Double-Layer Rotator Cuff Repair: Anatomic Reconstruction of the Superior Capsule and Rotator Cuff Improves Biomechanical Properties in Repairs of Delaminated Rotator Cuff Tears

2018 ◽  
Vol 46 (13) ◽  
pp. 3165-3173 ◽  
Author(s):  
Leo Pauzenberger ◽  
Philipp R. Heuberer ◽  
Felix Dyrna ◽  
Elifho Obopilwe ◽  
Bernhard Kriegleder ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Double Layer ◽  
Rotator Cuff Repair ◽  
External Rotation ◽  
Biomechanical Properties ◽  
Rotator Cuff Tears ◽  
Double Row ◽  
Cyclical Loading ◽  
Double Row Repair ◽  
Cuff Repair

Background: Delamination in rotator cuff tears has been identified as a prognostic factor for negative outcome after repair, with a reported prevalence between 38% and 88%. Purpose: To compare biomechanical properties of 3 repair techniques for delaminated rotator cuff tears. Study Design: Controlled laboratory study. Methods: Eighteen fresh-frozen cadaveric shoulders were used to evaluate rotator cuff footprint reconstruction, contact area and pressure, displacement under cyclical loading, and load to failure of 3 double-row repair configurations: double-row suture repair with medial row knots (medially knotted bridge, mkB); knotless double-row repair using suture tapes (knotless bridge, klB); and knotless double-row, double-layer-specific repair (double-layer, DL). Dynamic pressure sensors were used to assess contact patterns at the footprint region in 0°, 30°, and 60° of glenohumeral abduction and 5 rotational positions (0°, 30° of internal rotation, 30° of external rotation, 60° of internal rotation, 60° of external rotation). Optical markers were used to document whole tendon and individual layer displacement after rotator cuff repair under cyclical loading for 200 cycles (10 N to 100 N at 1 Hz). Specimens were then loaded monotonically to failure at a rate of 33 mm/min. Results: Mean contact area and footprint restoration were highest in the DL group at 60° of glenohumeral abduction for all rotational positions (mkB mean ± SD, 195.4 ± 54.3 mm2, 66.7% ± 19.7%; klB, 250.6 ± 34.9 mm2, 76.2% ± 10.3%; DL, 318.4 ± 36.6 mm2, 109.1% ± 24.0%; P < .001). The double-layer-specific repair showed the least displacement under cyclical loading (mkB mean ± SD, 0.53 ± 0.18 mm; klB, 0.79 ± 0.37 mm; DL, 0.31 ± 0.24 mm; P = .029), most closely resembling the native tendon. Peak loads at failure were comparable between repair groups (mkB mean ± SD, 366.92 ± 70.59 N; klB, 280.05 ± 77.66 N; DL, 398.35 ± 109.04 N; P = .083). Conclusion: Anatomic restoration of the superior capsular and tendon insertion in delaminated rotator cuff tears with a double-layer-specific repair configuration demonstrated superior footprint restoration with increasing abduction, while providing construct displacement comparable to the native tendon under cyclical loading. Peak load at failure was comparable between repair constructs. Clinical Relevance: The prevalence and clinical importance of delaminated rotator cuff tears have long been underestimated. Anatomically correct individual reconstruction of the superior capsule and rotator cuff could restore near-native biomechanics and potentially reduce the risk of rotator cuff repair failure.

scholarly journals Minimum Five-Year Outcomes and Clinical Survivorship Following Arthroscopic Double-Row Repair for Full-thickness Supraspinatus Tears

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0007
Author(s):  
Jonas Pogorzelski ◽  
Erik M. Fritz ◽  
Marilee P. Horan ◽  
Zaamin B. Hussain ◽  
Christoph Katthagen ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Double Row ◽  
Survivorship Analysis ◽  
Double Row Repair ◽  
Cuff Repair

Objectives: Rotator cuff tears lead to significant morbidity due to pain and decreased function. Despite the prevalence of cuff repairs, mid-term outcomes have been scarcely reported. The purpose of this study is to report minimum 5-year outcomes and clinical survivorship after double-row rotator cuff repair for full-thickness supraspinatus tendon tears. Methods: Patients at least five years out from arthroscopic double-row repair for a full-thickness cuff tear involving the supraspinatus tendon were included. Pre- and postoperative ASES, SF-12 PCS, QuickDASH, SANE, and satisfaction scores were collected. The relationship between outcomes and (1) tear chronicity, (2) number of tendons involved, (3) type of repair, and (4) primary versus revision procedure, was also evaluated. Kaplan-Meier survivorship analysis was conducted defining failures as progression to revision rotator cuff surgery. Results: From November 2005 to February 2012, a total of 189 shoulders were eligible for inclusion. Fifteen shoulders (7.9%) underwent revision rotator cuff repair and were considered failures. Outcomes data were reported at a mean follow-up of 6.6 (range, 5.0-11.0) years. All outcome scores significantly improved from pre- to postoperative time point, including mean ASES (57.9 to 92.9, P < 0.001), SF-12 PCS (43.4 to 52.0, P < 0.001), QuickDASH (35.2 to 10.5, P < 0.001), and SANE scores (61.5 to 86.5, P < 0.001). Acute tears demonstrated significantly better ASES and SANE scores than chronic tears (ASES 95.1 ± 8.9 versus 91.7 ± 11.2, P = 0.025; SANE 89.6 ± 19.9 versus 85.7 ± 21.3, P = 0.042). No other analyzed variable had a significant association with outcomes scores ( P > 0.05). Survivorship analysis demonstrated a postoperative clinical survivorship of the repair of 96.5% at two years and 93.8% at five years (Figure 1). Conclusion: Patients can expect excellent clinical outcomes and a low failure rate following arthroscopic double-row repair of full-thickness supraspinatus tears at mid-term follow-up. The repair of acute tears and primary repairs were associated with better postoperative outcomes.

