scholarly journals Is Arthroscopic Transosseous Rotator Cuff Repair Strength Dependent on the Tunnel Angle?

2019 ◽  
Vol 7 (6) ◽  
pp. 232596711984866 ◽  
Author(s):  
Daniel Bronsnick ◽  
Andrew Pastor ◽  
Dmitriy Peresada ◽  
Farid Amirouche ◽  
Giovanni Francesco Solitro ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Bone Quality ◽  
Rotator Cuff Repair ◽  
Failure Load ◽  
Longitudinal Axis ◽  
Bone Tunnel ◽  
Entry Points ◽  
Ultimate Failure ◽  
Cuff Repair ◽  
Tunnel Angle

Background: Previous studies have aimed to biomechanically improve the transosseous tunnel technique of rotator cuff repair. However, no previous work has addressed tunnel inclination at the time of surgery as an influence on the strength of the repair construct. Hypothesis: We hypothesized that the tunnel angle and entry point would influence the biomechanical strength of the transosseous tunnel in rotator cuff repair. Additionally, we investigated how tunnel length and bone quality affect the strength of the repair construct. Study Design: Controlled laboratory study. Methods: Mechanical testing was performed on 10 cadaveric humeri. Variations in the bone tunnel angle were imposed in the supraspinatus footprint to create lateral tunnels with inclinations of 30°, 45°, and 90° relative to the longitudinal axis of the humeral shaft. A closed loop of suture was passed through the bone tunnel, and cyclic loading was applied until failure of the construct. Load to failure and distance between entry points were the dependent variables. Analysis of variance, post hoc paired t tests, and the Bonferroni correction were used to analyze the relationship between the tunnel angle and failure load. The Pearson correlation coefficient was then used to evaluate the correlation of the distance between entry points to the ultimate failure load, and t tests were used to compare failure loads between healthy and osteoporotic bone. Results: Tunnels drilled perpendicularly to the longitudinal axis (90°) achieved the highest mean failure load (167.51 ± 48.35 N). However, there were no significant differences in the failure load among the 3 tested inclinations. Tunnels drilled perpendicularly to the longitudinal axis (90°) measured 13.86 ± 1.35 mm between entry points and were significantly longer ( P = .03) than the tunnels drilled at 30° and 45°. We found no correlation of the distance between entry points and the ultimate failure load. Within the scope of this study, we could not identify a significant effect of bone quality on failure load. Conclusion: The tunnel angle does not influence the strength of the bone-suture interface in the transosseous rotator cuff repair construct. Clinical Relevance: The transosseous technique has gained popularity in recent years, given its arthroscopic use. These findings suggest that surgeons should not focus on the tunnel angle as they seek to maximize repair strength.

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.

Arthroscopic Bone Tunnel Augmentation for Rotator Cuff Repair

Orthopedics ◽  
2012 ◽  
Vol 35 (5) ◽  
pp. 392-397 ◽  
Author(s):  
Grant E. Garrigues ◽  
Mark D. Lazarus
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Bone Tunnel ◽  
Cuff Repair

Intraoperative bone tunnel laceration affects integrity of arthroscopic transosseous rotator cuff repair with a tunneling device

2019 ◽  
Vol 30 (4) ◽  
pp. 336-342
Author(s):  
Yoshihiro Hirakawa ◽  
Tomoya Manaka ◽  
Yoichi Ito ◽  
Koichi Ichikawa ◽  
Yoshinobu Matsuda ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Bone Tunnel ◽  
Cuff Repair

scholarly journals Enhanced Tendon-to-Bone Healing via IKKβ Inhibition in a Rat Rotator Cuff Model

2021 ◽  
pp. 036354652098520
Author(s):  
Mikhail Golman ◽  
Xiaoning Li ◽  
Dimitrios Skouteris ◽  
Adam A. Abraham ◽  
Lee Song ◽  
...  
Keyword(s):  
Gene Expression ◽  
Rotator Cuff ◽  
Bone Healing ◽  
Rotator Cuff Repair ◽  
Failure Load ◽  
Early Period ◽  
Chemokine Production ◽  
Cuff Repair ◽  
Inhibitor Treatment

