Rotator cuff repair: the effect of double-row fixation versus single-row fixation on three-dimensional repair site (SS-03)

Abstract

In rotator cuff surgery, increasing emphasis is being placed on maximizing the repair site contact area, thereby increasing the tendon-bone interface to potentially enhance more complete healing. Previous studies have demonstrated that traditional repairs using a single row of suture anchors or trans-osseous sutures fail to reproduce the area of the native supraspinatus tendon insertion or “footprint” on the greater tuberosity. The purpose of this study was to demonstrate the superiority of a double-row fixation technique in restoring the normal area of the supraspinatus footprint. Materials and Methods: A cadaveric study was performed using 7 fresh frozen shoulders. Rotator cuff tears were created and then repaired using several techniques: single-row suture anchor fixation (SRSA) using Mitek Fastin RC anchors (Mitek Worldwide, Norwood, MA), double-row suture anchor fixation (DRSA), and trans-osseous suture technique (TOS). The repair footprint area was determined for each technique by three-dimensional digitation, using a MicroScribeG2X digitizer (Immersion Corp, San Jose, CA). The area of the original tendon insertion site was also assessed for comparison. The data was processed using Rhinoceros NURBS modeling software (McNeal and Associates, Seattle, WA) and the repair site areas were compared for the different repair techniques. Appropriate power analysis was performed to insure adequate sample size and a 2 tailed paired Student t test was performed to reveal statistical significance of detected differences. Results: The footprint area of the DRSA technique was larger than that of the other two techniques. These findings were statistically significant (P < .05). Furthermore, the DRSA technique consistently reproduced 100% of the original supraspinatus footprint area. Both the SRSA and TOS technique failed to do so. On average, the TOS technique reproduced only 71% of the original insertion site and the SRSA technique reproduced 46%. The differences between the area of the original footprint, TOS and SRSA were all statistically significant (P < .05). Conclusions: Double-row fixation in rotator cuff repair reproduces 100% of the supraspinatus footprint while traditional single-row techniques fail to do so. Double-row fixation may be a superior technique by providing a tendon-bone interface better suited for biologic healing and restoring normal anatomy. In rotator cuff surgery, increasing emphasis is being placed on maximizing the repair site contact area, thereby increasing the tendon-bone interface to potentially enhance more complete healing. Previous studies have demonstrated that traditional repairs using a single row of suture anchors or trans-osseous sutures fail to reproduce the area of the native supraspinatus tendon insertion or “footprint” on the greater tuberosity. The purpose of this study was to demonstrate the superiority of a double-row fixation technique in restoring the normal area of the supraspinatus footprint. Materials and Methods: A cadaveric study was performed using 7 fresh frozen shoulders. Rotator cuff tears were created and then repaired using several techniques: single-row suture anchor fixation (SRSA) using Mitek Fastin RC anchors (Mitek Worldwide, Norwood, MA), double-row suture anchor fixation (DRSA), and trans-osseous suture technique (TOS). The repair footprint area was determined for each technique by three-dimensional digitation, using a MicroScribeG2X digitizer (Immersion Corp, San Jose, CA). The area of the original tendon insertion site was also assessed for comparison. The data was processed using Rhinoceros NURBS modeling software (McNeal and Associates, Seattle, WA) and the repair site areas were compared for the different repair techniques. Appropriate power analysis was performed to insure adequate sample size and a 2 tailed paired Student t test was performed to reveal statistical significance of detected differences. Results: The footprint area of the DRSA technique was larger than that of the other two techniques. These findings were statistically significant (P < .05). Furthermore, the DRSA technique consistently reproduced 100% of the original supraspinatus footprint area. Both the SRSA and TOS technique failed to do so. On average, the TOS technique reproduced only 71% of the original insertion site and the SRSA technique reproduced 46%. The differences between the area of the original footprint, TOS and SRSA were all statistically significant (P < .05). Conclusions: Double-row fixation in rotator cuff repair reproduces 100% of the supraspinatus footprint while traditional single-row techniques fail to do so. Double-row fixation may be a superior technique by providing a tendon-bone interface better suited for biologic healing and restoring normal anatomy.