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Biomechanical Validation of Rotator Cuff Repair Techniques and Considerations for a “Technical Efficiency Ratio”

  • Maxwell C. Park
    Correspondence
    Address correspondence to Maxwell C. Park, M.D., Department of Orthopaedic Surgery, Woodland Hills Medical Center, Kaiser Foundation Hospital, 5601 De Soto Ave, Woodland Hills, CA 91365, U.S.A.
    Affiliations
    Department of Orthopaedic Surgery, Woodland Hills Medical Center, Kaiser Foundation Hospital, Woodland Hills, California, U.S.A.
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      Abstract

      Biomechanical studies are commonly used to validate new or modified rotator cuff repair techniques. Additional knots, more tendon suture passes, and obligatory suture management requirements are often the “cost” for improved biomechanical results. This cost can amount to increased technical difficulty and surgical times. However, technical ease or difficulty as a measurable variable has not been quantified. A basic measure for technical ease would allow surgeons the ability to objectively assess and compare rotator cuff repair practicality and potentially help in the design of future studies to standardize repair techniques alongside biomechanical measures. A proposed rotator cuff repair “technical efficiency ratio” is defined as follows: (No. of knots + No. of tendon suture passes + No. of suture limbs)/No. of pilot holes created. This can give a measure of “work” or utility achieved per fixation point created for a particular type of repair (e.g., single or double row), with a smaller number representing relatively more efficiency per anchor or fixation point used. If repairs validated in the laboratory are too cumbersome to perform in vivo from a practical standpoint, technical ease should be a prerequisite measure, and the success of a repair technique should not necessarily be based on biomechanics alone.
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      References

        • Park M.C.
        • ElAttrache N.S.
        • Ahmad C.S.
        • Tibone J.E.
        “Transosseous-equivalent” rotator cuff repair technique.
        Arthroscopy. 2006; 22: 1360.e1-1360.e5
        • Park M.C.
        • ElAttrache N.S.
        • Tibone J.E.
        • Ahmad C.S.
        • Jun B.J.
        • Lee T.Q.
        Part I: Footprint contact characteristics for an arthroscopic transosseous-equivalent rotator cuff repair technique.
        J Shoulder Elbow Surg. 2007; 16: 461-468
        • Park M.C.
        • Tibone J.E.
        • ElAttrache N.S.
        • Ahmad C.S.
        • Jun B.J.
        • Lee T.Q.
        Part II: Biomechanical assessment for a footprint-restoring arthroscopic transosseous-equivalent rotator cuff repair technique compared to a double-row technique.
        J Shoulder Elbow Surg. 2007; 16: 469-476
        • Burkhart S.S.
        • Adams C.R.
        • Burkhart S.S.
        • Schoolfield J.D.
        A biomechanical comparison of 2 techniques of footprint reconstruction for rotator cuff repair: The SwiveLock-FiberChain construct versus standard double-row repair.
        Arthroscopy. 2009; 25: 274-281
        • Rhee Y.G.
        • Cho N.S.
        • Parke C.S.
        Arthroscopic rotator cuff repair using modified Mason-Allen medial row stitch: Knotless versus knot-tying suture bridge technique.
        Am J Sports Med. 2012; 40: 2440-2447
        • Ostrander III, R.V.
        • McKinney B.I.
        Evaluation of footprint contact area and pressure using a triple-row modification of the suture-bridge technique for rotator cuff repair.
        J Shoulder Elbow Surg. 2012; 21: 1406-1412
        • Burkhart S.S.
        • Denard P.J.
        • Obopilwe E.
        • Mazzocca A.D.
        Optimizing pressurized contact area in rotator cuff repair: The diamondback repair.
        Arthroscopy. 2012; 28: 188-195
        • Kaplan K.
        • ElAttrache N.S.
        • Vazquez O.
        • Chen Y.J.
        • Lee T.Q.
        Knotless rotator cuff repair in an external rotation model: The importance of medial-row horizontal mattress sutures.
        Arthroscopy. 2011; 27: 471-478
        • Pauly S.
        • Kieser B.
        • Schill A.
        • Gerhardt C.
        • Scheibel M.
        Biomechanic comparison of 4 double-row suture bridging rotator cuff repair techniques using different medial-row configurations.
        Arthroscopy. 2010; 26: 1281-1288
        • Spang J.T.
        • Buchmann S.
        • Brucker P.U.
        • et al.
        A biomechanical comparison of 2 transosseous-equivalent double-row rotator cuff repair techniques using bioabsorbable anchors: Cyclic loading and failure behavior.
        Arthroscopy. 2009; 25: 872-879
        • Jost P.W.
        • Khair M.M.
        • Chen D.X.
        • Wright T.W.
        • Kelly A.M.
        • Rodeo S.A.
        Suture number determines strength of rotator cuff repair.
        J Bone Joint Surg Am. 2012; 94: e100
        • Garofalo R.
        • Castagna A.
        • Borroni M.
        • Krishnan S.G.
        Arthroscopic transosseous (anchorless) rotator cuff repair.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 1031-1035
        • Barber F.A.
        • Drew O.R.
        A biomechanical comparison of tendon-bone interface motion and cyclic loading between single-row, triple-loaded cuff repairs and double-row, suture-tape cuff repairs using biocomposite anchors.
        Arthroscopy. 2012; 28: 1197-1205
        • Park M.C.
        • Jun B.J.
        • Park C.J.
        • Ahmad C.S.
        • ElAttrache N.S.
        • Lee T.Q.
        The biomechanical effects of dynamic external rotation on rotator cuff repair compared to testing with the humerus fixed.
        Am J Sports Med. 2007; 35: 1931-1939
      1. Park MC, Peterson A, Patton J, Park CJ, McGarry MH, Lee TQ. Biomechanical effects of a 2 suture-pass interimplant mattress on transosseous-equivalent rotator cuff repair and considerations for a “technical efficiency ratio.” Poster presentation at the Arthroscopy Association of North America Annual Meeting, San Antonio, TX, April 25-27, 2013.

