Full-Thickness Rotator Cuff Tears

Reed, Stephen C.; Glossop, Neil; Ogilvie-Harris, Darrell

doi:10.1177/036354659602400108

Cited by 113 publications

(18 citation statements)

References 15 publications

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“…To simulate postoperative conditions, a cyclic loading was performed, similar to previous studies [6, 27]. These parameters have been reported as the physiologic loads and speeds that occur in normal daily activity and were therefore considered the best manner to simulate the postoperative condition [5, 17].…”

Section: Methodsmentioning

confidence: 99%

Biomechanical characteristics of single-row repair in comparison to double-row repair with consideration of the suture configuration and suture material

Baums

Buchhorn

Spahn

et al. 2008

Knee Surg Sports Traumatol Arthr

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The aim of the study was to evaluate the time zero mechanical properties of single- versus double-row configuration for rotator cuff repair in an animal model with consideration of the stitch technique and suture material. Thirty-two fresh-frozen sheep shoulders were randomly assigned to four repair groups: suture anchor single-row repair coupled with (1) braided, nonabsorbable polyester suture sized USP No. 2 (SRAE) or (2) braided polyblend polyethylene suture sized No. 2 (SRAH). The double-row repair was coupled with (3) USP No. 2 (DRAE) or (4) braided polyblend polyethylene suture No. 2 (DRAH). Arthroscopic Mason–Allen stitches were used (single-row) and combined with medial horizontal mattress stitches (double-row). Shoulders were cyclically loaded from 10 to 180 N. Displacement to gap formation of 5- and 10-mm at the repair site, cycles to failure, and the mode of failure were determined. The ultimate tensile strength was verified in specimens that resisted to 3,000 cycles. DRAE and DRAH had a lower frequency of 5- (P = 0.135) and 10-mm gap formation (P = 0.135). All DRAE and DRAH resisted 3,000 cycles while only three SRAE and one SRAH resisted 3,000 cycles (P < 0.001). The ultimate tensile strength in double-row specimens was significantly higher than in others (P < 0.001). There was no significant variation in using different suture material (P > 0.05). Double-row suture anchor repair with arthroscopic Mason–Allen/medial mattress stitches provides initial strength superior to single-row repair with arthroscopic Mason–Allen stitches under isometric cyclic loading as well as under ultimate loading conditions. Our results support the concept of double-row fixation with arthroscopic Mason–Allen/medial mattress stitches in rotator cuff tears with improvement of initial fixation strength and ultimate tensile load. Use of new polyblend polyethylene suture material seems not to increase the initial biomechanical aspects of the repair construct.

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Section: Methodsmentioning

confidence: 99%

Biomechanical characteristics of single-row repair in comparison to double-row repair with consideration of the suture configuration and suture material

Baums

Buchhorn

Spahn

et al. 2008

Knee Surg Sports Traumatol Arthr

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“…2,8,11 Poor fixation of suture anchors due to reduced bone quality of the proximal humerus is a problem in rotator cuff repair. 1,8,10,12,15,27,28,33 Pullout of suture anchors before tendon healing may result in gap formation between the tendon and the bone, rupture of the rotator cuff repair, and a poor outcome. 1,12,13,15,33 Recommendations in the literature regarding the optimum region for placement of lateral row suture anchors in rotator cuff repair are controversial.…”

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confidence: 99%

Optimal Lateral Row Anchor Positioning in Posterior-Superior Transosseous Equivalent Rotator Cuff Repair

