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Fang Y, Zhang S, Xiong J, Zhang Q. A Modified Arthroscopic Triple-row Repair Technique for L-shaped Delaminated Rotator Cuff Tears. Orthop Surg 2024; 16:1117-1126. [PMID: 38485458 PMCID: PMC11062871 DOI: 10.1111/os.14039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVE To compare the clinical outcomes of a modified arthroscopic triple-row (TR) repair technique with the suture bridge (SB) repair technique in treating L-shaped delaminated rotator cuff tears. Various surgical techniques for L-shaped delaminated rotator cuff tears have been reported, many of which aid in increasing the contact area and pressure of the rotator cuff. However, there is still debate over which technique yields superior results. METHODS From January 2017 to March 2020, 61 cases of L-shaped delaminated rotator cuff tears were included in this study. Of these, 34 cases underwent the modified arthroscopic triple-row repair technique, while 27 cases were addressed with the suture bridge repair technique. Functional assessment was conducted using the American Shoulder and Elbow Surgeons (ASES) score, the University of California Los Angeles (UCLA) shoulder score, the Constant score (CS), and the visual analogue scale (VAS) score. Magnetic Resonance Imaging (MRI) assessments for rotator cuff healing were performed at the 24-month postoperative mark. Statistical evaluations were conducted using SPSS for Windows (Version 25.0, IBM, Armonk, NY, USA), employing the Wilcoxon signed-rank test to compare preoperative and postoperative data and ROM differences, and the Mann-Whitney U test for statistical differences in clinical outcome scores between the two groups. A p-value of less than 0.05 was considered statistically significant. RESULTS Comparative analysis of the preoperative and final follow-up scores revealed a substantial enhancement in shoulder function, as indicated by the ASES, UCLA, CS, and VAS scores, with statistical significance (p < 0.001). At both the preoperative stage and final follow-up, no notable differences were observed in ASES, UCLA, CS, and VAS scores between the two groups. However, the TR repair group exhibited lower VAS scores than the SB group at 1 and 3 months postoperatively. Active range of motion (ROM) showed significant improvement in both groups. No significant differences in ROM were noted between the two groups either before the surgery or at the final follow-up. CONCLUSION The study demonstrates that both the modified arthroscopic TR and SB techniques for L-shaped delaminated cuff tears yield satisfactory outcomes, with no significant differences in overall clinical performance. Notably, early postoperative pain management appears more effective with the modified TR technique, suggesting its potential for enhanced early recovery experiences. This technique's design, promoting securer fixation and optimal contact conditions, is implied to facilitate superior long-term healing, warranting further investigation into its long-term benefits.
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Kajita Y, Iwahori Y, Harada Y, Takahashi R, Sagami R, Deie M. Comparison of clinical outcome and repair integrity after arthroscopic suture-bridge and triple-row rotator cuff repairs of Fosbury flop tears. J Orthop Sci 2024; 29:823-827. [PMID: 37236874 DOI: 10.1016/j.jos.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/08/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The Fosbury flop tear (FFT) has recently been described as a rotator cuff tear that has flipped upon itself and adhered medially. FFT is known to have a high retear rate after arthroscopic rotator cuff repair. The cause of the high postoperative retear rate after arthroscopic rotator cuff repair is believed to be due to the inability to achieve anatomical reduction because of difficulties in reducing the torn tendon stump. Arthroscopic rotator cuff repairs using the triple-row technique may allow better anatomical reduction of the cuff tear when compared with the suture-bridge technique. We compared the clinical outcomes and cuff integrity of the triple-row and suture-bridge techniques in arthroscopic rotator cuff repair for FFT. METHODS Patients with small-to-medium sized cuff tears of the supraspinatus tendon alone who were diagnosed with FFT, underwent arthroscopic rotator cuff repair, and had 2 or more years of follow-up were included. A total of 34 shoulders underwent the triple-row technique and 22 shoulders underwent the suture-bridge technique. The following were compared between the two techniques: patient background, operation time, number of anchors used during the operation, Japanese Orthopedic Association (JOA) score, active range of motion, and retear rate. RESULTS No significant difference in patient background was found between the two techniques. Although active range of motion was significantly improved compared with preoperative scores, no significant difference was observed between techniques. The triple-row technique demonstrated a significantly higher 24-month postoperative JOA score, significantly shorter surgery time, significantly lower retear rate, and significantly larger number of anchors used during the operation. CONCLUSIONS The triple-row technique was an effective method compared with the suture-bridge technique in cases with FFT.
