Biomechanical analysis of four different medial row configurations of suture bridge rotator cuff repair

Abstract

Background: Rotator cuff tendon rupture after suture bridge repair occasionally occurs at the medial row, with remnant tendon tissue remaining at the footprint. While concentrated medial row stress is suspected to be involved in such tears, the optimal suture bridge technique remains controversial. Methods: This study aimed to investigate the construct strength provided by suture bridge techniques having four different medial row configurations using artificial materials (n = 10 per group): Group 1, four-hole (two stitches per hole) knotless suture bridge; Group 2, eight-hole (one stitch per hole) parallel knotless suture bridge; Group 3, eight-hole non-parallel knotless suture bridge; and Group 4, eight-hole knot-tying suture bridge. Each construct underwent cyclic loading from 5 to 30 N for 20 cycles, followed by tensile testing to failure. The ultimate failure load and linear stiffness were measured. Findings: Group 2 had the highest ultimate failure load (mean 160.54 N, SD 6.40) [Group 4 (mean 150.21 N, SD 9.76, p = 0.0138), Group 3 (mean 138.80 N, SD 7.18, p < 0.0001), and Group 1 (mean 129.35 N, SD 4.25, p < 0.0001)]. The linear stiffness of Group 2 (mean 9.32 N/mm, SD 0.25) and Group 4 (mean 9.72 N/mm, SD 0.40) was significantly higher (p = 0.0032) than that of Group 1 (mean 8.44 N/mm, SD 0.29) and Group 3 (mean 8.61 N/mm, SD 0.31). Interpretation: In conclusion, increasing the number of suture-passed holes, arranging the holes in parallel, and a knotless technique improved the failure load following suture bridge repair.

Arthroscopic treatment of bursal-sided rotator cuff tears using knotted and knotless single-suture bridge techniques: a retrospective cohort study

“…The suture bridge knotted technique has often been used clinically to repair rotator cuff tears. This technique increases the tendon-to-bone contact area and pressure, reduces the gap in the tendon-to-bone healing area, prevents the in ltration of joint uid, and ultimately promotes tendon-to-bone healing [1,[13][14][15]. However, previous reports have suspected that this technique is associated with higher retear rates, especially type 2 retears at the tendon-to-bone junction, which means remnant cuff tissue remained at the insertion site in spite of retear [3,10,[16][17][18].…”

Modified double-pulley suture-bridge techniques with or without medial knot tying show comparable clinical and radiological outcomes in arthroscopic rotator cuff repair

“…In this technique, and the variations thereof, knot tying is often performed in the medial aspect of the footprint. In other suture‐bridge techniques, medial knot tying has been suspected to compromise vascular inflow of the tendon and increase the rate of medial row failure [27]. However, to date, no study has compared the clinical and radiological results of double‐pulley suture‐bridge (DPSB) repair with and without medial knot tying.…”