Arthroscopic Single-Row Modified Mason-Allen Repair Versus Double-Row Suture Bridge Reconstruction for Supraspinatus Tendon Tears

Gerhardt, Christian; Hug, Konstantin; Pauly, Stephan; Marnitz, Tim; Scheibel, Markus

doi:10.1177/0363546512462123

Cited by 88 publications

(93 citation statements)

References 63 publications

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“…When sutures cut through tendon, they tend to slip along the longitudinal orientation of the collagen fibers, analogous to passing a comb through a bundle of hair. Especially in arthroscopic repair, mechanically robust suture configurations (eg, modified MasonAllen,) are technically demanding and generally too time consuming to be clinically viable [31] and even shows no superiority in clinical results [9,20]. More simple (eg, double rows of single-loop suture) reconstruction techniques have been shown to provide adequate biomechanical strength, but also raise biological concern attributable to over-tensioning of the repair and incidence of intratendinous retearing [2].…”

Section: Discussionmentioning

confidence: 99%

Tendon Collagen Crosslinking Offers Potential to Improve Suture Pullout in Rotator Cuff Repair: An Ex Vivo Sheep Study

Camenzind

Wieser

Fessel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background The suture-tendon interface is often the weakest link in tendon to bone repair of massive rotator cuff tears. Genipin is a low-toxicity collagen crosslinker derived from the gardenia fruit that has been shown to augment collagen tissue strength and mechanically arrest tendon-tear progression. Question/Purpose The purpose of the current study was to evaluate whether genipin crosslinking can sufficiently augment the suture-tendon interface to improve suture pullout strength using simple single-loop sutures and the modified Mason-Allen technique. The study also aimed to assess whether time of genipin treatment is a relevant factor in efficacy. Methods In an ex vivo (cadaveric) sheep rotator cuff tendon model, a total of 142 suture pullout tests were performed on 32 infraspinatus tendons. Each tendon was prepared with three single-loop stitches. Two groups were pretreated by incubation in genipin solution for either 4 hours or 24 hours. Two corresponding control groups were incubated in phosphate buffered saline for the same periods. The same test protocol was applied to tendons using modified Mason-Allen technique stitch patterns. Each suture was loaded to failure on a universal materials testing machine. Suture pullout force, stiffness, and work to failure were calculated from force-displacement data, and then compared among the groups. Results Median single-loop pullout force on tendons incubated for 24 hours in genipin yielded an approximately 30% increase in maximum pullout force for single-loop stitches with a median of 73 N (range, 56-114 N) compared with 56 N (range, 40-69 N; difference of medians = 17 N; p = 0.028), with corresponding increases in the required work to failure but not stiffness. Genipin treatment for 4 hours showed no added benefit for suture-pullout behavior (46 N, [range, 35-95 N] versus 45 N, [range, 28-63 N]; difference of medians, 1 N; p = 1). No tested genipin crosslinking conditions indicated benefit for tendons grasped using the modified Mason-Allen technique after 4 hours (162 N, [range, 143-193 N] versus 140 N, [range, 129-151 N]; difference of medians, 22 N; p = 0.114) or after 24 hours of crosslinking (172 N, [range, 42-183 N] versus 164 N [range, 151-180 N]; difference of medians, 8 N; p = 0.886). Conclusion Exogenous collagen crosslinking in genipin can markedly improve resistance to pullout at the tendonsuture interface for simple stitch patterns while the modified Mason-Allen stitch showed no benefit in an ex vivo animal model.

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Section: Discussionmentioning

confidence: 99%

Tendon Collagen Crosslinking Offers Potential to Improve Suture Pullout in Rotator Cuff Repair: An Ex Vivo Sheep Study

Camenzind

Wieser

Fessel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…18) Recent suture bridge technique had generally reduced the retear rate compared with more conventional technique. 4,6,8,9,19,20) Many authors reported the retear rate from 8%…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6] A recent systematic review also underscored that the knot-tying of the medial row is superior to non-tying methods in the biomechanical aspect. 7) However, there is an increasing concern that strangulation of the medial tendinous portion can be elicited by multiple medial knot-tying, resulting in subsequent deterioration of tendon viability.…”

