Biomechanical Evaluation of Transosseous Rotator Cuff Repair
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Arthroscopic Rotator Cuff Repair Suture Anchor Fixation
Arthroscopic rotator cuff repair is a common orthopaedic procedure and has a high success rate with regard to patient satisfaction and functional improvement. Initially, rotator cuff repairs were performed in an open fashion and utilized a single row of fixation achieved by the creation of transosseous bone tunnels. With the development of shoulder arthroscopic surgery, suture anchor fixation has become the method of choice for those surgeons performing entirely arthroscopic repairs of rotator cuff tears. Suture anchor repair techniques have evolved from single-row to double-row constructs and recently to a transosseous-equivalent footprint reconstruction in an attempt to more closely reproduce the normal rotator cuff footprint anatomy. Current biomechanical data suggest that a transosseous-equivalent repair offers improved ultimate load to failure with reduced gap formation during cyclic loading when compared with either single or double-row suture anchor repairs. On the clinical front, the literature remains elusive in regard to improved clinical outcomes with more advanced repair techniques.
Transosseous Rotator Cuff Repair Technique
More recently, newer techniques for all arthroscopic transosseous repairs of the rotator cuff have been developed. These techniques utilize a custom device (ArthroTunneler, Tornier Inc, Edina, Minnesota) that enters perpendicular to the rotator cuff footprint and then exits at a nearly 90° angle toward the lateral wall of the greater tuberosity, creating a more sharply angled transosseous tunnel with potentially increased bone bridge length. Potential advantages of arthroscopic transosseous repairs include the associated decreased cost, elimination of suture anchors, and a similar ability to recreate the rotator cuff footprint. Potential disadvantages include increased surgical complexity, risk of fracture of the greater tuberosity, and suture cutout through bone, which is a known limitation of traditional open transosseous repairs.
What are the Differences in Rotator Cuff Repair Techniques?
To our knowledge, there have not been any published reports comparing the differences in initial biomechanical performance between these techniques. The purpose of this study was to evaluate the differences in initial biomechanical performance including ultimate load to failure and localized elongation with cyclic loading between transosseous-equivalent repair with suture anchors (TOE), anchorless designs of the traditional transosseous repair with curved bone tunnels (TO), and the arthroscopic transosseous repair technique utilizing a simple (AT) or X-box suture configuration (ATX). The hypothesis was that TOE suture anchor repair would demonstrate superior initial biomechanical performance in comparison to the transosseous repair techniques.