Suture-bridge subscapularis tendon repair technique using low anterior portals

Background: Restoring footprint anatomy, minimizing gap formation, and maximizing the strength of distal triceps tendon repairs are essential factors for a successful healing process and return to sport. Hypothesis: The novel V-shaped distal triceps tendon repair technique with unicortical button fixation closely restores footprint anatomy, provides minimal gap formation and high ultimate failure load, and minimizes iatrogenic fracture risk in acute/subacute distal triceps tendon tears. Study Design: Controlled laboratory study. Methods: Twenty-four cadaveric elbows (mean ± SD age, 66 ± 5 years) were randomly assigned to 1 of 3 repair groups: the transosseous cruciate repair technique (gold standard), the knotless suture-bridge repair technique, and the V-shaped distal triceps tendon repair technique. Anatomic measurements of the central triceps tendon footprint were obtained in all specimens with a 3-dimensional digitizer before and after the repair. Cyclic loading was performed for a total of 1500 cycles at a rate of 0.25 Hz, pulling in the direction of the triceps. Displacements were measured on the medial and lateral tendon sites with 2 differential variable reluctance transducers. Load to failure and construct failure mode were recorded. Results: The mean triceps bony insertion area was 399.05 ± 81.23 mm2. The transosseous cruciate repair technique restored 36.6% ± 16.8% of the native tendon insertion area, which was significantly different when compared with the knotless suture-bridge repair technique (85.2% ± 14.8%, P = .001) and the V-shaped distal triceps tendon repair technique (88.9% ± 14.8%, P = .002). Mean displacement showed no significant difference between the V-shaped distal triceps tendon repair technique (medial side, 0.75 ± 0.56 mm; lateral side, 0.99 ± 0.59 mm) and the knotless suture-bridge repair technique (1.61 ± 0.97 mm and 1.29 ± 0.8 mm) but significance between the V-shaped distal triceps tendon repair technique and the transosseous cruciate repair technique (4.91 ± 1.12 mm and 5.78 ± 0.9 mm, P < .001). Mean peak failure load of the V-shaped distal triceps tendon repair technique (732.1 ± 156.0 N) was significantly higher than that of the knotless suture-bridge repair technique (505.4 ± 173.9 N, P = .011) and the transosseous cruciate repair technique (281.1 ± 74.8 N, P < .001). Mechanism of failure differed among the 3 repairs, with the only olecranon fracture occurring in the knotless suture-bridge repair technique at the level of the lateral row suture anchors. Conclusion: At time zero, the V-shaped distal triceps tendon repair technique and the knotless suture-bridge repair technique both provided anatomic footprint coverage. Ultimate load to failure was highest for the V-shaped distal triceps tendon repair technique, while gap formation was different only in comparison with the transosseous cruciate repair technique. Clinical Relevance: The V-shaped distal triceps tendon repair technique provides an alternative procedure to other established repairs for acute/subacute distal triceps tendon ruptures. The reduced repair site motion of the V-shaped distal triceps tendon repair technique and the knotless suture-bridge repair technique at the time of surgery may allow a more aggressive rehabilitation program in the early postoperative period.

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Subscapularis Tendon Repair Using Suture Bridge Technique

Arthroscopy Techniques ◽

10.1016/j.eats.2014.11.013 ◽

2015 ◽

Vol 4 (2) ◽

pp. e133-e137 ◽

Cited By ~ 9

Author(s):

Yong Bok Park ◽

Young Eun Park ◽

Kyoung Hwan Koh ◽

Tae Kang Lim ◽

Min Soo Shon ◽

...

Keyword(s):

Tendon Repair ◽

Subscapularis Tendon ◽

Suture Bridge ◽

Suture Bridge Technique

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Arthroscopic Subscapularis Tendon Repair Using the Mason-Allen Technique

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1387-8079 ◽

2021 ◽

Author(s):

