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Use of electrocautery devices for suture passage through the greater tuberosity: a biomechanical study. J Shoulder Elbow Surg 2023; 32:512-518. [PMID: 36283564 DOI: 10.1016/j.jse.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/15/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The use of electrocautery to facilitate passage of a suture needle through bone without the aid of a drill or burr is a novel technique that has potential utility in orthopedic procedures, but there is a scarcity of research to support its utility. The specific aims of this cadaveric biomechanical study were to evaluate (1) the axial force reduction during suture passage using electrocautery when applied to rotator cuff repair, (2) the temperature change caused while using electrocautery, and (3) the failure loads and failure modes of this technique. METHODS Five matched pairs of fresh frozen humeri were used, classified into 2 groups: with electrocautery on needle (study group) and without electrocautery on needle (control group). Four individual osseous tunnels were made on the greater tuberosity around the insertion of the supraspinatus tendon. Each specimen was sequentially tested in 2 parts: a needle penetration test (part I) to measure the peak axial force and temperature change and a single load-to-failure test (part II) to measure the maximum load to failure as well as the mechanism of failure. A No. 2 FiberWire suture with a straight needle was used. RESULTS In part I, the mean peak axial force was lower in the study group compared with the control group for all osseous tunnels but was not statistically significant for individual tunnels. However, there was a significant decrease in peak axial force in the study group of 36% compared with the control group overall (P = .033). There was no significant change in temperature of the tunnel site with the use of electrocautery (mean: 0.2 ± 0.3°C, P = .435). In part II, 100% of the samples from each study group experienced bone tunnel failure. Forty percent of the trials in the study group found lower ultimate failure loads compared with the control group (reduction range: 7%-38%). There was no statistically significant difference in the ultimate failure load between either the loop tested or between the 2 study groups (loop 1: P = .352; loop 2: P = .270). CONCLUSION Suture passage using electrocautery does significantly decrease the peak force needed to pass a needle directly through the greater tuberosity. This technique does not appear to burn the bone or weaken the bone tunnels. This technique may be useful during open rotator cuff repair or shoulder arthroplasty, although clinicians should be cautious when using this technique as its utility depends on bone quality and cortical thickness, and in vivo results may differ.
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Wang YC, Chen HC, Wong CC, Chang WP, Lin CH, Liaw CK, Chen CH, Weng PW. Comparison of Locking-Loop Suture Bridge Repair and Single-Row Suture Anchor Repair in Small to Medium Rotator Cuff Tears: A Prospective Cohort Study With Clinical and Ultrasound Evaluations. Orthop J Sports Med 2023; 11:23259671221142242. [PMID: 36636031 PMCID: PMC9830097 DOI: 10.1177/23259671221142242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 01/07/2023] Open
Abstract
Background Single-row (SR) and double-row repair techniques have been described to treat rotator cuff tears. We present a novel surgical strategy of arthroscopic-assisted mini-open repair in which a locking-loop suture bridge (LLSB) is used. Purpose To compare the functional outcomes and repair integrity of LLSB technique to the SR technique for arthroscopic-assisted mini-open repair of small to medium rotator cuff tears. Study Design Cohort study; Level of evidence, 3. Methods Included were 39 patients who underwent LLSB repair (LLSB group) and 44 patients who underwent SR suture anchor repair (SR group) from 2015 to 2018. We evaluated all patients preoperatively and at 3, 6, 12, and 24 months postoperatively using the visual analog scale (VAS) for pain, Oxford Shoulder Score (OSS), and American Shoulder and Elbow Surgeons (ASES) score. Also, shoulder sonography was performed at 12 months postoperatively to evaluate repair integrity using the Sugaya classification system. The independent-sample t test was used to analyze functional outcomes (VAS, OSS, and ASES scores), and the Fisher exact test was used to analyze postoperative sonography results. Results Patients in both the LLSB and SR groups saw a significant improvement on all 3 outcome measures from preoperatively to 24 months postoperatively (P < .001 for all). However, when comparing scores between groups, only the scores at 3 months postoperatively differed significantly (VAS: P = .002; OSS: P < .001; ASES: P = .005). Shoulder sonography at 12 months postoperatively revealed no significant difference in repair integrity between the LLSB and SR groups (retear rate: 10.26% and 6.82%, respectively; P = .892). Conclusion Better outcome scores were seen at 3-month follow-up in the LLSB group, with no difference in retear rates compared with the SR group at 12 months postoperatively. The LLSB technique was found to be a reliable technique for rotator cuff repair of small- to medium-sized tears.
