Optimizing the Double-Row Construct: An Untied Medial Row Demonstrates Equivalent Mean Contact Pressures in a Rotator Cuff Model

Abstract

Background: The merits of a double-row rotator cuff repair (RCR) construct are well-established for restoration of the footprint and lateral-row security. The theoretical benefit of leaving the medial row untied is to prevent damage to the rotator cuff by tissue strangulation, and the benefit of suture tape is a more even distribution of force across the repair site. These benefits, to our knowledge, have not been evaluated in the laboratory. Hypothesis: Leaving the medial row untied and using a suture bridge technique with suture tape will offer more even pressure distribution across the repair site without compromising total contact force. Study Design: Controlled laboratory study. Methods: A laboratory model of RCR was created using biomechanical research-grade composite humeri and human dermal allografts. The pressure distribution in a double-row suture bridge repair construct was analyzed using the following testing matrix: double-loaded suture anchors with the medial row tied (n = 15) versus untied (n = 15) compared with double-loaded suture tape and anchors with the medial row tied (n = 15) versus untied (n = 15). A digital pressure sensor was used to measure pressure over time after tensioning of the repair site. A multivariate analysis of variance was used for statistical analysis with post hoc testing. Results: The total contact force did not significantly differ between constructs. The contact force between double-loaded suture anchors and double-loaded suture tape and anchors was similar when tied ( P = .15) and untied ( P = .44). An untied medial row resulted in similar contact forces in both the double-loaded suture anchor ( P = .16) and double-loaded suture tape and anchor ( P = .25) constructs. Qualitative increases in focal contact pressure were seen when the medial row was tied. Conclusion: An untied medial row did not significantly affect the total contact force with double-loaded suture anchors and with double-loaded suture tape and anchors. Tying the medial row qualitatively increased crimping at the construct’s periphery, which may contribute to tissue strangulation and hinder clinical healing. Qualitative improvements in force distribution were seen with double-loaded suture tape and anchors. Clinical Relevance: Both tied and untied medial rows demonstrated similar pressures across the repair construct.

Blended Suture-bridge Technique for Arthroscopic Rotator Cuff Repair

“…Multiple laboratory studies showed no significant difference in contact pressures between untied and tied medial row. 14 , 15 However, we have observed increased gap formation on the articular side in knotless medial-row constructs, which is an unfavorable condition in tendon repairs. Gapping at the repair site also allows synovial fluid leakage to the footprint, which was previously proposed to be an unfavorable environment for tendon healing.…”

Presión y área de contacto en reparación de manguito rotador: una revisión sistemática

“…Another 14 studies were excluded after a review of the full texts, and only 15 articles met all the eligibility criteria and were included for analysis (►Figure 1). [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Overall, inter-reviewer agreement regarding the final eligibility was excellent (there were no disagreements). These 15 studies were published in English from 2015 to 2020.…”

“…It is believed that preserving the structural integrity of the rotator cuff by avoiding knots in damaged tissues would improve healing. 33,34 Stone et al 31 measured the contact force and pressure at the tendon-footprint interface in a Sawbone (Vashon Island, WA, US) model graduated for biomechanical studies using an acellular human dermis allograft to simulate the rotator cuff tendon. The authors 31 compared a DR construct with a medial row with no knots to a medial row with knots, and found no significant differences.…”