
- The Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657
| | - Jared T Lee
- The Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657
| | - Peter J Millett
- The Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657
| | - Neal S ElAttrache
- The Kerlan-Jobe Orthopaedic Clinic, 6801 Park Terrace, Los Angeles, CA 90045
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Spiegl UJ, Euler SA, Millett PJ, Hepp P. Summary of Meta-Analyses Dealing with Single-Row versus Double-Row Repair Techniques for Rotator Cuff Tears. Open Orthop J 2016; 10:330-338. [PMID: 27708735 PMCID: PMC5041206 DOI: 10.2174/1874325001610010330] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 05/16/2015] [Accepted: 02/01/2016] [Indexed: 02/07/2023] Open
Abstract
Background: Several meta-analyses of randomized clinical trials have been performed to analyze whether double-row (DR) rotator cuff repair (RCR) provides superior clinical outcomes and structural healing compared to single-row (SR) repair. The purpose of this study was to sum up the results of meta-analysis comparing SR and DR repair with respect on clinical outcomes and re-tear rates. Methods: A literature search was undertaken to identify all meta-analyses dealing with randomized controlled trials comparing clinical und structural outcomes after SR versus DR RCR. Results: Eight meta-analyses met the eligibility criteria: two including Level I studies only, five including both Level I and Level II studies, and one including additional Level III studies. Four meta-analyses found no differences between SR and DR RCR for patient outcomes, whereas four favored DR RCR for tears greater than 3 cm. Two meta-analyses found no structural healing differences between SR and DR RCR, whereas six found DR repair to be superior for tears greater than 3 cm tears. Conclusion: No clinical differences are seen between single-row and double-row repair for small and medium rotator cuff tears after a short-term follow-up period with a higher re-tear rate following single-row repairs. There seems to be a trend to superior results with double-row repair in large to massive tear sizes.
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Affiliation(s)
- U J Spiegl
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Germany
| | - S A Euler
- Department of Trauma Surgery and Sports Traumatology, Medical University Innsbruck, Austria
| | | | - P Hepp
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Germany
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A 3D finite element model for geometrical and mechanical comparison of different supraspinatus repair techniques. J Shoulder Elbow Surg 2016; 25:557-63. [PMID: 26652702 DOI: 10.1016/j.jse.2015.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Contact pressure and contact area are among the most important mechanical factors studied to predict the effectiveness of a rotator cuff repair. The suture configurations can strongly affect these factors but are rarely correlated with each other. For example, there is a significant difference between the single-row technique and the transosseous or transosseous-like approaches in terms of footprint contact area coverage. A finite element model-based approach is presented and applied to account for various parameters (eg, suture pretension, geometry of the repair, effect of the sutures, geometry of the lesion) and to compare the efficacy of different repair techniques in covering the original footprint. METHODS The model allows us to evaluate the effect of parameters such as suture configuration and position and suture pretension. The validity of such an approach was assessed in comparing 3 different repair techniques: single row, transosseous equivalent, and double row. RESULTS Results from the application of the models show that the double-row and transosseous-equivalent techniques lead to progressive increase of the contact area compared with the single-row approach, supporting the conclusion that transosseous-equivalent fixation leads to an increase of the contact area and a better distribution of the pressure coverage. CONCLUSION The 3-dimensional finite element model approach allows multiple variables to be assessed singularly, weighing the specific influence. Moreover, the approach presented in this study could be a valid tool to predict and to reproduce different configurations, identifying how to reduce the stress over the tendon and when a repair could be effective or not.
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Lim CO, Park KJ. Biomechanical Test for Repair Technique of Full-thickness Rotator Cuff Tear. Clin Shoulder Elb 2016. [DOI: 10.5397/cise.2016.19.1.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kim SH, Kim J, Choi YE, Lee HR. Healing disturbance with suture bridge configuration repair in rabbit rotator cuff tear. J Shoulder Elbow Surg 2016; 25:478-86. [PMID: 26541205 DOI: 10.1016/j.jse.2015.08.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/13/2015] [Accepted: 08/25/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Medial row failure has been reported in the suture bridge technique of rotator cuff repair. This study compared the healing response of suture bridge configuration repair (SBCR) and parallel type transosseous repair (PTR). METHODS Acute rotator cuff repair was performed in 32 rabbits. Both shoulders were repaired using PTR or SBCR. In PTR, simple PTR was performed through 2 parallel transosseous tunnels created using a microdrill. In SBCR, 2 additional crisscross transosseous tunnels were added to mimic arthroscopic SBCR. At 1, 2, and 5 weeks postoperatively, comparative biomechanical testing was performed in 8 rabbits, and histologic analysis, including immunohistochemical staining for CD31, was performed in 4 rabbits. RESULTS Failure loads at 1 week (38.12 ± 20.43 N vs 52.00 ± 27.23 N; P = .284) and 5 weeks (97.93 ± 48.35 N vs 119.60 ± 60.81 N; P = .218) were not statistically different between the SBCR and PTR groups, respectively, but were significantly lower in the SBCR group than in the PTR group (23.56 ± 13.56 N vs. 44.25 ± 12.53 N; P = .009), respectively, at 2 weeks. Markedly greater fibrinoid deposition was observed in the SBCR group than in the PTR group at 2 weeks. For vascularization, there was a tendency that more vessels could be observed in PTR than in SBCR at 2 weeks (15.9 vs 5.6, P = .068). CONCLUSIONS In a rabbit acute rotator cuff repair model, SBCR exhibited inferior mechanical strength, and fewer blood vessels were observed at the healing site at 2 weeks postoperatively. Medial row tendon failure was more common in SBCR. Surgeons should consider the clinical effect of SBCR when performing rotator cuff repair.
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Affiliation(s)
- Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Jangwoo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Eun Choi
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hwa-Ryeong Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Arthroscopic knotless-anchor rotator cuff repair: a clinical and radiological evaluation. Knee Surg Sports Traumatol Arthrosc 2015; 23:2628-34. [PMID: 24792075 DOI: 10.1007/s00167-014-3026-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 04/19/2014] [Indexed: 01/26/2023]
Abstract
PURPOSE The goal of this study was to evaluate the clinical and radiological results of the arthroscopic knotless-anchor Speed-Bridge technique, in particular the pattern and the rate of retears. The results were compared with a modified Suture-Bridge knot-tying technique (mDR). The hypothesis is that arthroscopic knotless-anchor Speed-Bridge rotator cuff repair is a sufficient technique to address supraspinatus tears and differs in pattern of retears when compared to mDR. METHODS This study includes twenty-two consecutive patients (8f/14m ø 63.3 ± 7.2 years) undergoing knotless-anchor Speed-Bridge repair. The subjective shoulder value (SSV), Constant score (CS) and Western Ontario Rotator Cuff (WORC) Score were used for clinical follow-up. MRI scans were conducted within 3 weeks post-operatively, after 1 and after 2 years for analysis of (a) tendon integrity (according to Sugaya), (b) muscle atrophy according to Thomazeau and (c) fatty infiltration. Results were compared with 20 patients operated in mDR (ø 61.2 ± 7.5 years). RESULTS The mean follow-up was 24.4 ± 4.7 months. The average SSV was 88.7 ± 14.9 %, the CS was 78.2 ± 13.2 points (contralateral side 78.5 ± 16.6) and the WORC Score averaged 87.1 ± 18.2 %. On magnetic resonance imaging, the integrity failure rate was 22.7 % (n = 5). The pattern of retear was a medial cuff failure in 2/5 cases (mDR 4/5, n.s.). Muscular atrophy or fatty degeneration did not increase between surgery and follow-up (n.s.). Compared with mDR (25 %) reconstruction, no significant differences were obtained regarding integrity failure rate and muscular atrophy (n.s.). CONCLUSION The modified knotless-anchor Speed-Bridge technique shows good to excellent clinical results as well as acceptable retear rates. This technique eliminates medial and lateral knot impingement. Concerning the potential reduction in the medial strangulation of the tendon, there is a need for further clinical research.
