Published online Jan 18, 2020. doi: 10.5312/wjo.v11.i1.10
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
In rotator cuff repair surgery, the double-row technique is widely performed and remains one of the most commonly performed techniques. The double-row repair is traditionally performed using four suture anchors.
This study proves that the use of a 3-suture anchor construct is non-inferior to that of a 4-suture anchor construct in terms of footprint contact area. The use of a 3-suture anchor construct may potentially translate to significant reductions in surgical and anaesthetic times, as well as a reduction in healthcare costs in the long run. Future research studying the contact pressure and pull-out strength can be undertaken to validate further the use of a 3-suture anchor construct as a non-inferior alternative to the 4-suture anchor construct while achieving the abovementioned benefits.
The objective of our study was to demonstrate 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. By demonstrating so, it has introduced the possibility that the 3-anchor construct may be a comparable alternative to the standard 4-anchor construct in terms of efficacy. This study can be used in conjunction with future research comparing contact pressure and pull-out strength to further validate the use of 3-anchor construct over the traditional 4-anchor construct.
Twenty-four fresh porcine shoulders without gross evidence of rotator cuff pathology were used. The use of a porcine model was chosen due to a previous study reporting the geometric and biomechanical similarities between the porcine infraspinatus tendon and the human supraspinatus tendon. Identical tears were created in these 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, 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.
The study demonstrated 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. This study can be used in conjunction with future research comparing contact pressure and pull-out strength to further validate the use of 3-anchor construct over the traditional 4-anchor construct.
The study found 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. It has hence introduced the possibility that the 3-anchor construct may be a comparable alternative to the traditional 4-anchor construct in terms of efficacy. This may potentially translate to shorter surgical times and lower healthcare costs with the use of fewer anchors without compromising tendon-to-bone healing of rotator cuff tears.
This study introduces a new, alternative technique to the traditional 4-anchor construct that has been performed for years. This study can be used in conjunction with future research comparing contact pressure and pull-out strength to validate further the use of 3-anchor construct over the traditional 4-anchor construct.