scholarly journals Outcome and Structural Integrity of Rotator Cuff after Arthroscopic Treatment of Large and Massive Tears with Double Row Technique: A 2-Year Followup

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Ignacio Carbonel ◽  
Angel A. Martínez ◽  
Elisa Aldea ◽  
Jorge Ripalda ◽  
Antonio Herrera
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Functional Outcome ◽  
Rotator Cuff Repair ◽  
Structural Integrity ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Double Row ◽  
Massive Rotator Cuff Tears ◽  
Cuff Repair

Purpose. The purpose of this study was to evaluate the functional outcome and the tendon healing after arthroscopic double row rotator cuff repair of large and massive rotator cuff tears.Methods. 82 patients with a full-thickness large and massive rotator cuff tear underwent arthroscopic repair with double row technique. Results were evaluated by use of the UCLA, ASES, and Constant questionnaires, the Shoulder Strength Index (SSI), and range of motion. Follow-up time was 2 years. Magnetic resonance imaging (MRI) studies were performed on each shoulder preoperatively and 2 years after repair.Results. 100% of the patients were followed up. UCLA, ASES, and Constant questionnaires showed significant improvement compared with preoperatively (P<0.001). Range of motion and SSI in flexion, abduction, and internal and external rotation also showed significant improvement (P<0.001). MRI studies showed 24 cases of tear after repair (29%). Only 8 cases were a full-thickness tear.Conclusions. At two years of followup, in large and massive rotator cuff tears, an arthroscopic double row rotator cuff repair technique produces an excellent functional outcome and structural integrity.

Arthroscopic Single-Row versus Double-Row Suture Anchor Rotator Cuff Repair

2005 ◽  
Vol 33 (12) ◽  
pp. 1861-1868 ◽  
Author(s):  
Augustus D. Mazzocca ◽  
Peter J. Millett ◽  
Carlos A. Guanche ◽  
Stephen A. Santangelo ◽  
Robert A. Arciero
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Double Row ◽  
Single Row ◽  
Load To Failure ◽  
Arthroscopic Rotator Cuff ◽  
Double Row Repair ◽  
Cuff Repair ◽  
Repair Techniques

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.

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

2007 ◽  
Vol 16 (4) ◽  
pp. 461-468 ◽  
Author(s):  
Maxwell C. Park ◽  
Neal S. ElAttrache ◽  
James E. Tibone ◽  
Christopher S. Ahmad ◽  
Bong-Jae Jun ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Double Row ◽  
Repair Technique ◽  
Double Row Repair ◽  
Cuff Repair

Part II: Biomechanical assessment for a footprint-restoring transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique

2007 ◽  
Vol 16 (4) ◽  
pp. 469-476 ◽  
Author(s):  
Maxwell C. Park ◽  
James E. Tibone ◽  
Neal S. ElAttrache ◽  
Christopher S. Ahmad ◽  
Bong-Jae Jun ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Double Row ◽  
Biomechanical Assessment ◽  
Repair Technique ◽  
Double Row Repair ◽  
Cuff Repair

A New Knotless Suture Staple Double Row Construct for Medial Repair of Rotator Cuff Tears

2009 ◽  
Author(s):  
Theodore F. Schlegel ◽  
Karimdad Amir Otarodifard ◽  
Richard J. Hawkins ◽  
Thomas Vangsness ◽  
Christopher Bui ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
New Technology ◽  
Rotator Cuff Tears ◽  
Matched Pair ◽  
Anatomic Site ◽  
Double Row ◽  
Rotator Cuff Tendon ◽  
Anchoring System ◽  
Cuff Repair

Recently, there has been considerable interest in the ability to repair the rotator cuff tendon to its anatomic site along the articular margin of the footprint for either double row repairs or with a PASTA lesion. Unfortunately, this can often be difficult to perform since it requires placing a fixation device at the articular margin and then bringing sutures through the rotator cuff tendon. A new technology allows for easy piercing of the rotator cuff tendon under direct visualization with simultaneous placement of the anchoring device. The second preloaded anchor can then be used to create a suture bridge over the tendon for tensioning and eventual security without tying knots. We hypothesized that suture staple double row repair with a knotless anchoring system along with a traditional lateral row fixation has similar biomechanical characteristics to the TOE rotator cuff repair. Therefore, the objective of this study was to quantify and compare the biomechanical characteristics of a knotless suture staple double row (SSDR) repair and transosseous equivalent (TOE) rotator cuff repair using matched pair shoulders.

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