Background: More than 450,000 rotator cuff repairs are performed annually, yet healing of tendon to bone often fails. This failure is rooted in the fibrovascular healing response, which does not regenerate the native attachment site. Better healing outcomes may be achieved by targeting inflammation during the early period after repair. Rather than broad inhibition of inflammation, which may impair healing, the current study utilized a molecularly targeted approach to suppress IKKβ, shutting down only the inflammatory arm of the nuclear factor κB (NF-κB) signaling pathway. Purpose: To evaluate the therapeutic potential of IKKβ inhibition in a clinically relevant model of rat rotator cuff repair. Study Design: Controlled laboratory study. Methods: After validating the efficacy of the IKKβ inhibitor in vitro, it was administered orally once a day for 7 days after surgery in a rat rotator cuff repair model. The effect of treatment on reducing inflammation and improving repair quality was evaluated after 3 days and 2, 4, and 8 weeks of healing, using gene expression, biomechanics, bone morphometry, and histology. Results: Inhibition of IKKβ attenuated cytokine and chemokine production in vitro, demonstrating the potential for this inhibitor to reduce inflammation in vivo. Oral treatment with IKKβ inhibitor reduced NF-κB target gene expression by up to 80% compared with a nontreated group at day 3, with a subset of these genes suppressed through 14 days. Furthermore, the IKKβ inhibitor led to enhanced tenogenesis and extracellular matrix production, as demonstrated by gene expression and histological analyses. At 4 weeks, inhibitor treatment led to increased toughness, no effects on failure load and strength, and decreases in stiffness and modulus when compared with vehicle control. At 8 weeks, IKKβ inhibitor treatment led to increased toughness, failure load, and strength compared with control animals. IKKβ inhibitor treatment prevented the bone loss near the tendon attachment that occurred in repairs in control. Conclusion: Pharmacological inhibition of IKKβ successfully suppressed excessive inflammation and enhanced tendon-to-bone healing after rotator cuff repair in a rat model. Clinical Relevance: The NF-κB pathway is a promising target for enhancing outcomes after rotator cuff repair.

Gap formation in a transosseous rotator cuff repair as a function of bone quality

2014 ◽  
Vol 29 (4) ◽  
pp. 429-433 ◽  
Author(s):  
M. Mantovani ◽  
P. Baudi ◽  
P. Paladini ◽  
A. Pellegrini ◽  
M.A. Verdano ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Bone Quality ◽  
Rotator Cuff Repair ◽  
Gap Formation ◽  
Cuff Repair

Effect of Cyclic Loading on New Polyblend Suture Coupled with Different Anchors

2005 ◽  
Vol 33 (2) ◽  
pp. 214-219 ◽  
Author(s):  
Angelo De Carli ◽  
Antonio Vadalà ◽  
Edoardo Monaco ◽  
Luca Labianca ◽  
Edoardo Zanzotto ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Cyclic Load ◽  
Testing Machine ◽  
Biomechanical Properties ◽  
Mode Of Failure ◽  
Fresh Frozen ◽  
Ultimate Failure ◽  
Cuff Repair

Background Secure tendon-to-bone fixation is essential for successful rotator cuff repair. Biomechanical properties of devices used in rotator cuff repair should be better understood. Purpose To evaluate the response to incremental cyclic loading of 6 different anchor-suture complexes commonly used in rotator cuff repair. Study Design Controlled laboratory study. Methods Two absorbable anchors 5 mm and 6.5 mm in diameter and 1 metallic anchor, coupled with Ethibond or FiberWire, were tested on 5 pairs of fresh-frozen human cadaveric shoulders. An incremental cyclic load was applied until failure using a Zwich-Roell Z010 electromechanical testing machine. The ultimate failure load and mode of failure were recorded. An analysis of variance model was used for statistical analysis. Results The FiberWire suture coupled with both absorbable and metallic anchors provided statistically significantly stronger fixation. However, although the metallic anchors in most cases failed because of slippage of the anchor, absorbable anchors failed because of rupture of the eyelet. Conclusions The FiberWire seems to increase the strength of fixation devices under cyclic load using both absorbable and metallic anchors, with relevant differences in failure mode (slippage of the metallic anchor and eyelet failure in the absorbable anchor). Clinical Relevance Use of the FiberWire suture might change the mode of failure of the suture-anchor complexes.

