“Transosseous-Equivalent” Rotator Cuff Repair Technique

Park, Maxwell C.; ElAttrache, Neal S.; Ahmad, Christopher S.; Tibone, James E.

doi:10.1016/j.arthro.2006.07.017

Cited by 297 publications

(254 citation statements)

References 10 publications

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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%

“…Then, using standard suture-bridge technique, 1 suture limb from each of the medial anchors is then secured with 2 lateral-row anchors placed in line with the medial anchors. 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.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Yet, although studies have shown biomechanical advantages with the use of double-row repairs compared with single-row repairs, there is no definitive difference in clinical outcomes between the 2 repair constucts. [5][6][7] Furthermore, retear rates of 10% to 30% have been found in double-row techniques with higher rates (40% to 64%) in those patients with largeto-massive tears ( 3 cm).…”

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confidence: 92%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 92%

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

Ostrander

Smith

Saper

2016

Arthroscopy Techniques

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“…For transosseous-equivalent repair [33], the tendon was fixed at the medial edge of the native subscapularis footprint in the same fashion as described above for the doublerow repair, with the anterior and posterior anchors placed at the far medial footprint adjacent to the articular surface 4 to 5 mm apart from one another. However, unlike the double-row repair, the medial suture limbs were not cut after they were tied.…”

Section: Repair Techniquesmentioning

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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“…Double-row suture anchor techniques were developed in an attempt to increase the tendon-footprint contact area, improve unacceptably high retear rates, and ultimately improve functional outcomes. Transosseousequivalent repair, as described by Park et al, 1 sought to further maximize the tendon-footprint contact area and biomechanics by simulating a traditional open repair through transosseous tunnels. This technique preserves the suture limbs of the medial row, bridging them over the tendon's native insertion with fixation in the lateral humeral cortex.…”

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confidence: 99%

Arthroscopic Transosseous-Equivalent Rotator Cuff Repair

Lavery

Rasmussen

Dhawan

2013

Arthroscopy Techniques

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Rotator cuff repair techniques continue to evolve in an effort to improve repair biomechanics, maximize the biologic environment for tendon healing, and ultimately improve patient outcomes. The arthroscopic transosseousequivalent technique was developed to replicate the favorable tendon-bone contact area for healing seen in open transosseous tunnel repair. In this technical note and accompanying video, we present our all-arthroscopic transosseousequivalent rotator cuff repair technique with a focus on technical pearls. Double-row suture anchor techniques were developed in an attempt to increase the tendon-footprint contact area, improve unacceptably high retear rates, and ultimately improve functional outcomes. Transosseousequivalent repair, as described by Park et al., 1 sought to further maximize the tendon-footprint contact area and biomechanics by simulating a traditional open repair through transosseous tunnels. This technique preserves the suture limbs of the medial row, bridging them over the tendon's native insertion with fixation in the lateral humeral cortex. In this technical note with accompanying video (Video 1), we present an example of an arthroscopic transosseous-equivalent double-row rotator cuff repair. Surgical TechniqueWe prefer an interscalene block with sedation to maximize the duration of patient analgesia and intraoperative blood pressure control while diminishing the potential for cerebral hypoxic events. The patient is situated in the beach-chair position, and the shoulder and upper extremity are prepared and draped in standard aseptic fashion. Prophylactic antibiotics are infused within 1 hour of surgical incision.A modified posterior arthroscopic portal is established 1 cm inferior and 1 cm medial to the posterolateral corner of the acromion to ensure optimal visualization of both the subacromial space and glenohumeral joint. A standard anterosuperior portal is made under direct visualization, and a systematic diagnostic glenohumeral arthroscopy is performed. Careful attention is paid to the long head of the biceps and subscapularis tendinous insertion to evaluate for concomitant pathology. The arthroscope is then introduced into the subacromial space, and a midlateral portal 1 cm posterior and 3 to 4 cm distal to the midpoint of the lateral acromion is established. This portal can be tailored to the specific anatomy of the tear and desired anchor placement. A thorough bursectomy is performed with an arthroscopic shaver and radiofrequency device. A limited acromioplasty to co-plane the anterolateral acromion and elute marrow elements can be performed subsequent to the repair to limit osseous bleeding.After completion of the bursectomy, the configuration of the tear is characterized. The tendon is mobilized with a combination of subacromial and paraglenoid releases. Paraglenoid releases can be performed with a radiofrequency wand while one is viewing within the glenohumeral joint, releasing the interval between the superior labrum and undersurface of the rotator cuff (Fig 1)....

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“Transosseous-Equivalent” Rotator Cuff Repair Technique

Cited by 297 publications

References 10 publications

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

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

Arthroscopic Transosseous-Equivalent Rotator Cuff Repair

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