Rotator cuff repair: a biomechanical ex vivo ovine study

Comparative efficacy of 5 suture configurations for arthroscopic rotator cuff tear repair: a network meta-analysis

BACKGROUND

Rotator cuff tear is one of the most common complaint with shoulder pain, disability, or dysfunction. So far, different arthroscopic techniques including single row (SR), double row (DR), modified Mason-Allen (MMA), suture bridge (SB) and transosseous (TO) have been identified to repair rotator cuff. However, no study has reported the comparative efficacy of these 5 suture configurations. The overall aim of this network meta-analysis was to analyze the clinical outcomes and healing rate with arthroscopy among SR, DR, MMA, SB and TO.

METHODS

A systematic literature was searched from PubMed, EBSCO-MEDLINE, Web of Science, google scholar and www.dayi100.com , and checked for the inclusion and exclusion standards. The network meta-analysis was conducted using Review Manager 5.3 and SATA 15.0 software.

RESULTS

Thirty-four studies were eligible for inclusion, including 15 randomized controlled trials, 17 retrospective and 2 prospective cohort studies, with total 3250 shoulders. Two individual reviewers evaluated the quality of the 34 studies, the score form 5 and 9 of 10 were attained according to the Newcastle-Ottawa Scale for the 17 retrospective and 2 prospective studies. There was no significant distinction for the Constant score among 5 groups in the 16 studies with 1381 shoulders. The treatment strategies were ranked as MMA, DR, SB, SR and TO. In ASES score, 14 studies included 1464 shoulders showed that no significant differences was showed among all 5 groups after surgery. Whereas the efficacy probability was TO, MMA, DR, SB and SR according to the cumulative ranking curve. The healing rate in 25 studies include 2023 shoulders was significant in both SR versus DR [risk ratio 0.45 with 95% credible interval (0.31, 0.65)], and SR versus SB [risk ratio 0.45 (95% credible interval 0.29, 0.69)], and no significant in the other comparison, the ranking probability was MMA, SB, DR, TO and SR.

CONCLUSION

Based on the clinical results, this network meta-analysis revealed that these 5 suture configurations shows no significant difference. Meanwhile, suture bridge may be the optimum treatment strategy which may improve the healing rate postoperatively, whereas the DR is a suboptimal option for arthroscopic rotator cuff repairs.

Gap formation after single lateral row versus dual-row suture bridge cuff repair: An ovine biomechanical model

BACKGROUND

The aim of this study is to compare two types of suture bridging constructs; a laterally based bridging single row (SR) construct and a classic dual row (DR) suture bridge construct. The hypothesis is that the DR construct will demonstrate superior biomechanical properties.

METHODS

Six matched pairs of sheep infraspinatus tendon tears repaired with these two different types of suture bridging techniques were tested for gap formation, ultimate failure load and mode of failure. The specimens were pre-cycled for 10 cycles before they were subjected to a constant pre-load of 10N. The specimens were then subjected to cyclic loading at a speed of 8.33 mm/s. The test was stopped after every 500 cycles for a total of 3000 cycles.

RESULTS

Mean gap formation after 3000 cycles was lower in the DR group (0.81 ± 0.2 mm versus 2.44 ± 0.27 mm; p = 0.002). Mean change in gap (with every 500 cycles) was also lesser for the DR group after 1500 cycles. DR repairs failed at a higher load (523.4 ± 80.4 N) compared to the SR repairs (452.3 ± 66.3 N) but this did not reach significance. All repairs failed with sutures pulling through the tendon during load to failure testing.

CONCLUSIONS

Gap formation is significantly lower with a dual row suture bridge construct than a laterally based bridging single row construct.

LEVEL OF EVIDENCE

Biomechanical study.

Prospective multicentre study of the clinical and functional outcomes following quadriceps tendon repair with suture anchors

INTRODUCTION

Quadriceps tendon avulsions are typically treated by reattaching the tendon through bone tunnels, with or without tendon or hardware augmentation. The operated knee joint can be moved right away; however, tendon grafting or tension banding will be required to protect the repair, and the hardware must be removed later on. The goal of this study was to evaluate the clinical and functional outcomes when suture anchors are used to reattached torn quadriceps tendon, and also to assess tendon healing using MRI.

MATERIALS AND METHODS

Thirteen consecutive patients with avulsed quadriceps tendons were operated and then followed prospectively. The surgical technique consisted of tendon reattachment using at least three anchors, in addition to intratendinous weaving of the sutures. Weight bearing was allowed while using a splint. Rehabilitation was initiated immediately after surgery according to a set protocol.

RESULTS

Eleven patients were followed for a mean of 14.7 months. Two retears occurred in patients who did not wear the splint. Eighty-two per cent of patients were satisfied or very satisfied with the outcome. The mean knee flexion was 124.5°. All patients were able to return to their pre-injury activity levels. The mean time for clinical and functional recovery was 3 months. MRI performed 6 months after the surgical repair revealed good tendon healing.

DISCUSSION

This was the first prospective study performed on quadriceps avulsion patients undergoing suture anchor repair. Prior clinical case reports have shown that this method leads to predictable clinical and functional results. Our results were comparable to those in published cases.

CONCLUSION

The procedure is simpler when only suture anchors are used. Tendon healing was observed on MRI in all cases. This simple, reproducible technique is free of the drawbacks associated with the typical repair augmentation.