A Comparison of Two Arthroscopic Techniques for Interpositional Polytetrafluoroethylene Patch Repair for Massive Irreparable Rotator Cuff Tears: Speed and Biomechanics.

Abstract

Interpositional synthetic patch repairs are a novel method of treating massive irreparable rotator cuff tears. However, surgeons experience difficulty in the arthroscopic insertion of these patches. We compared two methods of arthroscopic interpositional synthetic patch repair: the newly devised slide-and-grip technique, using pre-loaded sliding knots and no arthroscopic knots, and the weave technique, using less arthroscopic knot tying than the earlier mattress technique. Study questions were as follows: (1) Would the slide-and-grip technique take less time than the weave technique? (2) Would the biomechanical strength of the two methods be comparable? Fourteen paired ovine infraspinatus tendon ex vivo models of the degenerative human rotator cuff underwent timed repair with a synthetic polytetrafluoroethylene (PTFE) patch, using either the weave technique (n = 7) or the slide-and-grip technique (n = 7). Each was pulled to failure using a tensile testing machine, the Instron 8874. The time to complete the slide-and-grip repairs was shorter (12 ± 0.9min) than that of the weave repairs (23 ± 1min). Ultimate load to failure was comparable for the slide-and-grip and weave techniques (211 ± 27N vs. 295 ± 35N, respectively), and the slide-and-grip was less stiff (14 ± 1N/mm vs. 19 ± 1N/mm). The slide-and-grip technique took less time than the weave technique for the interpositional patch repair of massive irreparable rotator cuff tears and when correctly performed had comparable biomechanical strength.