scholarly journals Biomechanical Comparison of Augmentation of Engineered Tendon-Fibrocartilage-Bone Composite With Acellular Dermal Graft Using Double Rip-Stop Technique for Canine Rotator Cuff Repair

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712093900
Author(s):  
Zhanwen Wang ◽  
Zeling Long ◽  
Peter C. Amadio ◽  
Anne Gingery ◽  
Steven L. Moran ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Failure Load ◽  
Control Group ◽  
Gap Formation ◽  
Dermal Graft ◽  
Acellular Dermal ◽  
Cuff Repair ◽  
Retear Rate ◽  
Tendon Fibrocartilage

Background: The retear rate after rotator cuff repair remains unacceptably high. Various biological engineered scaffolds have been proposed to reduce the retear rate. We have developed a double rip-stop repair with medial row knot (DRSK) technique to enhance suture-tendon strength and a novel engineered tendon-fibrocartilage-bone composite (TFBC) for rotator cuff repair. Hypothesis: DRSK rotator cuff repair augmented with TFBC will have better biomechanical properties than that of DRSK repair with an acellular dermal graft (DG). Study Design: Controlled laboratory study. Methods: Fresh-frozen canine shoulders (n = 30) and knees (n = 10) were used. TFBCs were harvested from the patellar tendon–tibia complex and prepared for rotator cuff repair. The infraspinatus tendon was sharply detached from its bony attachment and randomly assigned to the (1) control group: DRSK repair alone, (2) TFBC group: DRSK repair with TFBC, and (3) DG group: DRSK repair with DG. All specimens were tested to failure, and videos were recorded. The footprint area, tendon thickness, load to create 3-mm gap formation, failure load, failure modes, and stiffness were recorded and compared. Data were recorded as mean ± SD. Results: The mean load to create a 3-mm gap in both the control group (206.8 ± 55.7 N) and TFBC group (208.9 ± 39.1 N) was significantly higher than that in the DG group (157.7 ± 52.3 N) ( P < .05 for all). The failure load of the control group (275.7 ± 75.0 N) and TFBC group (275.2 ± 52.5 N) was significantly higher compared with the DG group (201.5 ± 49.7 N) ( P < .05 for both comparisons). The stiffness of the control group (26.4 ± 4.7 N/mm) was significantly higher than of the TFBC group (20.4 ± 4.4 N/mm) and the DG group (21.1 ± 4.8 N/mm) ( P < .05 for both comparisons). Conclusion: TFBC augmentation showed superior biomechanical performance to DG augmentation in rotator cuff tears repaired using the DRSK technique, while there was no difference between the TFBC and control groups. Clinical Relevance: TFBC may help to reduce retear or gap formation after rotator cuff repair using the DRSK technique.

Augmentation of rotator cuff repair with gelatin–resorcin–formalin glue: a biomechanical study

2020 ◽  
pp. 175857322095116
Author(s):  
William J McNamara ◽  
Patrick H Lam ◽  
George AC Murrell
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Ex Vivo ◽  
Biomechanical Study ◽  
Control Group ◽  
Cure Time ◽  
Ultimate Failure ◽  
Group 2 ◽  
Cuff Repair ◽  
Grf Glue

Introduction Rotator cuff tendons are typically reattached to the proximal humerus using transosseous sutures or suture anchors. Their primary mode of failure is at the tendon–bone interface. Methods We investigated the addition of an adhesive, gelatin–resorcin–formalin (GRF) glue, to a single-row rotator cuff repair (RCR) on ex vivo sheep models. We hypothesised the addition of GRF glue would increase the repair construct strength. The study consisted of three groups of six sheep infraspinatus tendons with an inverted-mattress stitch, tension-band configuration. Group 1 was the control group where no glue was applied. Group 2 involved applying 2 × 2 cm of GRF glue to the infraspinatus footprint and a 2-min curing time. Group 3 allowed for a 15-min cure time. Results Failure occurred at the tendon–bone–suture interface in 6/6 of the control group, and 4/6 from groups 2 and 3. Failure occurred via the suture pulling out of the anchor in 2/6 of groups 2 and 3. No significant differences were noted between all three groups in ultimate failure load, repair stiffness or total energy to failure (p > 0.05). Discussion The addition of GRF glue to the tendon–bone–suture interface did not enhance RCR strength in an ovine model.

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