The double-row suture bridge (SB) is an effective technique for rotator cuff repair. However, because of high-tension sutures and tendon vascular insufficiency, nonunion or retearing of the rotator cuff after SB repair is common. The low-tension suture and microfracture features of the SCOI Row (SR) technique may help address these issues.
Purpose:
To compare the biomechanical and histological outcomes of SR and SB techniques in treating rotator cuff tears in rabbits.
Study Design:
Controlled laboratory study.
Methods:
The study utilized a model of acute bilateral supraspinatus tendon tears in the shoulders of 42 New Zealand rabbits. The tear was randomly repaired using either the SR or SB technique on the left or right shoulder. Twelve rabbits were euthanized at 2, 4, and 8 weeks after surgery. Six rabbits were assigned for histological evaluation, while the other 6 were designated for biomechanical testing. Six of the original 42 animals were exclusively allocated for preliminary biomechanical testing at the 0-week time point.
Results:
At 8 weeks after surgery, all mended tendons were successfully attached to the footprint region of the greater tubercle without any postoperative complications. In comparison with the SB group, the SR group exhibited superior histological tendon-bone healing characterized by enhanced fibrocartilage regeneration, collagen composition, and fibrous tissue structure. The biomechanical results of the SR group exhibited superior performance compared with the SB group at both the 0- and 8-week postoperative assessments.
Conclusions:
Both repair techniques have demonstrated effectiveness in the rabbit rotator cuff tear model. Nevertheless, when compared with SB, SR demonstrates superior advantages in enhancing biomechanical properties and histological tendon-bone healing.
Clinical Relevance:
This study proposes that the SR technique could serve as a viable treatment alternative for rotator cuff tears in humans, as it can improve tendon-bone healing and decrease the incidence of failed healing.
Ansah-TwumJBelkJWCannizzaroCK, et al. Knotted transosseous-equivalent technique for rotator cuff repair shows superior biomechanical properties compared with a knotless technique: a systematic review and meta-analysis. Arthroscopy. 2022;38(3):1019-1027.
2.
ArroyoWGetelmanMHSnyderSJ.Single row rotator cuff repair with triple loaded suture anchors: the SCOI Row technique. Arthroscopy. 2021;37(8):2397-2398.
3.
BarberFAHerbertMASchroederFAAziz-JacoboJMaysMMRapleyJH.Biomechanical advantages of triple-loaded suture anchors compared with double-row rotator cuff repairs. Arthroscopy. 2010;26(3):316-323.
4.
BilselKYildizFKapiciogluM, et al. Efficacy of bone marrow-stimulating technique in rotator cuff repair. J Shoulder Elbow Surg. 2017;26(8):1360-1366.
5.
BurkhartSSDenardPJKonicekJHanypsiakBT.Biomechanical validation of load-sharing rip-stop fixation for the repair of tissue-deficient rotator cuff tears. Am J Sports Med. 2014;42(2):457-462.
6.
ChanskyHAIannottiJP.The vascularity of the rotator cuff. Clin Sports Med. 1991;10(4):807-822.
7.
ChoNSLeeBGRheeYG.Arthroscopic rotator cuff repair using a suture bridge technique: is the repair integrity actually maintained?Am J Sports Med. 2011;39(10):2108-2116.
8.
ChoNSMoonSCHongSJBaeSHRheeYG.Comparison of clinical and radiological results in the arthroscopic repair of full-thickness rotator cuff tears with and without the anterior attachment of the rotator cable. Am J Sports Med. 2017;45(11):2532-2539.
9.
ChoNSYiJWLeeBGRheeYG.Retear patterns after arthroscopic rotator cuff repair: single-row versus suture bridge technique. Am J Sports Med. 2010;38(4):664-671.
10.
ChristoforettiJJKruppRJSingletonSBKissenberthMJCookCHawkinsRJ.Arthroscopic suture bridge transosseus equivalent fixation of rotator cuff tendon preserves intratendinous blood flow at the time of initial fixation. J Shoulder Elbow Surg. 2012;21(4):523-530.
11.
CoonsDABarberFAHerbertMA.Triple-loaded single-anchor stitch configurations: an analysis of cyclically loaded suture-tendon interface security. Arthroscopy. 2006;22(11):1154-1158.
12.
DenardPJBurkhartSS.Techniques for managing poor quality tissue and bone during arthroscopic rotator cuff repair. Arthroscopy. 2011;27(10):1409-1421.
13.
DukanRLedinotPDonadioJBoyerP.Arthroscopic rotator cuff repair with a knotless suture bridge technique: functional and radiological outcomes after a minimum follow-up of 5 years. Arthroscopy. 2019;35(7):2003-2011.
14.
DuquinTRBuyeaCBissonLJ.Which method of rotator cuff repair leads to the highest rate of structural healing? A systematic review. Am J Sports Med. 2010;38(4):835-841.
15.
FoxMAHughesJDDrainNP, et al. Knotted and knotless double row transosseous equivalent repair techniques for arthroscopic rotator cuff repair demonstrate comparable post-operative outcomes. Knee Surg Sports Traumatol Arthrosc. 2023;31(5):1919-1924.
HeHBHuYLiC, et al. Biomechanical comparison between single-row with triple-loaded suture anchor and suture-bridge double-row rotator cuff repair. BMC Musculoskelet Disord. 2020;21(1):629.
18.
HegedusEJCookCBrennanMWylandDGarrisonJCDriesnerD.Vascularity and tendon pathology in the rotator cuff: a review of literature and implications for rehabilitation and surgery. Br J Sports Med. 2010;44(12):838-847.