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Affiliation(s)
- Yukihiro Kajita
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan.
| | - Yusuke Iwahori
- Department of Orthopaedic Surgery, Asahi Hospital, Japan
| | - Yohei Harada
- Department of Orthopaedic Surgery, Hiroshima University, Japan
| | | | - Ryosuke Sagami
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
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Lante E, Jany R. Isolated traumatic full-thickness supraspinatus tear with intact glenohumeral capsule: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:81-85. [PMID: 38323200 PMCID: PMC10840580 DOI: 10.1016/j.xrrt.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Affiliation(s)
- Erica Lante
- Department of Orthopedic Surgery and Traumatology, Riviera Chablais Hospital, Rennaz, Switzerland (CH)
| | - Richard Jany
- Department of Orthopedic Surgery, Saint Loup Hospital, Etablissements hospitaliers du Nord Vaudois, Pompaples, Switzerland (CH)
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Hoppe ED, Birman V, Kurtaliaj I, Guilliams CM, Pickard BG, Thomopoulos S, Genin GM. A discrete shear lag model of the mechanics of hitchhiker plants, and its prospective application to tendon-to-bone repair. Proc Math Phys Eng Sci 2023. [DOI: 10.1098/rspa.2022.0583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Tendon-to-bone repairs often fail when sutures pull through tendon, like a wire through cheese. Repair strength is maximized when loads are balanced equally among all sutures, relative to the pullout resistance of the tendon and the strength of the sutures. This problem of balancing loads across multiple, discrete attachment sites has been solved in nature by hitchhiker plants that proliferate by adhering relatively stiff fruit to relatively soft fur and fabrics through arrays of hooks. We, therefore, studied the fruits of such a plant,
Harpagonella palmeri
, and developed a discrete shear lag analysis of the force distributions in
H. palmeri
's linear arrays of long, slender hooks of varied lengths and spacing. Results suggested that strategies were used by the plant to distribute loads, including variations in the spacing and stiffnesses of hooks that serve to equalize forces over attachment sites. When applying these models to suturing schemes for surgical reattachment of tendon to bone, results suggested that strategies exhibited by
H. palmeri
show promise for balancing forces over sutures, potentially doubling repair strength relative to what could be achieved with a uniform suture distribution. Results suggest a potential pathway for strengthening surgical repairs, and more broadly for optimizing fasteners for bi-material attachment.
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Affiliation(s)
- Ethan D. Hoppe
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO
| | - Victor Birman
- Department of Mechanical and Aerospace Engineering, Missouri University of Science and Technology, Rolla, MO
| | - Iden Kurtaliaj
- Department of Orthopedic Surgery, Columbia University, New York, NY
| | | | - Barbara G. Pickard
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO
| | | | - Guy M. Genin
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO
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Kajita Y, Iwahori Y, Harada Y, Takahashi R, Sagami R, Deie M. Clinical outcome and repair integrity after arthroscopic full-thickness rotator cuff repair: Triple-row versus suture-bridge techniques. J Orthop Sci 2022:S0949-2658(22)00131-2. [PMID: 35688652 DOI: 10.1016/j.jos.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/08/2022] [Accepted: 05/11/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND This study aimed to compare the clinical outcomes and cuff integrity of the triple-row technique and suture-bridge technique in arthroscopic rotator cuff repair. METHODS Among patients with more than two years of follow-up (mean 27.4 ± 7.2 months), 71 shoulders that underwent the triple-row technique (46 male and 25 female; mean age, 62.7 ± 10.1 years; small-to-medium tears, 42 shoulders; large-to-massive tears, 29 shoulders) and 64 shoulders that underwent the suture-bridge technique (43 male and 21 female; mean age, 65.5 ± 8.4 years; small-to-medium tears, 46 shoulders; large-to-massive tears, 18 shoulders) were examined. The patient background, operation time, number of anchors used during the operation, Japanese Orthopedic Association (JOA) score, Active range of motion, and retear rate were evaluated and compared between the two techniques. RESULTS There was no significant difference in the patient background between the two techniques. The JOA score and Active range of motion were significantly improved compared to preoperative scores; however, there were no difference between the two techniques. The number of anchors used during the operation was 5.4 ± 1.6 for the triple-row technique and 4.1 ± 1.9 for the suture-bridge technique. Although significantly more anchors were used for the triple-row technique, there was no significant difference in the operation time between the two techniques. The retear rate was 7.1% for small-to-medium tears and 3.4% for large-to-massive tears using the triple-row technique, and 10.9% for small-to-medium tears and 33.3% for large-to-massive tears using the suture-bridge technique. The retear rate was significantly lower in large-to-massive tears when using the triple-row technique. CONCLUSION The triple-row technique was an effective method compared to the suture-bridge technique in cases with large-to-massive tears.
