Single-row Suture Research Articles

Which Method of Rotator Cuff Repair Leads to the Highest Rate of Structural Healing?

Background The purpose of rotator cuff repair is to diminish pain and restore function, and this most predictably occurs when the tendon is demonstrated to heal. Recent improvements in repair methods have led to improved biomechanical performance, but this has not yet been demonstrated to result in higher healing rates. The purpose of our study was to determine whether different repair methods resulted in different rates of recurrent tearing after surgery. Hypotheses We hypothesized that (1) the rotator cuff repair method will not affect retear rate, and (2) the surgical approach will not affect the retear rate for a given repair method. Study Design Systematic review of the literature. Methods The literature was systematically searched to find articles reporting imaging study assessment of structural healing rates after rotator cuff repair, with data stratified according to tear size. Retear rates were compared for transosseous (TO), single-row suture anchor (SA), double-row suture anchor (DA), and suture bridge (SB) repair methods, as well as for open (O), miniopen (MO), and arthroscopic (A) approaches. Results Retear rates were available for 1252 repairs collected from 23 studies. Retear rates were significantly lower for double-row repairs when compared with TO or SA for all tears greater than 1 cm and ranged from 7% for tears less than 1 cm to 41% for tears greater than 5 cm, in comparison with retear rates for single-row techniques (TO and SA) of 17% to 69% for tears less than 1 cm and greater than 5 cm, respectively. There was no significant difference in retear rates between TO and SA repair methods or between arthroscopic and nonarthroscopic approaches for any tear size. Conclusion Double-row repair methods lead to significantly lower retear rates when compared with single-row methods for tears greater than 1 cm. Surgical approach has no significant effect on retear rate.

In vitro biomechanical comparison of three different types of single- and double-row arthroscopic rotator cuff repairs: Analysis of continuous bone-tendon contact pressure and surface during different simulated joint positions

We assessed bone-tendon contact surface and pressure with a continuous and reversible measurement system comparing 3 different double- and single-row techniques of cuff repair with simulation of different joint positions. We reproduced a medium supraspinatus tear in 24 human cadaveric shoulders. For the 12 right shoulders, single-row suture (SRS) and then double-row bridge suture (DRBS) were used. For the 12 left shoulders, DRBS and then double-row cross suture (DRCS) were used. Measurements were performed before, during, and after knot tying and then with different joint positions. There was a significant increase in contact surface with the DRBS technique compared with the SRS technique and with the DRCS technique compared with the SRS or DRBS technique. There was a significant increase in contact pressure with the DRBS technique and DRCS technique compared with the SRS technique but no difference between the DRBS technique and DRCS technique. The DRCS technique seems to be superior to the DRBS and SRS techniques in terms of bone-tendon contact surface and pressure.

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.

Equivalent Clinical Results of Arthroscopic Single-Row and Double-Row Suture Anchor Repair for Rotator Cuff Tears: A Randomized Controlled Trial

Equivalent Clinical Results of Arthroscopic Single-Row and Double-Row Suture Anchor Repair for Rotator Cuff Tears: A Randomized Controlled Trial

Single-Row Suture Anchor Repair of the Rotator Cuff is Biomechanically Equivalent to Double-Row Repair in a Bovine Model