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A biomechanical and histological comparison of the suture bridge and conventional double-row techniques of the repair of full-thickness rotator cuff tears in a rabbit model. BMC Musculoskelet Disord 2015; 16:148. [PMID: 26076895 PMCID: PMC4466809 DOI: 10.1186/s12891-015-0601-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 05/27/2015] [Indexed: 12/20/2022] Open
Abstract
Background The suture bridge (SB) technique and conventional double-row (DR) are both effective in repair of full-thickness rotator cuff tears . However, increasing numbers of scholars believe that the SB technique produces better results than conventional DR because of the higher bone-tendon contact area and pressure. However, The clinical outcomes have been mixed and little direct evidence has been supplied in vivo. This study was designed using the SB and DR techniques to determine which is the better technique. Methods Sixty-four New Zealand white rabbits were randomly divided into 2 groups, the SB group and DR group. SB and DR were then used to repair their rotator cuff tears. Rabbits were then sacrificed at the 2nd, 4th, or 8th week after surgery and a histological comparison was made. The biomechanical comparison was made at the 8th week. Results The load to failure of the SB group was 134.59 ± 17.69 N at the 8th postoperative week, and that was significantly higher than in the DR group (103.83 ± 6.62, P = 0.001), but both repair groups remained lower than in the control group (199.25 ± 14.81). Histological evaluation showed that both the SB and DR groups healed at the bone-tendon interface. But there were subtle differences between the two groups in the structure and morphology of collagen fibers and cartilage cells at bone-tendon interface. In general, the collagen fibers of the SB group were more compact than those of the DR group at all times tested. At the 4th and 8th weeks, the collagen fibers and cartilage cells in the SB group were arranged in a column modality, but those in the DR group were distributed horizontally. Conclusion The SB technique facilitated healing more effectively than the conventional DR technique. The difference in morphology of collagen fibers and cartilage cells may be related to the difference in bone-tendon contact pressure.
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Brais G, Ménard J, Mutch J, Laflamme GY, Petit Y, Rouleau DM. Transosseous braided-tape and double-row fixations are better than tension band for avulsion-type greater tuberosity fractures. Injury 2015; 46:1007-12. [PMID: 25799475 DOI: 10.1016/j.injury.2015.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 02/02/2015] [Accepted: 02/09/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The optimal treatment for avulsion-type greater tuberosity fractures is yet to be determined. Three fixation methods are tested: tension band with #2 wire suture (TB), double-row suture bridge with anchors (DR), and simple transosseous fixation with braided tape (BT). MATERIALS AND METHODS Twenty-four porcine proximal humeri were randomised into three groups: TB, DR and BT. A standardised greater tuberosity (GT) osteotomy was performed at 90° to the humeral diaphysis axis. A mechanical testing machine was used to simulate supraspinatus contraction. The force required to produce 3mm and 5mm displacement, as well as complete failure was measured with an axial load cell. Also, three cycles of shoulder flexion/extension with 25 N of supraspinatus contraction were performed. Maximum GT fragment translation and rotation amplitude during one cycle were measured. RESULTS During supraspinatus contraction, DR and BT groups (p < 0.05) were superior to TB group for both displacements. The BT technique had the strongest maximal load to failure (BT = 466 N; DR = 386 N; TB = 320 N). For the flexion/extension, DR and BT groups had less displacement and rotation than TB group (anterio-posterior displacement: BT = 2.0mm, DR = 1.9 mm, TB = 5.8 mm; anterio-posterior angular displacement: BT = 1.4°, DR = 1.0°, TB = 4.8°). No significant difference was observed between DR and BT groups, except for the medio-lateral rotation favouring the DR group. CONCLUSION In conclusion, BT and DR are good fixation methods to treat displaced avulsion-type greater tuberosity fractures. They have similar mechanical properties, and are stronger and more stable that the TB construct. Potential advantages of the BT over the DR may be a lower cost and easier surgery. LEVEL OF EVIDENCE Basic science study (LEVEL II).
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Affiliation(s)
- Godefroy Brais
- Université de Montréal, Montreal, Canada; Hôpital du Sacré-Cœur de Montréal, Montreal, Canada
| | - Jérémie Ménard
- Hôpital du Sacré-Cœur de Montréal Research Center, Montreal, Canada
| | - Jennifer Mutch
- Université de Montréal, Montreal, Canada; Hôpital du Sacré-Cœur de Montréal, Montreal, Canada
| | - G-Yves Laflamme
- Université de Montréal, Montreal, Canada; Hôpital du Sacré-Cœur de Montréal, Montreal, Canada
| | - Yvan Petit
- Hôpital du Sacré-Cœur de Montréal Research Center, Montreal, Canada; Department of Mechanical Engineering, École de technologie supérieure, Montreal, Canada
| | - Dominique M Rouleau
- Université de Montréal, Montreal, Canada; Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.
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Li X, Xu CP, Hou YL, Song JQ, Cui Z, Yu B. Are platelet concentrates an ideal biomaterial for arthroscopic rotator cuff repair? A meta-analysis of randomized controlled trials. Arthroscopy 2014; 30:1483-90. [PMID: 24913394 DOI: 10.1016/j.arthro.2014.03.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 03/21/2014] [Accepted: 03/21/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE The present study aims to conduct a meta-analysis of Level I evidence studies to investigate the efficacy of concomitant platelet concentrate (PC) used in arthroscopic rotator cuff repair. METHODS We systematically searched electronic databases to identify randomized controlled trials (RCTs) evaluating the role of PC augmentation in arthroscopic rotator cuff repairs for patients with full-thickness tears. The search strategy followed the requirements in the Cochrane Library Handbook. The primary outcome was retearing of the rotator cuff. Functional outcomes were analyzed in terms of Constant score, specific Constant pain score, University of California, Los Angeles (UCLA) shoulder score, Simple Shoulder Test (SST) score, and American Shoulder and Elbow Surgeons (ASES) score. RESULTS Seven studies with a total of 417 patients available at the latest follow-up reporting data about retears were analyzed in this meta-analysis. However, 4 studies with Constant scores (n = 237), 3 studies with UCLA scores (n = 168), 2 studies with Constant pain scores (n = 164), 2 studies with ASES scores (n = 101), and 2 studies with SST scores (n = 121) were analyzed. The retear rates and functional scores showed that there was no significant efficacy of PC application in arthroscopic rotator cuff repairs. CONCLUSIONS This meta-analysis of high-level evidence suggests that PCs have no benefit regarding retear rate and overall clinical outcomes for the arthroscopic repair of full-thickness rotator cuff tears. LEVEL OF EVIDENCE Level II, meta-analysis of randomized controlled trials.