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Affiliation(s)
- Yukihiro Kajita
- Department of Orthopaedic Surgery, Aichi Medical University, Japan; Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan.
| | - Yusuke Iwahori
- Department of Orthopaedic Surgery, Asahi Hospital, Japan
| | - Yohei Harada
- Department of Orthopaedic Surgery, Hiroshima University, Japan
| | | | - Ryosuke Sagami
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
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Triple-Row Technique Confers a Lower Retear Rate Than Standard Suture Bridge Technique in Arthroscopic Rotator Cuff Repairs. Arthroscopy 2021; 37:3053-3061. [PMID: 33957211 DOI: 10.1016/j.arthro.2021.04.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/12/2021] [Accepted: 04/18/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the structural and clinical results between the knotless suture bridge (SB) and triple-row (TR) techniques. METHODS This study is a retrospective study and included 212 shoulders with repairable rotator cuff tears treated with the SB technique and 206 shoulders treated with the TR technique. In the TR technique, medial and lateral anchors were placed as they would be for the SB technique, with a middle row anchor added on the edge of footprint to reduce the torn tendons. All patients underwent primary arthroscopic rotator cuff repair and had magnetic resonance imaging 6 months postoperatively to evaluate for retear. Sugaya's classification was used to classify the retear pattern. The function of all patients preoperatively and 2 years postoperatively were assessed by the American Shoulder and Elbow Surgeons shoulder index and the University of California at Los Angeles rating scale. RESULTS According to Sugaya's classification, 24 (11.3%), 6 (2.8%), and 20 (9.4%) in SB-treated shoulders and 16 (7.8%), 12 (5.8%), and 8 (3.9%) in TR-treated shoulders, respectively had types 3, 4, and 5. There was a statistically significant greater type 5 retear in SB-treated shoulders (P = .038) than in TR-treated shoulders. The average clinical outcome scores at the final follow-up improved significantly relative to those before the surgeries in both groups. There were no statistical differences in the clinical outcome scores at the final follow-up between SB and TR groups. CONCLUSIONS The use of the TR technique in arthroscopic rotator cuff repair resulted in a lower large-size retear rate when compared with the use of the SB technique. No clinical differences were noted in the outcomes between the 2 groups. LEVEL OF EVIDENCE Level III, therapeutic, retrospective cohort study.
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Editorial Commentary: Anterior Cable Reconstruction for the Shoulder Superior Capsule: Time for "Indication Rounds". Arthroscopy 2021; 37:2780-2782. [PMID: 34481619 DOI: 10.1016/j.arthro.2021.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 02/02/2023]
Abstract
Anterior cable reconstruction (ACR) techniques for the superior capsule are multiple and varied. To optimize patient outcomes, technical considerations must be supported by basic science, both anatomically and biomechanically. ACR was designed to treat only partially repairable rotator cuff tendon tears, to provide a static support to a dynamic partial (and therefore "nonanatomic") repair, and to treat tears that could not be treated by transosseous-equivalent footprint-restoring "anatomic" repairs (both capsule and tendon repaired), but were also not so large as to necessitate superior capsule reconstruction. ACR allows restoration of posterosuperior capsular function with side-to-side repair sutures, and much of the biomechanical functionality comes from using whatever inherent native superior capsule is available. Cable reconstructions should be secured to normal attachment sites on the glenoid and greater tuberosity sulcus. Also, graft tension must be accounted for when considering humeral motion such as rotation and adduction. The indications for ACR need to be carefully considered and account for both anatomic and biomechanical rationales. In the face of new ACR techniques, the need to discern what is possible versus what procedure is indicated cannot be overlooked.
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Tokish JM, Hawkins RJ. Current concepts in the evolution of arthroscopic rotator cuff repair. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:75-83. [PMID: 37588146 PMCID: PMC10426701 DOI: 10.1016/j.xrrt.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Arthroscopic rotator cuff repair has become one of the most common and successful surgeries performed in orthopedics. It represents the culmination of advances in many diverse fields such as optics, fluid dynamics, mechanical engineering, and most recently, orthobiologics. This article reviews the current state of the art of arthroscopic rotator cuff repair, through the lens of its historical context and evolution to our present understanding. We review the limitations in the current approach, and glance toward the future of rotator cuff regeneration with emerging technologies.