        • Neyton L.
        • Godeneche A.
        • Nove-Josserand L.
        • Carrillon Y.
        • Clechet J.
        • Hardy M.B.
        Arthroscopic suture-bridge repair for small to medium size supraspinatus tear: Healing rate and retear pattern.
        Arthroscopy. 2013; 29: 10-18
        • Sethi P.M.
        • Noonan B.C.
        • Cunningham J.
        • Shreck E.
        • Miller S.
        Repair results of 2-tendon rotator cuff tears utilizing the transosseous equivalent technique.
        J Shoulder Elbow Surg. 2010; 19: 1210-1217
        • Frank J.B.
        • ElAttrache N.S.
        • Dines J.S.
        • Blackburn A.
        • Crues J.
        • Tibone J.E.
        Repair site integrity after arthroscopic “transosseous-equivalent/suture-bridge” rotator cuff repair.
        Am J Sports Med. 2008; 36: 1496-1503
        • Park M.C.
        • Cadet E.R.
        • Levine W.N.
        • Bigliani L.U.
        • Ahmad C.S.
        Tendon-to-bone pressure distributions at a repaired rotator cuff footprint using transosseous suture and suture anchor fixation techniques.
        Am J Sports Med. 2005; 33: 1154-1159
        • Park M.C.
        • Pirolo J.M.
        • Park C.J.
        • McGarry M.H.
        • Tibone J.E.
        • Lee T.Q.
        The effect of abduction and rotation on footprint contact for single-row, double-row, and transosseous-equivalent rotator cuff repair techniques.
        Am J Sports Med. 2009; 37: 1599-1608
        • Kim D.H.
        • ElAttrache N.S.
        • Tibone J.E.
        • et al.
        Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair.
        Am J Sports Med. 2006; 34: 407-414
        • Ma C.B.
        • Comerford L.
        • Wilson J.
        • Puttlitz C.
        Biomechanical evaluation of arthroscopic rotator cuff repairs: Double-row compared with single-row fixation.
        J Bone Joint Surg Am. 2006; 88: 403-410
        • Park M.C.
        • Bui C.
        • Park C.J.
        • Oh J.H.
        • Lee T.Q.
        Rotator cuff tendon repair morphology comparing 2 single-anchor repair techniques.
        Arthroscopy. 2013; 29: 1149-1156
        • Busfield B.T.
        • Glousman R.E.
        • McGarry M.H.
        • Tibone J.E.
        • Lee T.Q.
        A biomechanical comparison of 2 technical variations of double-row rotator cuff fixation: The importance of medial-row knots.
        Am J Sports Med. 2008; 36: 901-906
        • Park M.C.
        • Idjadi J.A.
        • ElAttrache N.S.
        • Tibone J.E.
        • McGarry M.H.
        • Lee T.Q.
        The effect of dynamic external rotation comparing 2 footprint-restoring rotator cuff repair techniques.
        Am J Sports Med. 2008; 36: 893-900
        • Ahmad C.S.
        • Vorys G.C.
        • Covey A.
        • Levine W.N.
        • Gardner T.R.
        • Bigliani L.U.
        Rotator cuff repair fluid extravasation characteristics are influenced by repair technique.
        J Shoulder Elbow Surg. 2009; 18: 976-981
        • Pennington W.T.
        • Gibbons D.J.
        • Bartz B.A.
        • et al.
        Comparative analysis of single-row versus double-row repair of rotator cuff tears.
        Arthroscopy. 2010; 26: 1419-1426
        • Voigt C.
        • Bosse C.
        • Vosshenrich R.
        • Schulz A.P.
        • Lill H.
        Arthroscopic supraspinatus tendon repair with suture-bridging technique.
        Am J Sports Med. 2010; 38: 983-991
        • Arrigoni P.
        • Brady P.C.
        • Burkhart S.S.
        The double-pulley technique for double-row rotator cuff repair.
        Arthroscopy. 2007; 23: 675.e1-675.e4
        • Lorbach O.
        • Kieb M.
        • Raber F.
        • Busch L.C.
        • Kohn D.M.
        • Pape D.
        Three-dimensional evaluation of cyclic displacement in single-row and double-row rotator cuff reconstruction under static external rotation.
        Am J Sports Med. 2013; 41: 153-162
        • Park M.C.
        • Ahmad C.S.
        • ElAttrache N.S.
        • Lee T.Q.
        Regarding biomechanical advantages of triple-loaded suture anchors.
        Arthroscopy. 2010; 26: 873-874