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Affiliation(s)
- Xue Li
- Department of Orthopaedics, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chang-Peng Xu
- Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yi-Long Hou
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jin-Qi Song
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhuang Cui
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Yu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Gaudelli C, Ménard J, Mutch J, Laflamme GY, Petit Y, Rouleau DM. Locking plate fixation provides superior fixation of humerus split type greater tuberosity fractures than tension bands and double row suture bridges. Clin Biomech (Bristol, Avon) 2014; 29:1003-8. [PMID: 25246375 DOI: 10.1016/j.clinbiomech.2014.08.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 08/11/2014] [Accepted: 08/12/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND This paper aims to determine the strongest fixation method for split type greater tuberosity fractures of the proximal humerus by testing and comparing three fixation methods: a tension band with No. 2 wire suture, a double-row suture bridge with suture anchors, and a manually contoured calcaneal locking plate. METHODS Each method was tested on eight porcine humeri. A osteotomy of the greater tuberosity was performed 50° to the humeral shaft and then fixed according to one of three methods. The humeri were then placed in a testing apparatus and tension was applied along the supraspinatus tendon using a thermoelectric cooling clamp. The load required to produce 3mm and 5mm of displacement, as well as complete failure, was recorded using an axial load cell. FINDINGS The average load required to produce 3mm and 5mm of displacement was 658N and 1112N for the locking plate, 199N and 247N for the double row, and 75N and 105N for the tension band. The difference between the three groups was significant (P<0.01). The average load to failure of the locking plate (810N) was significantly stronger than double row (456N) and tension band (279N) (P<0.05). The stiffness of the locking plate (404N/mm) was significantly greater than double row (71N/mm) and tension band (33N/mm) (P<0.01). INTERPRETATION Locking plate fixation provides the strongest and stiffest biomechanical fixation for split type greater tuberosity fractures.
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Affiliation(s)
- Cinzia Gaudelli
- Université de Montréal, Montréal, Canada; Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
| | - Jérémie Ménard
- Hôpital du Sacré-Cœur de Montréal Research Center, Montréal, Canada
| | - Jennifer Mutch
- Université de Montréal, Montréal, Canada; Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
| | - G-Yves Laflamme
- Université de Montréal, Montréal, Canada; Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
| | - Yvan Petit
- Department of Mechanical Engineering, École de technologie supérieure, Montréal, Canada
| | - Dominique M Rouleau
- Université de Montréal, Montréal, Canada; Hôpital du Sacré-Cœur de Montréal, Montréal, Canada.
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Abstract
The posterosuperior rotator cuff, composed of the supraspinatus and infraspinatus tendons, is the most common site for full-thickness rotator cuff tears and represents a significant source of shoulder disability worldwide. Recognition of and classification of full-thickness tear patterns are essential in order to optimize surgical treatment and to improve prognosis. Until recently, tear patterns have been described using one- or two-dimensional classification systems. Three-dimensional pattern recognition is critical to achieving the most successful outcome possible. For more complex patterns, a combination of side-to-side stitching, margin convergence, and interval slide techniques may be needed to achieve a tension-free tendon-bone repair. Biomechanical and anatomic evidence supports the use of linked double-row repairs for most full-thickness tears. Although double-row repairs seem to result in improved structural outcomes, clinical evidence has not shown differences in outcomes scores between single-row and double-row repairs. Single-row repair may be performed in partial-thickness, small full-thickness, or very massive, immobile tears, whereas double-row repair may be performed in most other cases.
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Abstract
Rotator cuff pathology accounts for most presentations of shoulder pain to primary care clinics. History and physical examination are important for excluding other causes of shoulder pain, while imaging assists in confirming the diagnosis and defining the severity of the abnormality. Treatment options include nonsteroidal anti-inflammatory agents, subacromial corticosteroid injections, and exercise therapy. Surgical intervention is generally reserved for those failing nonoperative measures and/or healthy, young, and middle-aged adults with full-thickness rotator cuff tears. No surgical technique has proved to be superior. Despite surgery, about 20% of patients experience retears, more likely occurring in those with larger tears.
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Affiliation(s)
- Viviane Bishay
- Department of Family Medicine, Mount Sinai Hospital, 1500 South California Avenue, Chicago, IL 60608, USA.
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31
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Millett PJ, Warth RJ, Dornan GJ, Lee JT, Spiegl UJ. Clinical and structural outcomes after arthroscopic single-row versus double-row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials. J Shoulder Elbow Surg 2014; 23:586-97. [PMID: 24411671 DOI: 10.1016/j.jse.2013.10.006] [Citation(s) in RCA: 201] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 09/30/2013] [Accepted: 10/11/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to perform a systematic review and meta-analysis of all available level I randomized controlled trials comparing single-row with double-row repair to statistically compare clinical outcomes and imaging-diagnosed re-tear rates. METHODS A literature search was undertaken to identify all level I randomized controlled trials comparing structural or clinical outcomes after single-row versus double-row rotator cuff repair. Clinical outcomes measures included in the meta-analysis were the American Shoulder and Elbow Surgeons, University of California-Los Angeles, and Constant scores; structural outcomes included imaging-confirmed re-tears. Meta-analyses compared raw mean differences in outcomes measures and relative risk ratios for imaging-diagnosed re-tears after single-row or double-row repairs by a random-effects model. RESULTS The literature search identified a total of 7 studies that were included in the meta-analysis. There were no significant differences in preoperative to postoperative change in American Shoulder and Elbow Surgeons, University of California-Los Angeles, or Constant scores between the single-row and double-row groups (P = .440, .116, and .156, respectively). The overall re-tear rate was 25.9% (68/263) in the single-row group and 14.2% (37/261) in the double-row group. There was a statistically significant increased risk of sustaining an imaging-proven re-tear of any type in the single-row group (relative risk, 1.76 [95% confidence interval, 1.25-2.48]; P = .001), with partial-thickness re-tears accounting for the majority of this difference (relative risk, 1.99 [95% confidence interval, 1.40-3.82]; P = .039). CONCLUSION Single-row repairs resulted in significantly higher re-tear rates compared with double-row repairs, especially with regard to partial-thickness re-tears. However, there were no detectable differences in improvement in outcomes scores between single-row and double-row repairs.
