Knotless Rotator Cuff Repair in an External Rotation Model: The Importance of Medial-Row Horizontal Mattress Sutures

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

“…Although several studies have shown the biomechanical benefits of triple-loaded anchors, 13,30,31 as compared with a double-loaded anchor, the benefit of an additional suture remains questionable in single-row repair outcomes. The technical efficiency ratio for a 2-anchor repair (simple suture configurations) using a double-loaded anchor (8) is less than that for a triple-loaded anchor repair (12) (Table 1). Furthermore, 3 sutures creating compressive and potentially strangulating focal tendon deformity over spot-weld 19 fixation points is concerning.…”

“…[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.…”

Effects of a lateral row anchor position on the suture holding strength of a double-row knotless fixation in rotator cuff repair

“…However, this system is not without its problems, since there is often a sense of suture loosening and/or the backup of lateral row anchors or sutures, possibly due to the lower bone strength of the greater tubercle. [3][4][5][6] Denard and Burkhart [7] described a rescue anchor technique to be used when the medial row anchor fixation seems insecure. In this technique, the sutures from the medial anchor are fixed at the lateral part of the greater tubercle (vertical to the humerus shaft axis) with the main purpose of load distribution, rather than footprint compression.…”

Current Biomechanical Concepts of Suture Bridge Repair Technique for Rotator Cuff Tear

“…Many studies have addressed an issue regarding whether tying of the medial-row sutures provides additional stability after a suture bridge rotator cuff repair [32][33][34] . A systematic review by Mall et al indicated that most authors reported that the biomechanical properties in terms of ultimate failure load, stiffness, gap formation, and contact area are significantly improved when medial knots are tied as part of a suture bridge construct when comparing with knotless constructs [35] .…”