Biomechanical Considerations for Rotator Cuff Repairs

Lam, Patrick H.; Murrell, George A. C.

doi:10.1097/bte.0b013e31823a59f2

Cited by 3 publications

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“…Rotator cuff tears are among the most common causes of pain and functional disability in the shoulder and commonly affect the supraspinatus tendon. 5 , 7 , 9 , 18 , 20 Integrity of the supraspinatus is vital for overhead shoulder function. 19 Full-thickness rotator cuff tears often do not heal without treatment.…”

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Arthroscopic Rotator Cuff Repair Using the Undersurface Technique

Rubenis

Lam

Murrell

2015

Orthopaedic Journal of Sports Medicine

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Background:Arthroscopic rotator cuff repair has traditionally been performed in the subacromial space from the bursal side of the tendon. The undersurface rotator cuff repair technique involves the arthroscope remaining in the glenohumeral joint, thus viewing the tendon from its undersurface during repair without a bursectomy or acromioplasty.Purpose:To compare the clinical and structural outcomes of undersurface rotator cuff repair with bursal-side repair.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective analysis of prospectively collected data was conducted on 2 cohorts of patients who had undergone arthroscopic rotator cuff repair with knotless suture anchors configured in a single-row formation using inverted mattress–style sutures from either the bursal side (n = 100) or undersurface (n = 165) of the supraspinatus tendon. Data were collected preoperatively, intraoperatively, and at 1 week, 6 weeks, 3 months, 6 months, and 2 years postoperatively. At each time point, patients completed a modified L’Insalata questionnaire to assess patient-ranked pain scores and were clinically examined using standardized tests. Ultrasound examination was performed at 6 months and 2 years to assess the integrity of the repair.Results:At 2 years postoperatively, patients in both cohorts had significantly less pain and less difficulty with overhead activities compared with preoperative levels (P < .001). The type of repair performed (bursal or undersurface) did not affect the ability to perform overhead activities at 2 years. At 2 years, both groups also had similar retear rates (21% for bursal side, 23% for undersurface). The mean operative time for the arthroscopic rotator cuff repair was 32 minutes when performed from the bursal side and 20 minutes when performed from the undersurface (P < .001).Conclusion:Arthroscopic rotator cuff repair, whether performed from the subacromial space or glenohumeral joint, resulted in decreased levels of pain and difficulty with overhead activities at 2 years. The major difference between the 2 techniques was operative time, with the undersurface technique being performed significantly faster than the bursal-side repair technique.

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Arthroscopic Rotator Cuff Repair Using the Undersurface Technique

Rubenis

Lam

Murrell

2015

Orthopaedic Journal of Sports Medicine

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“…Anchors pulled out of cancellous bone 18% of the time at an average of 4300 cycles of the 10 -180 N load which is significantly greater than a RCR would be subjected to during the healing phase. A previous study of RCRs concluded that condition of the tissue or bone was the limiting reason for repair failure [15][16][17]. High UFLs and the high number of cycles before pullout of generic anchors from cancellous bone indicate the anchors will not be the limiting factor of RCRs.…”

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confidence: 99%