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Affiliation(s)
| | - Ryan J Warth
- Steadman Philippon Research Institute, Vail, CO, USA
| | | | - Jared T Lee
- Steadman Philippon Research Institute, Vail, CO, USA
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Mantovani M, Baudi P, Paladini P, Pellegrini A, Verdano MA, Porcellini G, Catani F. Gap formation in a transosseous rotator cuff repair as a function of bone quality. Clin Biomech (Bristol, Avon) 2014; 29:429-33. [PMID: 24530155 DOI: 10.1016/j.clinbiomech.2014.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 01/18/2014] [Accepted: 01/22/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The transosseous approach has been well known for a long time as a valid repair approach. Over time, various criticisms have been raised over this technique principally classifiable in two main categories: technical difficulty and related reproducibility in an arthroscopic environment, and repair stability (in the suture-bone contact area). About cyclic performance, several authors have conceived test setups with the aim of simulating a real environment in dynamic load conditions. The aim of this study was to monitor gap formation in a cyclic test setup. METHODS The performance (measured as gap formation) has been monitored as a function of bone density to verify the effect of the latter. The test blocks have been shaped using sawbones® test bricks (Malmo, Sweden) of different densities, and the following values have been tested: 10, 15, 20, 30 and 40pcf. FINDINGS The comparison has been made between the two groups: traditional transosseous and new approach with an interposed device. Regarding the traditional transosseous approach in a 10-pcf environment, not even the first loading cycle was completed, the whole bone bridge was destroyed in the first loading ramp and no further loading capability was present in the repair. By increasing the block density, the surface damage in the suture-block contact decreased. INTERPRETATION With this work, it has been demonstrated how the traditional transosseous approach is strongly influenced by the bone quality up to the point where, in certain conditions, a safe and reliable repair is not guaranteed.
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Affiliation(s)
| | - P Baudi
- Orthopedic and Traumatology Department, University of Modena, Modena, Italy
| | - P Paladini
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, Italy
| | - A Pellegrini
- Orthopedic and Traumatology Department, University of Parma, Parma, Italy.
| | - M A Verdano
- Orthopedic and Traumatology Department, University of Parma, Parma, Italy
| | - G Porcellini
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, Italy
| | - F Catani
- Orthopedic and Traumatology Department, University of Modena, Modena, Italy
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33
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Kim KC, Shin HD, Cha SM, Park JY. Comparisons of retear patterns for 3 arthroscopic rotator cuff repair methods. Am J Sports Med 2014; 42:558-65. [PMID: 24585674 DOI: 10.1177/0363546514521577] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Only a few studies have reported an unusual retear pattern after arthroscopic rotator cuff repair based on the repair method. PURPOSE To compare the retear pattern of the arthroscopic single-row technique (SRT), conventional suture-bridge technique (SBT), and knotless suture-bridge technique (K-SBT) for rotator cuff tears. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This study evaluated 65 shoulders with retears revealed on magnetic resonance imaging at least 6 months after arthroscopic repair for a full-thickness rotator cuff tear. A retear was revealed in 21, 22, and 22 shoulders after the SRT, SBT, and K-SBT, respectively. Retears were classified as type 1 (unhealed tendons), type 2 (medially ruptured tendons with a healed footprint), or type 3 (unable to classify). Retear patterns were classified as full- or partial-thickness lesions; partial-thickness retears were further classified as articular- or bursal-side lesions. RESULTS A type 1 retear was observed in 71.4%, 40.9%, and 54.5% and a type 2 retear in 23.8%, 59.0%, and 40.9% of patients in the SRT, SBT, and K-SBT groups, respectively. No significant differences were observed among the 3 groups together (P = .195); however, a significant difference was observed between the SRT and SBT groups alone (P = .049). No significant differences were observed for either type 1 (P = .121) or type 2 (including both full- and partial-thickness) retears (P = .064) among the 3 groups together. When respective pairs of groups were compared, a significant difference was noted in both type 1 (P = .044) and type 2 retears (P = .019) between the SRT and SBT groups alone. No significant differences were observed in type 1 (P = .281) or type 2 full-thickness retears (P = .117) among the 3 groups together. When pairs of groups were compared, a significant difference in type 2 full-thickness retears was detected between the SRT and SBT groups alone (P = .037). CONCLUSION The SBT has a different retear pattern than that of the SRT. However, the K-SBT retear pattern was not different from that of the SRT.
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Affiliation(s)
- Kyung Cheon Kim
- Kyung Cheon Kim, Department of Orthopaedic Surgery, Chungnam National University School of Medicine, 640 Daesa-Dong, Jung-Gu, Daejeon 301-040, South Korea.
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Gartsman GM, Drake G, Edwards TB, Elkousy HA, Hammerman SM, O'Connor DP, Press CM. Ultrasound evaluation of arthroscopic full-thickness supraspinatus rotator cuff repair: single-row versus double-row suture bridge (transosseous equivalent) fixation. Results of a prospective, randomized study. J Shoulder Elbow Surg 2013; 22:1480-7. [PMID: 24012360 DOI: 10.1016/j.jse.2013.06.020] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 06/13/2013] [Accepted: 06/16/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to compare the structural outcomes of a single-row rotator cuff repair and double-row suture bridge fixation after arthroscopic repair of a full-thickness supraspinatus rotator cuff tear. MATERIAL AND METHODS We evaluated with diagnostic ultrasound a consecutive series of ninety shoulders in ninety patients with full-thickness supraspinatus tears at an average of 10 months (range, 6-12) after operation. A single surgeon at a single hospital performed the repairs. Inclusion criteria were full-thickness supraspinatus tears less than 25 mm in their anterior to posterior dimension. Exclusion criteria were prior operations on the shoulder, partial thickness tears, subscapularis tears, infraspinatus tears, combined supraspinatus and infraspinatus repairs and irreparable supraspinatus tears. Forty-three shoulders were repaired with single-row technique and 47 shoulders with double-row suture bridge technique. Postoperative rehabilitation was identical for both groups. Ultrasound criteria for healed repair included visualization of a tendon with normal thickness and length, and a negative compression test. RESULTS Eighty-three patients were available for ultrasound examination (40 single-row and 43 suture-bridge). Thirty of 40 patients (75%) with single-row repair demonstrated a healed rotator cuff repair compared to 40/43 (93%) patients with suture-bridge repair (P = .024). CONCLUSION Arthroscopic double-row suture bridge repair (transosseous equivalent) of an isolated supraspinatus rotator cuff tear resulted in a significantly higher tendon healing rate (as determined by ultrasound examination) when compared to arthroscopic single-row repair.
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Affiliation(s)
- Gary M Gartsman
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA
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35
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Kedgley AE, Shore BJ, Athwal GS, Johnson JA, Faber KJ. An in-vitro study of rotator cuff tear and repair kinematics using single- and double-row suture anchor fixation. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2013; 7:46-51. [PMID: 23960362 PMCID: PMC3743030 DOI: 10.4103/0973-6042.114224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose: Double-row suture anchor fixation of the rotator cuff was developed to reduce repair failure rates. The purpose of this study was to determine the effects of simulated rotator cuff tears and subsequent repairs using single- and double-row suture anchor fixation on three-dimensional shoulder kinematics. It was hypothesized that both single- and double-row repairs would be effective in restoring active intact kinematics of the shoulder. Materials and Methods: Sixteen fresh-frozen cadaveric shoulder specimens (eight matched pairs) were tested using a custom loading apparatus designed to simulate unconstrained motion of the shoulder. In each specimen, the rotator cuff was sectioned to create a medium-sized (2 cm) tear. Within each pair, one specimen was randomized to a single-row suture anchor repair, while the contralateral side underwent a double-row suture anchor repair. Joint kinematics were recorded for intact, torn, and repaired scenarios using an electromagnetic tracking device. Results: Active kinematics confirmed that a medium-sized rotator cuff tear affected glenohumeral kinematics when compared to the intact state. Single- and double-row suture anchor repairs restored the kinematics of the intact specimen. Conclusions: This study illustrates the effects of medium-sized rotator cuff tears and their repairs on active glenohumeral kinematics. No significant difference (P ≥ 0.10) was found between the kinematics of single- and double-row techniques in medium-sized rotator cuff repairs. Clinical Relevance: Determining the relative effects of single- and double-row suture anchor repairs of the rotator cuff will allow physicians to be better equipped to treat patients with rotator cuff disease.
