Single versus double row suture anchor fixation for greater tuberosity fractures – a biomechanical study

Abstract

BackgroundFractures of the humeral greater tuberosity (GT) are a frequent injury progressively treated with arthroscopic suture anchor repair. Yet, no biomechanical study has been performed comparing fixation strength of arthroscopic single- (SR) vs. double row (DR) fixation.MethodsStandardized fractures of the greater tuberosity were created in 12 fresh frozen proximal humeri. After random assignation to the SR or DR group the fixed humeri were tested applying cyclic loading to the supraspinatus and infraspinatus tendon. Load to failure and fragment displacement were assessed by means of an electrodynamic material testing machine using an optical tracking system.ResultsLoad to failure values were higher in the DR group (649 N; ±176) than in the SR group (490 N; ±145) however without statistical significance (p = .12). In greater tuberosity displacement of 3–5 mm surgical treatment is recommended. The fixing constructs in this study did not reach displacement landmarks of 3 or 5 mm before construct failure as shown in previous studies. Thus the applied traction force (N) at 1 mm displacement was analyzed. In the SR group the load at 1 mm displacement was 277 N; ±46 compared to 260 N; ±62 in the DR group (p = .65).ConclusionThe results suggest that both techniques are viable options for refixation of greater tuberosity fractures.Level of Evidence: Laboratory study.

Different suture anchor fixation techniques affect contact properties in humeral greater tuberosity fracture: a biomechanical study

“…Although several studies have investigated the biomechanical strength of GT fixation constructs, the results reflected only the strength immediately following fixation, not over time [9, 20–23]. In response, our report indicated that both the SB and DR constructs had the phenomenon of “stress and area relaxation” over time.…”

Arthroscopic Management of Displaced Greater Tuberosity Fractures

“…In their study, all failures with screw fixation occurred with screw pullout. 8 Seppel et al 15 reported favorable biomechanical results with single-row and double-row repair in a cadaver study, reinforcing either as a viable option for this injury pattern. Suture anchors also avoid the risk of intra-articular penetration inherent to screw-based constructs.…”

Die Tuberculum majus Fraktur – eine Problemfraktur?

“…So sind Rekonstruktionstechniken mittels offener oder gedeckter Schraubenosteosynthese, die Plattenosteosynthese, Drahtfixierung, Zuggurtungen und Ankerfixationssysteme in der Literatur beschrieben [3,6,24,25]. In den letzten Jahrzehnten sind zudem arthroskopische Techniken hinzugekommen [2,15,26,27]). Lässt die Knochenqualität oder die Frakturausdehnung eine Platzierung einer gelenknahen medialen Reihe nicht zu, so werden lediglich die Fäden am Knochen-Sehnen-Übergang durch die Rotatorenmanschette geführt und dann auf eine isolierte sog.…”

“…Das genannte Vorgehen wird durch die biomechanische Arbeit von Seppel et al [27] gestützt. Die Autoren konnten in ihrer Arbeit keinen signifikanten Unterschied zwischen Double-und Single-Suture-Row-Fadenanker-Konfigurationen erkennen und empfahlen die Entscheidung zwischen Single-oder Double-Row davon abhängig zu machen, ob die Platzierung einer medialen Reihe technisch möglich ist.…”