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Andrews JR, Elbayar JH, Jordan SE. Partial-Rotator Cuff Tears in Throwing Athletes. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Morsy MG, Gawish HM, Galal MA, Waly AH. Arthroscopic Linked Triple Row Repair for Large and Massive Rotator Cuff Tears. Arthrosc Tech 2021; 10:e117-e125. [PMID: 33532217 PMCID: PMC7823101 DOI: 10.1016/j.eats.2020.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/20/2020] [Indexed: 02/03/2023] Open
Abstract
Recently, many arthroscopic techniques have been described to improve the outcomes in rotator cuff repair of large and massive tears; these include conventional double-row, suture bridge, and triple-row techniques, in an effort to optimally reconstruct the rotator cuff footprint and improve fixation. This report describes a modified triple-row repair technique that links the double-row and suture-bridge techniques in one construct, merging the advantages of both to maximize the footprint contact area and contact pressure, which may lead to better healing and faster rehabilitation.
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Affiliation(s)
- Mohamed G. Morsy
- Department of Orthopaedic Surgery and Traumatology, Arthroscopy and Sports Injury Unit, Alexandria University, Alexandria, Egypt,Address correspondence to Mohamed Gamal Morsy, M.D., 21411, Gleem, Alexandria, Egypt.
| | - Hesham M. Gawish
- Department of Orthopaedic Surgery and Traumatology, Kafr El Sheikh University, Kafr el-Sheikh, Egypt
| | - Mostafa A. Galal
- Department of Orthopaedic Surgery and Traumatology, Arthroscopy and Sports Injury Unit, Alexandria University, Alexandria, Egypt
| | - Ahmed H. Waly
- Department of Orthopaedic Surgery and Traumatology, Arthroscopy and Sports Injury Unit, Alexandria University, Alexandria, Egypt
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Gould HP, Rate WR, Abbasi P, Mistretta KL, Hammond JW. Adjustable Cortical Fixation Device for Quadriceps Tendon Repair: A Cadaveric Biomechanical Study. Orthop J Sports Med 2021; 9:2325967120974393. [PMID: 33614795 PMCID: PMC7869174 DOI: 10.1177/2325967120974393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/29/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Adjustable cortical fixation devices have demonstrated utility in orthopaedic applications, such as ankle syndesmosis repair. PURPOSE To assess the cyclic gap formation of a quadriceps tendon repair technique using an adjustable cortical fixation device compared with repair with knotless suture anchors and suture tape, a modification of conventional suture anchor repair. STUDY DESIGN Controlled laboratory study. METHODS Eight fresh-frozen matched pairs of cadaveric knees were used. Specimens in each pair were randomized to undergo either modified suture anchor repair (control) or adjustable cortical fixation repair. The control repair was performed as previously described. The experimental repair was performed using 2 No. 2 FiberWire sutures placed into the quadriceps tendon in a running locked Krackow configuration and 2 adjustable loop devices passed through transosseous tunnels. The lagging strands of the devices were tensioned to seat the cortical fixation buttons at the inferior patellar pole and then tied to the free Krackow strands at the superior pole to complete the repair. The mean plastic gap (permanent tendon displacement that did not recover with cyclic extension) and mean maximum gap (peak displacement that occurred with cyclic knee flexion and partially recovered with extension) were evaluated during cyclic loading for 500 cycles of full knee extension to 90° of flexion. RESULTS At all testing intervals, the mean plastic gap was significantly smaller for the cortical fixation group versus the suture anchor group (P < .02). Similarly, the mean maximum gap was significantly smaller for the cortical fixation specimens at all testing intervals (P < .01). After cyclic loading, the mean maximum gap was significantly smaller in the cortical fixation group (4.80 ± 1.56 mm) versus the suture anchor group (8.47 ± 1.47 mm; P = < .001). The mean plastic gap was also significantly smaller in the cortical fixation versus the suture anchor group (3.25 ± 1.10 mm vs 6.57 ± 1.62 mm, respectively; P = < .001). CONCLUSION Quadriceps tendon repair using an adjustable cortical fixation device demonstrated superior biomechanical properties in cyclic displacement testing compared with repair using the suture anchor technique. CLINICAL RELEVANCE These results suggest that an adjustable cortical fixation device is a biomechanically viable alternative for quadriceps tendon repair.