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Affiliation(s)
- Angela E Kedgley
- Department of Bioengineering, Imperial College London, South Kensington Campus, London, United Kingdom
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Barber FA, Herbert MA, Crates JM. A comparison of lateral ankle ligament suture anchor strength. Foot Ankle Surg 2013; 19:108-11. [PMID: 23548452 DOI: 10.1016/j.fas.2012.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 11/26/2012] [Accepted: 12/11/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lateral ankle ligament repairs increasingly use suture anchors instead of bone tunnels. Our purpose was to compare the biomechanical properties of a knotted and knotless suture anchor appropriate for a lateral ankle ligament reconstruction. METHODS In porcine distal fibulae, 10 samples of 2 different PEEK anchors were inserted. The attached sutures were cyclically loaded between 10N and 60N for 200 cycles. A destructive pull was performed and failure loads, cyclic displacement, stiffness, and failure mode recorded. RESULTS PushLock 2.5 anchors failed before 200 cycles. PushLock 100 cycle displacement was less than Morphix 2.5 displacement (p<0.001). Ultimate failure load for anchors completing 200 cycles was 86.5N (PushLock) and 252.1N (Morphix) (p<0.05). The failure mode was suture breaking for all PushLocks while the Morphix failed equally by anchor breaking and suture breakage. CONCLUSIONS The knotted Morphix demonstrated more displacement and greater failure strength than the knotless PushLock. The PushLock failed consistently with suture breaking. The Morphix anchor failed both by anchor breaking and by suture breaking.
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Affiliation(s)
- F Alan Barber
- Plano Orthopedic Sports Medicine and Spine Center, 5228 West Plano Parkway, Plano, TX 75093, USA
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37
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Robinson PM, Wilson J, Dalal S, Parker RA, Norburn P, Roy BR. Rotator cuff repair in patients over 70 years of age. Bone Joint J 2013; 95-B:199-205. [PMID: 23365029 DOI: 10.1302/0301-620x.95b2.30246] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This study reports the clinical and sonographic outcome of arthroscopic rotator cuff repair in patients aged ≥ 70 years and aimed to determine factors associated with re-tear. A total of 69 consecutive repairs were performed in 68 patients with a mean age of 77 years (70 to 86). Constant-Murley scores were collected pre-operatively and at one year post-operatively. The integrity of the repair was assessed using ultrasound. Re-tear was detected in 20 of 62 patients (32%) assessed with ultrasound. Age at operation was significantly associated with re-tear free survival (p = 0.016). The mean pre-operative Constant score was 23 (sd 14), which increased to 58 (sd 20) at one year post-operatively (paired t-test, p < 0.001). Male gender was significantly associated with a higher score at one year (p = 0.019). We conclude that arthroscopic rotator cuff repair in patients aged ≥ 70 years is a successful procedure. The gender and age of the patient are important factors to consider when planning management. Cite this article: Bone Joint J 2013;95-B:199–205.
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Affiliation(s)
- P. M. Robinson
- Addenbrooke’s Hospital, Cambridge
University Hospitals NHS Foundation Trust, Hills Road, Cambridge
CB2 0QQ, UK
| | - J. Wilson
- North West Deanery, 3
Piccadilly Place, Manchester M1 3BN, UK
| | - S. Dalal
- Sunderland Royal Hospital, Kayll Road, Sunderland, Tyne & Wear SR4 7TP, UK
| | - R. A. Parker
- Centre for Applied Medical Statistics, University of Cambridge, Department of Public Health & Primary Care, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | - P. Norburn
- Trafford General Hospital, Moorside
Road, Davyhulme, Manchester
M41 5SL, UK
| | - B. R. Roy
- Trafford General Hospital, Moorside
Road, Davyhulme, Manchester
M41 5SL, UK
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Tudisco C, Bisicchia S, Savarese E, Fiori R, Bartolucci DA, Masala S, Simonetti G. Single-row vs. double-row arthroscopic rotator cuff repair: clinical and 3 Tesla MR arthrography results. BMC Musculoskelet Disord 2013; 14:43. [PMID: 23351978 PMCID: PMC3576341 DOI: 10.1186/1471-2474-14-43] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 01/10/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Arthroscopic rotator cuff repair has become popular in the last few years because it avoids large skin incisions and deltoid detachment and dysfunction. Earlier arthroscopic single-row (SR) repair methods achieved only partial restoration of the original footprint of the tendons of the rotator cuff, while double-row (DR) repair methods presented many biomechanical advantages and higher rates of tendon-to-bone healing. However, DR repair failed to demonstrate better clinical results than SR repair in clinical trials. MR imaging at 3 Tesla, especially with intra-articular contrast medium (MRA), showed a better diagnostic performance than 1.5 Tesla in the musculoskeletal setting. The objective of this study was to retrospectively evaluate the clinical and 3 Tesla MRA results in two groups of patients operated on for a medium-sized full-thickness rotator cuff tear with two different techniques. METHODS The first group consisted of 20 patients operated on with the SR technique; the second group consisted of 20 patients operated on with the DR technique. All patients were evaluated at a minimum of 3 years after surgery. The primary end point was the re-tear rate at 3 Tesla MRA. The secondary end points were the Constant-Murley Scale (CMS), the Simple Shoulder Test (SST) scores, surgical time and implant expense. RESULTS The mean follow-up was 40 months in the SR group and 38.9 months in the DR group. The mean postoperative CMS was 70 in the SR group and 68 in the DR group. The mean SST score was 9.4 in the SR group and 10.1 in the DR group. The re-tear rate was 60% in the SR group and 25% in the DR group. Leakage of the contrast medium was observed in all patients. CONCLUSIONS To the best of our knowledge, this is the first report on 3 Tesla MRA in the evaluation of two different techniques of rotator cuff repair. DR repair resulted in a statistically significant lower re-tear rate, with longer surgical time and higher implant expense, despite no difference in clinical outcomes. We think that leakage of the contrast medium is due to an incomplete tendon-to-bone sealing, which is not a re-tear. This phenomenon could have important medicolegal implications. Level of evidence III. Treatment study: Case-control study.
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Affiliation(s)
- Cosimo Tudisco
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, 81 Oxford Street, Rome 00133, Italy.
