Biomechanical Considerations for Rotator Cuff Repairs

Abstract

The ideal rotator cuff repair should have strong initial fixation strength to resist early structural failure and high footprint contact pressure to assist biological healing. Fixation strength can be enhanced by using more suture anchors in the repair construct and by placing anchors in area of high bone density such as the proximal part of the tuberosities. High footprint contact pressure can be achieved by using tension band repair constructs such as inverted mattress and suture bridge technique. These techniques pass sutures over the bursal surface of the tendon with lateral fixation. These bursal sutures push the tendon down to the footprint insertion creating a larger pressurized contact area beneficial for healing. Postoperative external rotation should be avoided to minimize strain on the anterolateral region of the repaired tendon. Abduction of 30 degrees should minimize loading stress on the repair construct and also facilitates blood flow to the footprint insertion.