scholarly journals A “Comma Sign”–Directed Subscapularis Repair in Anterosuperior Rotator Cuff Tears Yields Biomechanical Advantages in a Cadaveric Model

2021 ◽  
pp. 036354652110315
Author(s):  
Michael Hackl ◽  
Eduard Buess ◽  
Sandra Kammerlohr ◽  
Julia Nacov ◽  
Manfred Staat ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Failure Load ◽  
Primary Stability ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Gap Formation ◽  
Single Row ◽  
Ultimate Failure Load ◽  
Ultimate Failure ◽  
Comma Sign

Background: Additional stabilization of the “comma sign” in anterosuperior rotator cuff repair has been proposed to provide biomechanical benefits regarding stability of the repair. Purpose: This in vitro investigation aimed to investigate the influence of a comma sign–directed reconstruction technique for anterosuperior rotator cuff tears on the primary stability of the subscapularis tendon repair. Study Design: Controlled laboratory study. Methods: A total of 18 fresh-frozen cadaveric shoulders were used in this study. Anterosuperior rotator cuff tears (complete full-thickness tear of the supraspinatus and subscapularis tendons) were created, and supraspinatus repair was performed with a standard suture bridge technique. The subscapularis was repaired with either a (1) single-row or (2) comma sign technique. A high-resolution 3D camera system was used to analyze 3-mm and 5-mm gap formation at the subscapularis tendon-bone interface upon incremental cyclic loading. Moreover, the ultimate failure load of the repair was recorded. A Mann-Whitney test was used to assess significant differences between the 2 groups. Results: The comma sign repair withstood significantly more loading cycles than the single-row repair until 3-mm and 5-mm gap formation occurred ( P≤ .047). The ultimate failure load did not reveal any significant differences when the 2 techniques were compared ( P = .596). Conclusion: The results of this study show that additional stabilization of the comma sign enhanced the primary stability of subscapularis tendon repair in anterosuperior rotator cuff tears. Although this stabilization did not seem to influence the ultimate failure load, it effectively decreased the micromotion at the tendon-bone interface during cyclic loading. Clinical Relevance: The proposed technique for stabilization of the comma sign has shown superior biomechanical properties in comparison with a single-row repair and might thus improve tendon healing. Further clinical research will be necessary to determine its influence on the functional outcome.

scholarly journals Biomechanical evaluation of a novel double rip-stop technique with medial row knots for rotator cuff repair

2020 ◽  
Vol 9 (6) ◽  
pp. 285-292
Author(s):  
Zhanwen Wang ◽  
Hong Li ◽  
Zeling Long ◽  
Subin Lin ◽  
Andrew R. Thoreson ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Failure Modes ◽  
Failure Load ◽  
Biomechanical Properties ◽  
Gap Formation ◽  
Ultimate Failure Load ◽  
Fresh Frozen ◽  
Ultimate Failure ◽  
Cuff Repair

Aims Many biomechanical studies have shown that the weakest biomechanical point of a rotator cuff repair is the suture-tendon interface at the medial row. We developed a novel double rip-stop (DRS) technique to enhance the strength at the medial row for rotator cuff repair. The objective of this study was to evaluate the biomechanical properties of the DRS technique with the conventional suture-bridge (SB) technique and to evaluate the biomechanical performance of the DRS technique with medial row knots. Methods A total of 24 fresh-frozen porcine shoulders were used. The infraspinatus tendons were sharply dissected and randomly repaired by one of three techniques: SB repair (SB group), DRS repair (DRS group), and DRS with medial row knots repair (DRSK group). Specimens were tested to failure. In addition, 3 mm gap formation was measured and ultimate failure load, stiffness, and failure modes were recorded. Results The mean load to create a 3 mm gap formation in the DRSK and DRS groups was significantly higher than in the SB group. The DRSK group had the highest load to failure with a mean ultimate failure load of 395.0 N (SD 56.8) compared to the SB and DRS groups, which recorded 147.1 N (SD 34.3) and 285.9 N (SD 89.8), respectively (p < 0.001 for both). The DRS group showed a significantly higher mean failure load than the SB group (p = 0.006). Both the DRS and DRSK groups showed significantly higher mean stiffness than the SB group. Conclusion The biomechanical properties of the DRS technique were significantly improved compared to the SB technique. The DRS technique with medial row knots showed superior biomechanical performance than the DRS technique alone.