19.
HeinJReillyJMChaeJMaerzTAndersonK.Retear rates after arthroscopic single-row, double-row, and suture bridge rotator cuff repair at a minimum of 1 year of imaging follow-up: a systematic review. Arthroscopy. 2015;31(11):2274-2281.
20.
HwangSTHorinekJLArdebolJMenendezMEDenardPJ.Rip-stop fixation constructs for rotator cuff repair. Arthroscopy. 2023;39(11):2271-2272.
21.
IdeJKarasugiTOkamotoNTaniwakiTOkaKMizutaH.Functional and structural comparisons of the arthroscopic knotless double-row suture bridge and single-row repair for anterosuperior rotator cuff tears. J Shoulder Elbow Surg. 2015;24(10):1544-1554.
22.
KimDHElattracheNSTiboneJE, et al. Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair. Am J Sports Med. 2006;34(3):407-414.
23.
KimSHChoWSJoungHYChoiYEJungM.Perfusion of the rotator cuff tendon according to the repair configuration using an indocyanine green fluorescence arthroscope: a preliminary report. Am J Sports Med. 2017;45(3):659-665.
24.
KimSHKimJChoiYELeeHR.Healing disturbance with suture bridge configuration repair in rabbit rotator cuff tear. J Shoulder Elbow Surg. 2016;25(3):478-486.
25.
KimSJKimSHMoonHSChunYM.Footprint contact area and interface pressure comparison between the knotless and knot-tying transosseous-equivalent technique for rotator cuff repair. Arthroscopy. 2016;32(1):7-12.
26.
KummerFHerganDJThutDCPahkBJazrawiLM.Suture loosening and its effect on tendon fixation in knotless double-row rotator cuff repairs. Arthroscopy. 2011;27(11):1478-1484.
27.
LeeBGChoNSRheeYG.Modified Mason-Allen suture bridge technique: a new suture bridge technique with improved tissue holding by the modified Mason-Allen stitch. Clin Orthop Surg. 2012;4(3):242-245.
28.
LiXShenPSuWZhaoSZhaoJ.Into-tunnel repair versus onto-surface repair for rotator cuff tears in a rabbit model. Am J Sports Med. 2018;46(7):1711-1719.
29.
LiuSXieYChenQ, et al. Tendon healing progression evaluated with magnetic resonance imaging signal intensity and its correlation with clinical outcomes within 1 year after rotator cuff repair with the suture-bridge technique. Am J Sports Med. 2020;48(3):697-705.
30.
MallNALeeASChahalJ, et al. Transosseous-equivalent rotator cuff repair: a systematic review on the biomechanical importance of tying the medial row. Arthroscopy. 2013;29(2):377-386.
31.
MiyakeSIzakiTArashiroY, et al. Excessively high repair tension decreases microvascular blood flow within the rotator cuff. Am J Sports Med. 2022;50(13):3643-3648.
32.
NakagawaHMoriharaTFujiwaraH, et al. Effect of footprint preparation on tendon-to-bone healing: a histologic and biomechanical study in a rat rotator cuff repair model. Arthroscopy. 2017;33(8):1482-1492.
33.
NeytonLGodenècheANové-JosserandLCarrillonYCléchetJHardyMB.Arthroscopic suture-bridge repair for small to medium size supraspinatus tear: healing rate and retear pattern. Arthroscopy. 2013;29(1):10-17.
34.
NoyesMPLedermanEAdamsCRDenardPJ.Triple-loaded suture anchors versus a knotless rip stop construct in a single-row rotator cuff repair model. Arthroscopy. 2018;34(5):1414-1420.
35.
ParkMCElAttracheNSTiboneJEAhmadCSJunBJLeeTQ.Part I: Footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elbow Surg. 2007;16(4):461-468.
36.
ParkMCTiboneJEElAttracheNSAhmadCSJunBJLeeTQ.Part II: Biomechanical assessment for a footprint-restoring transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elbow Surg. 2007;16(4):469-476.
37.
RaillardMDetottoCGrepperS, et al. Anaesthetic and perioperative management of 14 male New Zealand White rabbits for calvarial bone surgery. Animals (Basel). 2019;9(11):896.
38.
RheeYGChoNSParkeCS.Arthroscopic rotator cuff repair using modified Mason-Allen medial row stitch: knotless versus knot-tying suture bridge technique. Am J Sports Med. 2012;40(11):2440-2447.
39.
SnyderSJBurnsJP.Rotator cuff healing and the bone marrow “crimson duvet” from clinical observations to science. Tech Shoulder Elbow Surg. 2009;10:130-137.
40.
SunYKwakJMQiC, et al. Remnant tendon preservation enhances rotator cuff healing: remnant preserving versus removal in a rabbit model. Arthroscopy. 2020;36(7):1834-1842.
41.
TakeuchiYSugayaHTakahashiN, et al. Repair integrity and retear pattern after arthroscopic medial knot-tying after suture-bridge lateral row rotator cuff repair. Am J Sports Med. 2020;48(10):2510-2517.
42.
WatkinsJPAuerJAGaySMorganSJ.Healing of surgically created defects in the equine superficial digital flexor tendon: collagen-type transformation and tissue morphologic reorganization. Am J Vet Res. 1985;46(10):2091-2096.
43.
ZwolakPMeyerPMolnarLKröberM.The functional outcome of arthroscopic rotator cuff repair with double-row knotless vs knot-tying anchors. Arch Orthop Trauma Surg. 2022;142(1):25-31.