The purpose of this study was to determine biomechanical differences in cyclic elongation and ultimate strength between double-row rotator cuff repair and single-row repair for partial rotator cuff repairs. We randomly assigned 18 immature bovine specimens (aged 12 to 16 weeks) to 3 repair groups (6 per group). A 1 x 2-cm defect was created at the infraspinatus tendon insertion site. Two suture anchors were implanted 1 cm apart at the anatomic insertion area for the lateral row. Two suture anchors were implanted 1 cm medial to the lateral row and 1 cm apart from each other for the medial row. Repair groups were constructed as follows: single-row repair with double-loaded suture anchors (group 1), double-row repair with single-loaded medial row and double-loaded lateral row (group 2), and double-row repair with single-loaded medial row and single-loaded lateral row (group 3). Specimens were cyclically loaded from 10 N to 90 N for 500 cycles and then loaded at 0.5 mm/s to failure. Data for cyclic elongation, with loads at 3 mm, 5 mm, and 10 mm, were analyzed via a 1-way analysis of variance (P < .05). There were no significant differences for peak elongation after cyclic loading between groups. There were no significant differences between repair groups for loads at 3 mm, 5 mm, and 10 mm of elongation. Constructs typically failed by knot slippage (83%), with a single sample having tendon-suture failure (17%). Double-row repair did not show a biomechanical advantage compared with single-row repair. With this result in mind, the theoretic advantage of a potentially larger footprint must be balanced against the added surgical time, complexity, and cost of double-row repair. Arthroscopic surgeons should choose the best form of fixation for a given patient, without undue emphasis on single-row repair versus double-row repair. The clinical and biologic impact of footprint restoration was not addressed in this study.

Equivalent Clinical Results of Arthroscopic Single-Row and Double-Row Suture Anchor Repair for Rotator Cuff Tears

Background Restoring the anatomical footprint may improve the healing and mechanical strength of repaired tendons. A double row of suture anchors increases the tendon-bone contact area, reconstituting a more anatomical configuration of the rotator cuff footprint. Hypothesis There is no difference in clinical and imaging outcome between single-row and double-row suture anchor technique repairs of rotator cuff tears. Study Design Randomized controlled trial; Level of evidence, 1. Methods The authors recruited 60 patients. In 30 patients, rotator cuff repair was performed with a single-row suture anchor technique (group 1). In the other 30 patients, rotator cuff repair was performed with a double-row suture anchor technique (group 2). Results Eight patients (4 in the single-row anchor repair group and 4 in the double-row anchor repair group) did not return at the final follow-up. At the 2-year follow-up, no statistically significant differences were seen with respect to the University of California, Los Angeles score and range of motion values. At 2-year follow-up, postoperative magnetic resonance arthrography in group 1 showed intact tendons in 14 patients, partial-thickness defects in 10 patients, and full-thickness defects in 2 patients. In group 2, magnetic resonance arthrography showed an intact rotator cuff in 18 patients, partial-thickness defects in 7 patients, and full-thickness defects in 1 patient. Conclusion Single- and double-row techniques provide comparable clinical outcome at 2 years. A double-row technique produces a mechanically superior construct compared with the single-row method in restoring the anatomical footprint of the rotator cuff, but these mechanical advantages do not translate into superior clinical performance.

Initial Fixation Strength of Massive Rotator Cuff Tears: In Vitro Comparison of Single-Row Suture Anchor and Transosseous Tunnel Constructs

The purpose of this study was to compare the in vitro repair integrity of massive rotator cuff tears fixed with transosseous tunnel and single-lateral row suture anchor techniques. A 5 x 2-cm crescent-shaped rotator cuff tear was created in 6 matched pairs of cadaveric shoulders. Paired shoulders were repaired with 3 transosseous tunnels and 6 Mason-Allen sutures or with 3 screw-in suture anchors and 6 simple sutures. The repairs were cyclically loaded at physiologic forces along the respective directions of pull when the arm was in 90 degrees of scapular plane elevation. Gap formation and repair displacements were monitored with digital video imaging at 3 sites for each repair. There was no significant difference between the maximal gapping of the repair constructs. After 4,000 cycles, the mean maximal gapping at any position along the repair was 6.2 +/- 2.99 mm in the transosseous tunnel construct and 4.9 +/- 1.27 mm in the suture anchor repair construct (P = .40). Gapping was significantly less in the anterior region when compared with the posterior region of the repair (P = .015). There is no difference in cyclic loading of transosseous and single-row suture anchor repair techniques. Significantly greater gap formation occurs at the posterior aspect of repairs of massive rotator cuff tears in this in vitro model. Initial fixation strength of single-row suture anchor repairs is equivalent to that of transosseous repairs. Further research is required to determine the unknown clinical significance of increased posterior repair gap formation.