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Abstract
Techniques for arthroscopic partial-thickness and full-thickness RTC repairs continue to advance. When selecting an RTC repair technique, it is important to identify the tear pattern and adhere to the fundamentals of tendon mobilization and footprint preparation. Partial RTC tears greater than 50% in thickness can be reproducibly repaired with tear completion or transtendinous techniques with good clinical outcomes. Based on the available literature, small, less than 1-cm RTC tears can effectively be repaired with single-row techniques. Tears sized 1 cm to 3 cm can be repaired with either single-row, double-row, or transosseous-equivalent techniques based on surgeon comfort, tendon quality, and tissue mobility. Tears greater than 3 cm have shown superior results when transosseous-equivalent techniques are used. Further clinical studies are needed to definitively conclude the ideal RTC repair technique.
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Affiliation(s)
- James E Voos
- Orthopaedic and Sports Medicine Clinic of Kansas City, 3651 College Boulevard, Leawood, KS 66211, USA.
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40
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Anderl W, Heuberer PR, Laky B, Kriegleder B, Reihsner R, Eberhardsteiner J. Superiority of bridging techniques with medial fixation on initial strength. Knee Surg Sports Traumatol Arthrosc 2012; 20:2559-66. [PMID: 22367007 DOI: 10.1007/s00167-012-1922-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 02/06/2012] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of our study was to evaluate the initial fixation strength of bridging techniques compared to other suture techniques for rotator cuff repair using a biomechanical animal model, which incorporated pretesting of intact tendons. METHODS Seventy-six fresh bovine shoulders were used for testing seven suture configurations including simple suture (SS), mattress suture (MS), Mason-Allen (MA), modified double row (mDR), SpeedBridge (SpB), SpeedBridge with medial fixation (mSpB), and double-mattress SutureBridge (dmSuB) techniques. Cyclic loading was performed with all intact bone-tendon complex before (pretest) and after repair of the tendon (main test) at the level of 10 and 180 N at 100 Hz with displacement-controlled ramps of ± 33 mm/s. The pretest was stopped after 200 cycles. For the main test, the loading scheme was continued for a maximum of 500 cycles or until failure. RESULTS The mean elongation of all 76 intact tendons measured at the pretest was 3.8 ± 0.6 mm (2.4-5.4 mm). No differences of gap formations at the 1st cycle were detected between SS, MS, MA, and mDR. SpB showed significant higher gap formations compared to all other suture techniques (p = 0.001). No significant differences were detected between mSpB and dmSuB, whereas both techniques were significant different when compared to the other groups (p < 0.05). CONCLUSIONS In this study, results showed that bridging techniques with medial fixations have superior initial repair strength compared to other suture techniques. Knowledge of initial fixation strength of rotator cuff repair techniques may be of informative value to the surgeon.
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Affiliation(s)
- Werner Anderl
- Department of Orthopaedic Surgery, St Vincent Hospital, Stumpergasse 13, 1060 Vienna, Austria.
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Gerhardt C, Hug K, Pauly S, Marnitz T, Scheibel M. Arthroscopic single-row modified mason-allen repair versus double-row suture bridge reconstruction for supraspinatus tendon tears: a matched-pair analysis. Am J Sports Med 2012; 40:2777-85. [PMID: 23104608 DOI: 10.1177/0363546512462123] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic double-row fixation of supraspinatus tendon tears compared with single-row techniques is still a matter of debate. HYPOTHESIS Arthroscopic double-row rotator cuff repair using the suture bridge technique provides better clinical results and lower retear rates than does single-row repair using a modified Mason-Allen stitch technique. STUDY DESIGN Cohort study; Level of evidence 3. METHODS Forty patients underwent either an arthroscopic single-row modified Mason-Allen stitch (SR) (n = 20; mean age ± SD, 61.5 ± 7.4 y) or a modified suture bridge double-row repair (DR) (n = 20; age, 61.2 ± 7.5 y). The anteroposterior extension was classified as Bateman I in 10% and Bateman II in 90% of patients in the SR group and as Bateman II in 80% and Bateman III in 20% of patients in the DR group. Patients were matched for sex and age. The subjective shoulder value (SSV), Constant-Murley score (CS), and Western Ontario Rotator Cuff Index (WORC) were used for clinical follow-up. Furthermore, MRI scans were conducted for analysis of tendon integrity, muscle atrophy, and fatty infiltration via semiquantitative signal intensity analysis. In addition, re-defect patterns were evaluated. RESULTS The mean follow-up time in the SR group was 16.8 ± 4.6 months. The mean SSV was 91.0% ± 8.8%, mean CS was 82.2 ± 8.1 (contralateral side, 88.8 ± 5.3), and mean WORC score was 96.5% ± 3.2%. The mean follow-up time in the DR group was 23.4 ± 2.9 months, with patients achieving scores of 92.9% ± 9.6% for the SSV, 77.0 ± 8.6 for the CS (contralateral side, 76.7 ± 17.1), and 90.7% ± 12.6% for the WORC (P > .05). No significant differences were detected in the clinical outcome between groups. Tendon integrity was as follows. Type 1, none in either group; type 2, 4 SR and 5 DR; type 3, 9 SR and 10 DR; type 4, 3 SR and 3 DR; and type 5, 3 SR and 2 DR. The failure rate was 31.6% (n = 6) in the SR group and 25% (n = 5) in the DR group (P > .05). No significant differences were obtained for muscular atrophy or fatty degeneration (SR group, 0.94 ± 0.16; DR group, 1.15 ± 0.5) (P > .05). Re-defects revealed lateral cuff failure in 83.3% of SR patients in contrast to patients treated with DR techniques. The re-defect pattern was medial cuff failure in 80% of the patients. CONCLUSION The clinical results after modified Mason-Allen single-row versus double-mattress suture bridge technique did not demonstrate significant differences in a matched patient cohort. Concerning the failure mode, single- and double-row techniques seem to demonstrate different re-defect patterns.
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Affiliation(s)
- Christian Gerhardt
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
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Lorbach O, Pape D, Raber F, Busch LC, Kohn D, Kieb M. Influence of the initial rupture size and tendon subregion on three-dimensional biomechanical properties of single-row and double-row rotator cuff reconstructions. Knee Surg Sports Traumatol Arthrosc 2012; 20:2139-47. [PMID: 22290126 DOI: 10.1007/s00167-012-1892-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 01/10/2012] [Indexed: 12/16/2022]
Abstract
PURPOSE Influence of the initial rotator cuff tear size and of different subregions of the SSP tendon on the cyclic loading behavior of a modified single-row reconstruction compared to a suture-bridging double-row repair. METHODS Artificial tears (25 and 35 mm) were created in the rotator cuff of 24 human cadaver shoulders. The reconstructions were performed as a single-row repair (SR) using a modified suture configuration or a suture-bridge double-row repair (DR). Radiostereometric analysis was used under cyclic loading (50 cycles, 10–180 N, 10–250 N) to calculate cyclic displacement in three different planes (anteroposterior (x), craniocaudal (y) and mediolateral (z) level). Cyclic displacement was recorded, and differences in cyclic displacement of the anterior compared to the posterior subregions of the tendon were calculated. RESULTS In small-to-medium tears (25 mm) and medium-to-large tears (35 mm), significant lower cyclic displacement was seen for the SR-reconstruction compared to the DR-repair at 180 N (p ≤ 0.0001; p = 0.001) and 250 N (p = 0.001; p = 0.007) in the x-level. These results were confirmed in the y-level at 180 N (p = 0.001; p = 0.0022) and 250 N (p = 0.005; p = 0.0018). Comparison of the initial tear sizes demonstrated significant differences in cyclic displacement for the DR technique in the x-level at 180 N (p = 0.002) and 250 N (p = 0.004). Comparison of the anterior versus the posterior subregion of the tendon revealed significant lower gap formation in the posterior compared to the anterior subregions in the x-level for both tested rotator cuff repairs (p ≤ 0.05). CONCLUSIONS The tested single-row repair using a modified suture configuration achieved superior results in three-dimensional measurements of cyclic displacement compared to the tested double-row suture-bridge repair. The results were dependent on the initial rupture size of the rotator cuff tear. Furthermore, significant differences were found between tendon subregions of the rotator cuff with significantly higher gap formation for the anterior compared to the posterior subregions.
