scholarly journals Fixationssysteme und Techniken zur arthroskopischen Rotatorenmanschettenrekonstruktion

Arthroskopie ◽  
2021 ◽  
Author(s):  
Paul Borbas ◽  
Karl Wieser ◽  
Florian Grubhofer
Keyword(s):  
Double Row ◽  
Single Row ◽  
Suture Bridge

ZusammenfassungArthroskopische Rotatorenmanschettenrekonstruktionen wurden initial mit einer einreihigen („single row“) Technik beschrieben. Im Rahmen technischer Weiterentwicklungen der arthroskopischen Chirurgie wurden diverse Techniken zur zweireihigen („double row“), transossären und transossär-äquivalenten Sehnenfixation entwickelt, nicht zuletzt durch eine zunehmende Verbreitung knotenloser Anker. Die klinischen Ergebnisse zeigen keine relevanten Unterschiede zwischen den jeweiligen Techniken. Biomechanisch sind zweireihige Rekonstruktionen jedoch durch Vergrößerung der Kontaktfläche an der Insertionsstelle und der erreichten Stabilität überlegen, insbesondere mit medial geknoteten Fäden, welche in eine laterale Reihe als sog. Suture-Bridge abgespannt werden. Klassischerweise wurden Schraubanker aus Metall für eine arthroskopische Sehnenfixierung verwendet. Im Laufe der letzten Jahre wurde das Anker-Portfolio jedoch durch moderne bioresorbierbare und nichtresorbierbare (PEEK) Schraub- und Einschlaganker sowie auch um reine Fadenanker (All-suture) erweitert. Ein allgemeingültiger Goldstandard für die Ankerverwendung existiert bis dato nicht, wobei die meisten gängigen Anker – zumindest bei guter Knochenqualität – ausreichende Stabilität gewährleisten. Beim Nahtmaterial kam es ebenso zu relevanten Weiterentwicklungen, sodass dem Versagen der Nähte heutzutage weniger Bedeutung zukommt. Das Aufkommen von bandartigem Nahtmaterial (Tapes) konnte in diversen biomechanischen Studien seine Überlegenheit nachweisen, jedoch ist bei geknoteten Techniken mit Tapes aufgrund des womöglich negativen Einflusses durch größere Knoten Vorsicht geboten. Nicht zuletzt ist die mediale Stichposition möglichst nahe des Rotatorenkabels von großer Bedeutung, da der häufigste Versagensmechanismus einer Rotatorenmanschettenrekonstruktion mit modernem Naht- und Ankermaterial weiterhin ein Hindurchschneiden der Fäden durch das vorgeschädigte Sehnengewebe ist.

Type 2 retear after arthroscopic single-row, double-row and suture bridge rotator cuff repair: a systematic review

2018 ◽  
Vol 29 (2) ◽  
pp. 373-382 ◽  
Author(s):  
Yehia H. Bedeir ◽  
Adam P. Schumaier ◽  
Ghada Abu-Sheasha ◽  
Brian M. Grawe
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Double Row ◽  
Single Row ◽  
Suture Bridge ◽  
Cuff Repair

Biomechanical Comparison of All-Soft Suture Anchor Single-Row vs Double-Row Bridging Construct for Insertional Achilles Tendinopathy

2020 ◽  
pp. 107110072095902
Author(s):  
Eric Lakey ◽  
Pam Kumparatana ◽  
Daniel K. Moon ◽  
Joseph Morales ◽  
Sophia Elizabeth Anderson ◽  
...  
Keyword(s):  
Suture Anchor ◽  
Early Mobilization ◽  
Achilles Tendinopathy ◽  
Matched Pair ◽  
Clinical Failure ◽  
Suture Anchors ◽  
Double Row ◽  
Single Row ◽  
Suture Bridge ◽  
Insertional Achilles Tendinopathy

Background: Two common operative fixation techniques for insertional Achilles tendinopathy are the use of all-soft suture anchors vs synthetic anchors with a suture bridge. Despite increasing emphasis on early postoperative mobilization, the biomechanical profile of these repairs is not currently known. We hypothesized that the biomechanical profiles of single-row all-soft suture anchor repairs would differ when compared to double-row suture bridge repairs. Methods: Achilles tendons were detached from their calcaneal insertions on 6 matched-pair, fresh-frozen cadaver through-knee amputation specimens. Group 1 underwent a single-row repair with all-soft suture anchors. Group 2 was repaired with a double-row bridging suture bridge construct. Achilles-calcaneal displacement was tracked while specimens were cyclically loaded from 10 to 100 N for 2000 cycles and then loaded to failure. Linear mixed models were used to analyze the independent effects of age, body mass index, tendon morphology, repair construct, and footprint size on clinical and ultimate failure loads, Achilles-calcaneal displacement, and mode of failure. Results: The suture bridge group was independently associated with an approximately 50-N increase in the load to clinical failure (defined as more than 5 mm tendon displacement). There was no difference in ultimate load to failure or tendon/anchor displacement between the 2 groups. Conclusion: This cadaveric study found that a double-row synthetic bridge construct had less displacement during cyclic loading but was not able to carry more load before clinical failure when compared to a single-row suture anchor construct for the operative repair of insertional Achilles tendinopathy. Clinical Relevance: Our data suggest that double-row suture bridge constructs increase the load to clinical failure for operative repairs of insertional Achilles tendinopathy. It must be noted that these loads are well below what occurs during gait and the repair must be protected postoperatively without early mobilization. This study also identified several clinical factors that may help predict repair strength and inform further research.

