Contact Area, Contact Pressure, and Pressure Patterns of the Tendon-Bone Interface after Rotator Cuff Repair

Tuoheti, Yilihamu; Itoi, Eiji; Yamamoto, Nobuyuki; Seki, Nobutoshi; Abe, Hidekazu; Minagawa, Hiroshi; Okada, Kyoji; Shimada, Yasuhiro

doi:10.1177/0363546505278256

Cited by 179 publications

(146 citation statements)

References 23 publications

Supporting

Mentioning

137

Contrasting

Unclassified

Order By: Relevance

“…The results of ORIF described previously are favorable [9,12]. However, because of the biomechanical advantage of double-row suture anchor fixation [31], this technique has been used in open and arthroscopic fixation of greater tuberosity fractures to restore the bone-tendon transition area accurately [3,17,19,22,27,28]. Even with various surgical techniques available, it is difficult for surgeons to choose which to use, since, to our knowledge, no studies have directly compared these approaches.…”

Section: Discussionmentioning

confidence: 99%

Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

Liao¹,

Zhang²,

Li³

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Arthroscopic double-row suture-anchor fixation and open reduction and internal fixation (ORIF) are used to treat displaced greater tuberosity fractures, but there are few data that can help guide the surgeon in choosing between these approaches. Questions/Purposes We therefore asked: (1) Is there a difference in surgical time between arthroscopic doublerow suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures? (2) Are there differences in the postoperative ROM and functional scores between arthroscopic double-row suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures? (3) Are there differences in complications resulting in additional operations between the two approaches?Methods Between 2006 and 2012, we treated 79 patients surgically for displaced greater tuberosity fractures. Of those, 32 (41%) were considered eligible for our study based on inclusion criteria for isolated displaced greater tuberosity fractures with a displacement of at least 5 mm but less than 2 cm. During that time, we generally treated patients with displaced greater tuberosity fractures with a displacement greater than 1 cm or with a fragment size greater than 393 cm with open treatment, and patients with displaced greater tuberosity fractures with a displacement less than 1 cm or with a fragment size less than 393 cm with arthroscopic treatment. Fifty-three underwent open treatment based on those indications, and 26 underwent arthroscopic treatment, of whom 17 (32%) and 15 (58%) were available for followup at a mean of 34 months (range, 24-28 months). All patients with such fractures identified from our institutional database were treated by these two approaches and no other methods were used. Surgical time was defined as the time from initiation of the incision to the time when suture of the incision was finished, and was determined by an observer with a stopwatch. Patients were followed up in the outpatient department at 6, 12, and 24 weeks, and every 6 month thereafter. Radiographs showed optimal reduction immediately after surgery and at every followup. Radiographs were obtained to assess fracture healing. Patients were followed up for a mean of 34 months (range, 24-48 months). At the last followup, ROM, VAS score, and American Shoulder and Elbow Surgeons (ASES) score were used to evaluate clinical outcomes. All these data were retrieved from our institutional database through chart review. Complications were assessed through chart review by one observer other than the operating surgeon.

show abstract

Section: Discussionmentioning

confidence: 99%

Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

Liao¹,

Zhang²,

Li³

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Many factors are thought to play a role in the pathogenesis of human chronic supraspinatus tears, with both intrinsic changes within the tendon and extrinsic influences of the tendons surrounding skeletal architecture believed to contribute to its etiology [1,2,4,10,19,43,44]. To ultimately advance therapeutic intervention, development of an appropriate animal model allowing in vivo simulation of rotator cuff disease and exploration of the factors affecting its repair is essential.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple factors are thought to influence healing after cuff repair, including initial fixation strength [10], tendonfootprint contact area and pressure [4,32,34,35,44], tendon-footprint interface motion [1], tendon and bone tissue quality [19,43], synovial fluid extravasation [2], and blood supply to the repair [15]. Development of an appropriate animal model could help in elucidating the relationship between these variables and healing.…”

Section: Introductionmentioning

confidence: 99%

Relative Fixation Strength of Rabbit Subscapularis Repair Is Comparable to Human Supraspinatus Repair at Time 0