Section: Introductionmentioning

confidence: 99%

“…4,5) Strangulation was speculated as one of the causes of medial cuff failure, which is a more frequentlyencountered condition in double row technique. [4][5][6] In fact, an unexpectedly high retear rate was reported with current medial knot-tying technique, in spite of enhanced time zero biomechanical strength. 4,6,9) To avoid excessive strangulation in medial row, we modified the medial knot-tying method to minimal-tying technique.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6] In fact, an unexpectedly high retear rate was reported with current medial knot-tying technique, in spite of enhanced time zero biomechanical strength. 4,6,9) To avoid excessive strangulation in medial row, we modified the medial knot-tying method to minimal-tying technique. In the modified technique, just one knot was made in the most anterior region of the supraspinatus (the most tendinous portion of the supraspinatus; Fig.…”

Section: Introductionmentioning

confidence: 99%

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Minimal Medial-row Tie with Suture-bridge Technique for Medium to Large Rotator Cuff Tears

Lee

Ryu²,

Shim

et al. 2015

Clinics in Shoulder and Elbow

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Background: The purpose of this study was to evaluate the postoperative magnetic resonance imaging (MRI) results of minimal-tying (one medial-row tie among 4 medial-row sutures) on the medial-row in double-row suture-bridge configuration (2×2 anchor with 4×4 suture stands). Methods: From 2011 March to 2012 July, 79 patients underwent arthroscopic rotator cuff repair using 2×2 anchor double-row configuration. The mean age was 61.3 years (range, 31-81 years). Two double-loaded suture anchors were used for medial-row. Four medialrow stitches were made with only one medial-row knot-tying (the most anterior suture). Lateral-row was secured using the conventional suture-bridge anchor technique; all 4 strands were used for each anchor. Repair integrity was evaluated with MRI at mean 6.2 months postoperatively. Retear and the pattern of retear, change of fatty infiltration, and muscle atrophy of supraspinatus were evaluated using pre-and postoperative MRI. Results: Repaired tendon integrity was 38 for type I, 30 for type II, 6 for type III, 4 for type IV, and 1 for type V, according to Sugaya classification. Considering type IV/V as retear, the rate was 6.3% (5 out of 79 patients). Medial cuff failure was observed in 4 patients. Fatty atrophy of supraspinatus was significantly improved postoperatively according to Goutallier grading (p=0.01). The level of muscle atrophy of supraspinatus was not changed significantly after surgery. Conclusions: Minimal tying technique with suture configuration of four-by-four strand double-row suture-bridge yielded a lower retear rate (6.3%) in medium to large rotator cuff tears. (Clin Shoulder Elbow 2015;18(4):197-205)

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Relationship between muscle fatty infiltration and the biological characteristics and stimulation potential of tenocytes from rotator cuff tears

Klatte‐Schulz

Gerhardt

Scheibel

et al. 2013

Journal Orthopaedic Research

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The healing after rotator cuff surgery is still dissatisfying, and increased muscle fatty infiltration even more impairs the healing success. To achieve sufficient healing after rotator cuff reconstructions, the use of growth factors may be one possibility. The aim of the study was to identify a possible relationship between fatty infiltration of the supraspinatus muscle and cellular biological characteristics and stimulation potential of tenocyte-like cells (TLCs). TLCs of 3 donor groups differing in grade of muscle fatty infiltration were analyzed for their cellular characteristics and were stimulated with BMP-2 or BMP-7 in a 3D scaffold culture. The cell count and potency for self-renewal were significantly decreased in TLCs from donors with high muscle fatty infiltration compared to the lower fatty infiltration groups. Cell count and collagen-I expression as well as protein synthesis were stimulated by growth factors. Interestingly, TLCs of the high fatty infiltration group exhibited a weaker stimulation potential compared to the other groups. TLCs from donors with high muscle fatty infiltration generally revealed inferior characteristics compared to cells of lower fatty infiltration groups, which may be one reason for a weaker healing potential and may represent a possible starting point for the development of future treatment options. ß

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Arthroscopic Single-Row Modified Mason-Allen Repair Versus Double-Row Suture Bridge Reconstruction for Supraspinatus Tendon Tears

Cited by 88 publications

References 63 publications

Tendon Collagen Crosslinking Offers Potential to Improve Suture Pullout in Rotator Cuff Repair: An Ex Vivo Sheep Study

Tendon Collagen Crosslinking Offers Potential to Improve Suture Pullout in Rotator Cuff Repair: An Ex Vivo Sheep Study

Minimal Medial-row Tie with Suture-bridge Technique for Medium to Large Rotator Cuff Tears

Relationship between muscle fatty infiltration and the biological characteristics and stimulation potential of tenocytes from rotator cuff tears

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