Biomechanical Validation of Rotator Cuff Repair Techniques and Considerations for a “Technical Efficiency Ratio”

Park, Maxwell C.

doi:10.1016/j.arthro.2013.03.079

Cited by 8 publications

(6 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Burkhart et al 14 would further discuss the self-reinforcing properties (the greater the load, the more the tendon is compressed onto the footprint) of such a linked ARCR construct. Park et al 67,69 also validated these biomechanical concepts in the laboratory.…”

Section: Fixation Techniquesmentioning

confidence: 92%

The Evolution of Arthroscopic Rotator Cuff Repair

Hazra

Ernat

Rakowski

et al. 2021

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Over the past 30 years, arthroscopic rotator cuff repair (ARCR) has evolved to become the gold standard in treating rotator cuff pathology. As procedural concepts of ARCR continue to improve, it is also continually compared with the open rotator cuff repair as the historical standard of care. This review highlights the evolution of ARCR, including a historical perspective; the anatomic, clinical, and surgical implications of the development of an arthroscopic approach; how arthroscopy improved some of the problems of the open approach; adaptations in techniques and technologies associated with ARCR; future perspectives in orthobiologics as they pertain to ARCR; and lastly, the clinical improvements, or lack of improvements, with all of these adaptations.

show abstract

Section: Fixation Techniquesmentioning

confidence: 92%

The Evolution of Arthroscopic Rotator Cuff Repair

Hazra

Ernat

Rakowski

et al. 2021

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

show abstract

“… 44 , 45 Furthermore, the lack of medial knots avoids the possibility of acute or chronic postoperative knot impingement within the subacromial space 26 while also decreasing operative time 46 and improving technical efficiency. 29 , 47 We have also observed new tissue growth on the suture tapes in second look arthroscopy and in postoperative magnetic resonance images, and believe this acts as a scaffold for tissue regeneration.…”

Section: Discussionmentioning

confidence: 67%

“…From our experience with second look arthroscopy and from postoperative magnetic resonance images, the suture tapes act as biological scaffolds for new tissue growth that aid in healing. Furthermore, the linked and crossed nature of the construct improves the biomechanics by dispersing forces across the whole repair construct to minimize point loading, maximize self-reinforcement, 29 and minimize the risk of suture cutout. After the repair, complete dynamic evaluation is then performed to ensure adequate stability and security of the repair.…”

Section: Surgical Techniquesmentioning

confidence: 99%

Rotator Cuff Tears at the Musculotendinous Junction: Classification and Surgical Options for Repair and Reconstruction

Millett

Hussain

Fritz

et al. 2017

Arthroscopy Techniques

View full text Add to dashboard Cite

Although uncommon, rotator cuff tears that occur medially at the musculotendinous junction can result from acute trauma, anatomic force imbalance, or medial row cuff failure following a previous rotator cuff repair. The quality of the torn muscle and tendon along with the length of the remnant tendon stump should be considered before deciding on the most appropriate repair technique. When muscle and tendon quality are sufficient, the tear can often be repaired directly to the remnant tendon stump and compressed onto the greater tuberosity. If the remnant tendon stump is degenerative, of insufficient length, or lacks tendon in which to place sutures, an allograft patch can be used to augment the repair. When the quality of the remaining muscle and tendon are poor or when the muscle is retracted too far medially and is nonmobile, a bridging technique such as superior capsule reconstruction is preferable. The purpose of this report is to (1) highlight that medial cuff failure can occur both primarily and after previous repair; (2) define and classify the 3 major tear patterns that are encountered, and (3) describe the authors' preferred techniques for medial cuff repair that specifically address each of the major tear patterns.

show abstract

“…2 The early learning curve dealt with overtensioning repairs, perhaps with overreaching indications based on biomechanical performance, [3][4][5] with many variations of the construct reported. [6][7][8][9][10][11][12][13] My concept of "technical efficiency ratio" was published first in Arthroscopy 14 dcertain reported repair techniques were arguably not indicated with supraphysiological extraneous suture passes, at least from a biomechanical perspective. 15 Similarly, whereas anterior cable reconstruction (ACR) as a technique has been introduced from a biomechanical standpoint, 16,17 there has been a rapid and varied technical application.…”

Section: See Related Article On Page 2769mentioning

confidence: 99%

Editorial Commentary: Anterior Cable Reconstruction for the Shoulder Superior Capsule: Time for “Indication Rounds”

Park

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Self Cite

View full text Add to dashboard Cite

Anterior cable reconstruction (ACR) techniques for the superior capsule are multiple and varied. To optimize patient outcomes, technical considerations must be supported by basic science, both anatomically and biomechanically. ACR was designed to treat only partially repairable rotator cuff tendon tears, to provide a static support to a dynamic partial (and therefore "nonanatomic") repair, and to treat tears that could not be treated by transosseous-equivalent footprint-restoring "anatomic" repairs (both capsule and tendon repaired), but were also not so large as to necessitate superior capsule reconstruction. ACR allows restoration of posterosuperior capsular function with side-to-side repair sutures, and much of the biomechanical functionality comes from using whatever inherent native superior capsule is available. Cable reconstructions should be secured to normal attachment sites on the glenoid and greater tuberosity sulcus. Also, graft tension must be accounted for when considering humeral motion such as rotation and adduction. The indications for ACR need to be carefully considered and account for both anatomic and biomechanical rationales. In the face of new ACR techniques, the need to discern what is possible versus what procedure is indicated cannot be overlooked.

show abstract

Biomechanical Validation of Rotator Cuff Repair Techniques and Considerations for a “Technical Efficiency Ratio”

Cited by 8 publications

References 31 publications

The Evolution of Arthroscopic Rotator Cuff Repair

The Evolution of Arthroscopic Rotator Cuff Repair

Rotator Cuff Tears at the Musculotendinous Junction: Classification and Surgical Options for Repair and Reconstruction

Editorial Commentary: Anterior Cable Reconstruction for the Shoulder Superior Capsule: Time for “Indication Rounds”

Contact Info

Product

Resources

About