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Affiliation(s)
- Heath P. Gould
- Department of Orthopaedic Surgery, MedStar Union Memorial
Hospital, Baltimore, Maryland, USA
| | | | - Pooyan Abbasi
- Department of Orthopaedic Surgery, MedStar Union Memorial
Hospital, Baltimore, Maryland, USA
| | - Katherine L. Mistretta
- Department of Orthopaedic Surgery, MedStar Union Memorial
Hospital, Baltimore, Maryland, USA
| | - Jason W. Hammond
- Department of Orthopaedic Surgery, MedStar Union Memorial
Hospital, Baltimore, Maryland, USA
- Jason W. Hammond, MD, c/o Lyn Camire, MA, ELS, Department of
Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert Street,
Suite 400, Baltimore, MD 21218, USA (email
)
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Morsy MG, Gawish HM, Galal MA, Waly AH. Outcomes of the Star Repair for Large and Massive Rotator Cuff Tears: A Modified Triple-Row Technique. Orthop J Sports Med 2020; 8:2325967120952998. [PMID: 32974412 PMCID: PMC7495945 DOI: 10.1177/2325967120952998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/21/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Large and massive rotator cuff repairs constitute a true challenge for arthroscopic shoulder surgeons. Retear rates as high as 20% have been reported after arthroscopic double-row and suture-bridge techniques used for these tears. Hypothesis: A modified triple-row repair will provide satisfactory clinical results with lower risk for retear. Study Design: Case series; Level of evidence, 4. Methods: Between March 2016 and August 2017, a total of 52 patients with large and massive rotator cuff tears received a modified triple-row cuff repair. A middle repositioning anchor was inserted between the medial and the lateral rows. The middle anchor sutures were loaded to lateral knotless anchors in a star-shaped configuration. Functional evaluation was performed using the American Shoulder and Elbow Surgeons score, University of California, Los Angeles score, Constant-Murley score, and Simple Shoulder Test. Subjective evaluation was carried out using a visual analog scale for pain and a subjective shoulder value score. Health-related as well as disease-specific quality-of-life scores were also used. Retear rates were assessed by means of musculoskeletal ultrasonography. Patients were evaluated for a minimum of 24 months. Results: This study included 34 female and 18 male patients with a mean age of 57.17 ± 6.7 years. There were 35 patients (67.3%) with large tears and 17 patients (32.7%) with massive tears. Significant improvement from preoperative values was seen in all functional and subjective scores (P < .001). The mean forward flexion was 163° ± 9.7°, and the mean lateral abduction was 159.4° ± 9.4°. All patients had excellent scores on the general health-related and disease-specific quality-of-life scales. No retears were reported at the end of the follow-up period. Conclusion: The star-shaped, modified triple-row cuff repair is a valid and effective solution for surgical management of large and massive rotator cuff tears, providing excellent results and low risk for retears.
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Affiliation(s)
- Mohamed G Morsy
- Department of Orthopaedic Surgery and Traumatology, Alexandria Arthroscopy and Sports Injury Unit, Alexandria University, Egypt
| | - Hesham M Gawish
- Department of Orthopaedic Surgery and Traumatology, Kafr El Sheikh University, Egypt
| | - Mostafa A Galal
- Department of Orthopaedic Surgery and Traumatology, Alexandria Arthroscopy and Sports Injury Unit, Alexandria University, Egypt
| | - Ahmed H Waly
- Department of Orthopaedic Surgery and Traumatology, Alexandria Arthroscopy and Sports Injury Unit, Alexandria University, Egypt
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Stone AV, Luo TD, Sharma A, Danelson KA, De Gregorio M, Freehill MT. Optimizing the Double-Row Construct: An Untied Medial Row Demonstrates Equivalent Mean Contact Pressures in a Rotator Cuff Model. Orthop J Sports Med 2020; 8:2325967120914932. [PMID: 32426405 PMCID: PMC7218996 DOI: 10.1177/2325967120914932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: The merits of a double-row rotator cuff repair (RCR) construct are well-established for restoration of the footprint and lateral-row security. The theoretical benefit of leaving the medial row untied is to prevent damage to the rotator cuff by tissue strangulation, and the benefit of suture tape is a more even distribution of force across the repair site. These benefits, to our knowledge, have not been evaluated in the laboratory. Hypothesis: Leaving the medial row untied and using a suture bridge technique with suture tape will offer more even pressure distribution across the repair site without compromising total contact force. Study Design: Controlled laboratory study. Methods: A laboratory model of RCR was created using biomechanical research-grade composite humeri and human dermal allografts. The pressure distribution in a double-row suture bridge repair construct was analyzed using the following testing matrix: double-loaded suture anchors with the medial row tied (n = 15) versus untied (n = 15) compared with double-loaded suture tape and anchors with the medial row tied (n = 15) versus untied (n = 15). A digital pressure sensor was used to measure pressure over time after tensioning of the repair site. A multivariate analysis of variance was used for statistical analysis with post hoc testing. Results: The total contact force did not significantly differ between constructs. The contact force between double-loaded suture anchors and double-loaded suture tape and anchors was similar when tied (P = .15) and untied (P = .44). An untied medial row resulted in similar contact forces in both the double-loaded suture anchor (P = .16) and double-loaded suture tape and anchor (P = .25) constructs. Qualitative increases in focal contact pressure were seen when the medial row was tied. Conclusion: An untied medial row did not significantly affect the total contact force with double-loaded suture anchors and with double-loaded suture tape and anchors. Tying the medial row qualitatively increased crimping at the construct’s periphery, which may contribute to tissue strangulation and hinder clinical healing. Qualitative improvements in force distribution were seen with double-loaded suture tape and anchors. Clinical Relevance: Both tied and untied medial rows demonstrated similar pressures across the repair construct.
