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.

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 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.

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 Biomechanical Comparison of Modified Suture Bridge Using Rip-Stop versus Traditional Suture Bridge for Rotator Cuff Repair

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
ZiYing Wu ◽  
Chong Zhang ◽  
Peng Zhang ◽  
TianWu Chen ◽  
ShiYi Chen ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Frozen Shoulder ◽  
Biomechanical Properties ◽  
Modified Technique ◽  
Promising Alternative ◽  
Suture Bridge ◽  
Load To Failure ◽  
Fresh Frozen ◽  
Cuff Repair

Purpose. To compare the biomechanical properties of 3 suture-bridge techniques for rotator cuff repair. Methods. Twelve pair-matched fresh-frozen shoulder specimens were randomized to 3 groups of different repair types: the medially Knotted Suture Bridge (KSB), the medially Untied Suture Bridge (USB), and the Modified Suture Bridge (MSB). Cyclic loading and load-to-failure test were performed. Parameters of elongation, stiffness, load at failure, and mode of failure were recorded. Results. The MSB technique had the significantly greatest load to failure (515.6±78.0 N, P=0.04 for KSB group; P<0.001 for USB group), stiffness (58.0±10.7 N/mm, P=0.005 for KSB group; P<0.001 for USB group), and lowest elongation (1.49±0.39 mm, P=0.009 for KSB group; P=0.001 for USB group) among 3 groups. The KSB repair had significantly higher ultimate load (443.5±65.0 N) than USB repair (363.5±52.3 N, P=0.024). However, there was no statistical difference in stiffness and elongation between KSB and USB technique (P=0.396 for stiffness and P=0.242 for elongation, resp.). The failure mode for all specimens was suture pulling through the cuff tendon. Conclusions. Our modified suture bridge technique (MSB) may provide enhanced biomechanical properties when compared with medially knotted or knotless repair. Clinical Relevance. Our modified technique may represent a promising alternative in arthroscopic rotator cuff repair.

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 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 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.

scholarly journals Load response and gap formation in a single-row cruciate suture rotator cuff repair

2017 ◽  
Vol 87 (6) ◽  
pp. 483-487 ◽  
Author(s):  
Lachlan Huntington ◽  
Martin Richardson ◽  
Tony Sobol ◽  
Jonathon Caldow ◽  
David C. Ackland
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Gap Formation ◽  
Single Row ◽  
Load Response ◽  
Cuff Repair

A biomechanical analysis of gap formation and failure mechanics of a xenograft-reinforced rotator cuff repair in a cadaveric model

2012 ◽  
Vol 21 (8) ◽  
pp. 1072-1079 ◽  
Author(s):  
Kevin P. Shea ◽  
Elifho Obopilwe ◽  
John W. Sperling ◽  
Joseph P. Iannotti
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Biomechanical Analysis ◽  
Gap Formation ◽  
Failure Mechanics ◽  
Cuff Repair ◽  
Cadaveric Model

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.

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