A comparison of single-<i>versus</i> double-row suture anchor techniques in a simulated repair of the rotator cuff

Özbaydar, Mehmet Uğur; Elhassan, Bassem T.; Esenyel, Cem Zeki; Atalar, Ata Can; Bozdağ, Ergün; Sünbüloğlu, Emin; Kopuz, N.; Demirhan, Mehmet

doi:10.1302/0301-620x.90b10.20862

Cited by 59 publications

(38 citation statements)

References 26 publications

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“…4 Thus, it appears that the natural history of outcomes of large tears is due to the inelasticity and poor function of the muscle-tendon unit. Despite the importance of muscle quality and function in RCT, a majority of the studies on large and massive RCT have focused on improved repair techniques (i.e., single vs. double row repair 6,7 ) or biologic factors to improve tendon to bone healing. [8][9][10] There is no established small animal model for massive RCT.…”

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confidence: 99%

A rat model of massive rotator cuff tears

Liu

Manzano

Kim

2010

Journal Orthopaedic Research

121

152

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Rotator cuff tears (RCTs) are the most common tendon injury seen in orthopedic patients. Massive RCT does not heal spontaneously and results in poor clinical outcomes. Muscle atrophy and fatty infiltration in rotator cuff muscles are major complications of chronic massive RCT and are thought to be the key factors responsible for the failure of attempted massive RCT repair. However, the pathophysiology of rotator cuff muscle atrophy and fat infiltration remains largely unknown, and no small animal model has been shown to reproduce the histologic and molecular changes seen in massive RCT. In this article, we report a novel rat massive RCT model, in which significant and consistent muscle atrophy and fat infiltration were observed in the rotator cuff muscles after rotator cuff tendon transection and denervation. The supraspinatus and infraspinatus muscle lost 25.4% and 28.9% of their wet weight 2 weeks after complete tendon transection, respectively. Six weeks after surgery, the average wet weight of supraspinatus and infraspinatus muscles decreased 13.2% and 28.3%, respectively. Significant fat infiltration was only observed in infraspinatus 6 weeks after tendon transection. Keywords: rotator cuff tear; muscular atrophy; fat infiltration Rotator cuff tears (RCTs) are one of the most common orthopedic conditions treated. Chronic RCTs lead to poor shoulder function, pain, and decreased quality of life.1 In the setting of chronic RCTs, studies have demonstrated that muscle atrophy and fatty infiltration are independent predictors of poor outcome following surgical repair.2,3 Understanding the factors that are responsible for muscle degeneration and atrophy as well as fatty infiltration may lead to pharmacologic treatments that will improve the outcomes of patients with massive RCTs.Massive RCTs, or tears that are greater than 4 cm, have been found to be associated with atrophy of the supraspinatus and infraspinatus muscle, as well as fatty infiltration of the muscle. 4 Cofield et al. 5 found that 94% of patients with a small RCT repair had a good or excellent outcome, compared to only 27% of patients with a massive RCT. Importantly, patients with large RCT with atrophy and fatty infiltration have poorer clinical outcomes than those that do not have atrophy and fatty infiltration. 4 Thus, it appears that the natural history of outcomes of large tears is due to the inelasticity and poor function of the muscle-tendon unit. Despite the importance of muscle quality and function in RCT, a majority of the studies on large and massive RCT have focused on improved repair techniques (i.e., single vs. double row repair 6,7 ) or biologic factors to improve tendon to bone healing. [8][9][10] There is no established small animal model for massive RCT. Although an acute animal model is not appropriate to test the degeneration of the tendon, it is likely appropriate to evaluate the atrophy and fatty infiltration that is seen in the setting of massive RCT. Gupta and Lee 11 have evaluated a rabbit model of RCT and demonstrat...

