Suture Anchor Repair Research Articles

The 2.5 mm PushLock suture anchor system versus a traditional suture anchor for ulnar collateral ligament injuries of the thumb: a biomechanical study

We compared the biomechanical strength of the 2.5 mm PushLock suture anchor with a traditional Bio-SutureTak suture anchor in repair of ulnar collateral ligament injuries. Iatrogenic ulnar collateral ligament injuries in 18 cadaveric thumbs were repaired and used to test for load to failure and cyclic loading. The average force required to generate a 2 mm gap was 7.7 N for the 2.5 mm PushLock and 6.3 N for the Bio-SutureTak (p = 0.04). The ultimate load to failure was 28.0 N for the 2.5 mm PushLock and 18.8 N for the Bio-SutureTak (p = 0.16). There were no statistical differences between the two suture anchors under cyclic loading. The 2.5 mm PushLock suture anchor provides significantly stronger resistance to 2 mm gap formation at the repair site and is less likely to fail at the suture-ligament interface. However, there was no difference in the load to failure between the two suture anchors.

Distal Biceps Tendon Repair

Background Distal biceps tendon repair with interference screw or double suture-anchor fixation are 2 successful techniques performed with either 1- or 2-incision approaches. No study has examined the accuracy and quality of the repaired tendon footprint with these devices and approaches. Hypothesis A 2-incision approach will allow a more anatomic repair of the distal biceps footprint compared with a 1-incision anterior approach. Fixation technique will affect insertional footprint location and footprint contact area. Study Design Controlled laboratory study. Methods After randomization, 36 distal biceps repairs were performed on human cadaveric upper extremity specimens, with 1- or 2-incision approaches and with fixation devices of either two 5.5-mm suture anchors or an 8-mm interference screw. Native and repaired footprint areas and centroid location were calculated with a 3-dimensional digitizer. Results Interference screw repair had the smallest footprint area (135 mm 2 ) compared with suture anchor repair (197 mm 2 ) and the native tendon (259 mm 2 ) (P = .013). The 2-incision approach repaired the footprint to a more posterior and anatomic position (2.5 mm) than a 1-incision approach (P = .001). The fixation device did not affect footprint location significantly. Conclusion Suture anchor repair more closely re-creates the footprint area on the radial tuberosity of the native distal biceps tendon compared with the interference screw repair. A 2-incision approach more closely re-creates footprint position compared with the 1-incision approach. Clinical Relevance A 2-incision approach with double suture-anchor fixation may yield a more anatomic distal biceps repair based on reproduction of the footprint compared with a 1-incision approach.

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.

A Biomechanical Comparison of Transosseous–Suture Anchor and Suture Bridge Rotator Cuff Repairs in Cadavers

Background Several biomechanical studies comparing open and arthroscopic rotator cuff repair methods have shown inferior performance of arthroscopic repairs. Suture anchor–augmented transosseous repairs and suture bridge repairs have shown superior biomechanical performance when compared with other methods, but these 2 repair methods have not been directly compared. Hypothesis There will be no difference in the biomechanical performance of the transosseous–suture anchor and suture bridge techniques. Study Design Controlled laboratory study. Methods Eight paired cadaveric shoulder specimens (16 specimens) had creation followed by repair of a complete tear of the supraspinatus, with the first member of each pair undergoing repair by a transosseous–suture anchor technique and the second member undergoing repair by the suture bridge technique. Specimens were then cycled from 10 to 180 N for 200 cycles, followed by testing to failure at 33 mm/s. Elongation was measured during cyclic testing, and failure load and stiffness were obtained during load-to-failure testing. Failure method was recorded. Results There was no significant difference between transosseous–suture anchor repairs and suture bridge repairs for elongation (4.0 ± 1.60 mm vs 3.5 ± 1.1 mm, P = .31), failure load (408 ± 93 N vs 419 ± 62 N, P = .70), or stiffness (58 ± 10 N/mm vs 58 ± 14 N/mm, P = .94). The most common mode of failure with each method was suture cutting through tendon. Conclusion The suture bridge repair exhibited similar biomechanical performance during cyclic and load-to-failure testing as a transosseous–suture anchor repair, which historically has been performed in open or mini-open fashion. Clinical Relevance Arthroscopic rotator cuff repairs can be performed that are as strong as open or mini-open repairs.

Arthroscopic suture anchor repair for lateral patellar instability

Several all-arthroscopic techniques have been described to address patellar instability. Most arthroscopic procedures focus on soft tissue plication or "tightening" of the medial retinacular structures to correct lateral patellar instability. We found these techniques to be ineffective when the medial stabilizers were avulsed from the patella. As a result, we have developed an arthroscopic technique to repair medial patellofemoral ligament avulsions to the patella using suture anchors.