Biomechanical Strength of Rotator Cuff Repairs: A Systematic Review and Meta-regression Analysis of Cadaveric Studies

2018 ◽  
Vol 47 (8) ◽  
pp. 1984-1993 ◽  
Author(s):  
Brendan Y. Shi ◽  
Miguel Diaz ◽  
Matthew Binkley ◽  
Edward G. McFarland ◽  
Uma Srikumaran
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Failure Load ◽  
Gap Formation ◽  
Double Row ◽  
Data Set ◽  
Ultimate Failure Load ◽  
Ultimate Failure ◽  
Meta Regression ◽  
Meta Regression Analysis

Background:Biomechanical cadaveric studies of rotator cuff repair (RCR) have shown that transosseous equivalent and double-row anchored repairs are stronger than other repair constructs.Purpose:To identify technical and procedural parameters that most reliably predict biomechanical performance of RCR constructs.Study Design:Systematic review.Methods:The authors systematically searched the EMBASE and PubMed databases for biomechanical studies that measured RCR performance in cadaveric specimens. The authors performed a meta-regression on the pooled data set with study outcomes (gap formation, failure mode, and ultimate failure load) as dependent variables and procedural parameters (eg, construct type, number of suture limbs) as covariates. Stratification by covariates was performed. An alpha level of .05 was used.Results:Data from 40 eligible studies were included. Higher number of suture limbs correlated with higher ultimate failure load (β = 38 N per limb; 95% CI, 28 to 49 N) and less gap formation (β = −0.6 mm per limb; 95% CI, −1 to −0.2 mm). Other positive predictors of ultimate failure load were number of sutures, number of mattress stitches, and use of wide suture versus standard suture. When controlling for number of suture limbs, we found no significant differences among single-row anchored, double-row anchored, transosseous equivalent, and transosseous repairs. Higher number of suture limbs and transosseous equivalent repair both increased the probability of catastrophic construct failure.Conclusion:This study suggests that the number of sutures, suture limbs, and mattress stitches in a RCR construct are stronger predictors of overall strength than is construct type. There is a need to balance increased construct strength with higher risk of type 2 failure.

scholarly journals Efficacy of Bone Marrow-Stimulating Technique in Rotator Cuff Repair

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0008
Author(s):  
İsmail Kerem Bilsel ◽  
Fatih Yıldız ◽  
Mehmet Kapıcıoglu ◽  
Gokcer Uzer ◽  
Mehmet Elmadag ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Rotator Cuff ◽  
Failure Load ◽  
Tendon Healing ◽  
Histological Evaluation ◽  
Control Group ◽  
Time Interval ◽  
Lesser Tuberosity ◽  
Ultimate Failure Load ◽  
Ultimate Failure

Background: This study investigates the effect of microfracture as a bone marrow-stimulating(BMS) technique on rotatory cuff(RC) healing using a chronic RC tear model. Methods: Chronic retracted RC tendon tear model was created in the subscapularis(SSC) tendons of 20 New Zealand rabbits, bilaterally. The tendons were repaired after eight weeks using a single-row configuration with suture anchors. In right shoulders, tendons were repaired in a standard fashion(control group). In left shoulders, microfractures were performed on the SSC footprint before repair(microfracture group). The animals were sacrificed 8 and 16 weeks after repair. The repaired tendons were tested biomechanically for their ultimate failure load, linear stiffness and elongation at failure. Gross and histological evaluation of the tendon-to-bone healing was evaluated. Results: In every sample, the SSC tendon was attached to its footprint on the lesser tuberosity. In microfracture group, collagen fibers were organized in relatively ticker bundles at both time intervals. The mean ultimate failure load of microfracture was significantly greater than that of control group at 8 (148.4+31 N vs. 101.4+26 N; p=0.011) and 16 (155+30 N vs. 114.9+25 N; p=0.017) weeks after repair, respectively. There were no significant differences between the two groups at each time interval for linear stiffness (15.9+2.7N/mm vs. 15.8+1.3N/mm, p=0.798 and 16.9+4.3N/mm vs. 17.1+3.6N/mm, p=0.848, respectively) and elongation at failure (4.7+1.1 mm vs. 4.7+1.3 mm, p=0.848 and 4.8+1.5 mm vs. 4.9+0.9 mm, p=0.749, respectively). Conclusions: The BMS technique of microfracture on the tuberosity of the repaired chronic rotator cuff tear promotes the dynamic tendon healing with significant ultimate force to failure and apparent microscopic findings.

