Biomechanical Advantages of Triple-Loaded Suture Anchors Compared With Double-Row Rotator Cuff Repairs

Barber, F. Alan; Herbert, Morley A.; Schroeder, F. Alexander; Aziz-Jacobo, Jorge; Mays, Matthew M.; Rapley, Jay H.

doi:10.1016/j.arthro.2009.07.019

Cited by 75 publications

(46 citation statements)

References 34 publications

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“…Jost et al [57] evaluated the effects of increasing suture number on rotator cuff healing strength in a sheep model and determined that increasing the number of sutures decreased cyclic gap formation and increased load to failure. Barber et al [58] determined that single row repairs utilizing triple-loaded anchors were more resistant to cyclic displacement has been reported to influence rotator cuff tear size as well [33] . Smoking has been shown to delay tendon-tobone healing in a rat model and clinical studies have demonstrated inferior clinical outcomes after repair in smokers [34,35] .…”

Section: Muscle-tendon Unit Retractionmentioning

confidence: 99%

Factors affecting healing after arthroscopic rotator cuff repair

Abtahi

Granger

Tashjian

2015

WJO

162

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Rotator cuff repair has been shown to have good longterm results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscle-tendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing. Surgeon related factors that can influence healing include repair construct-single vs double row, rehabilitation, and biologics including platelet rich plasma and mesenchymal stem cells. Double-row repairs are biomechanically stronger and have better healing rates compared with single-row repairs although clinical outcomes are equivalent between both constructs. Slower, less aggressive rehabilitation programs have demonstrated improved healing with no negative effect on final range of motion and are therefore recommended after repair of most full thickness tears. Additionally no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates and clinical outcomes. Further research is needed to identify effective biologically directed augmentations that will improve healing rates and clinical outcomes after rotator cuff repair. Core tip: Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscletendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing after rotator cuff repair. Smoking cessation and blood glucose and cholesterol control are methods to potentially improve healing rates. Slower, less aggressive rehabilitation programs may improve healing rates with no negative effect on final range of motion and are therefore recommended after arthroscopic repair of most full thickness tears. Finally, no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates after rotator cuff repair. Routine use of these adjuvants is therefore not currently recommended.

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Section: Muscle-tendon Unit Retractionmentioning

confidence: 99%

Factors affecting healing after arthroscopic rotator cuff repair

Abtahi

Granger

Tashjian

2015

WJO

162

View full text Add to dashboard Cite

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“…Also, this is not to say that single-row constructs do not have indications based on the above considerations as well. 12 Based on the current study, the effect of medial knots on passive muscle stiffness could be another variable to consider as we garner deeper understanding with future studies.…”

Section: See Related Article On Page 1973mentioning

confidence: 83%

Editorial Commentary: Can Passive Muscle Stiffness in a Cadaveric Study Be Clinically Related to Using Knotted Versus Knotless Rotator Cuff Repair?

Park

2016

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Is a biomechanical cadaveric study to assess the effect of rotator cuff tear size and repair technique on supraspinatus muscle stiffness clinically relevant? A study in this issue compared double-row and knotless transosseous-equivalent repairs, but notably, muscle loading was not simulated. Results showed that the knotless transosseous-equivalent repair for larger tears demonstrated a more uniform stiffness distribution across the supraspinatus muscle compared with the double-row repair. However, given the inherently asymmetrical functional anatomy and morphology of the supraspinatus tendon-muscle unit, when muscle tone exists, the effect of the repair technique on muscle stiffness in vivo may not be determined based on the findings of this study.

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“…In the comparison of the anterior versus posterior tendon subregions, a trend toward higher gap formation in the anterior compared with the posterior subregions was found, although the calculated differences, in this adequately powered study, were not statistically significant. To our knowledge, this is the first study comparing the biomechanical properties of a modified single-row suture configuration to a double-row suture bridge technique on 7 who compared the biomechanical properties of triple-loaded suture anchors and modified suture configurations with the double-row suture bridge repair in a bovine biomechanical study. They found that the single-row repair was more resistant to stretching to a 5-mm gap than the double-row groups.…”

Section: Discussionmentioning

confidence: 97%