Osseous Suture Anchors for Repair of Ulnar Translation of the Carpus

Osseous Suture Anchors for Repair of Ulnar Translation of the Carpus

Arthroscopic Posterior Stabilization and Anterior Capsular Plication for Recurrent Posterior Glenohumeral Instability (SS-18)

Posterior shoulder instability is less common than anterior shoulder instability and consists of a broad spectrum of clinical presentations and pathology. Recurrent, traumatic, involuntary, unidirectional posterior instability is the most common form. Arthroscopic techniques are currently employed as treatment for these patients. The purpose of this study is to evaluate the outcomes of arthroscopic posterior Bankart reconstruction with modern suture anchor repair in a well-defined patient population and to evaluate preoperative and operative factors as determinants of success. Thirty patients with an average age of 26.9 years (range 15.7-43.4) all had traumatic detachment of the posterior labrum and underwent suture anchor repair with posterior capsulolabral plication. Supplemental anterior capsulolabral plication and additional surgeries were performed as required. Patients were evaluated an at an average follow-up of 5.5 years (range 2.0-12.4 years) with shoulder outcomes scores including the American Shoulder and Elbow Surgeons (ASES) Rating Scale, the Western Ontario Shoulder Instability (WOSI) Index, the University of California at Los Angeles (UCLA) score and the Simple Shoulder Test (SST). Subjective patient evaluations for success, strength, range of motion, instability, pain and return to sport were also recorded. All patients had posterior Bankart lesions that required suture anchor repair. The average postoperative ASES score was 90.0 (range 53.3-100), UCLA score of 32.6 (range 24-35), SST of 11.7 (10-12), WOSI of 366 (0-1033) or 82.6% of normal (50.8-100%). Ninety-seven percent of patients (29/30) reported they were satisfied and better, 97% (29/30) reported a successful treatment and 97% (29/30) felt the surgery was worthwhile and would repeat it if necessary. Recurrent postoperative posterior instability occurred in 3.3% (1/30) of patients. Eighty-five percent of patients (23/27) returned back to sports with 69.2% (18/26) being able to return to the their previous level of athletics. Patients who required additional procedures at the time of surgery had worse postoperative ASES, WOSI, UCLA outcomes scores (p<0.0107) and higher subjective pain and instability scores (p<0.0428). Younger patients (<30 years old) reported lower subjective postoperative strength and higher instability scores (p<0.0347). Patients who received supplemental anterior plication capsulolabral sutures reported higher subjective pain scores (p<0.0315). This is the longest known follow-up reported for arthroscopic posterior shoulder instability surgery. Suture anchor stabilization of posterior Bankart lesions is an effective treatment for recurrent, traumatic, involuntary, unidirectional posterior shoulder instability. Younger patients and patients with more extensive pathology who require supplemental procedures may have slightly less reliable outcomes.

Prospective Randomized Clinical Trial of Single versus Double Row Suture Anchor Repair in Medium to Large Rotator Cuff Tears (SS-07)

Prospective Randomized Clinical Trial of Single versus Double Row Suture Anchor Repair in Medium to Large Rotator Cuff Tears (SS-07)

Comparative evaluation of the tendon-bone interface contact pressure in different single- versus double-row suture anchor repair techniques

The aim of the study was to evaluate the time zero contact pressure over a defined rotator cuff footprint using different repair and stitch techniques in an established sheep model. Forty fresh-frozen sheep shoulders were randomly assigned to five repair groups: single-row repair using simple stitches (SRA-s), single-row repair using horizontal mattress stitches (SRA-m), and single-row repair using arthroscopic Mason-Allen stitches (SRA-ama). Double-row repair was either performed with a combination of simple and horizontal mattress stitches (DRA-sm) or with arthroscopic Mason-Allen/horizontal mattress stitches (DRA-amam). Investigations were performed using a pressure-sensitive film system. The average contact pressure and pressure pattern were measured for each group. Contact pressure was lowest in SRA-m followed by SRA-s. SRA-ama showed highest contact pressure of all single-row treatment groups (P < 0.05). DRA-amam presented the highest overall contact pressure (P < 0.05), whereas DRA-sm exerted contact pressure equal to that of SRA-ama. Both double-row techniques showed the most expanded pressure pattern. Average contact pressures for the more complex single- and double-row techniques utilizing arthroscopic Mason-Allen stitches were greater than were those of the repair techniques utilizing simple and horizontal mattress stitches. However, the contact pattern between the anchors could be increased by using the double-row technique, resulting in more footprint coverage compared to patterns utilizing the single-row techniques. These results support the use of the more complex arthroscopic Mason-Allen stitches and may improve the environment for healing of the repaired rotator cuff tendon.

