Basic Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2020; 11(1): 10-17
Published online Jan 18, 2020. doi: 10.5312/wjo.v11.i1.10
Double-row repair of rotator cuff tears: Comparing tendon contact area between techniques
Shao Hui Allan Ng, Chung Hui James Tan
Shao Hui Allan Ng, Chung Hui James Tan, Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
Author contributions: Tan CHJ designed, directed and coordinated the research; Ng SHA performed the majority of the experiments and analysed the data; Ng SHA and Tan CHJ wrote the manuscript.
Institutional animal care and use committee statement: No human or live animal subjects were involved in this study. Use of animal tissues does not require IACUC approval if the tissues are obtained from commercial sources or from the Tissue Sharing Programme.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shao Hui Allan Ng, FRCS (Orth), MB, BCh, MRCS (Edin), MMed (Ortho), Doctor, Surgeon, Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore. ng.allan.sh@ktph.com.sg
Received: March 12, 2019
Peer-review started: March 20, 2019
First decision: June 11, 2019
Revised: August 30, 2019
Accepted: November 6, 2019
Article in press: November 6, 2019
Published online: January 18, 2020
Abstract
BACKGROUND

In rotator cuff repair surgery, the double-row technique is widely performed. Studies have shown that with increased contact area and pressure between tendon and bone interface, better healing is promoted.

AIM

To assess the different suture configurations with the double-row technique and how this influences the contact area of the rotator cuff tendon to bone.

METHODS

This was a controlled laboratory study where identical tears were created in 24 fresh porcine shoulders over a 1.5 cm × 2.5 cm infraspinatus insertion footprint. Double-row repair techniques, with 3 to 4-suture anchors in different configurations (2 medial, 2 lateral vs 2 medial, 1 lateral vs 1 medial, 2 lateral), were employed for three control groups. Each group consisted of eight shoulders with identical repair configurations. Footprint contact areas of the repaired tendon against the tuberosity were determined using pressure sensitive Fujifilm placed between the tendon and tuberosity.

RESULTS

The mean contact area between tendon and insertion footprint from the imprinted Fujifilm was obtained using computer software. The contact area measured from a standard 4-suture anchor double row repair was 75.1 ± 9.3 mm2, whereas areas obtained for the 2 lateral - 1 medial and 2 medial - 1 lateral anchor configurations were 72.9 ± 5.2 mm2 and 75.0 ± 4.9 mm2 respectively. No statistical significance was noted between the three groups.

CONCLUSION

In the technique of double-row repair, using a 3-suture anchor configuration may offer a non-inferior alternative to the standard 4-anchor construct in terms of efficacy. This may also result in overall cost reduction and shorter surgical time.

Keywords: Basic science study, Double-row, Different suture anchor configurations, Footprint contact area, Porcine model, Pressure sensitive film, Tendon healing

Core tip: We report our first results derived from a porcine model investigating different suture configurations in the double-row technique, and how this influences the contact area of the rotator cuff tendon to bone. This study demonstrates for the first time that there is no statistical difference in tendon to bone contact area when using a 3 or 4-suture anchor construct, suggesting that the 3-anchor construct may be a comparable alternative to the standard 4-anchor construct in terms of efficacy.