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

Abstract

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.

Modified Double-Row Suture Bridge Technique With Double-Row Biceps Tenodesis for Massive Rotator Cuff Tear

“…A study by Wu et al, 5 describing a modification of the TOE knotless suture bridge (SB) technique, called the "modified suture bridge," claims to combine the advantages of the knotless technique in the medial row with better biomechanics than knot-tying repairs. The modification was designed to augment the initial weak fixation provided by the knotless approach with a combined decrease in knot irritation and impingement.…”

“…In addition, the rip-stop technique, compared with a simple or mattress stitch pattern, is superior regarding load-to-failure characteristics and providing resistance to tissue cutout, with better distribution of the medial-to-lateral tensile strength. 5 However, it is important to state that although biomechanical studies are important to gauge the best construct and compare different approaches, they fail to replicate rotator cuff repairs performed in clinical practice and they provide data only on the initial biomechanics, with no insight on the durability of the repair. 1 Initially created to enhance and facilitate the surgical approach, the SB repair technique has been shown to be an easier, biomechanically promising, more costeffective approach.…”

Biomechanical evaluation of a novel double rip-stop technique with medial row knots for rotator cuff repair

“…The results confirmed that the DRS technique showed significantly improved biomechanical properties compared to the conventional SB technique, which is consistent with previous research. 47 …”

A Modified SpeedBridge Technique for Retracted or Delaminated Rotator Cuff Repairs

“…The development of new techniques for rotator cuff repair have revealed an effort toward increased footprint surface contact, leading from the single-row technique to the double-row technique, and from there to the interosseous equivalent, or suture bridge technique 11, 12, 13. A wide variety of modifications have been proposed to these techniques, including the rip-stop suture bridge, 14 the tension-band suture technique, 15 the roman bridge technique, 16 the hybrid technique, 17 and a technique combining a modified SpeedBridge with the double pulley technique 18 . One factor these modifications are not well equipped to address is the tensioning of an inferior layer in a delaminated lesion and “dog earing,” which can arise during repair of a larger or retracted tear.…”