Junqi Huang ◽

Jiajia Cheng ◽

Shitian Tang ◽

Bo Shi ◽

Gang Liu ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Tendon Repair ◽

Shoulder Function ◽

Arthroscopic Rotator Cuff Repair ◽

Subscapularis Tendon ◽

Function Recovery ◽

The Mean ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Abstract Background Arthroscopic rotator cuff repair has recently been popularized for treating tears. In a biomechanical trial, the Mason-Allen stitch improved the fixation quality of poorly vascularized tendons. The use of this technique involving the subscapularis tendon remains rare. The aim of this study was to evaluate the clinical outcomes of Mason-Allen technique repaired subscapularis tendons. Methods A retrospective research of collected data from 98 patients with subscapularis tears who had undergone arthroscopic repair between May 2015 and December 2018. There were 75 males and 23 females. The mean age was 56.4 ± 9.6 years and the mean follow-up was 12.5 ± 4.0 months. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and Constant-Murley score were used to analyze shoulder function. An MRI was performed to assess the integrity of the repair. Results Patients had significantly less pain and a better active range of motion compared with preoperative levels. VAS improved significantly from a preoperative mean of 3.42 to a postoperative mean of 1.91. ASES increased significantly from the preoperative mean of 43.6 to the postoperative mean of 74.5. Seven cases suffered from retears, which were confirmed by an MRI examination. Conclusion Arthroscopic rotator cuff repair with the Mason-Allen method resulted in a decreased level of pain and satisfied function recovery.

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Rotator Interval Lesion and Damaged Subscapularis Tendon Repair in a High School Baseball Player

Case Reports in Orthopedics ◽

10.1155/2015/890721 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Tomoyuki Muto ◽

Hiroki Ninomiya ◽

Hiroaki Inui ◽

Masahiko Komai ◽

Katsuya Nobuhara

Keyword(s):

Tendon Repair ◽

Limited Range ◽

High Signal ◽

Subscapularis Tendon ◽

Rotator Interval ◽

Glenohumeral Ligaments ◽

Limited Range Of Motion ◽

Arthroscopic Examination ◽

Magnetic Resonance Imaging Mri ◽

One Year

In 2013, a 16-year-old baseball pitcher visited Nobuhara Hospital complaining of shoulder pain and limited range of motion in his throwing shoulder. High signal intensity in the rotator interval (RI) area (ball sign), injured subscapularis tendon, and damage to both the superior and middle glenohumeral ligaments were identified using magnetic resonance imaging (MRI). Repair of the RI lesion and partially damaged subscapularis tendon was performed in this pitcher. During surgery, an opened RI and dropping of the subscapularis tendon were observed. The RI was closed in a 90° externally rotated and abducted position. To reconfirm the exact repaired state of the patient, arthroscopic examination was performed from behind. However, suture points were not visible in the >30° externally rotated position, which indicates that the RI could not be correctly repaired with the arthroscopic procedure. One year after surgery, the patient obtained full function of the shoulder and returned to play at a national convention. Surgical repair of the RI lesion should be performed in exactly the correct position of the upper extremity.

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16 Arthroscopic Single-Row Subscapularis Tendon Repair Arthroscopic single-row subscapularis tendon repair

Video Atlas of Arthroscopic Rotator Cuff Repair ◽

10.1055/b-0041-179878 ◽

2021 ◽

Keyword(s):

Tendon Repair ◽

Subscapularis Tendon ◽

Single Row

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Simultaneous, Bilateral Acute Subscapularis Ruptures and Their Arthroscopic Management

Case Reports in Orthopedics ◽

10.1155/2019/7964351 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Andrew M. Schwartz ◽

Jacob M. Wilson ◽

Kyle Hammond

Keyword(s):

External Rotation ◽

Primary Repair ◽

Constant Score ◽

Tendon Repair ◽

Functional Independence ◽

Young Person ◽

Successful Outcome ◽

Subscapularis Tendon ◽

Shoulder Injuries ◽

Early Therapy

We present the first known case of bilateral, acute ruptures of the subscapularis tendons following a bicycle accident in a 43-year-old male. He underwent right shoulder arthroscopic, anatomic subscapularis tendon repair two weeks postinjury, with the left side staged for surgical treatment six weeks after the index procedure. Postoperatively, the patient remained in a sling for 6 weeks before advancing with therapy protocols. The interval between arthroscopic treatments allowed for independence with activities of daily living and focused, early therapy for each shoulder. This approach yielded a right-sided constant score of 89 and subjective shoulder value of 90%; the left side was 87 and 90%, respectively, at 33 months postoperatively. The patient’s only postoperative complaint was slightly diminished external rotation, a near-universal limitation after unilateral repair. This represents a successful outcome that balances functional independence, concentrated rehabilitation, and adherence to safe indications for primary repair. While bilateral traumatic shoulder injuries in a young person is a rare clinical entity, early and staged treatment can lead to good patient outcomes.

