Part I: Footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique

Park, Maxwell C.; ElAttrache, Neal S.; Tibone, James E.; Ahmad, Christopher S.; Jun, Bong-Jae; Lee, Thay Q.

doi:10.1016/j.jse.2006.09.010

Cited by 365 publications

(354 citation statements)

References 45 publications

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“…In rotator cuff repairs, these two methods both refer to the double-row technique. Double-row suture-bridge repair, which was initially described by Park et al, [17][18][19] allows quick arthroscopic transosseous-equivalent cuff repair with improved pressurized footprint coverage and biomechanical properties compared to conventional double-row technique. Because suture-bridge repair is interconnected medially to laterally and anteriorly to posteriorly, it may share load more efficiently than the double-row repair, which has four separate fixation points.…”

Section: Discussionmentioning

confidence: 99%

Suture anchor versus screw fixation for greater tuberosity fractures of the humerus—a biomechanical study

Lin

Hong

Jou

et al. 2011

Journal Orthopaedic Research

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Suture anchors and screws are commonly used for fixation of humeral greater tuberosity (GT) fractures in either arthroscopic or open surgeries, but no biomechanical studies have been performed to compare the strength of fixation constructs using these two implants. This cadaveric study aimed to compare the biomechanical strength of three different fixation constructs in the management of GT fractures: Double-Row Suture Anchor Fixation (DR); Suture-Bridge Technique using suture anchors and knotless suture anchors (SB); and Two-Screw Fixation (TS). The experimental procedure was designed to assess fracture displacement after cyclic loading, failure load, and failure mode of the fixation construct. Significant differences were found among the SB (321 N), DR (263 N), and TS (187 N) groups (SB > DR > TS, p < 0.05) in the mean force of cyclic loading to create 3 mm displacement. Regarding the mean force of cyclic loading to create 5 mm displacement and ultimate failure load, no significant difference was found between the DR (370 N, 480 N) and SB (399 N, 493 N) groups, but both groups achieved superior results compared with the TS group (249 N, 340 N) (p < 0.05). The results suggested that the suture anchor constructs would be stronger than the fixation construct using screws for the humeral GT fracture. Keywords: humeral greater tuberosity fracture; suture anchor; screw; double-row fixation; biomechanics Isolated greater tuberosity (GT) fractures of the humerus are common. The rate of incidence is $17% to 21% among proximal humeral fractures.1 GT fractures often occur in anterior shoulder dislocation or as the result of an impaction injury. Although the amount of displacement requiring operative reduction and fixation is disputed, the consequences of an untreated malunited GT fracture can be pain and limited motion.2 Current literature recommends surgical intervention in cases with >5 mm of displacement in the general population or >3 mm of displacement in active patients. 1,[3][4][5] Open surgeries or percutaneous techniques with the aid of fluoroscopy using suture anchors or screws are well accepted for the reduction and fixation of GT fractures. 1,6,7 However, the techniques continue to evolve, particularly minimally invasive and arthroscopic techniques that have the advantages of minimizing skin incision, soft tissue dissection, and associated morbidities. 8,9 The materials used for arthroscopic fixation include suture anchors 9-13 or percutaneous screws.14,15 Although both implants are commonly used for fixation in GT fractures, mechanical stability remains a major concern for early postoperative mobilization and optimal functional results. No biomechanical studies have been performed to compare the strength of fixation constructs using suture anchors or screws. Therefore, our purpose was to analyze the strength of three different fixation constructs, using suture anchors or screws, for the management of GT fractures. We hypothesized that the suture anchor configurations would provide more biomechanica...

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Section: Discussionmentioning

confidence: 99%

Suture anchor versus screw fixation for greater tuberosity fractures of the humerus—a biomechanical study

Lin

Hong

Jou

et al. 2011

Journal Orthopaedic Research

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“…Double-row fixation techniques, such as the suture bridge construct, were developed to help address these factors in effort to improve repair rates. 1,15,16 Nevertheless, there are shortcomings associated with these standard double-row techniques. The success rate of any repair is influenced by tear size.…”

Section: Discussionmentioning

confidence: 99%

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

Ostrander

Smith

Saper

2016

Arthroscopy Techniques

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Recent advances to improve outcomes in rotator cuff repair include using arthroscopic double-row suturebridge techniques in an effort to reconstruct the rotator cuff footprint and improve fixation. However, when using this technique for larger tears, it can be difficult to get the lateral portion of the rotator cuff into an anatomic position. This report describes a triple-row modification of the suture-bridge technique that results in significantly more footprint contact area and contact pressure compared with the double-row and standard suture-bridge techniques. Maximizing the rotator cuff footprint contact area exposes more of the tendon to bone and may improve the healing potential.

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“…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

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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.

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Part I: Footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique

Cited by 365 publications

References 45 publications

Suture anchor versus screw fixation for greater tuberosity fractures of the humerus—a biomechanical study

Suture anchor versus screw fixation for greater tuberosity fractures of the humerus—a biomechanical study

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

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

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