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Affiliation(s)
- Yu-Chun Wang
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical
University, New Taipei City
| | - Hung-Chou Chen
- Department of Orthopedics, College of Medicine, Taipei Medical
University, Taipei.,Department of Physical Medicine and Rehabilitation, Shuang Ho
Hospital, Taipei Medical University, New Taipei City
| | - Chin-Chean Wong
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical
University, New Taipei City.,Department of Orthopedics, College of Medicine, Taipei Medical
University, Taipei.,Graduate Institute of Biomedical Materials and Tissue Engineering,
College of Biomedical Engineering, Taipei Medical University, Taipei.,Research Center for Biomedical Devices and Prototyping Production,
Taipei Medical University, Taipei.,College of Medicine, Taipei Medical University, Taipei.,Non-Invasive Cancer Therapy Research Institute of Taiwan,
Taipei
| | - Wen-Pei Chang
- Department of Nursing, Shuang Ho Hospital, Taipei Medical
University, New Taipei City.,College of Nursing, Taipei Medical University, Taipei
| | - Chun-Hao Lin
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical
University, New Taipei City
| | - Chen-Kun Liaw
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical
University, New Taipei City.,Department of Orthopedics, College of Medicine, Taipei Medical
University, Taipei.,Graduate Institute of Biomedical Materials and Tissue Engineering,
College of Biomedical Engineering, Taipei Medical University, Taipei
| | - Chih-Hwa Chen
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical
University, New Taipei City.,Department of Orthopedics, College of Medicine, Taipei Medical
University, Taipei.,Graduate Institute of Biomedical Materials and Tissue Engineering,
College of Biomedical Engineering, Taipei Medical University, Taipei
| | - Pei-Wei Weng
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical
University, New Taipei City.,Department of Orthopedics, College of Medicine, Taipei Medical
University, Taipei.,Graduate Institute of Biomedical Materials and Tissue Engineering,
College of Biomedical Engineering, Taipei Medical University, Taipei.,Pei-Wei Weng, MD, PhD, Taipei Medical University, Shuang Ho
Hospital, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City 23561
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Huntington L, Coles-Black J, Richardson M, Sobol T, Caldow J, Chuen J, Ackland DC. The use of suture-tape and suture-wire in arthroscopic rotator cuff repair: A comparative biomechanics study. Injury 2018; 49:2047-2052. [PMID: 30224178 DOI: 10.1016/j.injury.2018.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/22/2018] [Accepted: 09/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Rotator cuff repair surgery aims to create a secure, pressurized tendon-bone footprint to permit re-establishment of the fibrovascular interface and tendon healing. Flat-braided suture-tape is an alternative suture material to traditional suture-wire that has potential to reproduce a larger repair construct contact area. The objective of this study was to compare contact pressure, area as well as the mechanical fatigue strength between suture-wire and suture-tape Suture-bridge repair constructs in an ovine model. METHODS Sixty lamb infraspinatus tendons were harvested and randomly allocated to three- and four-anchor Suture-bridge repairs performed using either suture-wire or suture-tape. Thirty-two specimens were cyclically loaded for 200 cycles in an Instron testing machine, while tendon gap formation was recorded using a high speed digital motion analysis system. Loading to failure was then performed to evaluate construct ultimate tensile strength and stiffness. The remaining 28 specimens were assessed for repair contact pressure and area using pressure-sensitive film. RESULTS There was a significantly greater average tendon contact pressure (mean difference: 0.064 MPa, p = 0.04) and area (mean difference: 2.71 mm2, p = 0.03) in fiber-tape repair constructs compared to those in fiber-wire constructs for the three-anchor Suture-bridge configuration. The four-anchor suture-tape constructs had a significantly larger ultimate tensile strength than that of the four-anchor suture-wire constructs (mean difference: 56.4 N, p = 0.04). There were no significant differences in gap formation or stiffness between suture-tape and suture-wire constructs (p > 0.05). CONCLUSION Suture-tape offers greater pressurised tendon-bone contact than suture-wire in three-anchor Suture-bridge repairs, while greater mechanical strength is achieved with the use of suture-tape in four-anchor Suture-bridge constructs.
