Three Medial All Suture Anchors Improves Contact Force Compared to Two Hard Body Anchors in a Biomechanical Two-Tendon Rotator Cuff Tear Model

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PurposeTo biomechanically compare a knotless double-row construct with 3 medial all-suture (3AS) anchors with a standard 2 medial hard body (2HB) anchor construct.MethodsTwelve matched cadaveric shoulder specimens with a mean age of 57 years (range: 54-61 years) were randomized to receive a knotless double-row repair with either a 3AS or 2HB construct. In the 3AS construct, three 2.6-mm all-suture anchors were placed adjacent to the articular margin and secured laterally with two 4.75-mm knotless hard body anchors. In the 2HB construct, two 4.75-mm medial hard body anchors were placed medially, lateral fixation was identical to the 3AS construct. Creep, displacement, stiffness, and ultimate load were recorded for each sample. In addition, a SynDaver model was used to compare contact pressure between the 2 repair constructs.ResultsThere were no differences in cyclic displacement at 1, 30, and 100 cycles (P = .616, .497, .190, respectively), cyclic stiffness (.928), ultimate load (.445), or load to failure (P = .445) between the 2 constructs. The 3AS repair construct had improved contact pressure between tendon and bone when compared with the 2HB construct at loads of 20 N, 30 N, and 40 N (P = .01, .02, and .04, respectively).ConclusionsDisplacement and load to failure properties are similar between knotless constructs using either 2HB or 3AS for the medial row. However, contact force may improve with the use of 3 medial all-suture anchors.Clinical RelevanceAs all-suture anchors are smaller in size when compared with hard body anchors. For this reason, there is potential to place an additional all-suture medial anchor to improve contact force and potentially improve rotator cuff healing when compared with the use of hard body anchors.