Early Outcomes After Hip Arthroscopy for Femoroacetabular Impingement in the Athletic Adolescent Patient

Hip arthroscopy is becoming a more popular method of treatment of pediatric hip disorders. We report on the treatment of femoroacetabular impingement (FAI) in the adolescent population. Between March 2005 and May 2006, 16 patients (aged 16 years or younger) underwent hip arthroscopy for FAI. There were 14 female adolescents and 2 male adolescents, with 1 patient undergoing a bilateral procedure. Five patients had isolated pincer impingement, 2 had isolated cam impingement, and 9 had mixed pathology. All patients had labral pathology. Seven patients were treated with suture anchor repair of the labrum and 9 with partial labral debridement. Subjective data were collected from each patient during their initial visit and at follow-up after surgery. Subjective data included the modified Harris hip score (MHHS), patient satisfaction, and hip outcome score (HOS) activities of daily living (ADL), and sports subscales. The mean age at the time of arthroscopy was 15 years old (range, 11-16 years). The mean preoperative MHHS was 55 (range, 33-70), HOS ADL was 58 (range, 38-75), and HOS sport was 33 (range, 0-78). The mean time from injury to surgery was 10.6 months (range, 6 weeks-30 months). The mean time to follow-up was 1.36 years (range, 1-2 years). The mean postoperative MHHS improved 35 points to 90 (range, 70-100; P = 0.005), postoperative HOS ADL improved 36 points to 94 (range, 74-100; P = 0.001), and postoperative HOS sport score improved 56 points to 89 (range, 58-100; P = 0.001). The mean patient satisfaction score was 9 (range, 9-10). Hip arthroscopy for FAI in the adolescent population produces excellent improvement in function and a high level of patient satisfaction in the short-term.

Biomechanical characteristics of single-row repair in comparison to double-row repair with consideration of the suture configuration and suture material

The aim of the study was to evaluate the time zero mechanical properties of single- versus double-row configuration for rotator cuff repair in an animal model with consideration of the stitch technique and suture material. Thirty-two fresh-frozen sheep shoulders were randomly assigned to four repair groups: suture anchor single-row repair coupled with (1) braided, nonabsorbable polyester suture sized USP No. 2 (SRAE) or (2) braided polyblend polyethylene suture sized No. 2 (SRAH). The double-row repair was coupled with (3) USP No. 2 (DRAE) or (4) braided polyblend polyethylene suture No. 2 (DRAH). Arthroscopic Mason–Allen stitches were used (single-row) and combined with medial horizontal mattress stitches (double-row). Shoulders were cyclically loaded from 10 to 180 N. Displacement to gap formation of 5- and 10-mm at the repair site, cycles to failure, and the mode of failure were determined. The ultimate tensile strength was verified in specimens that resisted to 3,000 cycles. DRAE and DRAH had a lower frequency of 5- (P = 0.135) and 10-mm gap formation (P = 0.135). All DRAE and DRAH resisted 3,000 cycles while only three SRAE and one SRAH resisted 3,000 cycles (P < 0.001). The ultimate tensile strength in double-row specimens was significantly higher than in others (P < 0.001). There was no significant variation in using different suture material (P > 0.05). Double-row suture anchor repair with arthroscopic Mason–Allen/medial mattress stitches provides initial strength superior to single-row repair with arthroscopic Mason–Allen stitches under isometric cyclic loading as well as under ultimate loading conditions. Our results support the concept of double-row fixation with arthroscopic Mason–Allen/medial mattress stitches in rotator cuff tears with improvement of initial fixation strength and ultimate tensile load. Use of new polyblend polyethylene suture material seems not to increase the initial biomechanical aspects of the repair construct.