Results of the Operative Treatment of Gastroesophageal Reflux in Childhood with Particular Focus on Patients with Esophageal Atresia

Although the literature on fundoplications in childhood is relatively extensive, only few reports exist which correlate the rate of complications with the primary disease. Other important questions such as the incidence of postoperative dumping syndrome or Barrett's esophagus in childhood are barely treated. Nor have operative techniques such as single or double-row cuff sutures or the benefit of performing pylorotomy or pyloroplasty in addition to fundoplication been investigated with respect to their recurrence rates. In particular studies on laparoscopic fundoplications tend to be generally confined to a discussion of the feasibility of the endoscopic procedure, the duration of the intervention, the length of the hospital stay and the costs. The study presented here aims to analyze such still unanswered questions listed above for open fundoplication procedures, including an analysis of the authors' own patient population, and to discuss the questions together with the most important reports in the literature. The aim is to create a basis for later studies which will compare conventional and laparoscopic fundoplications. In the period between 1993 and 2005, 160 children underwent a fundoplication procedure. From 2003 onwards, fundoplications were carried out laparoscopically. The data of 148 patients were analyzed, some of them on the basis of clinical follow-up and some on the basis of an extensive questionnaire and among others with the help of the parents' support group KEKS. The underlying disease in 87 patients was reflux disease stemming from esophageal atresia, previous diaphragmatic operation in 8 children and mental retardation with swallowing difficulties in 30 patients. Only 23 patients suffered from isolated gastroesophageal reflux disease without an underlying primary disease. Intraoperative complications occurred in 4.6 % of patients with esophageal atresia (EA), while the rate for the remaining collective of patients was 1.6 %. Postoperative complications were observed in 10.3 % of the children with esophageal atresia and in 8.2 % of the other cases. The recurrence rate was 16.1 % in the children with EA and 6.5 % in the other cases. Dysphagia and/or stenosis occurred in 17.2 % and 6.5 % of children, respectively, and dumping syndrome was observed in 18.3 % of the EA group and only in 1.6 % of the comparison group. An evaluation of 79 esophageal biopsies showed no difference between patients with EA and the comparison group concerning the degree of histological changes. When evaluating the suturing technique, it was found that a double-row fundus suture was more effective in preventing reflux recurrence than a single-row suture but also resulted in an increased rate of dysphagia. When considering the not infrequent occurrence of dumping syndrome, it was found that drainage operations such as pyloroplasty or pyloromyotomy are only indicated for reduced gastric motility. The data of the children without EA, who initially served as a comparison group, was analyzed further. Four summaries of the current literature in table form complete this discussion. Particularly in children with EA, Nissen fundoplication cannot be considered a procedure with few complications. The problems resulting from disturbed gastric and esophageal motility should not be underestimated nor should the postoperative occurrence of dumping syndrome. Postoperative long-term follow-up until the patients reach adulthood is absolutely necessary to ensure that development of a Barrett's esophagus is not overlooked.

Rotator cuff repair: The effect of double-row fixation on three-dimensional repair site

There is a high rate of recurrent and residual tears after rotator cuff repair surgery. Recent cadaveric studies have provided surgeons with new knowledge about the anatomy of the supraspinatus tendon insertion. Traditional repair techniques fail to reproduce the area of the supraspinatus insertion, or footprint, on the greater tuberosity anatomically. Double-row suture anchor (DRSA) fixation is a new technique that has been developed to restore the supraspinatus footprint better. In this study, 3-dimensional mapping was used to determine the area of the footprint recreated with 3 different repair methods: a transosseous simple suture technique, fixation with a single row of suture anchors, and DRSA fixation. The DRSA fixation technique consistently reproduced 100% of the original supraspinatus footprint, whereas the single-row suture anchor fixation and transosseous simple suture techniques reproduced only 46% and 71% of the insertion site, respectively. Therefore, the footprint area of the DRSA fixation technique was significantly larger (P < .05) than that of the other 2 techniques. Furthermore, double-row fixation may provide a tendon-bone interface better suited for biologic healing and restoring normal anatomy.

