A Biomechanical Comparison of Single and Double-row Fixation in Arthroscopic Rotator Cuff Repair.
From: The Shoulder Unit, Hospital of St. John and St. Elizabeth, 60 Grove End Road, London NWB 9NH, United Kingdom.
The Journal of bone and joint surgery. American volume
- Publish Date: Nov 2006
- ISSN: 0021-9355
- Volume: 88
- Issue: 11
- Pages: 2425-31
- Medium: Print
- Language: English
- Citation (JAMA): Smith Christopher D, Alexander Susan, Hill Adam M, et al. A Biomechanical Comparison of Single and Double-row Fixation in Arthroscopic Rotator Cuff Repair.. Nov 2006;88:2425-31
Abstract
BACKGROUND: The optimal method for arthroscopic rotator cuff repair is not yet known. The hypothesis of the present study was that a double-row repair would demonstrate superior static and cyclic mechanical behavior when compared with a single-row repair. The specific aims were to measure gap formation at the bone-tendon interface under static creep loading and the ultimate strength and mode of failure of both methods of repair under cyclic loading. METHODS: A standardized tear of the supraspinatus tendon was created in sixteen fresh cadaveric shoulders. Arthroscopic rotator cuff repairs were performed with use of either a double-row technique (eight specimens) or a single-row technique (eight specimens) with nonabsorbable sutures that were double-loaded on a titanium suture anchor. The repairs were loaded statically for one hour, and the gap formation was measured. Cyclic loading to failure was then performed. RESULTS: Gap formation during static loading was significantly greater in the single-row group than in the double-row group (mean and standard deviation, 5.0 +/- 1.2 mm compared with 3.8 +/- 1.4 mm; p < 0.05). Under cyclic loading, the double-row repairs failed at a mean of 320 +/- 96.9 N whereas the single-row repairs failed at a mean of 224 +/- 147.9 N (p = 0.058). Three single-row repairs and three double-row repairs failed as a result of suture cut-through. Four single-row repairs and one double-row repair failed as a result of anchor or suture failure. The remaining five repairs did not fail, and a midsubstance tear of the tendon occurred. CONCLUSIONS: Although more technically demanding, the double-row technique demonstrates superior resistance to gap formation under static loading as compared with the single-row technique. CLINICAL RELEVANCE: A double-row reconstruction of the supraspinatus tendon insertion may provide a more reliable construct than a single-row repair and could be used as an alternative to open reconstruction for the treatment of isolated tears.
Mesh Headings (Keywords): Arthroscopy, Biomechanics, Cadaver, Humans, Postoperative Complications, Rotator Cuff, Suture Techniques
Check for Full Text / PubMed Unique Identifier (PMID): 17079400
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