Double-row Suture Bridge Research Articles

Paper # 29: Arthroscopic Suture Bridge Repair for Greater Tuberosity Avulsion Fractures: A Prospective Case Series with Minimum 1 Year Follow-Up

Background and AimsFixation is the treatment of choice for displaced greater tuberosity avulsion fractures of the proximal humerus. Although open reduction has been the traditional method for internal fixation, recent case reports of arthroscopic greater tuberosity fracture fixation have described promising results. There is, however, insufficient evidence that the arthroscopic procedure consistently results in reliable fixation, radiographic healing, and satisfactory surgical outcomes. This prospective case series was designed to determine whether arthroscopic double-row suture bridge repair for displaced greater tuberosity avulsion fractures provided high fixation strength with minimal gap formation, repair integrity maintenance till ultimate radiographic healing, and satisfactory clinical outcomes.

Single-Row RC-Repair Using A Modified Suture Configuration Versus a Suturebridge Double-Row Repair: Comparable Biomechanical Results and Complete Footprint Coverage Independent of the Initial Tear Size (SS-20)

Introduction Influence of the initial tear size and repair technique of single-row and double-row repairs on the biomechanical properties and footprint coverage. Methods 25 (Bateman grade II) and 35mm (Bateman grade III) artificial defects were created in the rotator cuff of 24 human cadaver shoulders. The reconstructions were performed as either a single-row repair using triple-loaded suture anchors (2-3) and a modified suture configuration or a modified suturebridge double-row repair (4-6). Reconstructions were cyclically loaded from 10-60N. The load was stepwise increased up to 100, 180, and 250N. Cyclic displacement and load-to-failure were determined. Furthermore, footprint widths were quantified before and after the repair. Results In the 25mm rupture, 533±107N were achieved for the SR-repair and 681±250N were measured for the DR-suturebridge technique. In the 35mm artificial tear, ultimate failure load was 792±122N for the SR-reconstruction and 891±174N for the DR-reconstruction. There were no differences in load-to-failure between the tested repairs (p>.05). Cyclic displacement showed no significant differences between the tested configurations at 60, 100, 180 und 250N (p>.05) for the 25mm tear. In the reconstruction of the 35mm RC tear, significant lower gap formation was found for the SR-reconstruction at 180N (p=.037) and 250N (p=.020). No significant differences were found at 60 and 100N (p>.05). A significantly greater footprint width was seen with the double-row technique compared to the single-row repair. However, both reconstructions were able to achieve a complete footprint coverage compared to the initial footprint. Conclusion The single-row repair technique using a modified suture configuration showed similar results in load-to-failure and cyclic displacement compared to the modified double-row suturebridge technique independent of the initial size of the rupture. The double-row repair consistently restored a larger footprint than the single-row method. However, both repair techniques achieved complete footprint coverage.

Evaluation of glenoid capsulolabral complex insertional anatomy and restoration with single- and double-row capsulolabral repairs

The purpose of this study was to evaluate the normal glenoid insertional anatomy of the anterior-inferior capsulolabral complex and to compare the ability of a single-row repair and a double-row suture bridge repair to restore the insertional anatomy. Eight fresh frozen cadaver shoulders were dissected and the native glenoid insertion of the anterior-inferior capsulolabral complex was digitized. Bankart lesions were created, the shoulders were randomized to receive either the standard single-row suture anchor repair or a double-row suture bridge repair, and the insertion repair sites were then digitized. The single-row repair recreated 42.3% of the native footprint surface area while the double-row repair recreated 85.9%. The double-row repair was significantly larger and recreated significantly more of the native footprint compared with single-row repair (P < .01). Double-row repair of the capsulolabral complex reestablishes the native insertional footprint on the anterior inferior glenoid better than a single-row repair. Basic science study.

Rotator cuff repair fluid extravasation characteristics are influenced by repair technique

This study evaluates rotator cuff repair fluid extravasation characteristics for different rotator cuff repair techniques. Eight fresh-frozen cadaveric shoulders were dissected free of soft tissues, with the glenohumeral joint capsule and rotator cuff muscles being left intact. A custom fluid infusion device was used to deliver fluid at constant pressure into the glenohumeral joint. The shoulders were tested in conditions of (1) intact rotator cuff, (2) supraspinatus tear, (3) repaired supraspinatus tear with a single-row technique, and (4) repaired supraspinatus tear with a double-row suture bridge technique. The volume per minute of saline solution extravasation for single-row repair and double-row suture bridge repair was 48.53 mL/min and 11.73 mL/min, respectively, at 2 psi; 73.3 _ 24.1 mL/min and 24.5 _ 19.7 mL/min, respectively, at 3 psi; and 95.2 _ 22.6 mL/min and 39.2 _ 23.8 mL/min, respectively, at 4 psi. There was a statistically significant greater fluid extravasation for the single-row repair compared with the double-row suture bridge repair at all 3 pressures tested (P < .05). Single-row rotator cuff repair exposes the healing zone to greater extravasation of fluid compared with double-row suture bridge repair. Therefore, double-row repair potentially enhances rotator cuff healing. Controlled laboratory study.

Comparison of Early Results of Rotator Cuff Repair: Single Row MAC Configuration Versus Double Row Suture Bridge Technique (SS-27)

Double- row repair techniques in arthroscopic rotator cuff repair have been increasingly utilized by orthopaedists when treating rotator cuff tears. While this offers theoretical advantage over previous techniques such as single row fixation, the current study is aimed to compare results of the two methods of fixation. To compare single row with double row fixation in rotator cuff repair. Non-randomized assessment of 66 patients who had undergone arthroscopic rotator cuff repair with a single row simple over horizontal configuration (MAC) were compared to 26 patients who had the double row suture bridge configuration which effectively provided double row fixation and re-creation of the rotator cuff footprint. VAS, UCLA, and ASES scores were collected for both groups pre-operatively; then again at 3, 6, and 12 month intervals. In addition, dynometric strength assessment for subscapularis, supraspinatus, and infraspinatus was compared. No significant difference was shown between the two fixation methods preoperatively or at the 3 month follow-up visit. At the 6 month follow-up visit, the suture bridge configuration group showed poorer results for each of the VAS, UCLA, and ASES scores. At 12 months the UCLA and ASES scores were no different and the VAS score was slightly better for the MAC group. Strength in the MAC repair group at 12 months exceeded that for the suture bridge group for subscapularis, supraspinatus, and infraspinatus. Suture bridge configuration for rotator cuff repair is thought to provide a better repair by providing increased contact pressure of the repaired tendinous cuff to the native footprint while also increasing repair strength. Our current results suggest that a single row fixation method with a MAC configuration provides comparable results to double row repair outcomes as per strength assessment as well as VAS scores.