Arthroscopic Repair of Massive “Irreparable” Tears of the Rotator Cuff Using Double Interval Slides: Clinical And Magnetic Resonance Imaging Results (SS-43)

The objective of this study was to examine the clinical and anatomical outcomes following arthroscopic double interval slides in the repair of massive, otherwise “irreparable” rotator cuff tears. 11 patients were evaluated clinically and with MRI at a minimum 12 months post-operative. Double interval slides resulted in improved shoulder specific quality of life scores (post-operative versus pre-operative) and improved forward flexion. Active external rotation demonstrated no significant change. Anatomically, 55% of patients demonstrated massive re-tearing on MRI, 18% demonstrated a thin though grossly intact repair, and 27% showed a robust repair. Some chronic massive rotator cuff tears are irreparable using standard mobilization techniques. The double interval slide releases the interval between the supraspinatus and rotator interval (i.e. the anterior interval slide) and the interval between the supraspinatus and infraspinatus (i.e. the posterior interval slide) allowing repair of some massive “irreparable” rotator cuff tears. The purpose of this study was to review the clinical and MRI results following arthroscopic rotator cuff repair of massive “irreparable” rotator cuff tears using double interval slides. Eleven patients (5 females, 6 males; mean age 57.5 +/- 8 years) with massive, contracted, immobile rotator cuff tears that were irreparable using standard mobilization techniques, but reparable using arthroscopic double interval slides, were reviewed. The mean duration of symptoms was 16 +/- 12 months with 9 primary and 2 revision procedures. All patients had massive tears of the rotator cuff isolated to the supraspinatus and infraspinatus. All tears were irreparable using standard releases including capsular release but were reparable using a double interval slide mobilization technique and standard arthroscopic suture anchor repair to bone. All patients were reviewed using a standardized clinical examination by an independent observer, the ASES shoulder index and the Simple shoulder test (SST). All patients were evaluated by MRI interpreted by a musculoskeletal trained radiologist. Paired two-tailed t-tests were used to determine significant differences between preoperative and postoperative scores and unpaired t-tests were used to determine significant differences between intact and re-ruptured repairs. A p<0.05 was considered statistically significant. At a mean follow-up of 21 +/- 10 months (range: 12-42 months), 10 of 11 patients were satisfied with surgery and would have surgery again. The ASES shoulder index increased from a mean of 41.5 +/- 18.3 preoperatively to a mean of 79.1 +/- 17.4 post-operatively (p< 0.0001) and the SST increased from 2.8 +/- 2.6 out of 12 preoperatively to 8.8 +/− 2.7 out of 12 post-operatively (p< 0.0001). The mean active forward elevation increased significantly from 119.5 o +/- 45.2o to 152.7o +/- 23.0o (p=0.05). However, the mean active external rotation did not significantly change (preop= 38.2o +/- 17.1o; postop= 32.3o +/- 17.4o; p=0.5). MRI demonstrated that 6 patients (55%) had massive re-tearing of the rotator cuff to its original size, 2 had a thin but grossly intact repair and 3 had a thick and robust repair. Patients with intact repairs had significantly more external rotation strength on manual muscle testing (p=0.002) and trended toward improved ASES scores (ASES= 87 versus 72; p=0.15) but was not significantly different. The current early results suggest that rotator cuff repair using the double interval slide can provide significantly improved subjective and objective results even in the presence of a re-torn rotator cuff. Furthermore, although 55% of patients had massive re-tearing of the rotator cuff to its original size, 5 of 11 patients had at least some tissue connecting the rotator cuff to bone with some evidence for improved results. Level of Evidence Level IV case series.

Arthroscopic Repair of Type II SLAP Lesions: Clinical and Magnetic Resonance Imaging Arthrogram Follow-up (SS-12)