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Affiliation(s)
- Lachlan Huntington
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Jasamine Coles-Black
- Department of Surgery, Austin Health, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Martin Richardson
- Department of Orthopaedic Surgery, Epworth Healthcare, Richmond, Victoria, 3121, Australia
| | - Tony Sobol
- Department of Orthopaedic Surgery, Epworth Healthcare, Richmond, Victoria, 3121, Australia
| | - Jonathon Caldow
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Jason Chuen
- Department of Surgery, Austin Health, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, 3010, Australia.
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Thomas R, Richardson M, Patel M, Page R, Sangeux M, Ackland DC. Rotator cuff contact pressures at the tendon-implant interface after anatomic total shoulder arthroplasty using a metal-backed glenoid component. J Shoulder Elbow Surg 2018; 27:2085-2092. [PMID: 29954661 DOI: 10.1016/j.jse.2018.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/19/2018] [Accepted: 04/27/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff tears following anatomic total shoulder arthroplasty increase with duration of follow-up. This study aimed to evaluate contact pressure between the rotator cuff tendons and prosthesis after anatomic total shoulder arthroplasty and compare these with the tendon-contact pressures in the native shoulder. METHODS Eight entire upper extremities were mounted onto a testing apparatus, and simulated muscle loading was applied to each rotator cuff tendon with the shoulder positioned in abduction, internal rotation, and external rotation. Pressure-sensitive film placed between each tendon and bone was used to measure the resultant tendon contact pressures. Experiments were repeated after anatomic total shoulder arthroplasty using standardized implant sizes, and pressure-sensitive film was used to evaluate tendon-prosthesis contact pressure. RESULTS Both joint angle and shoulder joint replacement surgery had significant effects on the maximum contact pressure measured between the humeral head and all rotator cuff tendons (P < .05) except the teres minor. The supraspinatus demonstrated a significantly larger peak tendon contact pressure after surgery at 45° of abduction relative to that in the native shoulder (mean difference, 0.2 MPa; P = .031), while the subscapularis had a significantly larger maximum contact pressure at 10° of abduction (mean difference, 0.45 MPa; P = .032) and 90° of abduction (mean difference, 0.80 MPa; P = .008) postoperatively. CONCLUSION Anatomic total shoulder arthroplasty results in significantly larger tendon contact pressures relative to those in the native shoulder. High tendon contact pressures may ultimately predispose rotator cuff tendons to postoperative wear-induced damage and tearing.
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Affiliation(s)
- Richard Thomas
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Martin Richardson
- Department of Orthopaedic Surgery, Epworth Healthcare, Richmond, Victoria, Australia
| | - Minoo Patel
- Department of Orthopaedic Surgery, Epworth Healthcare, Richmond, Victoria, Australia
| | - Richard Page
- Department of Orthopaedic Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Morgan Sangeux
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia.