Functional and Structural Outcomes of Single-Row Versus Double-Row Versus Combined Double-Row and Suture-Bridge Repair for Rotator Cuff Tears

2011 ◽  
Vol 39 (10) ◽  
pp. 2091-2098 ◽  
Author(s):  
Teruhisa Mihata ◽  
Chisato Watanabe ◽  
Kunimoto Fukunishi ◽  
Mutsumi Ohue ◽  
Tomoyuki Tsujimura ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Double Row ◽  
Single Row ◽  
Suture Bridge

Arthroscopic Single-Row Versus Double-Row Suture Bridge Technique for Rotator Cuff Tears in Patients Younger Than 55 Years: A Prospective Comparative Study

2017 ◽  
Vol 46 (1) ◽  
pp. 116-121 ◽  
Author(s):  
Michael E. Hantes ◽  
Yohei Ono ◽  
Vasilios A. Raoulis ◽  
Nikolaos Doxariotis ◽  
Aaron Venouziou ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Constant Score ◽  
Tendon Healing ◽  
Rotator Cuff Tears ◽  
Double Row ◽  
Single Row ◽  
Suture Bridge ◽  
Ucla Score ◽  
Arthroscopic Rotator Cuff

Background: When arthroscopic rotator cuff repair is performed on a young patient, long-lasting structural and functional tendon integrity is desired. A fixation technique that potentially provides superior tendon healing should be considered for the younger population to achieve long-term clinical success. Hypothesis/Purpose: The purpose was to compare the radiological and clinical midterm results between single-row and double-row (ie, suture bridge) fixation techniques for arthroscopic rotator cuff repair in patients younger than 55 years. We hypothesized that a double-row technique would lead to improved tendon healing, resulting in superior mid- to long-term clinical outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: A consecutive series of 66 patients younger than 55 years with a medium to large full-thickness tear of supraspinatus and infraspinatus tendons who underwent arthroscopic single-row or double-row (ie, suture bridge) repair were enrolled and prospectively observed. Thirty-four and 32 patients were assigned to single-row and double-row groups, respectively. Postoperatively, tendon integrity was assessed by MRI following Sugaya’s classification at a minimum of 12 months, and clinical outcomes were assessed with the Constant score and the University of California, Los Angeles (UCLA) score at a minimum of 2 years. Results: Mean follow-up time was 46 months (range, 28-50 months). A higher tendon healing rate was obtained in the double-row group compared with the single-row group (84% and 61%, respectively [ P < .05]). Although no difference in outcome scores was observed between the 2 techniques, patients with healed tendon demonstrated superior clinical outcomes compared with patients who had retorn tendon (UCLA score, 34.2 and 27.6, respectively [ P < .05]; Constant score, 94 and 76, respectively [ P < .05]). Conclusion: The double-row repair technique potentially provides superior tendon healing compared with the single-row technique. Double-row repair should be considered for patients younger than 55 years with medium to large rotator cuff tears.

Arthroscopic Repair of the Isolated Subscapularis Full-Thickness Tear: Single- Versus Double-Row Suture-Bridge Technique

2019 ◽  
Vol 47 (6) ◽  
pp. 1427-1433 ◽  
Author(s):  
Ji-Sang Yoon ◽  
Sung-Jae Kim ◽  
Yun-Rak Choi ◽  
Sang-Ho Kim ◽  
Yong-Min Chun
Keyword(s):  
Clinical Outcomes ◽  
Structural Integrity ◽  
Arthroscopic Repair ◽  
Full Thickness ◽  
Double Row ◽  
Single Row ◽  
Suture Bridge ◽  
Active Range Of Motion ◽  
Suture Bridge Technique

Background: No clinical comparative study has addressed isolated subscapularis tears after arthroscopic repair with either single-row or double-row suture-bridge technique. Purpose/Hypothesis: The purpose of this study is to compare clinical outcomes and structural integrity after arthroscopic repair of an isolated subscapularis full-thickness tear with either the single-row technique or the double-row suture-bridge technique. The authors hypothesized that there would be no significant differences in clinical outcomes and structural integrity between approaches. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 56 patients who underwent arthroscopic repair of an isolated subscapularis full-thickness tear with grade II or less fatty infiltration in the subscapularis muscle with either a single-row technique (n = 31) or a double-row suture-bridge technique (n = 25). Functional outcomes were assessed with the visual analog scale (VAS) for pain, Subjective Shoulder Value (SSV), American Shoulder and Elbow Surgeons (ASES) score, the University of California, Los Angeles (UCLA) shoulder score, and active range of motion. Magnetic resonance arthrography (MRA) or computed tomographic arthrography (CTA) was performed 6 months after surgery to assess the structural integrity of the repaired tendon. Results: At the 2-year follow-up, all scoring parameters applied (VAS, SSV, ASES, and UCLA), subscapularis strength, and active range of motion improved significantly in both groups as compared with preoperative values ( P < .001). However, there were no significant differences between groups in any of these clinical outcome measurements (VAS, 1.2 vs 1.1; SSV, 91.3 vs 91.8; ASES, 91.0 vs 91.4; UCLA, 31.9 vs 32.1). On follow-up MRA or CTA, the overall retear rate did not differ significantly between the single-row group (13%, 4 of 31) and the double-row group (12%, 3 of 25). Conclusion: Arthroscopic single-row repair and double-row suture-bridge repair of isolated full-thickness subscapularis tears both yielded satisfactory clinical outcomes and structural integrity with no significant differences among patients with good muscle quality.

A cost analysis of single-row versus double-row and suture bridge rotator cuff repair methods

2012 ◽  
Vol 23 (2) ◽  
pp. 487-493 ◽  
Author(s):  
Leslie Bisson ◽  
Nikola Zivaljevic ◽  
Samuel Sanders ◽  
David Pula
Keyword(s):  
Rotator Cuff ◽  
Cost Analysis ◽  
Rotator Cuff Repair ◽  
Double Row ◽  
Single Row ◽  
Suture Bridge ◽  
Cuff Repair
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