Outcomes of arthroscopically repaired type II SLAP lesions were examined clinically and using MR-arthrography in this study. Twenty-five patients were reviewed and 20 agreed to have a postoperative MRI arthrogram to assess the integrity of the repair. Clinical outcomes following arthroscopic repair of type II SLAP lesions showed statistically significant improvement in shoulder scores (ASES, SST, patient satisfaction) from pre to post-operative. However, MRI arthrogram results did not necessarily correlate with clinical outcome. Arthroscopic repair of type II SLAP lesions can lead to improved clinical outcomes. However, the structural integrity of arthroscopically repaired type II SLAP lesions is unknown. The purpose of this study was to evaluate the clinical outcome of arthroscopically repaired type II SLAP lesions, and to evaluate the appearance of the repair on MRI arthrogram performed at least 1 year post-operatively. Between March 2003 and June 2006, the senior author performed isolated repairs of 25 type II SLAP lesions in 25 patients (18 male, 7 female) with a mean age of 40 +/- 12 years. The mean duration of symptoms was 32 months. None of the patients had undergone previous surgery on the affected shoulder. All tears were repaired using standard arthroscopic suture anchor repair to bone. All patients were reviewed using a standardized clinical examination by a blinded, independent observer, and using the ASES shoulder index and the Simple Shoulder test (SST). In addition, 20 of the 25 patients were evaluated by MRI arthrography at least 1 year post-operatively which was interpreted by a musculoskeletal trained radiologist who was blinded to the patients' clinical outcome. Paired and unpaired t-tests were used to determine significant differences between pre-operative and post-operative scores and re-torn and intact SLAP repairs, respectively. A p<0.05 was considered statistically significant. Follow-up was an average of 24.9 months. The mean ASES scores improved from 51.7 pre-operatively to 86.3 post-operatively (p<0.0001) and the SST scores from 7.76 to 10.76 (p<0.001). Twenty-two out of the 25 patients stated that they would have surgery again and there was a mean patient satisfaction of 8.7+/- 1.4 out of 10. Of the 20 patients who had post-operative MRI arthrograms, no patient had an obvious recurrent type II SLAP lesion, 8 patients had equivocal MRI arthrograms with a small amount of Gadolium insinuating between labrum and bone, and 12 patient had a completely intact superior labrum. There was no significant difference in ASES, SST and patient satisfaction scores between patients with equivocal or completely intact repairs (ASES= 87.7 versus 85.4; p = 0.71; SST = 10.8 versus 10.8; p = 0.97; Pt satisfaction = 8.2 versus 8.8; p = 0.40). However, of the three patients who were not satisfied with the procedure (i.e. would not have the surgery again) two had postoperative MRI arthrograms and both had equivocal SLAP repairs. Clinical outcomes following arthroscopic repair of type II SLAP lesions showed statistically significant improvement in shoulder scores from pre to post-operative. MRI arthrogram results do not necessarily correlate with clinical outcome. Level of Evidence Level IV case series.

Arthroscopic Salvage of Failed Arthroscopic Bankart Repair

Background Data on arthroscopic salvage of failed arthroscopic Bankart repair are lacking. Purpose To prospectively evaluate the surgical outcome of arthroscopic salvage of failed arthroscopic Bankart repair. Study Design Case series; Level of evidence, 4. Methods Operations were performed on 10 patients (8 male and 2 female; mean age at revision, 25.6 years; range, 18-41 years). The mean interval from the time of the revision surgery to the final follow-up was 68 months (range, 46-83 months). Objective testing included preoperative and postoperative range of motion. Outcome measures included the rating system of the University of California at Los Angeles. The surgical procedure was performed in a consistent manner: capsular plications, suture anchor repair of the displaced labrum, and, when indicated, rotator interval closure. Results The University of California at Los Angeles rating system showed a statistically significant improvement from a preoperative mean rating of 11.7 (range, 6-14) to a mean of 31.7 (range, 29-35) postoperatively (P < .05). All patients had a full and equal postoperative range of motion compared with the preoperative range of motion. One patient experienced recurrent dislocations after the salvage procedure. None of the other 9 patients experienced a recurrent dislocation, with all returning to their previous sports levels. Conclusion Arthroscopic Bankart revision surgery is a reliable procedure with respect to recurrence rate, range of motion, and shoulder function in carefully selected patients.

A biomechanical comparison of repair techniques in posterior type II superior labral anterior and posterior (SLAP) lesions

The purpose of this study was to compare the 3 different fixation methods of posterior type superior labral anterior posterior (SLAP) II lesion. Fifteen cadavers were randomly divided into 3 groups to compare the initial strength of 3 different fixation methods in posterior type II SLAP lesions. Group I used 1 anchor for 1-point fixation with a conventional simple suture; group II used 1 anchor passing both limbs through the posterior-superior labrum in a mattress fashion; and group III used 2 anchors for 2-point fixation with conventional simple sutures. Repair failure (2 mm permanent displacement of repaired site) and ultimate failure were measured. The mean load to (clinical) failure was 156 +/- 22 N in group I, 117 +/- 33 N in group II, and 161 +/- 44 N in group III. The mean load to ultimate failure was 198 +/- 6 N in group I, 189 +/- 23 N in group II, and 179 +/- 22 N in group III. The specimen stiffness was equivalent among groups. In mode of failure, clinical failure (more than 2 mm separations) first occurred between the markers on the biceps tendon just above (A) and below (B) compared to other markers, and ultimate failure occurred at the labral-implant interface. A single simple suture anchor repair in posterior type II SLAP seems sufficient to withstand the initial load without clinical failure. A mattress suture, although it anchors the biceps root, seems to be inferior than simple suture technique.

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.

All-Inside Arthroscopic Repair of Partial-Thickness Supraspinatus Tendon Tear

To date, the reported arthroscopic suture anchor repair techniques for partial-thickness articular-sided rotator cuff tears use a transtendon placement of the anchor. We describe a new technique of an all-inside arthroscopic suture anchor repair.

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.