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Affiliation(s)
| | - T David Luo
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Aman Sharma
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kerry A Danelson
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
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14
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Buckup J, Smolen D, Hess F, Sternberg C, Leuzinger J. The arthroscopic triple-row modified suture bridge technique for rotator cuff repair: functional outcome and repair integrity. J Shoulder Elbow Surg 2020; 29:308-315. [PMID: 31451350 DOI: 10.1016/j.jse.2019.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/04/2019] [Accepted: 06/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal technique for arthroscopic rotator cuff repair is still controversial. Large tears with a high grade of retraction have an especially high risk of retearing. This study reports the clinical and radiologic results of a triple-row modified suture bridge technique for the treatment of full-thickness rotator cuff tears with medium and high grades of retraction. METHODS A total of 101 shoulders in 100 patients underwent a triple-row modified suture bridge reconstruction for full-thickness rotator cuff tears with retraction grade II and grade III according to Patte; 81 patients were reached for follow-up 36.2 months after surgery. At follow-up, clinical outcome was assessed by the American Shoulder and Elbow Surgeons score, subjective shoulder value, visual analog scale score, University of California-Los Angeles shoulder score, and Constant score (CS). At follow-up, an ultrasound examination was performed to determine tendon integrity or retears in all patients. RESULTS The overall retear rate was 4.9% (4/81). The clinical outcome was good to excellent (American Shoulder and Elbow Surgeons score, 94 ± 11; subjective shoulder value, 92 ± 12; University of California-Los Angeles shoulder score, 33 ± 5; Constant score, 90 ± 9). In the radiologic follow-up, no retear was found in any of the follow-up patients after an average of 36.2 months. There was no significant difference in clinical outcome parameters between rotator cuff tears Patte II and Patte III (P > .05). CONCLUSION For tears with a high grade of retraction, surgical treatment using a triple-row modified suture bridge technique represents a good treatment option with a low rate of retearing and good to excellent clinical results.
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Affiliation(s)
- Johannes Buckup
- Center for Minimally Invasive Surgery, Etzelclinic, Pfäffikon, Switzerland; Department of Sport Traumatology, Knee, and Shoulder Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany.
| | - Daniel Smolen
- Center for Minimally Invasive Surgery, Etzelclinic, Pfäffikon, Switzerland
| | - Florian Hess
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Switzerland
| | | | - Jan Leuzinger
- Center for Minimally Invasive Surgery, Etzelclinic, Pfäffikon, Switzerland
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15
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Lin CL, Yeh ML, Su FC, Wang YC, Chiang CH, Hong CK, Su WR. Different suture anchor fixation techniques affect contact properties in humeral greater tuberosity fracture: a biomechanical study. BMC Musculoskelet Disord 2019; 20:26. [PMID: 30654770 PMCID: PMC6337758 DOI: 10.1186/s12891-019-2412-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/09/2019] [Indexed: 11/20/2022] Open
Abstract
Background Suture anchor-based fixations of humeral greater tuberosity (GT) fractures have yielded good outcomes in both clinical and biomechanical studies. Be that as it may, the interface contact properties of these fixations have yet to be elaborated. In response, the contact characteristics of two double-row suture anchor fixations for the management of GT fracture were compared. Methods Two suture anchor-based fixation techniques, namely the Double-Row Suture Anchor Fixation (DR) and Suture-Bridge Technique (SB), were used to repair humeral GT fractures in 12 fresh-frozen human cadaveric shoulders. A Tekscan pressure sensor placed between the repaired tuberosity and humerus recorded continuous data points directly after repair and for 60 min at set time intervals. The constructs were then cyclically loaded until 100 N, and the shoulders tested at 0°, 30°, and 60° of abduction. Under an applied force, the contact pressure and contact area of the interface were determined. Results Although both fixation configurations showed decreased contact pressure and area over time, the SB group had higher contact pressure right after fixation and at all time points thereafter. In contrast, the DR group demonstrated significantly more contact pressure and area at each abduction position with the applied load. Nevertheless, contact pressure and area decreased in response to increasing abduction position for both fixation constructs. Conclusion Findings suggest that despite the SB construct having superior interface contact immediately after fixation, the DR construct offered better contact performance at all abduction angles with applied force. Level of evidence Basic Science, Biomechanics.
