Clinical outcomes and repair integrity after arthroscopic full-thickness rotator cuff repair: suture-bridge versus double-row modified Mason-Allen technique

Lee, Kwang Won; Yang, Dae Suk; Lee, Gyu Sang; Hyun, Chang; Choy, Won Sik

doi:10.1016/j.jse.2018.04.005

Cited by 24 publications

(18 citation statements)

References 32 publications

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“…At a mean follow-up of 25 months, no significant differences were found between the groups in either the functional results or the rerupture rate. Lee et al 27 retrospectively compared the clinical and radiologic outcomes of patients who underwent arthroscopic rotator cuff repairs by the TOE (n = 37) and DR modified Mason-Allen (n = 39) techniques. The patients who underwent DR modified Mason-Allen repair had comparable shoulder functional outcomes and a comparable retear rate with those who underwent TOE repairs.…”

Section: Functional Outcomes and Healing Ratesmentioning

confidence: 99%

Current Concepts in Rotator Cuff Repair Techniques: Biomechanical, Functional, and Structural Outcomes

Rossi

Rodeo

Chahla

et al. 2019

Orthopaedic Journal of Sports Medicine

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There is substantial evidence indicating that double-row (DR) repair restores more of the anatomic rotator cuff footprint and is biomechanically superior to single-row (SR) repair. Transosseous-equivalent (TOE) techniques have shown biomechanical advantages when compared with traditional DR, including increased contact at the rotator cuff footprint, higher pressure at the tendon-bone interface, and increased failure strength. Several meta-analyses of evidence level 1 and 2 studies have shown a lower rate of failed/incomplete healing when DR repair was compared with SR repair types. There is some limited evidence that TOE techniques improve healing rates in large and massive tears as compared with SR and DR. Overall, most level 1 and 2 studies have failed to prove a significant difference between SR and DR repairs in terms of clinical outcomes. However, most studies include only short-term follow-up, minimizing the impact that the higher rate of retears/failed healing seen with SR repairs can have in the long term. There are no high-quality clinical studies comparing different DR configurations, and there are currently not enough clinical data to determine the functional advantages of various DR technique modifications over one another. Although numerous biomechanical and clinical studies comparing different rotator cuff repair techniques have been published in the past decade, none has achieved universal acceptance. It is essential for the orthopaedic surgeon to know in detail the available literature to be able to apply the most appropriate and cost-effective technique in terms of healing and functional outcomes. This review provides a critical analysis of the comparative biomechanical and clinical studies among SR, DR, and TOE techniques reported in the literature in the past decade.

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Section: Functional Outcomes and Healing Ratesmentioning

confidence: 99%

Current Concepts in Rotator Cuff Repair Techniques: Biomechanical, Functional, and Structural Outcomes

Rossi

Rodeo

Chahla

et al. 2019

Orthopaedic Journal of Sports Medicine

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show abstract

“… 26 , 28 , 39 , 40 Another technique to limit medial suture cut-through is to create a rip-stop at the medial row. 23 , 27 , 37 These studies showed that with medial row knots or rip-stop, the biomechanical properties, contact area, gap formation, ultimate failure load, and stiffness were significantly improved. However, Smith et al 41 reported that there was no difference in stiffness, ultimate failure load, or total energy to failure between the knotless and knotted techniques.…”

Section: Discussionmentioning

confidence: 99%

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

Wang

Long

et al. 2020

Bone & Joint Research

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Aims Many biomechanical studies have shown that the weakest biomechanical point of a rotator cuff repair is the suture-tendon interface at the medial row. We developed a novel double rip-stop (DRS) technique to enhance the strength at the medial row for rotator cuff repair. The objective of this study was to evaluate the biomechanical properties of the DRS technique with the conventional suture-bridge (SB) technique and to evaluate the biomechanical performance of the DRS technique with medial row knots. Methods A total of 24 fresh-frozen porcine shoulders were used. The infraspinatus tendons were sharply dissected and randomly repaired by one of three techniques: SB repair (SB group), DRS repair (DRS group), and DRS with medial row knots repair (DRSK group). Specimens were tested to failure. In addition, 3 mm gap formation was measured and ultimate failure load, stiffness, and failure modes were recorded. Results The mean load to create a 3 mm gap formation in the DRSK and DRS groups was significantly higher than in the SB group. The DRSK group had the highest load to failure with a mean ultimate failure load of 395.0 N (SD 56.8) compared to the SB and DRS groups, which recorded 147.1 N (SD 34.3) and 285.9 N (SD 89.8), respectively (p < 0.001 for both). The DRS group showed a significantly higher mean failure load than the SB group (p = 0.006). Both the DRS and DRSK groups showed significantly higher mean stiffness than the SB group. Conclusion The biomechanical properties of the DRS technique were significantly improved compared to the SB technique. The DRS technique with medial row knots showed superior biomechanical performance than the DRS technique alone.

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“…Surgical techniques of rotator cuff repair have been developed over the last two decades. Many studies reported that the clinical outcome has been improved after surgery regarding pain relief and range of shoulder motion (14,(33)(34)(35)(36). The retear rate was reported regardless of the repair techniques (37)(38)(39).…”

Section: Discussionmentioning

confidence: 99%

A biomechanical comparison of a mesh suture to a polyblend suture in a porcine tendon model

Wang¹,

Long²,

Li³

et al. 2021

Ann Transl Med

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Background: The suture-tendon interface turned out to be the weak point of a repaired rotator cuff. A double rip-stop (DRS) technique was developed to enhance the strength of the suture-tendon interface. The first aim of this study was to compare the suture-tendon interface strength between mesh suture and the No. 2 FiberWire (FW), which is commonly used in the clinic. The second aim was to compare the biomechanical properties of rotator cuff repair between mesh suture and No. 2 FiberWire using a typical suture-bridge (SB) and DRS techniques.Methods: Eighteen porcine subscapularis tendon (SST) was randomly assigned to the Mesh-tendon group and FiberWire-tendon group. A single suture loop was passed through the SST with a Mesh suture or FiberWire. Thirty-two infraspinatus tendons (ISTs) were randomly assigned to four groups: SB-Mesh group: SB technique with Mesh suture, SB-FW group: SB technique with FiberWire, DRS-Mesh group: DRS technique with Mesh suture, and DRS-FW group: DRS technique with FiberWire. All repaired specimens were underwent failure testing. Failure modes, load to create a 3-mm gap, failure load, and stiffness were compared.Results: There were no significant differences between the Mesh-tendon group and FiberWire-tendon group regarding the failure load, stiffness, and ultimate stress. When the same technique was used, the rotator cuff repaired with a mesh suture had the similar load to create a 3-mm gap, failure load, and stiffness compared with FiberWire. When the same suture was used, the DRS technique had a significantly higher load to create a 3-mm gap formation and failure load compared with the SB technique. Conclusions:The repair failure strength and stiffness using the mesh suture were similar to the FiberWire suture regardless of the repair techniques. However, the repair strength in the DRS technique was significantly stronger than the SB technique when the same suture material was used.

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Clinical outcomes and repair integrity after arthroscopic full-thickness rotator cuff repair: suture-bridge versus double-row modified Mason-Allen technique

Cited by 24 publications

References 32 publications

Current Concepts in Rotator Cuff Repair Techniques: Biomechanical, Functional, and Structural Outcomes

Current Concepts in Rotator Cuff Repair Techniques: Biomechanical, Functional, and Structural Outcomes

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

A biomechanical comparison of a mesh suture to a polyblend suture in a porcine tendon model

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