Comparison Between Single and Double‐Row Rotator Cuff Repair: A Biomechanical Study (SS‐24)

PurposeTo compare the mechanical behavior under cyclic loading test of single-row and double-row rotator cuff repair with suture anchors in an ex-vivo animal biomechanical model.Materials and methodsFor the present study, 48 fresh porcine shoulders were used. On each shoulder, a crescent-like full-thickness tear of the infraspinatus was performed. Width of the tendon tear was 2 cm. The lesion was repaired using metal suture anchors (Corkscrew 5 mm; Arthrex, Naples). After repair, anterior and posterior parts of the tendon were left intact, to reproduce a tension-free repair, or were detached from the humerus, to reproduce a repair in tension. Shoulders were divided into 6 groups of 8 samples each, according the type of repair: Group 1: control group with intact tendon; Group 2: single-row tension-free repair; Group 3: single-row tension repair; Group 4: double-row tension-free repair, using the “tendon bridge” repair technique; Group 5: double-row tendon bridge tension repair; and Group 6: double-row tension repair, using a mattress suture technique. Shoulders were subjected to a cyclic loading test on a materials testing machine (Galdabini Sun 1000). On each sample, we performed 1000 load cycles between 10 and 180 N, at a strain rate of 33 mm/sec. Distance between gripping points was set at 40 mm, and the angle between tendon and bone surface was 45°. At the cyclic loading test, we calculated the number of cycles completed at 5 mm of elongation, deformation at failure, and the number of cycles at failure. Statistical analysis was carried out to compare groups, using the analysis of variance (Kruskal-Wallis, ANOVA). Post hoc analysis for paired multiple comparisons was performed with the Tukey test. Significance was set at p < 0.05.ResultsSignificant differences were observed between single-row tension repair and all other groups for deformation at failure and number of cycles at failure, Group 3 being significantly lower than the other groups. About the number of cycles at 5 mm of elongation, we observed a non significant difference between Groups 3 and 5 (single- and double-row tendon-bridge tension repair), and between Groups 2 and 4 (single- and double-row tendon-bridge tension-free repair); and a significant difference between Groups 2 and 3 (single-row in tension and tension-free); moreover, there was a significant difference between double-row mattress (Group 6) and single-row or double-row tendon-bridge technique, when repair was in tension.ConclusionsA tension-free repair was not significantly improved by a double-row repair technique. On the contrary, a tension repair was significantly stronger when performed with a double-row technique (mattress significantly more than tendon-bridge). PurposeTo compare the mechanical behavior under cyclic loading test of single-row and double-row rotator cuff repair with suture anchors in an ex-vivo animal biomechanical model. To compare the mechanical behavior under cyclic loading test of single-row and double-row rotator cuff repair with suture anchors in an ex-vivo animal biomechanical model. Materials and methodsFor the present study, 48 fresh porcine shoulders were used. On each shoulder, a crescent-like full-thickness tear of the infraspinatus was performed. Width of the tendon tear was 2 cm. The lesion was repaired using metal suture anchors (Corkscrew 5 mm; Arthrex, Naples). After repair, anterior and posterior parts of the tendon were left intact, to reproduce a tension-free repair, or were detached from the humerus, to reproduce a repair in tension. Shoulders were divided into 6 groups of 8 samples each, according the type of repair: Group 1: control group with intact tendon; Group 2: single-row tension-free repair; Group 3: single-row tension repair; Group 4: double-row tension-free repair, using the “tendon bridge” repair technique; Group 5: double-row tendon bridge tension repair; and Group 6: double-row tension repair, using a mattress suture technique. Shoulders were subjected to a cyclic loading test on a materials testing machine (Galdabini Sun 1000). On each sample, we performed 1000 load cycles between 10 and 180 N, at a strain rate of 33 mm/sec. Distance between gripping points was set at 40 mm, and the angle between tendon and bone surface was 45°. At the cyclic loading test, we calculated the number of cycles completed at 5 mm of elongation, deformation at failure, and the number of cycles at failure. Statistical analysis was carried out to compare groups, using the analysis of variance (Kruskal-Wallis, ANOVA). Post hoc analysis for paired multiple comparisons was performed with the Tukey test. Significance was set at p < 0.05. For the present study, 48 fresh porcine shoulders were used. On each shoulder, a crescent-like full-thickness tear of the infraspinatus was performed. Width of the tendon tear was 2 cm. The lesion was repaired using metal suture anchors (Corkscrew 5 mm; Arthrex, Naples). After repair, anterior and posterior parts of the tendon were left intact, to reproduce a tension-free repair, or were detached from the humerus, to reproduce a repair in tension. Shoulders were divided into 6 groups of 8 samples each, according the type of repair: Group 1: control group with intact tendon; Group 2: single-row tension-free repair; Group 3: single-row tension repair; Group 4: double-row tension-free repair, using the “tendon bridge” repair technique; Group 5: double-row tendon bridge tension repair; and Group 6: double-row tension repair, using a mattress suture technique. Shoulders were subjected to a cyclic loading test on a materials testing machine (Galdabini Sun 1000). On each sample, we performed 1000 load cycles between 10 and 180 N, at a strain rate of 33 mm/sec. Distance between gripping points was set at 40 mm, and the angle between tendon and bone surface was 45°. At the cyclic loading test, we calculated the number of cycles completed at 5 mm of elongation, deformation at failure, and the number of cycles at failure. Statistical analysis was carried out to compare groups, using the analysis of variance (Kruskal-Wallis, ANOVA). Post hoc analysis for paired multiple comparisons was performed with the Tukey test. Significance was set at p < 0.05. ResultsSignificant differences were observed between single-row tension repair and all other groups for deformation at failure and number of cycles at failure, Group 3 being significantly lower than the other groups. About the number of cycles at 5 mm of elongation, we observed a non significant difference between Groups 3 and 5 (single- and double-row tendon-bridge tension repair), and between Groups 2 and 4 (single- and double-row tendon-bridge tension-free repair); and a significant difference between Groups 2 and 3 (single-row in tension and tension-free); moreover, there was a significant difference between double-row mattress (Group 6) and single-row or double-row tendon-bridge technique, when repair was in tension. Significant differences were observed between single-row tension repair and all other groups for deformation at failure and number of cycles at failure, Group 3 being significantly lower than the other groups. About the number of cycles at 5 mm of elongation, we observed a non significant difference between Groups 3 and 5 (single- and double-row tendon-bridge tension repair), and between Groups 2 and 4 (single- and double-row tendon-bridge tension-free repair); and a significant difference between Groups 2 and 3 (single-row in tension and tension-free); moreover, there was a significant difference between double-row mattress (Group 6) and single-row or double-row tendon-bridge technique, when repair was in tension. ConclusionsA tension-free repair was not significantly improved by a double-row repair technique. On the contrary, a tension repair was significantly stronger when performed with a double-row technique (mattress significantly more than tendon-bridge). A tension-free repair was not significantly improved by a double-row repair technique. On the contrary, a tension repair was significantly stronger when performed with a double-row technique (mattress significantly more than tendon-bridge).