Knotless rotator cuff repair in an external rotation model: the importance of medial-row horizontal mattress sutures.
نویسندگان
چکیده
PURPOSE To evaluate the effect of the addition of 2 horizontal mattress knots to the medial row of a knotless rotator cuff construct on the biomechanical properties in terms of both cyclic and failure testing parameters in an external rotation model. METHODS In 8 fresh-frozen human cadaveric shoulders, a knotless transosseous repair was performed, whereas in 8 contralateral matched-pair specimens, 2 horizontal mattress knots were added to the medial-row fixation. A custom jig was used that allowed external rotation (0° to 30°) with loading. A materials testing machine was used to cyclically load repairs from 0 to 180 N for 30 cycles and then to failure. Video digitizing software was used for analysis. Data from paired specimens were compared by use of paired Student t tests. RESULTS Ultimate load to failure was significantly higher in the modified construct (549 N v 311 N, P = .01). Linear stiffness in the first cycle, at the 30th cycle, and at failure was significantly higher (P = .02, P = .02, and P = .04, respectively) in the modified construct as well. Energy absorbed by the repaired tissue was significantly less in the modified construct at the first cycle, at the 30th cycle, and at ultimate load to failure (P = .03, P = .02, and P = .04, respectively). Significantly greater anterior gap formation occurred with the knotless technique at the first cycle (4.55 v 1.35) and 30th cycle (7.67 mm v 1.77 mm) (P = .02). CONCLUSIONS The modified construct shows improved biomechanical properties when allowing for external rotation during high-load testing. Using an additional horizontal mattress from separate sutures in the medial-row anchors helps to neutralize forces experienced by the repair. CLINICAL RELEVANCE The addition of medial-row fixation to a knotless construct will enhance the stability of rotator cuff repairs with the goal of improved patient outcomes.
منابع مشابه
Transosseous-equivalent rotator cuff repair: a systematic review on the biomechanical importance of tying the medial row.
PURPOSE Double-row and transosseous-equivalent repair techniques have shown greater strength and improved healing than single-row techniques. The purpose of this study was to determine whether tying of the medial-row sutures provides added stability during biomechanical testing of a transosseous-equivalent rotator cuff repair. METHODS We performed a systematic review of studies directly compa...
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BACKGROUND Rotator cuff tears are a significant cause of shoulder morbidity. Surgical techniques for repair have evolved to optimize the biologic and mechanical variables critical to tendon healing. Double-row repairs have demonstrated superior biomechanical advantages to a single-row. METHODS The preferred technique for rotator cuff repair of the senior author was reviewed and described in a...
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BACKGROUND Traditional biomechanical evaluations of rotator cuff repair techniques employ cyclic loading of the supraspinatus tendon in an isolated medial direction. PURPOSE This study was conducted to evaluate 2 different rotator cuff repair techniques that are currently the subject of debate with cyclic loading and with internal and external humeral rotation to better simulate postoperative...
متن کاملBiomechanical Performance of Medial Row Suture Placement Relative to the Musculotendinous Junction in Transosseous Equivalent Suture Bridge Double-Row Rotator Cuff Repair.
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We present a new method of suture bridge technique for medial row fixation using a modified Mason-Allen stitch instead of a horizontal mattress. Medial row configuration of the technique is composed of the simple stitch limb and the modified Mason-Allen stitch limb. The limbs are passed through the tendon by a shuttle relay. The simple stitch limb passes the cuff once and the modified Mason-All...
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ورودعنوان ژورنال:
- Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
دوره 27 4 شماره
صفحات -
تاریخ انتشار 2011