Arthroscopic Rotator Cuff Repair Using a Triple-Loaded Suture Anchor and a Modified Mason-Allen Technique (Alex Stitch)

Background Surgeons can control not only the angle but also the depth of suture anchor placement during arthroscopic rotator cuff repair, although the tendency may be to place suture anchors on the deep side to avoid damage from prominent anchor eyelets. However, little information is available regarding possible effects of suture anchor depth on construct failure mechanisms. Hypothesis Anchor depth affects the mode of suture failure with physiologically relevant cyclic loads. Study Design Controlled laboratory study. Methods Metallic screw-in suture anchors loaded with No. 2 braided polyester sutures were inserted into the bovine infra-spinatus footprint with the eyelet proud, standard, or deep. Sutures were hand tied to create a closed loop. Constructs were cyclically loaded from 10 to 90 N and, if still intact at 500 cycles, taken to ultimate failure (maximum load). Results When clinical failure was defined as greater than 3-mm construct elongation, anchors placed with the eyelet deep experienced statistically earlier clinical failure via cutting of the suture through the bone (P <. 02). However, anchors placed at this level did not experience catastrophic failure during cyclic loading. The standard and proud anchors experienced 3 mm of elongation at a greater number of cycles, but the suture material degraded at the anchor eyelet, and a majority of these constructs broke during cyclic physiologic loading. At failure testing, the deep anchors had a significantly increased failure load (164 N) compared to standard (133 N) (P <. 04) and proud (113 N) anchors (P <. 005). Conclusion Varying the depth of suture anchor insertion changes the mechanical properties and mode of failure of suture anchor constructs. Clinical Relevance Surgeons should be aware of the effects of suture anchor depth and abrasive eyelet wear on construct failure during arthroscopic rotator cuff repair.

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A Prospective Randomized Study Comparing the Interference Screw and Suture Anchor Techniques for Biceps Tenodesis

The American Journal of Sports Medicine ◽

10.1177/0363546516667577 ◽

2016 ◽

Vol 45 (2) ◽

pp. 440-448 ◽

Cited By ~ 32

Author(s):

Ji Soon Park ◽

Sae Hoon Kim ◽

Ho Jin Jung ◽

Ye Hyun Lee ◽

Joo Han Oh

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Functional Outcomes ◽

Suture Anchor ◽

Interference Screw ◽

Arthroscopic Rotator Cuff Repair ◽

Biceps Tenodesis ◽

Work Level ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Background: Several methods are used to perform biceps tenodesis in patients with superior labrum-biceps complex (SLBC) lesions accompanied by a rotator cuff tear. However, limited clinical data are available regarding the best technique in terms of clinical and anatomic outcomes. Purpose: To compare the clinical and anatomic outcomes of the interference screw (IS) and suture anchor (SA) fixation techniques for biceps tenodesis performed along with arthroscopic rotator cuff repair. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 80 patients who underwent arthroscopic rotator cuff repair with SLBC lesions were prospectively enrolled and randomly divided according to the tenodesis method: the IS and SA groups. Functional outcomes were evaluated with the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), Constant score, Korean Shoulder Score (KSS), and long head of the biceps (LHB) score at least 2 years after surgery. The anatomic status of tenodesis was estimated using magnetic resonance imaging or ultrasonography, and the anatomic failure of tenodesis was determined when the biceps tendon was not traced in the intertubercular groove directly from the insertion site of the IS or SA. Results: Thirty-three patients in the IS group and 34 in the SA group were monitored for more than 2 years. All postoperative functional scores improved significantly compared with the preoperative scores (all P < .001) and were not significantly different between the groups, including the LHB score (all P > .05). Nine anatomic failures of tenodesis were observed: 7 in the IS group and 2 in the SA group ( P = .083). In a multivariate analysis using logistic regression, IS fixation ( P = .003) and a higher (ie, more physically demanding) work level ( P = .022) were factors associated with the anatomic failure of tenodesis significantly. In patients with tenodesis failure, the LHB score ( P = .049) and the degree of Popeye deformity by the patient and examiner ( P = .004 and .018, respectively) were statistically different compared with patients with intact tenodeses. Conclusion: Care must be taken while performing biceps tenodesis in patients with a higher work level; IS fixation appears to pose a higher risk in terms of the anatomic failure of tenodesis than SA fixation, although functional outcomes were not different.

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