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Randelli P, Stoppani CA, Zaolino C, Menon A, Randelli F, Cabitza P. Advantages of Arthroscopic Rotator Cuff Repair With a Transosseous Suture Technique: A Prospective Randomized Controlled Trial. Am J Sports Med 2017; 45:2000-2009. [PMID: 28339286 DOI: 10.1177/0363546517695789] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rotator cuff tear is a common finding in patients with painful, poorly functioning shoulders. The surgical management of this disorder has improved greatly and can now be fully arthroscopic. PURPOSE To evaluate clinical and radiological results of arthroscopic rotator cuff repair using 2 different techniques: single-row anchor fixation versus transosseous hardware-free suture repair. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Sixty-nine patients with rotator cuff tears were enrolled: 35 patients were operated with metal anchors and 34 with standardized transosseous repair. The patients were clinically evaluated before surgery, during the 28 days after surgery, and at least 1 year after the operation by the use of validated rating scores (Constant score, QuickDASH, and numerical rating scale [NRS]). Final follow-up was obtained at more than 3 years by a QuickDASH evaluation to detect any difference from the previous follow-up. During the follow-up, rotator cuff integrity was determined through magnetic resonance imaging and was classified according to the 5 Sugaya categories. RESULTS Patients operated with the transosseous technique had significantly less pain, especially from the 15th postoperative day: In the third week, the mean NRS value for the anchor group was 3.00 while that for transosseous group was 2.46 ( P = .02); in the fourth week, the values were 2.44 and 1.76, respectively ( P < .01). No differences in functional outcome were noted between the 2 groups at the final evaluation. In the evaluation of rotator cuff repair integrity, based on Sugaya magnetic resonance imaging classification, no significant difference was found between the 2 techniques in terms of retear rate ( P = .81). CONCLUSION No significant differences were found between the 2 arthroscopic repair techniques in terms of functional and radiological results. However, postoperative pain decreased more quickly after the transosseous procedure, which therefore emerges as a possible improvement in the surgical repair of the rotator cuff. Registration: NCT01815177 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Pietro Randelli
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Carlo Zaolino
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | | | - Paolo Cabitza
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Huntington L, Richardson M, Sobol T, Caldow J, Ackland DC. Load response and gap formation in a single-row cruciate suture rotator cuff repair. ANZ J Surg 2017; 87:483-487. [PMID: 28124403 DOI: 10.1111/ans.13875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 10/30/2016] [Accepted: 11/06/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Double-row rotator cuff tendon repair techniques may provide superior contact area and strength compared with single-row repairs, but are associated with higher material expenses and prolonged operating time. The purpose of this study was to evaluate gap formation, ultimate tensile strength and stiffness of a single-row cruciate suture rotator cuff repair construct, and to compare these results with those of the Mason-Allen and SutureBridge repair constructs. METHODS Infraspinatus tendons from 24 spring lamb shoulders were harvested and allocated to cruciate suture, Mason-Allen and SutureBridge repair groups. Specimens were loaded cyclically between 10 and 62 N for 200 cycles, and gap formation simultaneously measured using a high-speed digital camera. Specimens were then loaded in uniaxial tension to failure, and construct stiffness and repair strength were evaluated. RESULTS Gap formation in the cruciate suture repair was significantly lower than that of the Mason-Allen repair (mean difference = 0.6 mm, P = 0.009) and no different from that of the SutureBridge repair (P > 0.05). Both the cruciate suture repair (mean difference = 15.7 N/mm, P = 0.002) and SutureBridge repair (mean difference = 15.8 N/mm, P = 0.034) were significantly stiffer than that of the Mason-Allen repair; however, no significant differences in ultimate tensile strength between repair groups were discerned (P > 0.05). CONCLUSION The cruciate suture repair construct, which may represent a simple and cost-effective alternative to double-row and double-row equivalent rotator cuff repairs, has comparable biomechanical strength and integrity with that of the SutureBridge repair, and may result in improved construct longevity and tendon healing compared with the Mason-Allen repair.
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Affiliation(s)
- Lachlan Huntington
- Department of Mechanical Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Martin Richardson
- Department of Orthopaedic Surgery, Epworth Healthcare, Richmond, Victoria, Australia
| | - Tony Sobol
- Department of Orthopaedic Surgery, Epworth Healthcare, Richmond, Victoria, Australia
| | - Jonathon Caldow
- Department of Mechanical Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - David C Ackland
- Department of Mechanical Engineering, The University of Melbourne, Melbourne, Victoria, Australia
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