Purpose
The purpose of this study was to compare the biomechanical characteristics of a massive
L-shaped retracted rotator cuff tear repaired with either soft-tissue side-to-side
sutures or margin convergence anchorage to bone.
Methods
Eight matched pairs of cadaveric shoulders were used. The supraspinatus and infraspinatus
were secured in a clamp at 30° of glenohumeral abduction. The subscapularis was secured
in a separate clamp, and a constant load was applied. A massive L-shaped rotator cuff
tear of the supraspinatus and infraspinatus tendon was created. In all specimens the
posterior aspect of the tear was repaired by a transosseous-equivalent technique.
In 1 group we placed 2 margin convergence sutures between the supraspinatus and the
rotator interval. In the comparison group, a suture anchor was inserted at the anterior
attachment of the rotator cable. Margin convergence anchorage to bone was then performed
between the supraspinatus and the rotator interval. Each specimen was tested with
an Instron machine (Instron, Canton, MA) and a video digitizing system. A paired t test was used for statistical analysis.
Results
Margin convergence anchorage to bone decreased gap formation at cycle 1, cycle 30,
and yield load across the entire footprint (P < .05). In both constructs the anterior gap was greater than the posterior gap at
cycle 1, cycle 30, and yield load (P < .05). Margin convergence anchorage to bone decreased hysteresis and increased stiffness
during the first cycle and increased yield load (P < .05).
Conclusions
Using margin convergence anchorage to bone to restore the anterior attachment of the
rotator cable decreased gap formation across the entire footprint and improved biomechanical
properties for cycle 1 and yield load compared with soft-tissue margin convergence
for massive rotator cuff repairs.
Clinical Relevance
Repairing the anterior rotator cuff with margin convergence anchorage to bone may
improve clinical outcomes of an L-shaped massive tear repair.
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Article info
Publication history
Published online: May 21, 2012
Accepted:
February 17,
2012
Received:
August 29,
2011
Footnotes
The authors report the following potential conflict of interest or source of funding in relation to this article: VA Rehabilitation Research and Development and Merit Review.
Identification
Copyright
Published by Elsevier Inc.
