Part I: Footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique

Background Recurrent defects after open and arthroscopic rotator cuff repair are common. Double-row repair techniques may improve initial fixation and quality of rotator cuff repair. Purpose To evaluate the load to failure, cyclic displacement, and anatomical footprint of 4 arthroscopic rotator cuff repair techniques. Hypothesis Double-row suture anchor repair would have superior structural properties and would create a larger footprint compared to single-row repair. Study Design Controlled laboratory study. Methods Twenty fresh-frozen cadaveric shoulders were randomly assigned to 4 arthroscopic repair techniques. The repair was performed as either a single-row technique or 1 of 3 double-row techniques: diamond, mattress double anchor, or modified mattress double anchor. Angle of loading, anchor type, bone mineral density, anchor distribution, angle of anchor insertion, arthroscopic technique, and suture type and size were all controlled. Footprint length and width were quantified before and after repair. Displacement with cyclic loading and load to failure were determined. Results There were no differences in load to failure and displacement with cyclic loading between the single-row repair and each double-row repair. All repair groups demonstrated load to failure greater than 250 N. A significantly greater supraspinatus footprint width was seen with double-row techniques compared to single-row repair. Conclusions The single-row repair technique was similar to the double-row techniques in load to failure, cyclic displacement, and gap formation. The double-row anchor repairs consistently restored a larger footprint than did the single-row method. Clinical Relevance The arthroscopic techniques studied have strong structural properties that approached the reported performance of open repair techniques. Double-row techniques provide a larger footprint width; although not addressed by this study, such a factor may improve the biological quality of repair.

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Paper # 25: Single-Row Rotator Cuff Repair Using a Modified Suture Configuration versus a Suture-Bridging Double-Row Repair - Comparable Biomechanical Results and Complete Footprint Coverage Independent of the Initial Tear Size

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2011.08.026 ◽

2011 ◽

Vol 27 (10) ◽

pp. e86-e87

Author(s):

Olaf Lorbach ◽

Dietrich Pape ◽

Florian Raber ◽

Dieter Kohn ◽

Matthias Kieb

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Double Row ◽

Single Row ◽

Double Row Repair ◽

Cuff Repair ◽

Tear Size

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Arthroscopic Rotator Cuff Repair (Double Row Repair): Current Evidence

International Journal of Orthopaedics ◽

10.17554/j.issn.2311-5106.2019.06.281-1 ◽

2019 ◽

Vol 6 (1) ◽

pp. 991-995

Author(s):

Nobuyuki Yamamoto ◽

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Arthroscopic Rotator Cuff Repair ◽

Current Evidence ◽

Double Row ◽

Arthroscopic Rotator Cuff ◽

Double Row Repair ◽

Cuff Repair

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Arthroscopic Rotator Cuff Repair : Double-Row Repair

Minimally Invasive Shoulder and Elbow Surgery ◽

10.3109/9781420019872-26 ◽

2007 ◽

pp. 261-272

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Arthroscopic Rotator Cuff Repair ◽

Double Row ◽

Arthroscopic Rotator Cuff ◽

Double Row Repair ◽

Cuff Repair

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A Knotless Dual Row Loop Rotator Cuff Repair: Does It Hold Up to a Transosseous Equivalent Repair?

ASME 2009 4th Frontiers in Biomedical Devices ◽

10.1115/biomed2009-83062 ◽

2009 ◽

Author(s):

Theodore F. Schlegel ◽

Karimdad Amir Otarodifard ◽

Richard J. Hawkins ◽

Thomas Vangsness ◽

Christopher Bui ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Matched Pair ◽

Knot Tying ◽

Double Row ◽

Double Row Repair ◽

Cuff Repair

A transosseous-equivalent rotator cuff repair has shown improved biomechanical characteristics compared to other more cumbersome arthroscopic double row repairs. However, the transosseous equivalent repair, which requires knot tying, still can be challenging when tensioning the repair construct. We hypothesized that a knotless dual row loop repair has similar biomechanical characteristics to the transosseous-equivalent rotator cuff repair. Therefore, the objective of this study was to quantify and compare the biomechanical characteristics of a knotless double row repair and transosseous equivalent rotator cuff repair using matched pair shoulders.

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Arthroscopic double-row rotator cuff repair: a comprehensive review of the literature

SICOT-J ◽

10.1051/sicotj/2018048 ◽

2018 ◽

Vol 4 ◽

pp. 57 ◽

Cited By ~ 3

Author(s):

Nuri Aydin ◽

Bedri Karaismailoglu ◽

Mert Gurcan ◽

Mahmut Kursat Ozsahin

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Structural Integrity ◽

Tendon Healing ◽

Functional Results ◽

Double Row ◽

Single Row ◽

Repair Technique ◽

Medial Side ◽

Cuff Repair

Rotator cuff repairs seek to achieve adequate tendon fixation and to secure the fixation during the process of biological healing. Currently, arthroscopic rotator cuff repair has become the gold standard. One of the earliest defined techniques is single-row repair but the inadequacy of single-row repair to precisely restore the anatomical footprint as well as the significant rates of retear especially in large tears have led surgeons to seek other techniques. Double-row repair techniques, which have been developed in response to these concerns, have various modifications like the number and placement of anchors and suture configurations. When the literature is reviewed, it is possible to say that double-row repairs demonstrate superior biomechanical properties. In regard to retear rates, both double row and transosseous equivalent (TOE) techniques have also yielded more favorable outcomes compared to single-row repair. But the clinical results are conflicting and more studies have to be conducted. However, it is more probable that superior structural integrity will yield better structural and functional results in the long run. TOE repair technique is regarded as promising in terms of better biomechanics and healing since it provides better footprint contact. Knotless TOE structures are believed to reduce impingement on the medial side of tendons and thus aid in tendon nutrition; however, there are not enough studies about its effectiveness. It is important to optimize the costs without endangering the treatment of the patients. We believe that the arthroscopic TOE repair technique will yield superior results in regard to both repair integrity and functionality, especially with tears larger than 3 cm. Although defining the pattern of the tear is one of the most important guiding steps when selecting the repair technique, the surgeon should not forget to evaluate every patient individually for tendon healing capacity and functional expectations.

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