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First published on February 22, 2008, doi:10.1177/0363546508314424
This version was published on August 1, 2008
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The American Journal of Sports Medicine 36:1504-1510 (2008)
© 2008 American Orthopaedic Society for Sports Medicine

Cyclic Loading of Rotator Cuff Reconstructions

Single-Row Repair With Modified Suture Configurations Versus Double-Row Repair

Olaf Lorbach, MD*, Felix Bachelier, MD, Jochen Vees, Dieter Kohn, MD, PhD and Dietrich Pape, MD

From the Department of Orthopedic Surgery, University of Saarland, Homburg/Saar, Germany

* Address correspondence to Olaf Lorbach, MD, Department of Orthopedic Surgery, Saarland University, Homburg/Saar, Kirrberger Str, 66421 Homburg/Saar, Germany (e-mail: olaf.lorbach{at}gmx.de).

Background: Double-row repair is suggested to have superior biomechanical properties in rotator cuff reconstruction compared with single-row repair. However, double-row rotator cuff repair is frequently compared with simple suture repair and not with modified suture configurations.

Hypothesis: Single-row rotator cuff repairs with modified suture configurations have similar failure loads and gap formations as double-row reconstructions.

Study Design: Controlled laboratory study.

Methods: We created 1 x 2-cm defects in 48 porcine infraspinatus tendons. Reconstructions were then performed with 4 single-row repairs and 2 double-row repairs. The single-row repairs included transosseous simple sutures; double-loaded corkscrew anchors in either a double mattress or modified Mason-Allen suture repair; and the Magnum Knotless Fixation Implant with an inclined mattress. Double-row repairs were either with Bio-Corkscrew FT using modified Mason-Allen stitches or a combination of Bio-Corkscrew FT and PushLock anchors using the SutureBridge Technique. During cyclic load (10 N to 60–200 N), gap formation was measured, and finally, ultimate load to failure and type of failure were recorded.

Results: Double-row double-corkscrew anchor fixation had the highest ultimate tensile strength (398 ± 98 N) compared to simple sutures (105 ± 21 N; P < .0001), single-row corkscrews using a modified Mason-Allen stitch (256 ± 73 N; P = .003) or double mattress repair (290 ± 56 N; P = .043), the Magnum Implant (163 ± 13 N; P < .0001), and double-row repair with PushLock and Bio-Corkscrew FT anchors (163 ± 59 N; P < .0001). Single-row double mattress repair was superior to transosseous sutures (P < .0001), the Magnum Implant (P = .009), and double-row repair with PushLock and Bio-Corkscrew FT anchors (P = .009). Lowest gap formation was found for double-row double-corkscrew repair (3.1 ± 0.1 mm) compared to simple sutures (8.7 ± 0.2 mm; P < .0001), the Magnum Implant (6.2 ± 2.2 mm; P = .002), double-row repair with PushLock and Bio-Corkscrew FT anchors (5.9 ± 0.9 mm; P = .008), and corkscrews with modified Mason-Allen sutures (6.4 ± 1.3 mm; P = .001).

Conclusion: Double-row double-corkscrew anchor rotator cuff repair offered the highest failure load and smallest gap formation and provided the most secure fixation of all tested configurations. Double-loaded suture anchors using modified suture configurations achieved superior results in failure load and gap formation compared to simple suture repair and showed similar loads and gap formation with double-row repair using PushLock and Bio-Corkscrew FT anchors.

Clinical Relevance: Single-row repair with modified suture configurations may lead to results comparable to several double-row fixations. If double-row repair is used, modified stitches might further minimize gap formation and increase failure load.

Key Words: rotator cuff repair • double-row • suture anchors • cyclic loading






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