Does Suture Technique Affect Re-Rupture in Arthroscopic Rotator Cuff Repair? A Meta-analysis

Brown, Matthew; Pula, David A.; Kluczynski, Melissa A.; Mashtare, Terry; Bisson, Leslie J.

doi:10.1016/j.arthro.2015.02.004

Cited by 39 publications

(25 citation statements)

References 31 publications

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“…7 Brown et al performed a meta-analysis to evaluate suture configuration, repair method and tear size on retear rates and found that the suture technique may not affect rerupture rates after rotator cuff repair. 8 A more recent prospective comparative study found lower retear rates in a conventional KT technique as compared to a KL technique, although the difference was not statistically significant. 9 This study did not account for biomechanical differences in the 2 techniques; there is evidence to suggest that tying the medial row may allow for better footprint apposition and better initial biomechanical strength than the KL technique.…”

Section: Limitationsmentioning

confidence: 94%

Rotator Cuff Repair With Knotless Technique Is Quicker and More Cost-Effective Than Knotted Technique

Burns

Robbins

LeMarr

et al. 2019

Arthroscopy, Sports Medicine, and Rehabilitation

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Section: Limitationsmentioning

confidence: 94%

Rotator Cuff Repair With Knotless Technique Is Quicker and More Cost-Effective Than Knotted Technique

Burns

Robbins

LeMarr

et al. 2019

Arthroscopy, Sports Medicine, and Rehabilitation

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“…When sutures cut through tendon, they tend to slip along the longitudinal orientation of the collagen fibers, analogous to passing a comb through a bundle of hair. Especially in arthroscopic repair, mechanically robust suture configurations (eg, modified MasonAllen,) are technically demanding and generally too time consuming to be clinically viable [31] and even shows no superiority in clinical results [9,20]. More simple (eg, double rows of single-loop suture) reconstruction techniques have been shown to provide adequate biomechanical strength, but also raise biological concern attributable to over-tensioning of the repair and incidence of intratendinous retearing [2].…”

Section: Discussionmentioning

confidence: 99%

Tendon Collagen Crosslinking Offers Potential to Improve Suture Pullout in Rotator Cuff Repair: An Ex Vivo Sheep Study

Camenzind

Wieser

Fessel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background The suture-tendon interface is often the weakest link in tendon to bone repair of massive rotator cuff tears. Genipin is a low-toxicity collagen crosslinker derived from the gardenia fruit that has been shown to augment collagen tissue strength and mechanically arrest tendon-tear progression. Question/Purpose The purpose of the current study was to evaluate whether genipin crosslinking can sufficiently augment the suture-tendon interface to improve suture pullout strength using simple single-loop sutures and the modified Mason-Allen technique. The study also aimed to assess whether time of genipin treatment is a relevant factor in efficacy. Methods In an ex vivo (cadaveric) sheep rotator cuff tendon model, a total of 142 suture pullout tests were performed on 32 infraspinatus tendons. Each tendon was prepared with three single-loop stitches. Two groups were pretreated by incubation in genipin solution for either 4 hours or 24 hours. Two corresponding control groups were incubated in phosphate buffered saline for the same periods. The same test protocol was applied to tendons using modified Mason-Allen technique stitch patterns. Each suture was loaded to failure on a universal materials testing machine. Suture pullout force, stiffness, and work to failure were calculated from force-displacement data, and then compared among the groups. Results Median single-loop pullout force on tendons incubated for 24 hours in genipin yielded an approximately 30% increase in maximum pullout force for single-loop stitches with a median of 73 N (range, 56-114 N) compared with 56 N (range, 40-69 N; difference of medians = 17 N; p = 0.028), with corresponding increases in the required work to failure but not stiffness. Genipin treatment for 4 hours showed no added benefit for suture-pullout behavior (46 N, [range, 35-95 N] versus 45 N, [range, 28-63 N]; difference of medians, 1 N; p = 1). No tested genipin crosslinking conditions indicated benefit for tendons grasped using the modified Mason-Allen technique after 4 hours (162 N, [range, 143-193 N] versus 140 N, [range, 129-151 N]; difference of medians, 22 N; p = 0.114) or after 24 hours of crosslinking (172 N, [range, 42-183 N] versus 164 N [range, 151-180 N]; difference of medians, 8 N; p = 0.886). Conclusion Exogenous collagen crosslinking in genipin can markedly improve resistance to pullout at the tendonsuture interface for simple stitch patterns while the modified Mason-Allen stitch showed no benefit in an ex vivo animal model.

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“…Thus, the phenomenon of tendon tearing is prevented. 8,9 It is an added advantage over knotless sutures in that traction is realized through the impact of the suture on the lateral implant. 10 Conventional suture bridges reduce cuff tears from traction forces exerted on the medial row, which makes for cases of retearing being located on the myotendinous junction.…”

Section: Discussionmentioning

confidence: 99%

All-Suture Repair for Compressive Rotator Cuff Tears: Reducing the Traction of the Tissue

Uroz¹,

Abat²,

Díaz³

2017

Arthroscopy Techniques

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Tears of the rotator cuff are a frequent pathology, but the best surgical procedure remains unclear. The arthroscopic approach has become the gold standard, but there are many different suture configurations that can be used. We describe an all-suture repair system with which the anatomical reduction of the rotator cuff is achieved performing traction from the anchor of the lateral row to subsequently performing a suture bridge suture from the medial row. The major advantage of this technique is that it creates compression forces and minimizing tensioning of the tissue.

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Does Suture Technique Affect Re-Rupture in Arthroscopic Rotator Cuff Repair? A Meta-analysis

Cited by 39 publications

References 31 publications

Rotator Cuff Repair With Knotless Technique Is Quicker and More Cost-Effective Than Knotted Technique

Rotator Cuff Repair With Knotless Technique Is Quicker and More Cost-Effective Than Knotted Technique

Tendon Collagen Crosslinking Offers Potential to Improve Suture Pullout in Rotator Cuff Repair: An Ex Vivo Sheep Study

All-Suture Repair for Compressive Rotator Cuff Tears: Reducing the Traction of the Tissue

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