Three-Dimensional Evaluation of Cyclic Displacement in Single-Row and Double-Row Rotator Cuff Reconstructions Under Static External Rotation

2012 ◽  
Vol 41 (1) ◽  
pp. 153-162 ◽  
Author(s):  
Olaf Lorbach ◽  
Matthias Kieb ◽  
Florian Raber ◽  
Lüder C. Busch ◽  
Dieter M. Kohn ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
External Rotation ◽  
Rotator Cuff Tears ◽  
Gap Formation ◽  
Double Row ◽  
Single Row ◽  
Initial Rupture ◽  
Cyclic Displacement ◽  
Double Row Repair ◽  
Tear Size

Background: The double-row suture bridge repair was recently introduced and has demonstrated superior biomechanical results and higher yield load compared with the traditional double-row technique. It therefore seemed reasonable to compare this second generation of double-row constructs to the modified single-row double mattress reconstruction. Hypothesis: The repair technique, initial tear size, and tendon subregion will have a significant effect on 3-dimensional (3D) cyclic displacement under additional static external rotation of a modified single-row compared with a double-row rotator cuff repair. Study Design: Controlled laboratory study. Methods: Rotator cuff tears (small to medium: 25 mm; medium to large: 35 mm) were created in 24 human cadaveric shoulders. Rotator cuff repairs were performed as modified single-row or double-row repairs, and cyclic loading (10-60 N, 10-100 N) was applied under 20° of external rotation. Radiostereometric analysis was used to calculate cyclic displacement in the anteroposterior (x), craniocaudal (y), and mediolateral (z) planes with a focus on the repair constructs and the initial tear size. Moreover, differences in cyclic displacement of the anterior compared with the posterior tendon subregions were calculated. Results: Significantly lower cyclic displacement was seen in small to medium tears for the single-row compared with double-row repair at 60 and 100 N in the x plane ( P = .001) and y plane ( P = .001). The results were similar in medium to large tears at 100 N in the x plane ( P = .004). Comparison of 25-mm versus 35-mm tears did not show any statistically significant differences for the single-row repairs. In the double-row repairs, lower gap formation was found for the 35-mm tears ( P ≤ .05). Comparison of the anterior versus posterior tendon subregions revealed a trend toward higher anterior gap formation, although this was statistically not significant. Conclusion: The tested single-row reconstruction achieved superior results in 3D cyclic displacement to the tested double-row repair. Extension of the initial rupture size did not have a negative effect on the biomechanical results of the tested constructs. Clinical Relevance: Single-row repairs with modified suture configurations provide comparable biomechanical strength to double-row repairs. Furthermore, as increased gap formation in the early postoperative period might lead to failure of the construct, a strong anterior fixation and restricted external rotation protocol might be considered in rotator cuff repairs to avoid this problem.

Biomechanical testing of small versus large lesser tuberosity osteotomies: effect on gap formation and ultimate failure load

2014 ◽  
Vol 23 (4) ◽  
pp. 470-476 ◽  
Author(s):  
Matthew P. Fishman ◽  
Matthew D. Budge ◽  
James E. Moravek ◽  
Mark Mayer ◽  
Michael D. Kurdziel ◽  
...  
Keyword(s):  
Failure Load ◽  
Biomechanical Testing ◽  
Gap Formation ◽  
Lesser Tuberosity ◽  
Ultimate Failure Load ◽  
Ultimate Failure

scholarly journals Biomechanical comparison between single-row with triple-loaded suture anchor and suture-bridge double-row rotator cuff repair

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
He-Bei He ◽  
Yong Hu ◽  
Chuan Li ◽  
Cheng-Guo Li ◽  
Min-Cong Wang ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Suture Anchor ◽  
Biomechanical Properties ◽  
Gap Formation ◽  
Double Row ◽  
Single Row ◽  
Dr Method ◽  
Ultimate Failure ◽  
Cuff Repair

