Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

Open Access 01-11-2008 | Experimental Study

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

Authors: M. H. Baums, G. H. Buchhorn, G. Spahn, B. Poppendieck, W. Schultz, H.-M. Klinger

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 11/2008

Abstract

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.

Apreleva M, Özbaydar M, Fitzgibbons PG, Warner JJP (2002) Rotator cuff tears: the effect of the reconstruction method on three-dimensional repair site area. Arthroscopy 18:519–526PubMed

Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL (2006) Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elbow Surg 15:290–299PubMedCrossRef

Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG (2005) Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am 87-A:1229–1240CrossRef

Burkhart SS (1995) The deadman theory of suture anchors: observations along a south Texas fence line. Arthroscopy 11:119–123PubMed

Burkhart SS, Diaz Pagan JL, Wirth MA, Athanasiou KA (1997) Cyclic loading of anchor-based rotator cuff repairs: confirmation of the tension overload phenomenon and comparison of suture anchor fixation with transosseous fixation. Arthroscopy 13:720–724PubMed

Burkhart SS, Johnson TC, Wirth MA, Athanasiou KA (1997) Cyclic loading of transosseous rotator cuff repairs: tension overload as a possible cause of failure. Arthroscopy 13:172–176PubMed

Charousset C, Grimberg J, Duranthon LD, Bellaiche L, Petrover D (2007) Can a double-row anchorage technique improve tendon healing in arthroscopic rotator cuff repair? A prospective, nonrandomized, comparative study of double-row and single-row anchorage techniques with computed tomography arthrography tendon healing assessment. Am J Sports Med 35:1247–1253PubMedCrossRef

Cummis CA, Murrell GA (2003) Mode of failure for rotator cuff repair with suture anchors identified at revision surgery. J Shoulder Elbow Surg 12:128–133CrossRef

DeCarli A, Vadala A, Monaco E, Labianca L, Zanzotto E, Ferretti A (2005) Effect of cyclic loading on new polyblend suture coupled with different anchors. Am J Sports Med 33:214–219CrossRef

10.

Demirhan M, Atalar AC, Kilicoglu O (2003) Primary fixation strength of rotator cuff repair techniques: a comparative study. Arthroscopy 19:572–576PubMed

11.

Fealy S, Kingham TP, Altcheck DW (2002) Mini-open rotator cuff repair using a two-row fixation technique: outcomes analysis in patients with small, moderate and large rotator cuff tears. Arthroscopy 18:665–670PubMed

12.

Franceschi F, Ruzzini L, Longo UG, Martina FM, Zobel BB (2007) Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears. Am J Sports Med 35:1254–1260PubMedCrossRef

13.

Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K (2004) The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 86-A:219–224PubMed

14.

Gerber C, Schneeberger AG, Beck M, Schlegel U (1994) Mechanical strength of repairs of the rotator cuff. J Bone Joint Surg Br 76-B:371–380

15.

Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and post-operative evaluation by CT scan. Clin Orthop Relat Res 304:78–83PubMed

16.

Kim DH, ElAttrache NS, Tibone JE, Jun BJ, DeLaMora SN, Kvitne RS, Lee TQ (2005) Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair. Am J Sport Med 34:407–414CrossRef

17.

Klinger HM, Steckel H, Spahn G, Buchhorn GH, Baums MH (2007) Biomechanical comparison of double-loaded suture anchors using arthroscopic Mason-Allen stitches versus traditional transosseous suture technique and modified Mason-Allen stitches for rotator cuff repair. Clin Biomech 22:106–111CrossRef

18.

Klinger H-M, Kahl E, Buchhorn GH, Heidrich G, Steckel H, Baums MH (2008) Biomechanical evaluation of rotator cuff repairs in a sheep model: Suture anchors using arthroscopic Mason-Allen stitches compared with transosseous sutures using traditional modified Mason-Allen stitches. Clin Biomech 23:291–298CrossRef

19.

Lo IK, Burkart SS (2003) Double-row arthroscopic rotator cuff repair: re-establishing the footprint of the rotator cuff. Arthroscopy 19:1035–1042PubMed

20.

Ma CM, Comerford L, Wilson J, Puttlitz CM (2006) Biomechanical evaluation of arthroscopic rotator cuff repairs: double-row compared with single-row fixation. J Bone Joint Surg Am 88-A:403–410CrossRef

21.

Mahar A, Tamborlane J, Oka R, Esch J, Pedowitz RA (2007) Single-row suture anchor repair of the rotator cuff is biomechanically equivalent to double-row repair in a bovine model. Arthroscopy 23:1265–1270PubMed

22.

