Evaluation of footprint contact area and pressure using a triple-row modification of the suture-bridge technique for rotator cuff repair

Triple-Row Modification of the Suture-Bridge Technique for Arthroscopic Rotator Cuff Repair

“…1 Technically, this triple-row modification has been shown to significantly improve footprint contact area and contact pressure when compared with the standard suture bridge. 12 As discussed, it enables the surgeon to reconstruct the footprint anatomically, increasing the TRIPLE-ROW CUFF REPAIR e1011 contact area of the tendon to the tuberosity. This is difficult to achieve with the standard suture-bridge technique, especially for larger tears that are often retracted.…”

“…This technique has been shown to result in significantly more footprint contact area and contact pressure compared with the double-row and standard suture-bridge techniques. 12 …”

Double-row rotator cuff repair yields improved tendon structural integrity, but no difference in clinical outcomes compared with single-row and triple-row repair: a systematic review

“…Proponents of this technique cite greater footprint contact area and stronger contact pressures compared with SR and DR repairs 17. Despite the biomechanical advantages of such a construct, there is very little clinical evidence to support the use of a TR repair 18 19…”

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

“…[5][6][7][8][9][10] Biomechanical studies have commonly been used to validate rotator cuff repair constructs before in vivo applicationdtherefore emphasis naturally has been placed on optimizing biomechanical performance. This has led to validating repairs that use more suture passes and therefore more suture limbs that require management, which can typically involve more knots as well.…”

“…[16][17][18] Regarding "triple-row" repair, one study tested the effect of adding a knotless inverted mattress to the original transosseous-equivalent repair with a ratio of (2 þ 6 þ 6)/5 ¼ 2.8 (Table 1). 6 In another 5-anchor repair, Burkhart et al 7 described the modified transosseous-equivalent "diamondback repair" ([3 þ 8 þ 8]/ 5 ¼ 3.8), which incorporates a medial inter-implant mattress creating 7 tendon-bridging sutures. Although more sutures and anchors may improve repair failure loads, 11 the tradeoff may preclude practical application, and it may not be worth testing the hypothesis for repairs with a ratio that is deemed to be too high.…”