High-Tension Double-Row Footprint Repair Compared with Reduced-Tension Single-Row Repair for Massive Rotator Cuff Tears

Abstract

Amassive, retracted tear of the rotator cuff poses a unique challenge to the orthopaedic surgeon. All attempts must be made to mobilize the tendons such that they can be repaired to their anatomic insertion sites on the greater tuberosity in a tension-free manner. However, many retracted tears cannot be fully mobilized. In this situation, there is substantial controversy over the most successful repair technique. The advent of double-row repairs has been a substantial advance in rotator cuff repair. The double-row technique has been shown to be biomechanically superior to single-row and transosseous suture techniques1-4. However, the studies comparing these repair constructs have subjected all specimens to the same loads, failing to account for differences in tension between the repair constructs. In the case of a retracted massive cuff tear that cannot be adequately mobilized, performing a double-row footprint repair as advocated by several authors requires repairing the cuff under tension1,4. For this reason, Snyder and others have advocated performing a medialized repair with a single-row technique5, which may allow for repair under reduced tension. Thus, controversy exists around the question of which approach is biomechanically superior: a double-row technique under tension at the footprint or a reduced-tension medialized repair with a single-row technique. The purpose of the present study was to compare the biomechanical behavior of these two approaches in a cadaver model accounting for differences in tension between the constructs. Our hypothesis was that the double-row footprint repair construct would demonstrate superior biomechanical properties in spite of being subjected to higher load conditions. ### Preliminary Data In order to compare the medial repair with the anatomic repair, it was necessary to determine the tension differential between the two sites. Hersche and Gerber studied long-standing ruptures of the supraspinatus and found a 45-N …