The Effect of Double-Row Fixation on Initial Repair Strength in Rotator Cuff Repair: A Biomechanical Study

The purpose of this study was to compare the initial mechanical strength of 3 rotator cuff repair techniques. A total of 30 fresh-frozen cadaveric shoulders were prepared, and full-thickness supraspinatus tears were created. Specimens were randomized and placed into 3 groups: (1) transosseous suture technique (group I: TOS, n = 10, 6F/4M), (2) single-row suture anchor fixation (group II: SRSA, n = 10, 6F/4M), and (3) double-row suture anchor fixation (group III: DRSA, n = 10, 6F/4M). Each specimen underwent cyclic load testing from 5 N to 180 N at a rate of 33 mm/sec. The test was stopped when complete failure (repair site gap of 10 mm) or a total of 5,000 cycles was attained. Group I (TOS) failed at an average of 75.3 +/- 22.49 cycles, and group II (SRSA) at an average of 798.3 +/- 73.28 cycles; group III (DRSA) had no failures because all samples were stopped when 5,000 cycles had been completed. Fixation strength of the DRSA technique proved to be significantly greater than that of SRSA (P < .001), and both suture anchor groups were significantly stronger than the TOS group (P < .001). Suture anchor repairs were significantly stronger than transosseous repairs. Furthermore, double-row suture anchor fixation was significantly stronger than was single-row repair. Therefore, double-row fixation may be superior to other techniques in that it provides a substantially stronger repair that could lead to improved biologic healing. A high incidence of incomplete healing occurs in rotator cuff repair. Use of double-row fixation may help the clinician to address some deficiencies in current methods by increasing the strength of the repair, potentially leading to improved healing rates.

Contact Area, Contact Pressure, and Pressure Patterns of the Tendon-Bone Interface after Rotator Cuff Repair

Background The contact pressure and contact area at the tendon-bone interface after the most commonly used rotator cuff repair methods have not been investigated. Hypothesis There are no significant differences among the transosseous, the single-row suture anchor, and the double-row suture anchor techniques in terms of contact pressure, contact area, and pressure patterns at the tendon-bone interface. Study Design Controlled laboratory study. Methods After creating a full-thickness supraspinatus tendon tear in 10 cadaveric shoulder specimens, we inserted pressure-sensitive film between the tendon stump and the bone, and we repaired the tear by (1) transosseous, (2) single-row suture anchor, and (3) double-row suture anchor techniques. Results The contact area of the double-row technique was 42% greater than that of the transosseous technique (P <. 0001) and 60% greater than that of the single-row technique. The contact area of the transosseous technique was 31% greater than that of the single-row technique (P =. 0015). The average pressures of the single-row and double-row techniques were 18% (P =. 014) and 16% (P =. 03) greater, respectively, than that of the transosseous technique, but there was no significant difference between the single-row and double-row techniques (P =. 915). Conclusions The double-row technique produced the greatest contact area and the second-highest contact pressure, whereas the single-row technique created the highest contact pressure and the least contact area. The transosseous technique produced the second-greatest contact area and the least contact pressure. Clinical Relevance The double-row suture anchor technique and the transosseous technique may provide a better environment for tendon healing.

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

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.

Double-row arthroscopic rotator cuff repair: re-establishing the footprint of the rotator cuff

Recently, there has been an increased interest in the normal anatomy of the rotator cuff footprint and the re-establishment of the footprint during rotator cuff repair. Single-row suture anchor techniques have been criticized because of their inability to restore the normal medial-to-lateral width of the rotator cuff footprint. In this report, the authors describe a double-row technique for rotator cuff repair that re-establishes the normal rotator cuff footprint, increases the contact area for healing, and may potentially improve clinical results.

Morphofunctional assessment of intestinal wound repair in different age

Anastomoses were formed with a single-row continuous suture in dogs of different age. The course of intestinal wound repair was the least favorable in the youngest dogs, which was apparently due to greater disorders of regional blood flow, high activity of free-radical processes, and pronounced tissue hypoxia at the site of anastomosis, in comparison with the older dogs.