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Affiliation(s)
- Cheng-Li Lin
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, 70428, Tainan City, Taiwan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.,Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.,Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Fong-Chin Su
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Chih Wang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chen-Hao Chiang
- Department of Orthopaedics, Chiayi Christian Hospital, Chiayi, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, 70428, Tainan City, Taiwan.,Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, 70428, Tainan City, Taiwan. .,Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan.
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16
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Bishop ME, MacLeod R, Tjoumakaris FP, Hammoud S, Cohen SB, Dodson CC, Ciccotti MG, Freedman KB. Biomechanical and Clinical Comparison of Suture Techniques in Arthroscopic Rotator Cuff Repair. JBJS Rev 2017; 5:e3. [DOI: 10.2106/jbjs.rvw.17.00019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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17
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Rush LN, Savoie FH, Itoi E. 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. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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18
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Ostrander RV, Smith J, Saper M. Triple-Row Modification of the Suture-Bridge Technique for Arthroscopic Rotator Cuff Repair. Arthrosc Tech 2016; 5:e1007-e1013. [PMID: 27909668 PMCID: PMC5124061 DOI: 10.1016/j.eats.2016.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/09/2016] [Indexed: 02/03/2023] Open
Abstract
Recent advances to improve outcomes in rotator cuff repair include using arthroscopic double-row suture-bridge 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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Affiliation(s)
- Roger V. Ostrander
- Address correspondence to Roger V. Ostrander III, M.D., Andrews Institute for Orthopaedics and Sports Medicine, 1040 Gulf Breeze Pkwy, Gulf Breeze, FL 32561, U.S.A.Andrews Institute for Orthopaedics and Sports Medicine1040 Gulf Breeze PkwyGulf BreezeFL32561U.S.A.
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19
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A 3D finite element model for geometrical and mechanical comparison of different supraspinatus repair techniques. J Shoulder Elbow Surg 2016; 25:557-63. [PMID: 26652702 DOI: 10.1016/j.jse.2015.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Contact pressure and contact area are among the most important mechanical factors studied to predict the effectiveness of a rotator cuff repair. The suture configurations can strongly affect these factors but are rarely correlated with each other. For example, there is a significant difference between the single-row technique and the transosseous or transosseous-like approaches in terms of footprint contact area coverage. A finite element model-based approach is presented and applied to account for various parameters (eg, suture pretension, geometry of the repair, effect of the sutures, geometry of the lesion) and to compare the efficacy of different repair techniques in covering the original footprint. METHODS The model allows us to evaluate the effect of parameters such as suture configuration and position and suture pretension. The validity of such an approach was assessed in comparing 3 different repair techniques: single row, transosseous equivalent, and double row. RESULTS Results from the application of the models show that the double-row and transosseous-equivalent techniques lead to progressive increase of the contact area compared with the single-row approach, supporting the conclusion that transosseous-equivalent fixation leads to an increase of the contact area and a better distribution of the pressure coverage. CONCLUSION The 3-dimensional finite element model approach allows multiple variables to be assessed singularly, weighing the specific influence. Moreover, the approach presented in this study could be a valid tool to predict and to reproduce different configurations, identifying how to reduce the stress over the tendon and when a repair could be effective or not.
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20
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Abstract
Tendinopathy is a debilitating musculoskeletal
condition which can cause significant pain and lead to complete rupture
of the tendon, which often requires surgical repair. Due in part
to the large spectrum of tendon pathologies, these disorders continue
to be a clinical challenge. Animal models are often used in this
field of research as they offer an attractive framework to examine
the cascade of processes that occur throughout both tendon pathology and
repair. This review discusses the structural, mechanical, and biological
changes that occur throughout tendon pathology in animal models,
as well as strategies for the improvement of tendon healing. Cite this article: Bone Joint Res 2014;3:193–202.
