Authors' Reply

Abstract

We highly appreciate the comments of Drs. Osterhoff and Hepp on our article “Arthroscopic lamina-specific double-row fixation for large delaminated rotator cuff tears” (available at arthroscopytechniques.org). Actually, comparing techniques between lamina-specific double-row (LSDR) and knotless anatomic double-layer double-row (DLDR) rotator cuff repair, the DLDR repair is superior to LSDR repair in terms of avoiding suture knots buried within the repaired tendons.The purpose of our article was to present the operative technique and indications for DLDR repair. As described in the article, we indicate DLDR repair for delaminated rotator cuff tears whose inferior layer is retracted medial to the glenoid (large-sized rotator cuff tears). Moreover, DLDR repair is limited to cases in which the inferior layer can be pulled laterally to the footprint with a tendon grasper, avoiding DLDR repair for shoulders that have friable inferior and superior layers. This is why we believe more suture knots and their proper placement is more beneficial in tendon healing for repairing larger rotator cuff tears.1Jost P.W. Khair M. Chen D.X. et al.Suture number determines strength of rotator cuff repair.J Bone Joint Surg Am. 2012; 94: e100Crossref PubMed Scopus (54) Google ScholarWe would expect DLDR repair to achieve better tendon healing in terms of the following aspects: The technique (1) creates a larger area of contact between the inferior layer and the footprint, (2) leads to higher initial fixation strength of the articular-side components of the repaired rotator cuff tendon, and (3) forms an adaptation between the superficial and inferior layers. However, we have not yet presented the clinical and structural results or complications, such as an inflammatory foreign-body response. Therefore clinical and structural studies are required to confirm our expectation. We highly appreciate the comments of Drs. Osterhoff and Hepp on our article “Arthroscopic lamina-specific double-row fixation for large delaminated rotator cuff tears” (available at arthroscopytechniques.org). Actually, comparing techniques between lamina-specific double-row (LSDR) and knotless anatomic double-layer double-row (DLDR) rotator cuff repair, the DLDR repair is superior to LSDR repair in terms of avoiding suture knots buried within the repaired tendons. The purpose of our article was to present the operative technique and indications for DLDR repair. As described in the article, we indicate DLDR repair for delaminated rotator cuff tears whose inferior layer is retracted medial to the glenoid (large-sized rotator cuff tears). Moreover, DLDR repair is limited to cases in which the inferior layer can be pulled laterally to the footprint with a tendon grasper, avoiding DLDR repair for shoulders that have friable inferior and superior layers. This is why we believe more suture knots and their proper placement is more beneficial in tendon healing for repairing larger rotator cuff tears.1Jost P.W. Khair M. Chen D.X. et al.Suture number determines strength of rotator cuff repair.J Bone Joint Surg Am. 2012; 94: e100Crossref PubMed Scopus (54) Google Scholar We would expect DLDR repair to achieve better tendon healing in terms of the following aspects: The technique (1) creates a larger area of contact between the inferior layer and the footprint, (2) leads to higher initial fixation strength of the articular-side components of the repaired rotator cuff tendon, and (3) forms an adaptation between the superficial and inferior layers. However, we have not yet presented the clinical and structural results or complications, such as an inflammatory foreign-body response. Therefore clinical and structural studies are required to confirm our expectation. Lamina-Specific Double-Row Fixation of Rotator Cuff TearsArthroscopyVol. 31Issue 6PreviewWe read with great interest the recent article by Mori et al.1 published in the December 2014 issue of Arthroscopy Techniques (available at arthroscopytechniques.org ). We congratulate the authors for their work but would like to elucidate some aspects of lamina-specific rotator cuff repairs. Full-Text PDF