Otarodifard

Wong

Preston

et al. 2014

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Recent evidence suggests that the rabbit subscapularis tendon may be anatomically, biomechanically, and histologically suitable to study rotator cuff pathology and repair. However, biomechanical comparisons of rotator cuff repairs in this model have not been evaluated and compared to those in human cadaveric specimens. Questions/purposes We quantified the biomechanical properties of the repaired rabbit subscapularis tendon after (1) single-row, (2) double-row, and (3) transosseousequivalent rotator cuff repair techniques and compared the ratios of repairs to previously published data for human repairs.Methods Tensile testing was performed on 21 New Zealand White rabbit subscapularis tendon-humerus complexes for single-row repair, double-row repair, and transosseous-equivalent repair (n = 7 for each group). Video digitizing software was used to quantify deformation. Load elongation data were then used to quantify structural properties. We compared the ratios of rotator cuff repairs for the rabbit data to data from human supraspinatus repair studies previously performed in our laboratory. For our primary end points (linear stiffness, yield load, ultimate load, and energy absorbed to failure), with the numbers available, our statistical power to detect a clinically important difference (defined as 15%) was 85%. Results The ratios of single-row/double-row repair were 0.72, 0.73, 0.71, and 0.66 for human supraspinatus and 0.77, 0.74, 0.79, and 0.89 for rabbit subscapularis repair for linear stiffness, yield load, ultimate load, and energy absorbed to failure, respectively. The ratios of double-row/transosseousequivalent repair were 1.0, 0.86, 0.70, and 0.41 for human supraspinatus and 1.22, 0.85, 0.76, and 0.60 for rabbit subscapularis for linear stiffness, yield load, ultimate load, and energy absorbed to failure, respectively. There were no differences comparing rabbit to human repair ratios for any parameter (p [ 0.09 for all comparisons). Conclusions Subscapularis repairs in the rabbit at Time 0 result in comparable ratios to human supraspinatus repairs. Clinical Relevance The biomechanical similarities between the different types of rotator cuff repair in the rabbit subscapularis and human supraspinatus at Time 0 provide more evidence that the rabbit subscapularis may be an appropriate model to study rotator cuff repairs.

show abstract

“…21) The technique of using double rows of suture anchors to re-create the native footprint attachment has been recently described. 22) This double-row technique has been shown to closely re-create the repair site of the footprint insertion and would theoretically improve the ability of the tendon to heal to bone. Double-row repair was created to increase the footprint contact area and distribute the stress over multiple fixation points.…”

mentioning

confidence: 99%

“…They concluded that a double row technique should be considered for large, unstable tears, especially if the single-row repair would be under tension. Tuoheti et al 22) reported the double-row repair technique to have a repair contact area 60% greater than that of the single-row repair technique. They also showed that double-row repair restored 42% more area when compared with a traditional transosseous rotator cuff repair.…”

mentioning

confidence: 99%

Biomechanical Test for Repair Technique of Full-thickness Rotator Cuff Tear

Lim¹,

Park²

2016

Clinics in Shoulder and Elbow

View full text Add to dashboard Cite

The arthroscopic rotator cuff repair is now considered a mainstream technique with highly satisfactory clinical results. However, concerns remain regarding healing failures for large and massive tears and high revision rate. In recent decades, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. The focus of biomechanical test in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. Recent studies have shown that a transosseous tunnel technique provides improved contact area and pressure between rotator cuff tendon and insertion footprint, and the technique of using double rows of suture anchors to recreate the native footprint attachment has been recently described. The transosseous equivalent suture bridge technique has the highest contact pressure and fixation force. In this review, the biomechanical tests about repair techniques of rotator cuff tear will be reviewed and discussed.

show abstract

Contact Area, Contact Pressure, and Pressure Patterns of the Tendon-Bone Interface after Rotator Cuff Repair

Abstract: The double-row suture anchor technique and the transosseous technique may provide a better environment for tendon healing.

Cited by 179 publications

References 23 publications

Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

Relative Fixation Strength of Rabbit Subscapularis Repair Is Comparable to Human Supraspinatus Repair at Time 0

Biomechanical Test for Repair Technique of Full-thickness Rotator Cuff Tear

Contact Info

Product

Resources

About