Zumstein

Raniga

Labrinidis

et al. 2016

Orthopaedic Journal of Sports Medicine

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Background:The optimal placement of suture anchors in transosseous-equivalent (TOE) double-row rotator cuff repair remains controversial.Purpose:A 3-dimensional (3D) high-resolution micro–computed tomography (micro-CT) histomorphometric analysis of cadaveric proximal humeral greater tuberosities (GTs) was performed to guide optimal positioning of lateral row anchors in posterior-superior (infraspinatus and supraspinatus) TOE rotator cuff repair.Study Design:Descriptive laboratory study.Methods:Thirteen fresh-frozen human cadaveric proximal humeri underwent micro-CT analysis. The histomorphometric parameters analyzed in the standardized volumes of interest included cortical thickness, bone volume, and trabecular properties.Results:Analysis of the cortical thickness of the lateral rows demonstrated that the entire inferior-most lateral row, 15 to 21 mm from the summit of the GT, had the thickest cortical bone (mean, 0.79 mm; P = .0001), with the anterior-most part of the GT, 15 to 21 mm below its summit, having the greatest cortical thickness of 1.02 mm (P = .008). There was a significantly greater bone volume (BV; posterior, 74.5 ± 27.4 mm3; middle, 55.8 ± 24.9 mm3; anterior, 56.9 ± 20.7 mm3; P = .001) and BV as a percentage of total tissue volume (BV/TV; posterior, 7.3% ± 2.7%, middle, 5.5% ± 2.4%; anterior, 5.6% ± 2.0%; P = .001) in the posterior third of the GT than in intermediate or anterior thirds. In terms of both BV and BV/TV, the juxta-articular medial row had the greatest value (BV, 87.3 ± 25.1 mm3; BV/TV, 8.6% ± 2.5%; P = .0001 for both) followed by the inferior-most lateral row 15 to 21 mm from the summit of the GT (BV, 62.0 ± 22.7 mm3; BV/TV, 6.1% ± 2.2%; P = .0001 for both). The juxta-articular medial row had the greatest value for both trabecular number (0.3 ± 0.06 mm–1; P = .0001) and thickness (0.3 ± 0.08 μm; P = .0001) with the lowest degree of trabecular separation (1.3 ± 0.4 μm; P = .0001). The structure model index (SMI) has been shown to strongly correlate with bone strength, and this was greatest at the inferior-most lateral row 15 to 21 mm from the summit of the GT (2.9 ± 0.9; P = .0001).Conclusion:The inferior-most lateral row, 15 to 21 mm from the tip of the GT, has good bone stock, the greatest cortical thickness, and the best SMI for lateral row anchor placement. The anterior-most part of the GT 15 to 21 mm below its summit had the greatest cortical thickness of all zones. The posterior third of the GT also has good bone stock parameters, second only to the medial row. The best site for lateral row cortical anchor placement is 15 to 21 mm below the summit of the GT.Clinical Relevance:Optimal lateral anchor positioning is 15 to 21 mm below the summit of the greater tuberosity in TOE.

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“…To simulate postoperative conditions, a cyclic loading was performed, similar to previous studies [2, 8, 27]. Shoulders were loaded in the physiologic direction of the rotator cuff tendon, perpendicular to the longitudinal axis of the humerus, as previously described [2, 19, 27]. The loading force was applied with the humerus maintained at a constant angle relative to the tendon, resulting in simulated isometric muscle contraction.…”

Section: Methodsmentioning

confidence: 99%

“…After pretension to 10 N for 1 min, each construct was cyclically loaded to 3,000 cycles from 10 to 180 N with a 5-s cycle [2, 7, 8, 19]. These parameters have been reported as the physiologic loads and speeds that occur in normal daily activity and were therefore considered the best manner to simulate the postoperative condition [8, 27]. The tests were stopped when complete failure (e.g.…”

Section: Methodsmentioning

confidence: 99%

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Tendon–bone contact pressure and biomechanical evaluation of a modified suture-bridge technique for rotator cuff repair

Baums

Geyer

Büschken

et al. 2009

Knee Surg Sports Traumatol Arthrosc

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The aim of the study was to evaluate the time-zero mechanical and footprint properties of a suture-bridge technique for rotator cuff repair in an animal model. Thirty fresh-frozen sheep shoulders were randomly assigned among three investigation groups: (1) cyclic loading, (2) load-to-failure testing, and (3) tendon–bone interface contact pressure measurement. Shoulders were cyclically loaded from 10 to 180 N and displacement to gap formation of 5- and 10-mm at the repair site. Cycles to failure were determined. Additionally, the ultimate tensile strength and stiffness were verified along with the mode of failure. The average contact pressure and pressure pattern were investigated using a pressure-sensitive film system. All of the specimens resisted against 3,000 cycles and none of them reached a gap formation of 10 mm. The number of cycles to 5-mm gap formation was 2,884.5 ± 96.8 cycles. The ultimate tensile strength was 565.8 ± 17.8 N and stiffness was 173.7 ± 9.9 N/mm. The entire specimen presented a unique mode of failure as it is well known in using high strength sutures by pulling them through the tendon. We observed a mean contact pressure of 1.19 ± 0.03 MPa, applied on the footprint area. The fundamental results of our study support the use of a suture-bridge technique for optimising the conditions of the healing biology of a reconstructed rotator cuff tendon. Nevertheless, an individual estimation has to be done if using the suture-bridge technique clinically. Further investigation is necessary to evaluate the cell biological healing process in order to achieve further sufficient advancements in rotator cuff repair.

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Full-Thickness Rotator Cuff Tears

Cited by 113 publications

References 15 publications

Biomechanical characteristics of single-row repair in comparison to double-row repair with consideration of the suture configuration and suture material

Biomechanical characteristics of single-row repair in comparison to double-row repair with consideration of the suture configuration and suture material

Optimal Lateral Row Anchor Positioning in Posterior-Superior Transosseous Equivalent Rotator Cuff Repair

Tendon–bone contact pressure and biomechanical evaluation of a modified suture-bridge technique for rotator cuff repair

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