Initial Fixation Strength of Transosseous-Equivalent Suture Bridge Rotator Cuff Repair Is Comparable With Transosseous Repair

Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
The American Journal of Sports Medicine (Impact Factor: 4.36). 11/2011; 40(1):133-40. DOI: 10.1177/0363546511426071
Source: PubMed


The outcome of rotator cuff repair correlates with tendon healing. Early studies of arthroscopic rotator cuff repair demonstrate lower healing rates than traditional open techniques. Transosseous-equivalent repair techniques (suture bridge) were developed to improve the initial fixation strength.
To compare the initial in vitro tensile fixation strength of a transosseous-equivalent suture bridge (TOE-SB) rotator cuff repair construct to a traditional transosseous (TO) suture construct.
Controlled laboratory study.
Identical simulated rotator cuff tears were created on 8 matched pairs of humeri. Each matched pair underwent repair with 4 sutures using either the TOE-SB or TO technique. Initial fixation strength was tested in a custom testing jig. Each shoulder underwent 1000 cycles each of low and then high load testing. Gap displacement was measured at anterior and posterior sites of the repair with digital video tracking of paired reflective markers and recorded at predetermined cycle intervals.
There were no statistically significant differences in gap formation at the repair sites under low or high load conditions between TOE-SB and TO techniques. The mean maximal gap formation of the repairs during low load testing in the TOE-SB and TO constructs was 0.93 ± 0.88 mm and 0.55 ± 0.22 mm, respectively (P = .505). The mean maximal gap formation during high load testing in the TOE-SB and TO constructs was 2.04 ± 1.10 mm and 2.28 ± 1.62 mm, respectively (P = .517). The most significant increase in gap distance occurred at the transition from low load to high load in both constructs. Most of the incremental displacement occurred within the first 100 cycles for both high and low load testing (P < .001).
The arthroscopic TOE-SB technique is comparable in initial fixation strength to the traditional TO simple suture repair technique.
Arthroscopic techniques can achieve initial fixation strength comparable with traditional TO techniques performed without suture anchors.

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    • "Transosseous-equivalent repair techniques have demonstrated improved outcomes. Such techniques lead to greater contact area and pressure over the native cuff footprint than single or double-row suture and equivalent to traditional transosseous techniques.[2021] Early results have demonstrated improved clinical and radiographic healing at short-term follow-up.[11] "
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    ABSTRACT: Purpose:The purpose of this study was to measure and compare the subjective, objective, and radiographic healing outcomes of single-row (SR), double-row (DR), and transosseous equivalent (TOE) suture techniques for arthroscopic rotator cuff repair.Materials and Methods:A retrospective comparative analysis of arthroscopic rotator cuff repairs by one surgeon from 2004 to 2010 at minimum 2-year followup was performed. Cohorts were matched for age, sex, and tear size. Subjective outcome variables included ASES, Constant, SST, UCLA, and SF-12 scores. Objective outcome variables included strength, active range of motion (ROM). Radiographic healing was assessed by magnetic resonance imaging (MRI). Statistical analysis was performed using analysis of variance (ANOVA), Mann — Whitney and Kruskal — Wallis tests with significance, and the Fisher exact probability test <0.05.Results:Sixty-three patients completed the study requirements (20 SR, 21 DR, 22 TOE). There was a clinically and statistically significant improvement in outcomes with all repair techniques (ASES mean improvement P = <0.0001). The mean final ASES scores were: SR 83; (SD 21.4); DR 87 (SD 18.2); TOE 87 (SD 13.2); (P = 0.73). There was a statistically significant improvement in strength for each repair technique (P < 0.001). There was no significant difference between techniques across all secondary outcome assessments: ASES improvement, Constant, SST, UCLA, SF-12, ROM, Strength, and MRI re-tear rates. There was a decrease in re-tear rates from single row (22%) to double-row (18%) to transosseous equivalent (11%); however, this difference was not statistically significant (P = 0.6).Conclusions:Compared to preoperatively, arthroscopic rotator cuff repair, using SR, DR, or TOE techniques, yielded a clinically and statistically significant improvement in subjective and objective outcomes at a minimum 2-year follow-up.Level of Evidence:Therapeutic level 3.
    International Journal of Shoulder Surgery 03/2014; 8(1):15-20. DOI:10.4103/0973-6042.131850 · 0.65 Impact Factor
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    • "Cadaveric studies investigating transosseous repairs showed good biomechanical characteristics after repairs.28,51,53,55-57) Of these, two interesting studies were the studies by Yu et al.57) and Ahmad et al.28) "
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    ABSTRACT: For the past few decades, the repair of rotator cuff tears has evolved significantly with advances in arthroscopy techniques, suture anchors and instrumentation. From the biomechanical perspective, the focus in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. To accomplish these objectives, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. In addition, the healing response may be compromised by intrinsic factors such as decreased vascularity, hypoxia, and fibrocartilaginous changes or aforementioned extrinsic compression factors. Furthermore, it is well documented that torn rotator cuff muscles have a tendency to atrophy and become subject to fatty infiltration which may affect the longevity of the repair. Despite all the aforementioned factors, initial fixation strength is an essential consideration in optimizing rotator cuff repair. Therefore, numerous biomechanical studies have focused on elucidating the strongest devices, knots, and repair configurations to improve contact characteristics for rotator cuff repair. In this review, the biomechanical concepts behind current rotator cuff repair techniques will be reviewed and discussed.
    Clinics in orthopedic surgery 06/2013; 5(2):89-97. DOI:10.4055/cios.2013.5.2.89
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    ABSTRACT: As attempts have been made to improve rotator cuff healing, transosseous equivalent repairs have garnered interest because they combine strong initial fixation with broad foot print coverage. A number of different suture configurations can be used to secure the rotator cuff repair. Results, particularly in large or massive tears, have been encouraging for the double-row technique. Areas for concern include disruption of the vascular supply to the healing tendon, increased cost and operating room time, and potentially higher risk for tuberosity fracture. Rotator cuff tendon healing is a complex interaction between biomechanical, biological, and patient factors. Although the technique and overall outcomes are still evolving, transosseous rotator cuff repair may offer improvements in the biomechanical stability and clinical outcomes of rotator cuff repairs.
    Operative Techniques in Sports Medicine 09/2012; 20(3):220–223. DOI:10.1053/j.otsm.2012.07.003 · 0.20 Impact Factor
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