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Optimal configuration of the spiral linking technique for tendon repair. Biomechanical evaluation

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193410390759 ◽

2010 ◽

Vol 36 (3) ◽

pp. 210-214 ◽

Cited By ~ 3

Author(s):

Y. I. Kulikov ◽

Y. Vinogradova ◽

A. W. Miles ◽

G. Giddins

Keyword(s):

Clinical Practice ◽

Tendon Repair ◽

Optimal Number ◽

Optimal Configuration ◽

Tendon Length ◽

Repair Technique ◽

Biomechanical Evaluation

A previous study described a new spiral linking technique for tendon repairs and demonstrated that it was strong enough to be used in clinical practice as an alternative to the Pulvertaft tendon weave repair. However the repairs were less stiff, needed slightly more tendon length for the same repair and were a little bulkier. In this study two variables have been changed with a view to improving the spiral technique. At first the number of spirals was reduced consecutively, keeping the same number of standard mattress sutures. Once the optimal number of spirals had been identified, repairs with different numbers of sutures were tested using an alternative cross-stitch technique. The spiral repair technique using two spirals linked with six sutures was at least as strong and stiff as a four-weave Pulvertaft technique and was also easier to do.

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Current Biomechanical Concepts of Suture Bridge Repair Technique for Rotator Cuff Tear

International Journal of Orthopaedics ◽

10.17554/j.issn.2311-5106.2015.02.48 ◽

2015 ◽

Vol 2 (3) ◽

pp. 284-288

Author(s):

Ming-Long Yeh ◽

◽

Chih-Kai Hong ◽

Wei-Ren Su ◽

I-Ming Jou ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Suture Bridge ◽

Cuff Tear ◽

Repair Technique

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Clinical Outcomes and Cadaveric Biomechanical Analysis of Endoscopic Percutaneous Achilles Tendon Rupture Repair With Absorbable Suture

Foot & Ankle Orthopaedics ◽

10.1177/2473011420965967 ◽

2020 ◽

Vol 5 (4) ◽

pp. 247301142096596

Author(s):

Daniel Carpenter ◽

Katherine Dederer ◽

Paul Weinhold ◽

Joshua N. Tennant

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Return To Sport ◽

Biomechanical Analysis ◽

Absorbable Suture ◽

Operative Repair ◽

Repair Technique ◽

Achilles Tendon Repair

Background: Percutaneous repair of acute Achilles tendon rupture (ATR) continues to gain in popularity. The primary aim of the study was to review the outcomes of a patient cohort undergoing a novel technique of endoscopic percutaneous Achilles tendon repair with absorbable suture. A secondary purpose of this study was to evaluate the basic biomechanical properties of the technique. Methods: A cohort of 30 patients who underwent percutaneous ATR repair was retrospectively analyzed with Achilles Tendon Rupture Scores (ATRS), complications, and additional outcome measures. For a biomechanical analysis portion of the study, 12 cadaveric specimens were paired and randomized to either novel percutaneous repair or open Kessler repair with absorbable suture. These specimens were subjected to 2 phases of cyclical testing (100 cycles 10-43 N followed by 200 cycles 10-86 N) and ultimate strength testing. Results: In the clinical portion of the study we report excellent patient reported outcomes (mean ATRS 94.1), high level of return to sport, and high patient satisfaction. One partial re-rupture was reported but with no major wound or neurologic complications. In the biomechanical portion of the study we found no significant difference in tendon gapping between percutaneous and open repairs in phase 1 of testing. In phase 2, increased gapping occurred between percutaneous (17.8 mm [range 10.7-24.1, SD 6.4]) and open repairs (10.8 mm [range 7.6-14.9, SD 2.7, P = .037]). The ultimate load at failure was not statistically different between the 2 repairs. Conclusions: A percutaneous ATR repair technique using endoscopic assistance and absorbable suture demonstrated low complications and good outcomes in a cohort of patients, with high satisfaction, and excellent functional outcomes including high rates of return to sport. Cadaveric biomechanical testing demonstrated excellent survival during testing and minimal increase in gapping compared with open repair technique, representing sufficient strength to withstand forces seen in early rehabilitation. A percutaneous Achilles tendon repair technique with absorbable suture may minimize risks associated with operative repair while still maintaining the benefit of operative repair. Level of Evidence: Level IV, retrospective case series.

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