Basic ScienceIn vitro biomechanical comparison of three different types of single- and double-row arthroscopic rotator cuff repairs: Analysis of continuous bone-tendon contact pressure and surface during different simulated joint positions
Section snippets
Specimen preparation and loading simulation
We used 24 fresh-frozen cadaveric shoulders (12 left and 12 right shoulders) in 12 cadavers (5 female and 7 male cadavers; mean age, 78 years [range, 53-96 years]). All rotator cuff tendons were initially intact. All muscles but the rotator cuff muscles were removed. The distal part of the humerus was fixed in a specially designed metallic box and embedded with a low–melting point alloy (MCP 70; Mining & Chemical Products Ltd, Wellingborough, England).
The scapula was fixed at 3 points, inferior
Specific material
Cuff repair was conducted with the usual arthroscopic materials (knot pusher, cuff-penetrating graspers) and with BioZip anchors double loaded with Fiberforce sutures (Stryker, Kalamazoo, MI). For single-row anchors, we used two 6.5-mm anchors placed 2 cm below the edge of the greater tuberosity, with a 2-cm distance between the anchors. For double-row anchors, we used two 5-mm anchors placed just lateral to the bone-cartilage junction in alignment with the 6.5-mm lateral anchors.
For contact
Results
Qualitatively, measurements indicated different patterns with greater contact surface for the DRCS technique compared with the DRBS technique and greater contact surface for the DRBS technique compared with the SRS technique. During knot tying, contact pressure and surface variations were important and difficult to analyze because of important instantaneous variations of values (Figure 3). Mean initial contact surfaces for each position are described in Table I.
Initial contact surfaces were
Discussion
Clinical and healing results of arthroscopically repaired cuffs are similar to results obtained after open repair.6, 26, 41 However, for large to massive tears, Galatz et al18 found a retear rate of 94%, and there is still controversy in the literature about residual symptoms and shoulder function after retear. Most authors have found decreasing results regarding shoulder function after retear,11, 20, 21, 23 but those inferior results may appear more than 2 years after surgery whereas patients
Acknowledgments
The authors thank the European Society for Surgery of the Shoulder and the Elbow for partial funding of this study through the 2006 SECEC/ESSSE Research Grant. We also thank Stryker for its financial support of this study; the Centre des Don du Corps of the René Descartes Paris V University, where the anatomic specimens were obtained; and finally, Florent Lachaud and Yann Huruguen, engineering students, for their technical support and their involvement in the experiments.
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Rates of medial and lateral row failure and risk factors for Re-tear in arthroscopic double row rotator cuff repair
2023, Journal of Clinical Orthopaedics and TraumaCitation Excerpt :Common repair techniques include double row, transosseous equivalent (TOE), and single row.7 Double row and transosseous techniques have shown superior biomechanical strength due to the improved contact area and pressure at the tendon-bone interface.8–10 Double row repairs maximize the contact area at the rotator cuff footprint to enhance the biological healing process and to improve the mechanical strength of the repaired tendon.11
Current concepts in the evolution of arthroscopic rotator cuff repair
2021, JSES Reviews, Reports, and TechniquesA Prospective Randomized Trial Comparing Suture Bridge and Medially Based Single-Row Rotator Cuff Repair in Medium-Sized Supraspinatus Tears
2019, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :Factors affecting rotator cuff healing are multifactorial.32 From biomechanical and biological points of view, basic research has suggested that the initial stiffness and strength of the repair, gap formation resistance, footprint coverage at the end of surgery, vascularity of the cuff, and mechanical stress on the repaired cuff are important factors.33-40 Advocates of the suture bridge technique stressed biomechanical superiority in terms of ultimate strength, stiffness, and gap formation resistance.2-8,13-23,34
Double row equivalent for rotator cuff repair: A biomechanical analysis of a new technique
2018, Journal of OrthopaedicsComparison of Passive Stiffness Changes in the Supraspinatus Muscle After Double-Row and Knotless Transosseous-Equivalent Rotator Cuff Repair Techniques: A Cadaveric Study
2016, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :To date, there have been a number of biomechanical studies related to rotator cuff repair techniques.10-13,16 Repair techniques have been investigated to improve repair site properties, including maximal initial failure strength, minimal gap formation, or mechanical stability.13,39-41 In addition to these approaches, the effect of repair techniques on the alteration of mechanical properties in the muscular regions should also be evaluated.