Mazzocca AD, Millet PJ, Guanche CA, Santangelo SA, Arciero RA (2005) Arthroscopic single-row versus double-row suture anchor rotator cuff repair. Am J Sports Med 33:1861–1868PubMedCrossRef

23.

Meier SW, Meier JD (2006) The effect of double-row fixation on initial repair strength in rotator cuff repair: a biomechanical study. Arthroscopy 22:1168–1173PubMedCrossRef

24.

Milano G, Grasso A, Zarelli D, Deriu L, Cillo M, Fabbriciani C (2008) Comparison between single-row and double-row rotator cuff repair: a biomechnical study. Knee Surg Sports Traumatol Arthrosc 16:75–80. doi:10.1007/s00167-007-0382-0 PubMedCrossRef

25.

Park MC, Tibone JE, ElAttrache NS, Ahmad CS, Jun BJ, Lee TQ (2007) Part II: biomechanical assessment for a footprint-restoring transosseous-eqivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elbow Surg 16:469–476PubMedCrossRef

26.

Petit CJ, Boswell R, Mahar A, Tasto J, Pedowitz RA (2003) Biomechanical evaluation of a new technique for rotator cuff repair. Am J Sports Med 31:849–853PubMed

27.

Reed SC, Glossop N, Ogilvie-Harris DJ (1996) Full-thickness rotator cuff tears. A biomechanical comparison of suture versus bone anchor techniques. Am J Sports Med 24:46–48PubMedCrossRef

28.

Rickert M, Georgousis H, Witzel U (1998) Tensile strength of the tendon of the supraspinatus muscle in the human. A biomechanical study [German]. Unfallchirurg 101:265–270PubMedCrossRef

29.

Scheibel MT, Habermeyer P (2003) A modified Mason-Allen technique for rotator cuff repair using suture anchors. Arthroscopy 19:330–333PubMed

30.

Smith CD, Alexander S, Hill AM, Huijsmans PE, Bull AMJ, Amis AA, Beer JF, Wallace AL (2006) A biomechanical comparison of single and double-row fixation in arthroscopic rotator cuff repair. J Bone Joint Surg Am 88-A:2425–2431CrossRef

31.

Schneeberger AG, von Roll A, Kalberer F, Jacob HA, Gerber C (2002) Mechanical strength of arthroscopic rotator cuff repair techniques: an in vitro study. J Bone Joint Surg Am 84-A:2152–2160PubMed

32.

Sugaya H, Maeda K, Matsuki K, Moriishi J (2007) Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. J Bone Joint Surg Am 89-A:953–960CrossRef

33.

Tuoheti Y, Itoi E, Yamamoto N, Seki N, Abe H, Minagawa H, Okada K, Shimada Y (2005) Contact area, contact pressure, and pressure patterns of the tendon-bone interface after rotator cuff repair. Am J Sports Med 33:1869–1874PubMedCrossRef

34.

Woo SL, Orlando CA, Camp JF, Akeson WH (1986) Effects of postmortem storage by freezing on ligament tensile behavior. J Biomech 19:399–404PubMedCrossRef

35.

Wüst DM, Meyer DC, Favre P, Gerber C (2006) Mechanical and handling properties of braided polyblend polyethylene sutures in comparison to braided polyester and monofilament polydioxanone sutures. Arthroscopy 22:1146–1153PubMed

Title: Biomechanical characteristics of single-row repair in comparison to double-row repair with consideration of the suture configuration and suture material
Authors: M. H. Baums
G. H. Buchhorn
G. Spahn
B. Poppendieck
W. Schultz
H.-M. Klinger
Publication date: 01-11-2008
Publisher: Springer-Verlag
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 11/2008
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-008-0590-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 11/2008

Anterior cruciate ligament reconstruction using autografts and double biodegradable femoral cross-pin fixation: functional, radiographic and MRI outcome after 2-year minimum follow-up

Effect of arthroscopic partial meniscectomy on the function of quadriceps femoris

Active non-operative treatment of acute isolated posterior cruciate ligament injury with cylinder cast immobilization

Reply to the comments on our article “Sclerosing injections in midportion Achilles tendinopathy: a retrospective study of 25 patients”

Sclerosing polidocanol injections in Achilles tendinopathy in high level athletes

Histological and ultrastructural evaluation of Leeds-Keio ligament 20 years after implant: a case report