Abstract Background Numerous biomechanical and clinical studies comparing different techniques for rotator cuff repair have been reported, yet universal consensus regarding the superior technique has not achieved. A medially-based single-row with triple-loaded suture anchor (also referred to as the Southern California Orthopedic Institute [SCOI] row) and a suture-bridge double-row (SB-DR) with Push-Locks have been shown to result in comparable improvement in treating rotator cuff tear, yet the biomechanical difference is unknown. The purpose of the current study was to determine whether a SCOI row repair had comparable initial biomechanical properties to a SB-DR repair. Methods Six matched pairs of fresh-frozen cadaveric shoulders with full-thickness supraspinatus tendon tears we created were included. Two different repairs were performed for each pair (SCOI row and SB-DR methods). Specimens were mounted on a material testing machine to undergo cyclic loading, which was cycled from 10 to 100 N at 1 Hz for 500 cycles. Construct gap formation was recorded at an interval of 50 cycles. Samples were then loaded to failure and modes of failure were recorded. Repeated-measures analysis of variance and pair-t test were used for statistical analyses. Results The construct gap formation did not differ between SCOI row and SB-DR repairs (P = 0.056). The last gap displacement was 1.93 ± 0.37 mm for SCOI row repair, and 1.49 ± 0.55 mm for SB-DR repair. The tensile load for 5 mm of elongation and ultimate failure were higher for SCOI row repair compared to SB-DR repair (P = 0.011 and 0.028, respectively). The ultimate failure load was 326.34 ± 11.52 N in the SCOI row group, and 299.82 ± 27.27 N in the SB-DR group. Rotator cuff repair with the SCOI row method failed primarily at the suture- tendon interface, whereas pullout of the lateral row anchors was the primary mechanism of failure for repair with the SB-DR method. Conclusion Rotator cuff repair with the SCOI row method has superior biomechanical properties when compared with the SB-DR method. Therefore, SCOI row repair using a medially-based single-row technique with triple-loaded suture anchor is recommended to improve the initial strength in treating full-thickness rotator cuff tears.

scholarly journals Biceps Detachment Preserves Joint Function in a Chronic Massive Rotator Cuff Tear Rat Model

2018 ◽  
Vol 46 (14) ◽  
pp. 3486-3494 ◽  
Author(s):  
Mengcun Chen ◽  
Snehal S. Shetye ◽  
Julianne Huegel ◽  
Corinne N. Riggin ◽  
Daniel J. Gittings ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Joint ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Joint Function ◽  
Massive Rotator Cuff Tears ◽  
Sham Surgery ◽  
Biceps Tenotomy

Background: Lesions of the long head of the biceps tendon are often associated with massive rotator cuff tears (MRCTs), and biceps tenotomy is frequently performed for pain relief and functional reservation. However, the efficacy and safety of biceps tenotomy regarding the effects on the surrounding tissues in chronic MRCT are unclear. Hypothesis: Biceps tenotomy would result in improved mechanical and histological properties of the intact subscapularis tendon and improved in vivo shoulder function while not compromising glenoid cartilage properties. Study Design: Controlled laboratory study. Methods: Right supraspinatus and infraspinatus tendons were detached in 25 male Sprague-Dawley rats, followed by 4 weeks of cage activity to create a chronic MRCT condition. Animals were randomly divided into 2 groups and received either biceps tenotomy (n = 11) or sham surgery (n = 14) and were sacrificed 4 weeks thereafter. Forelimb gait and ground-reaction forces were recorded 1 day before the tendon detachment (baseline), 1 day before the surgical intervention (biceps tenotomy or sham), and 3, 7, 10, 14, 21, and 28 days after the intervention to assess in vivo shoulder joint function. The subscapularis tendon and glenoid cartilage were randomly allocated for mechanical testing or histologic assessment after the sacrifice. Results: Compared with sham surgery, biceps tenotomy partially restored the in vivo shoulder joint function, with several gait and ground-reaction force parameters returning closer to preinjury baseline values at 4 weeks. With biceps tenotomy, mechanical properties of the subscapularis tendons were improved, while mechanical properties and histological Mankin scores of the glenoid cartilage were not diminished when compared with the sham group. Conclusion: Biceps tenotomy in the presence of chronic MRCT partially preserves overall shoulder function and potentially restores subscapularis tendon health without causing detrimental effects to joint cartilage. This laboratory study adds to the growing literature regarding the protective effects of biceps tenotomy on the shoulder joint in a chronic MRCT model. Clinical Relevance: This study provides important basic science evidence supporting the use of biceps tenotomy in patients with massive rotator cuff tears.

scholarly journals Arthroscopic knotless single-row repair preserving full footprint versus tear completion repair for partial articular-sided rotator cuff tear

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901877089 ◽  
Author(s):  
Cen Tao Liu ◽  
Heng an Ge ◽  
Rui Hu ◽  
Jing Biao Huang ◽  
Yi Chao Cheng ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Pain Score ◽  
Operation Time ◽  
Clinical Results ◽  
Rotator Cuff Tears ◽  
Single Row ◽  
Repair Technique ◽  
Randomized Controlled Studies ◽  
Group 2 ◽  
Group 1