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Affiliation(s)
- M W Hast
- University of Pennsylvania, McKay Orthopaedic Research Laboratory, 424 Stemmler Hall 36th Street and Hamilton Walk, Philadelphia, 19104-6081, USA
| | - A Zuskov
- University of Pennsylvania, McKay Orthopaedic Research Laboratory, 424 Stemmler Hall 36th Street and Hamilton Walk, Philadelphia, 19104-6081, USA
| | - L J Soslowsky
- University of Pennsylvania, McKay Orthopaedic Research Laboratory, 424 Stemmler Hall 36th Street and Hamilton Walk, Philadelphia, 19104-6081, USA
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21
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Park MC, Peterson A, Patton J, McGarry MH, Park CJ, Lee TQ. Biomechanical effects of a 2 suture-pass medial inter-implant mattress on transosseous-equivalent rotator cuff repair and considerations for a "technical efficiency ratio". J Shoulder Elbow Surg 2014; 23:361-8. [PMID: 24035567 DOI: 10.1016/j.jse.2013.06.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 06/08/2013] [Accepted: 06/16/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff repair involving fewer tendon suture passes without compromising biomechanical performance would represent a technical advancement. An inter-implant "medial pulley-mattress" transosseous-equivalent (MP-TOE) repair requiring fewer tendon suture-passes was hypothesized to provide equivalent biomechanical characteristics compared to the control. METHODS In 6 human cadaveric shoulders, a transosseous-equivalent (TOE) repair (control) was performed utilizing 2 separate medial mattresses resulting in 4 tendon-bridging sutures. In 6 matched-pairs, 2 single-loaded anchors were used to create a medial inter-implant mattress construct (all sutures shuttled in 1 tendon pass per anchor)-after knot-tying, the same tendon-bridging pattern as the control was created. A materials testing machine cyclically loaded each repair from 10-180 N for 30 cycles; each repair subsequently underwent failure testing. Gap and strain were measured with a video digitizing system. A "technical efficiency ratio" (TER) was defined as: (#knots + #suture passes + #suture limbs)/#fixation points. RESULTS Cyclic and failure testing demonstrated no significant differences between constructs. Gap formation at cycle 30 was 5.3 ± 0.8 mm (TOE) and 5.0 ± 0.3 mm (MP-TOE) (P = .62). Cycle 30 anterior strain values were -16.0 ± 7.3% (TOE) and -15.8 ± 6.6% (MP-TOE) (P = .99). Yield loads were 208.7 ± 2.7 N (TOE) and 204.0 ± 1.3 N (MP-TOE) (P = .17). Mode of failure demonstrated less tendon cut-out with the MP-TOE repair. The MP-TOE repair has a TER of 2.0 vs 2.5 for the control. CONCLUSION The MP-TOE repair requiring fewer tendon suture passes, yet creating an additional inter-implant mattress configuration, is biomechanically equivalent to the original TOE technique, and may limit failure with improved medial load-sharing capacity. A TER may help quantify technical ease and help standardize comparisons between repair techniques.
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Affiliation(s)
- Maxwell C Park
- Southern California Permanente Medical Group, Woodland Hills, CA, USA.
| | - Alexander Peterson
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System, University of California, Irvine, CA, USA
| | - John Patton
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System, University of California, Irvine, CA, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System, University of California, Irvine, CA, USA
| | | | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System, University of California, Irvine, CA, USA
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22
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Park MC. Biomechanical validation of rotator cuff repair techniques and considerations for a "technical efficiency ratio". Arthroscopy 2013; 29:1230-4. [PMID: 23707185 DOI: 10.1016/j.arthro.2013.03.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 03/21/2013] [Accepted: 03/27/2013] [Indexed: 02/02/2023]
Abstract
Biomechanical studies are commonly used to validate new or modified rotator cuff repair techniques. Additional knots, more tendon suture passes, and obligatory suture management requirements are often the "cost" for improved biomechanical results. This cost can amount to increased technical difficulty and surgical times. However, technical ease or difficulty as a measurable variable has not been quantified. A basic measure for technical ease would allow surgeons the ability to objectively assess and compare rotator cuff repair practicality and potentially help in the design of future studies to standardize repair techniques alongside biomechanical measures. A proposed rotator cuff repair "technical efficiency ratio" is defined as follows: (No. of knots + No. of tendon suture passes + No. of suture limbs)/No. of pilot holes created. This can give a measure of "work" or utility achieved per fixation point created for a particular type of repair (e.g., single or double row), with a smaller number representing relatively more efficiency per anchor or fixation point used. If repairs validated in the laboratory are too cumbersome to perform in vivo from a practical standpoint, technical ease should be a prerequisite measure, and the success of a repair technique should not necessarily be based on biomechanics alone.
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Affiliation(s)
- Maxwell C Park
- Department of Orthopaedic Surgery, Woodland Hills Medical Center, Kaiser Foundation Hospital, Woodland Hills, CA 91365, USA.
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