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Affiliation(s)
- O Lorbach
- Department of Orthopedic Surgery, Saarland University, Kirrberger Str, Homburg (Saar), Germany.
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Abstract
The management of patients with a failed rotator cuff repair is challenging. Revision arthroscopic repairs can be entertained in select patients when realistic outcomes are understood. Complete evaluation of the shoulder is needed to identify and treat potential confounding pain generators. The ability to determine if a recurrent tear is repairable is difficult, because there are no established criteria to make this determination. If a recurrent tear is found to be repairable, the results of the surgery are encouraging, although persistent limitations in shoulder function are common. Strategies to improve the rates of tendon healing should be used and include the use of stronger repair constructs, when possible, and implementation of a slower rehabilitation progression.
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Affiliation(s)
- Jay D Keener
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University, Campus Box #8233, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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Jost PW, Khair MM, Chen DX, Wright TM, Kelly AM, Rodeo SA. Suture number determines strength of rotator cuff repair. J Bone Joint Surg Am 2012; 94:e100. [PMID: 22810407 DOI: 10.2106/jbjs.k.00117] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Failure of surgical repair of a rotator cuff tear continues to be a clinical problem. For other tendon repairs, increasing the number of sutures improves both biomechanical performance and clinical outcomes. Several investigators have shown biomechanical advantages of double-row techniques but have used many more sutures than were used with the single-row techniques with which the double-row techniques were compared. The purposes of our study were to establish whether using a greater number of sutures would improve the biomechanical properties of a rotator cuff repair model, and whether using equal numbers of sutures would lead to equivalent results between single and double-row configurations. METHODS Fresh-frozen sheep infraspinatus tendons underwent single-row repair with two, four, or six mattress sutures and double-row repair with use of four mattress sutures. Specimens were pretensioned at 10 N for one minute, then cycled from 10 to 180 N for 200 cycles at 0.2 Hz; this was followed by load to failure. Cyclic gap formation, failure load, and failure type were recorded. RESULTS The four-suture single-row and four-suture double-row repairs had similar gap formation during cyclic testing, with no significant differences between them. Cyclic gap formation in the two-suture single-row group was 6.7 and 7.1 mm (97% and 109%) greater than that in the four and six-suture single-row groups after 200 cycles (p < 0.001). The average loads to failure of the two, four, and six-suture single-row groups were 274, 362, and 572 N (p < 0.0001). The average load to failure of the four-suture double-row group was 386 N, which was similar to the value in the four-suture single-row group (p = 0.58). CONCLUSIONS In an ovine rotator cuff tendon repair model, increasing the number of sutures decreased cyclic gap formation and increased load to failure. Single and double-row repairs are biomechanically equivalent when the number of sutures is kept constant. CLINICAL RELEVANCE The results of this study support the use of greater numbers of sutures in rotator cuff repair and disagree with the assertion that double-row repairs are biomechanically superior to single-row repairs.
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Affiliation(s)
- Patrick W Jost
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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Lapner PLC, Sabri E, Rakhra K, McRae S, Leiter J, Bell K, Macdonald P. A multicenter randomized controlled trial comparing single-row with double-row fixation in arthroscopic rotator cuff repair. J Bone Joint Surg Am 2012; 94:1249-57. [PMID: 22810395 DOI: 10.2106/jbjs.k.00999] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Controversy exists regarding the optimal technique for arthroscopic rotator cuff repair. The purpose of this multicenter, randomized, double-blind controlled study was to compare the functional outcomes and healing rates after use of single-row and double-row suture techniques for repair of the rotator cuff. METHODS Ninety patients undergoing arthroscopic rotator cuff repair were randomized to receive either a single-row or a double-row repair. The primary objective was to compare the Western Ontario rotator cuff index (WORC) score at twenty-four months. Secondary objectives included comparison of the constant and american shoulder and elbow surgeons (ASES) scores and strength between groups. Anatomical outcomes were assessed with magnetic resonance imaging (MRI) or ultrasonography to determine the postoperative healing rates. RESULTS Baseline demographic data including age (p = 0.29), sex (p = 0.68), affected side (p = 0.39), and rotator cuff tear size (p = 0.28) did not differ between groups. The WORC score did not differ significantly between groups at any time point (p = 0.48 at baseline, p = 0.089 at three months, p = 0.52 at six months, p = 0.83 at twelve months, and p = 0.60 at twenty-four months). The WORC score at each postoperative time point was significantly better than the baseline value. The Constant score, ASES score, and strength did not differ significantly between groups at any time point. Logistic regression analysis demonstrated that a smaller initial tear size and double-row fixation were associated with higher healing rates. CONCLUSIONS No significant differences in functional or quality-of-life outcomes were identified between single-row and double-row fixation techniques. A smaller initial tear size and a double-row fixation technique were associated with higher healing rates as assessed with ultrasonography or MRI. LEVEL OF EVIDENCE Therapeutic level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Peter L C Lapner
- Division of Orthopaedics, The Ottawa Hospital, General Campus, 501 Smyth Road, W1648, Box 502, Ottawa, ON K1H 8L6, Canada. Lapner:
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47
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DeHaan AM, Axelrad TW, Kaye E, Silvestri L, Puskas B, Foster TE. Does double-row rotator cuff repair improve functional outcome of patients compared with single-row technique? A systematic review. Am J Sports Med 2012; 40:1176-85. [PMID: 22156169 DOI: 10.1177/0363546511428866] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The advantage of single-row versus double-row arthroscopic rotator cuff repair techniques has been a controversial issue in sports medicine and shoulder surgery. There is biomechanical evidence that double-row techniques are superior to single-row techniques; however, there is no clinical evidence that the double-row technique provides an improved functional outcome. HYPOTHESIS When compared with single-row rotator cuff repair, double-row fixation, although biomechanically superior, has no clinical benefit with respect to retear rate or improved functional outcome. STUDY DESIGN Systematic review. METHODS The authors reviewed prospective studies of level I or II clinical evidence that compared the efficacy of single- and double-row rotator cuff repairs. Functional outcome scores included the American Shoulder and Elbow Surgeons (ASES) shoulder scale, the Constant shoulder score, and the University of California, Los Angeles (UCLA) shoulder rating scale. Radiographic failures and complications were also analyzed. A test of heterogeneity for patient demographics was also performed to determine if there were differences in the patient profiles across the included studies. RESULTS Seven studies fulfilled our inclusion criteria. The test of heterogeneity across these studies showed no differences. The functional ASES, Constant, and UCLA outcome scores revealed no difference between single- and double-row rotator cuff repairs. The total retear rate, which included both complete and partial retears, was 43.1% for the single-row repair and 27.2% for the double-row repair (P = .057), representing a trend toward higher failures in the single-row group. CONCLUSION Through a comprehensive literature search and meta-analysis of current arthroscopic rotator cuff repairs, we found that the single-row repairs did not differ from the double-row repairs in functional outcome scores. The double-row repairs revealed a trend toward a lower radiographic proven retear rate, although the data did not reach statistical significance. There may be a concerning trend toward higher retear rates in patients undergoing a single-row repair, but further studies are required.