Background: The comparison of clinical outcomes of arthroscopic footprint-preserving knotless single-row repair with the tear completion repair technique for articular-sided partial-thickness rotator cuff tears (PTRCTs) remains unclear. Methods: A total of 68 patients diagnosed with articular-sided PTRCTs who underwent rotator cuff repair between December 2014 and June 2015 were included. Of the 68 patients, 30 received footprint-preserving knotless single-row repair (group 1) and 38 received the tear completion repair technique (group 2). Preoperative and postoperative assessments were compared. Results: Both groups had significantly improved American Shoulder and Elbow Surgeons (ASES) scores (group 1: 48.2 preoperatively to 81.9 postoperatively, p < 0.001; group 2: 47.1 preoperatively to 84.9 postoperatively, p < 0.001) and visual analog scale (VAS) pain score (group 1: 6.0 preoperatively to 0.93 postoperatively, p < 0.001; group 2: 6.1 preoperatively to 1.1 postoperatively, p < 0.001), showing that the two procedures significantly improved postoperative shoulder function. No significant differences were shown in ASES score or VAS pain score between the two groups ( p > 0.05). The mean operation time was significantly shorter in group 1 with an average of 48.1 min than in group 2 with an average of 60.4 min ( p < 0.001). Conclusions: Footprint-preserving knotless single-row repair obtains similar clinical results compared to tear completion repair in the treatment of articular-sided PTRCTs. Footprint-preserving knotless single-row repair may be a convenient choice for the treatment of articular-sided PTRCTs. Randomized controlled studies are needed to investigate whether the footprint-preserving knotless single-row repair yields better long-term outcomes through the protection of the bursal cuff and restoration of the healthy footprint.

scholarly journals Different Suture Materials for Arthroscopic Transtibial Pull-out Repair of Medial Meniscal Posterior Root Tears: A Human Biomechanical Study

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711987327
Author(s):  
Gilberto Y. Nakama ◽  
Zachary S. Aman ◽  
Hunter W. Storaci ◽  
Alexander S. Kuczmarski ◽  
Joseph J. Krob ◽  
...  
Keyword(s):  
Medial Meniscus ◽  
Failure Load ◽  
Clinical Care ◽  
Posterior Root ◽  
Clinical Failure ◽  
Postoperative Rehabilitation ◽  
Pull Out ◽  
Ultimate Failure Load ◽  
Ultimate Failure ◽  
Suture Tape

Background: Transtibial pull-out repair of the medial meniscal posterior root (MMPR) has been largely assessed through biomechanical studies. Biomechanically comparing different suture types would further optimize MMPR fixation and affect clinical care. Purpose/Hypothesis: The purpose of this study was to determine the optimal suture material for MMPR fixation. It was hypothesized that ultra high–molecular weight polyethylene (UHMWPE) suture tape would be biomechanically superior to UHMWPE suture and standard suture. Study Design: Controlled laboratory study. Methods: The MMPR attachment was divided in 24 human cadaveric knees and randomly assigned to 3 repair groups: UHMWPE suture tape, UHMWPE suture, and standard suture. Specimens were dissected down to the medial meniscus, and the posterior root attachments were sectioned off the tibia. Two-tunnel transtibial pull-out repair with 2 sutures, as determined by the testing group, was performed. The repair constructs were cyclically loaded between 10 and 30 N at 0.5 Hz for 1000 cycles to mimic the forces experienced on the medial meniscus during postoperative rehabilitation. Displacement was recorded at 1, 50, 100, 500, and 1000 cycles. Ultimate failure load, displacement at failure, and load at 3 mm of displacement (clinical failure) were also recorded. Results: UHMWPE suture tape had significantly less displacement of the medial meniscus when compared with standard suture at 1 (–0.22 mm [95% CI, –0.41 to –0.02]; P = .025) and 50 (–0.35 mm [95% CI, –0.67 to –0.03]; P = .029) cycles. There were no other significant differences observed in displacement between groups at any number of cycles. UHMWPE suture tape had significantly less displacement at the time of failure than standard suture (–3.71 mm [95% CI, –7.17 to –0.24]; P = .034). UHMWPE suture tape had a significantly higher load to reach the clinical failure displacement of 3 mm than UHMWPE suture (15.64 N [95% CI, 0.02 to 31.26]; P = .05). There were no significant differences in ultimate failure load between groups. Conclusion: The meniscal root repair construct with UHMWPE suture tape may be stronger and less prone to displacement than that with standard suture or UHMWPE suture. Clinical Relevance: UHMWPE suture tape may provide better clinical results compared with UHMWPE suture and standard suture.

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