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

Abstract

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.

A false-pouch closure technique with an intact superior peroneal retinaculum for recurrent dislocation of the peroneal tendon

“…Further biomechanical studies are needed to confirm whether the current procedure can fix SPR more firmly to the bone than the previously reported false-pouch closure technique. Previous biomechanical studies have shown that a wider contact area with the suture bridge technique has superior time-zero structural properties in rotator cuff repair [ 20 , 22 ].…”

Biomechanical comparison between single-row with triple-loaded suture anchor and suture-bridge double-row rotator cuff repair

“…Controversy remains in terms of placing the anchors in a single-row or double-row arrangement [ 21 ]. Meier and Meier [ 22 ] suggested that DR suture anchor fixation provided significantly stronger initial strength than conventional SR repair, because DR suture anchor fixation consistently reproduces 100% of the original supraspinatus footprint, whereas SR suture anchor fixation reproduces only 46% of the insertion site [ 23 ].…”

Editorial Commentary: Living in the Material World: Could Viscoelastic Properties of Sutures Impact Patient Outcomes?

“…The truth is, we presently lack the clinical data supporting this. Even with extensive evidence of advantages of certain techniques over others (e.g., double row over single row, transosseous equivalent), there is currently few highquality data supporting one technique over another, 5 let alone one suture material over another, leading to superior clinical outcomes. But in the end, there is little reason not to use a stronger suture material in a ligament or tendon repair.…”