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confidence: 99%

A rat model of massive rotator cuff tears

Liu

Manzano

Kim

2010

Journal Orthopaedic Research

121

152

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“…The rat supraspinatus also does not undergo histologic changes comparable to those seen in the human supraspinatus after injury, and the size of the rat model makes it impossible to perform repair techniques similar to those performed in humans [6]. In the rabbit supraspinatus tendon, fatty infiltration and atrophy appear after injury [8,12] and human rotator cuff repair techniques have been performed in this model with biomechanical outcomes similar to those expected for human cuffs [31]. However, the tendon does not pass under any type of bony or ligamentous arch during motion as does the rabbit subscapularis tendon.…”

Section: Discussionmentioning

confidence: 90%

Relative Fixation Strength of Rabbit Subscapularis Repair Is Comparable to Human Supraspinatus Repair at Time 0

Otarodifard

Wong

Preston

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Recent evidence suggests that the rabbit subscapularis tendon may be anatomically, biomechanically, and histologically suitable to study rotator cuff pathology and repair. However, biomechanical comparisons of rotator cuff repairs in this model have not been evaluated and compared to those in human cadaveric specimens. Questions/purposes We quantified the biomechanical properties of the repaired rabbit subscapularis tendon after (1) single-row, (2) double-row, and (3) transosseousequivalent rotator cuff repair techniques and compared the ratios of repairs to previously published data for human repairs.Methods Tensile testing was performed on 21 New Zealand White rabbit subscapularis tendon-humerus complexes for single-row repair, double-row repair, and transosseous-equivalent repair (n = 7 for each group). Video digitizing software was used to quantify deformation. Load elongation data were then used to quantify structural properties. We compared the ratios of rotator cuff repairs for the rabbit data to data from human supraspinatus repair studies previously performed in our laboratory. For our primary end points (linear stiffness, yield load, ultimate load, and energy absorbed to failure), with the numbers available, our statistical power to detect a clinically important difference (defined as 15%) was 85%. Results The ratios of single-row/double-row repair were 0.72, 0.73, 0.71, and 0.66 for human supraspinatus and 0.77, 0.74, 0.79, and 0.89 for rabbit subscapularis repair for linear stiffness, yield load, ultimate load, and energy absorbed to failure, respectively. The ratios of double-row/transosseousequivalent repair were 1.0, 0.86, 0.70, and 0.41 for human supraspinatus and 1.22, 0.85, 0.76, and 0.60 for rabbit subscapularis for linear stiffness, yield load, ultimate load, and energy absorbed to failure, respectively. There were no differences comparing rabbit to human repair ratios for any parameter (p [ 0.09 for all comparisons). Conclusions Subscapularis repairs in the rabbit at Time 0 result in comparable ratios to human supraspinatus repairs. Clinical Relevance The biomechanical similarities between the different types of rotator cuff repair in the rabbit subscapularis and human supraspinatus at Time 0 provide more evidence that the rabbit subscapularis may be an appropriate model to study rotator cuff repairs.

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“…Although limited comparative studies with more traditional techniques exist, the double-row technique is believed to more effectively re-create the anatomic footprint of the tendon, as well as increase tendon to bone surface area, and apposition for healing. 4,5 This report highlights the technique for RC repair in an adult by using a doublerow transosseous-equivalent suture bridge.…”

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confidence: 94%

Arthroscopic Rotator Cuff Repair: Double-Row Transosseous Equivalent Suture Bridge Technique

Abdelshahed

Mahure

Kaplan

et al. 2016

Arthroscopy Techniques

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Following a failed course of conservative management, arthroscopic rotator cuff repair (ARCR) has become the gold standard treatment for patients presenting with symptomatic rotator cuff (RC) tears. Traditionally, the single-row repair technique was used. Although most patients enjoy good to excellent clinical outcomes, structural healing to bone remains problematic. As a result, orthopaedic surgeons have sought to improve outcomes with various technological and technical advancements. One such possible advancement is the double-row technique. We present a method for repairing an RC tear using double-row suture anchors in a transosseous equivalent suture bridge technique. The doublerow technique is believed to more effectively re-create the anatomic footprint of the tendon, as well as increase tendon to bone surface area, and apposition for healing. However, it requires longer operating times and is costlier. This report highlights this technique for ARCR in an adult by using a double-row transosseous equivalent suture bridge.

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A comparison of single-versus double-row suture anchor techniques in a simulated repair of the rotator cuff

Cited by 59 publications

References 26 publications

A rat model of massive rotator cuff tears

A rat model of massive rotator cuff tears

Relative Fixation Strength of Rabbit Subscapularis Repair Is Comparable to Human Supraspinatus Repair at Time 0

Arthroscopic Rotator Cuff Repair: Double-Row Transosseous Equivalent Suture Bridge Technique

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