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Affiliation(s)
- Alexander M DeHaan
- Department of Orthopaedic Surgery and Sports Medicine, Boston University School of Medicine, Boston, MA, USA
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Papalia R, Franceschi F, Del Buono A, Zampogna B, Maffulli N, Denaro V. Double row repair: is it worth the hassle? Sports Med Arthrosc Rev 2012; 19:342-7. [PMID: 22089283 DOI: 10.1097/jsa.0b013e3182394215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In the operative management of rotator cuff disease, comparable functional results have been reported after open or mini-open repair and arthroscopic fixation. Surgical repair aims to re-establish an anatomical configuration of the tendon-bone construct for restoring its mechanical performance. Single row repair is the most commonly used technique, but recently some authors have proposed to re-establish the rotator cuff footprint with 2 rows of suture anchors ("double row" repair). In regard to imaging assessment, at time zero double row repair results being more anatomic and allows for structurally sound restoration of the rotator cuff footprint. However, this does not seem to translate into superior clinical outcomes for the double row repair when evaluating all different sizes of rotator cuff tears as a whole. The scientific basis for recommending single or double row repair as preferred treatment for patients with rotator cuff tear is questionable, as minimal differences have been measured on clinical and functional rating scales.
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Affiliation(s)
- Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo, Rome, Italy
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Lorbach O, Kieb M, Raber F, Busch LC, Kohn D, Pape D. Comparable biomechanical results for a modified single-row rotator cuff reconstruction using triple-loaded suture anchors versus a suture-bridging double-row repair. Arthroscopy 2012; 28:178-87. [PMID: 22112611 DOI: 10.1016/j.arthro.2011.08.298] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 08/16/2011] [Accepted: 08/16/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical properties and footprint coverage of a single-row (SR) repair using a modified suture configuration versus a double-row (DR) suture-bridge repair in small to medium and medium to large rotator cuff tears. METHODS We created 25- and 35-mm artificial defects in the rotator cuff of 24 human cadaveric shoulders. The reconstructions were performed as either an SR repair with triple-loaded suture anchors (2 to 3 anchors) and a modified suture configuration or a modified suture-bridge DR repair (4 to 6 anchors). Reconstructions were cyclically loaded from 10 to 60 N. The load was increased stepwise up to 100, 180, and 250 N. Cyclic displacement and load to failure were determined. Furthermore, footprint widths were quantified. RESULTS In the 25-mm rupture, ultimate load to failure was 533 ± 107 N for the SR repair and 681 ± 250 N for the DR technique (P ≥ .21). In the 35-mm tear, ultimate load to failure was 792 ± 122 N for the SR reconstruction and 891 ± 174 N for the DR reconstruction (P ≥ .28). There were no statistically significant differences for both tested rupture sizes. Cyclic displacement showed no significant differences between the tested configurations at 60 N (P = .563), 100 N (P = .171), 180 N (P = .211), and 250 N (P = .478) for the 25-mm tear. For the 35-mm tear, cyclic displacement showed significantly lower gap formation for the SR reconstruction at 180 N (P = .037) and 250 N (P = .020). No significant differences were found at 60 N (P = .296) and 100 N (P = .077). A significantly greater footprint width (P = .028) was seen for the DR repair (16.2 mm) compared with the SR repair (13.8 mm). However, both reconstructions were able to achieve complete footprint coverage compared with the initial footprint. CONCLUSIONS The tested SR repair using a modified suture configuration was similar in load to failure and cyclic displacement to the DR suture-bridge technique independent of the tested initial sizes of the rupture. The tested DR repair consistently restored a larger footprint than the SR method. However, both constructs achieved complete footprint coverage. CLINICAL RELEVANCE SR repairs with modified suture configurations might combine the biomechanical advantages and increased footprint coverage that are described for DR repairs without increasing the overall costs of the reconstruction.
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Affiliation(s)
- Olaf Lorbach
- Department of Orthopedic Surgery, Saarland University, Homburg/Saar, Germany.
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Ma HL, Chiang ER, Wu HTH, Hung SC, Wang ST, Liu CL, Chen TH. Clinical outcome and imaging of arthroscopic single-row and double-row rotator cuff repair: a prospective randomized trial. Arthroscopy 2012; 28:16-24. [PMID: 21982391 DOI: 10.1016/j.arthro.2011.07.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 07/03/2011] [Accepted: 07/06/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare the clinical and imaging outcomes of single-row and double-row suture anchor fixation in arthroscopic rotator cuff repair with emphasis on analysis of the effect of various tear size on repair integrity. METHODS Fifty-three patents were randomized to either single-row or double-row rotator cuff repair at the time of surgical intervention. The clinical results were evaluated by applying the UCLA score and the ASES index and assessing muscle strength in abduction and external rotation with a minimum 2-year follow-up. The postoperative rotator cuff integrity was evaluated by magnetic resonance arthrography at 6-month and minimum 2-year follow-up. RESULTS We enrolled 27 patients in the single-row group and 26 patients in the double-row group. Statistically, the UCLA score; the ASES index; and muscle strength were significantly increased in both groups after surgery, but there was no significant difference between the 2 groups. At minimum 2-year follow-up, intact rotator cuffs were found in 17 patients in the single-row group and 20 in the double-row group, based on magnetic resonance arthrography results. Overall, there was no significant difference in postoperative structural integrity between the 2 groups at 6-month and 2-year follow-up. In patients with tear size larger than 3 cm, the muscle strength of the shoulder was significantly better in the double-row group. For the final imaging results, regardless of the tear size, there was no difference between the single-row and double-row groups. CONCLUSIONS Arthroscopic rotator cuff repair with double-row fixation showed better shoulder strength in patients with larger tear size (>3 cm) in comparison with single-row fixation. However, the imaging results showed no significant difference in cuff integrity in both groups in patients with any tear size at 6-month and minimum 2-year follow-up. LEVEL OF EVIDENCE Level II, lesser-quality randomized control trial.
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Affiliation(s)
- Hsiao-Li Ma
- National Yang-Ming University School of Medicine, Taipei, Taiwan.
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