Biomechanical evaluation of a single-row versus double-row repair for complete subscapularis tears

Abstract

The purpose of the study was to compare a single-row repair and a double-row repair technique for the specific characteristics of a complete subscapularis lesion. Ten pairs of human cadaveric shoulder human shoulder specimens were tested for stiffness and ultimate tensile strength of the intact tendons in a load to failure protocol. After a complete subscapularis tear was provoked, the specimens were assigned to two treatment groups: single-row repair (1) and a double-row repair using a "suture bridge" technique (2). After repair cyclic loading a subsequent load to failure protocol was performed to determine the ultimate tensile load, the stiffness and the elongation behaviour of the reconstructions. The intact subscapularis tendons had a mean stiffness of 115 N/mm and a mean ultimate load of 720 N. The predominant failure mode of the intact tendons was a tear at the humeral insertion site (65%). The double-row technique restored 48% of the ultimate load of the intact tendons (332 N), while the single-row technique revealed a significantly lower ultimate load of 244 N (P = 0.001). In terms of the stiffness, the double-row technique showed a mean stiffness of 81 N/mm which is significantly higher compared to the stiffness of the single-row repairs of 55 N/mm (P = 0.001). The double-row technique has been shown to be stronger and stiffer when compared to a conventional single-row repair. Therefore, this technique is recommended from a biomechanical point of view irrespectively if performed by an open or arthroscopic approach.

Reconstruction of 25 and 50 % subscapularis tears: a single anchor with a double-mattress suture is sufficient for the reconstruction

“…Moreover, a load of 180 Newton represents approximately 20 % of the ultimate failure load of the intact tendon [42], which might also be a viable load in the early post-operative period. Finally, ultimate tensile strength was tested.…”

Functional and structural comparisons of the arthroscopic knotless double-row suture bridge and single-row repair for anterosuperior rotator cuff tears

“…Biomechanical tests have shown that the TOE repair technique is superior to the unlinked double-row and single-row methods for the repair of the supraspinatus 30,32 and subscapularis. 36 However, to our knowledge, no study comparing the outcomes of arthroscopic TOE and single-row repairs of anterosuperior RCTs has yet been published. Thus, the purpose of this study was to compare the outcomes of TOE and single-row repairs in patients undergoing arthroscopic repair of anterosuperior RCTs.…”

Suture-bridge subscapularis tendon repair technique using low anterior portals

“…1 Pictures showing the different arthroscopic portals used for subscapularis repair using the suture-bridge technique (a anterior, b lateral, c posterior, d low anteromedial, e low anterolateral) Fig. 2 Arthroscopic view of high-speed burr brought into the subacromial space through the anterolateral portal to decorticate the lesser tuberosity subscapularis tendon [14], the double-row technique restored higher ultimate load and stiffness compared to that of the single-row technique. Therefore, from a biomechanical point of view, double-row fixation is more recommendable than single-row repair.…”

“…Although single-row repair for subscapularis tendon tears showed good results regarding shoulder function and repaired cuff integrity, concerns still remain for retear rate, as reported 35% for arthroscopic fixation of combined anterosuperior tears (subscapularis and supraspinatus tendon tears) [6,8]. Recent biomechanical study revealed that double-row technique restored significant higher ultimate load and stiffness compared to those of single-row technique [14]. The suturebridge technique has been adapted for arthroscopic subscapularis repair to attain the ideal cuff integrity and footprint restoration.…”