Abstract
BackgroundSupraspinatus (SSP) tendon ruptures requiring surgical repair are common. Arthroscopic suture anchor fixation has gradually replaced transosseous repair in supraspinatus tendon tear. Our objective was to compare mechanical properties between transosseous and anchor supraspinatus repair in the first 6 postoperative weeks in a rabbit model.MethodsOne hundred and fifty-two rabbits had one supraspinatus tendon repaired either with an anchor suture 1 week after detachment or with transosseous sutures. Rabbits were euthanized at 0, 1, 2, 4 or 6 postoperative weeks. Experimental and contralateral tendons (304 tendons) were mechanically tested to failure. Data are expressed as percent of contralateral.ResultsAnchor repair had higher loads to failure compared to transosseous repair, at immediate repair (week 0, 52 ± 21% vs 25 ± 17%, respectively; p = 0.004) and at 1 postoperative week (64 ± 32% vs 28 ± 10%; p = 0.003) with no difference after 2 weeks. There was no difference in stiffness. Transosseous repairs showed higher rates of midsubstance failures compared to anchor repairs at 1 (p = 0.004) and 2 postoperative weeks (p < 0.001). Both transosseous and anchor repairs restored supraspinatus mechanical properties after 4 postoperative weeks.ConclusionAnchor repair provided better initial tensile strength while transosseous repair led to a faster normalization (namely, midsubstance) of the mode of failure. Research to optimize supraspinatus repair may need to consider the advantages from both surgical approaches.
Highlights
Supraspinatus (SSP) tendon ruptures requiring surgical repair are common
Anchor repairs were significantly stronger than transosseous repairs both at initial surgery (52 ± 21% vs 25 ± 17%, respectively; p = 0.004) and at 1 postoperative week (61 ± 32% vs. 28 ± 10; p = 0.003; Fig. 1a)
The difference between the two techniques was the site of contact of the SSP with bone: in transosseous repairs, the tendon stump was inserted into the footprint, its anatomical site, whereas in anchor repairs the articular side of the SSP contacted the lateral side of the greater tuberosity; the tendon stump did not participate in the healing process lying further distally to the site of repair
Summary
Supraspinatus (SSP) tendon ruptures requiring surgical repair are common. Arthroscopic suture anchor fixation has gradually replaced transosseous repair in supraspinatus tendon tear. Our objective was to compare mechanical properties between transosseous and anchor supraspinatus repair in the first 6 postoperative weeks in a rabbit model. Cadaveric studies were conducted but they solely inform on the mechanical properties of the initial construct without evidence on the postoperative period. Two reported significantly higher loads in transosseous-equivalent repairs [13, 14] and one found anchor repairs to be stronger [15]. These cadaveric studies fail to study the postoperative new enthesis formation with progressive mechanical restoration which is critically important to ensure long-term surgical success [16]
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