Mechanical Strength of Arthroscopic Rotator Cuff Repair Techniques

Schneeberger, Alberto G.; Roll, Andreas von; Kalberer, Fabian; Jacob, H. A. C.; Gerber, Christian

doi:10.2106/00004623-200212000-00005

Cited by 185 publications

(172 citation statements)

References 18 publications

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“…In this study design the authors opted to compare a MO transosseous repair with an ASC double-row refixation technique. The transosseous repair was chosen because it provides a stable [17][18][19], cost-effective [20,21] and potentially biologically favourable fixation, since it obviates high stress concentrations of a point fixation with an anchor [22]. For the ASC technique a double-row fixation was used because it provides a similarly stable fixation with comparable footprint coverage [23,24].…”

Section: Introductionmentioning

confidence: 99%

Prospective randomised comparison of arthroscopic versus mini-open rotator cuff repair of the supraspinatus tendon

Kasten

Keil

Grieser

et al. 2011

International Orthopaedics (SICOT)

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Purpose The aim of the study was to evaluate whether arthroscopic (ASC) repair of rotator cuff ruptures causes less postoperative pain and better range of motion (ROM) in the early postoperative period than a mini-open (MO) technique. Methods Inclusion criteria were a rupture of the supraspinatus tendon with retraction with a maximum to the apex of the humeral head and minor fatty degeneration and atrophy of the muscle. Each group (n=17) had similar demographics and preoperative magnetic resonance imaging (MRI) findings (mean age 60.1 years, SD 8.8, range 43-71). The ASC group underwent double-row repair with resorbable anchors; the MO group received a transosseous repair. The postoperative rehabilitation was standardised and equivalent in both groups. Results In the first week fewer nonsteroidal anti-inflammatory drug (NSAID) tablets were needed in the ASC group. Pain scores on the visual analogue scale were similar in the first three weeks; however, from week four to eight the MO group had less pain (p<0.05). After six months, the ConstantMurley score and the ROM improved significantly (p<0.05) in both groups without differences between the groups. Postoperative MRI revealed in three of 16 patients a discontinuity of the tendon in both groups; in the ASC group there were more patients (n=9) with a thinning of the tendon compared to the MO group (n=6). Conclusions There was less use of NSAIDs in the first postoperative week in the ASC group, indirectly indicating less pain, but higher pain scores in the later course (weeks four to eight) compared to the MO group. ROM, MRI findings and the scores were similar after six months, demonstrating that both techniques are equivalent regarding the outcome in this period.

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Section: Introductionmentioning

confidence: 99%

Prospective randomised comparison of arthroscopic versus mini-open rotator cuff repair of the supraspinatus tendon

Kasten

Keil

Grieser

et al. 2011

International Orthopaedics (SICOT)

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“…In addition associated rotator cuff muscle degeneration (ie, fatty degeneration, fibrosis, [31] and atrophy), tendon shortening [26] and degeneration [32] are known factors that decrease reparability and tendon to bone healing. In the majority of cases the suture-tendon interface is the weakest link of the reconstruction [7,12,19,31] leading to high rates of retearing. 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.…”

Section: Discussionmentioning

confidence: 99%

“…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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“…Simple, mattress, and other suture configurations such as the Mason-Allen stitch have been biomechanically compared throughout the literature. 10) A Mason-Allen suture has been shown to have a higher tensile load and ultimate tensile strength when compared with simple and mattress suture configurations. Gerber et al 11) studied current techniques of rotator-cuff repair to assess their mechanical properties and consider potential improvements.…”

Section: The Mechanical Properties Of Repairmentioning

confidence: 99%

Biomechanical Test for Repair Technique of Full-thickness Rotator Cuff Tear

Lim¹,

Park²

2016

Clinics in Shoulder and Elbow

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The arthroscopic rotator cuff repair is now considered a mainstream technique with highly satisfactory clinical results. However, concerns remain regarding healing failures for large and massive tears and high revision rate. In recent decades, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. The focus of biomechanical test in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. Recent studies have shown that a transosseous tunnel technique provides improved contact area and pressure between rotator cuff tendon and insertion footprint, and the technique of using double rows of suture anchors to recreate the native footprint attachment has been recently described. The transosseous equivalent suture bridge technique has the highest contact pressure and fixation force. In this review, the biomechanical tests about repair techniques of rotator cuff tear will be reviewed and discussed.

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Mechanical Strength of Arthroscopic Rotator Cuff Repair Techniques

Cited by 185 publications

References 18 publications

Prospective randomised comparison of arthroscopic versus mini-open rotator cuff repair of the supraspinatus tendon

Prospective randomised comparison of arthroscopic versus mini-open rotator cuff repair of the supraspinatus tendon

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

Biomechanical Test for Repair Technique of Full-thickness Rotator Cuff Tear

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