Arthroscopic single anchor repair techniques for upper third subscapularis tears provide sufficient biomechanical stability.
Biomechanics
Rotator cuff
Shoulder
Tendon repair
Journal
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
ISSN: 1433-7347
Titre abrégé: Knee Surg Sports Traumatol Arthrosc
Pays: Germany
ID NLM: 9314730
Informations de publication
Date de publication:
Jun 2022
Jun 2022
Historique:
received:
03
05
2021
accepted:
15
11
2021
pubmed:
26
11
2021
medline:
26
5
2022
entrez:
25
11
2021
Statut:
ppublish
Résumé
Upper third tears of the subscapularis tendon can be repaired successfully with a single anchor according to previous literature. The aim of the present study was to compare three single anchor repair techniques regarding fixation strength, footprint coverage and contact pressure in a biomechanical test set-up on human cadaveric shoulders. Eighteen human cadaveric shoulders were randomized in three groups with respect to the repair technique; group 1: knotted lasso-loop mattress, group 2: knotted mattress and group 3: knotless tape repair. Upper third tears of the subscapularis tendon (Lafosse type 2) were created and repairs were performed with additional contact pressure and area measurement using a pressure mapping system. Cyclic testing was performed by loading the subscapularis from 10 to 100 N for 300 cycles. A position-controlled ramp protocol up to 30 and 50 N was used to allow for pressure measurements. Finally, specimens were loaded to failure and failure modes were recorded. The three groups were not significantly different regarding age, gender, bone mineral density at the lesser tuberosity, subscapularis footprint size and defect area created at the upper subscapularis insertion. A significant difference was detected between group 1 (48.6 ± 13.8%) and group 2 (25.9 ± 5.7%) regarding pressurized footprint coverage (p = 0.028). Ultimate load to failure was 630.8 ± 145.3 N in group 1, 586.9 ± 220.7 N in group 2 and 678.2 ± 236.5 N in group 3, respectively. Cyclic displacement was similar in all three groups with an average displacement of 1.2 ± 0.6 mm. The highest stiffness was found in group 1 with 88 ± 30.3, which was not statistically significantly different to group 2 (65 ± 27 N/mm) and group 3 (83.9 ± 32.9 N/mm). The most common mode of failure was suture cut-through at the suture-tendon interface (44%). Failures in group 3 were less common associated with suture cut-through (33% vs. 50% in group 1 and 2), but no significant differences were found. All three tested single anchor repair techniques of upper third subscapularis tears were able to provide sufficient biomechanical stability. Knotted lasso-loop mattress and knotless tape repair were superior regarding pressurized footprint coverage compared to a knotted horizontal mattress technique and are, therefore, preferable techniques for upper subscapularis repair.
Identifiants
pubmed: 34821943
doi: 10.1007/s00167-021-06808-0
pii: 10.1007/s00167-021-06808-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2105-2112Informations de copyright
© 2021. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
Références
Bisson LJ, Manohar LM, Wilkins RD, Gurske-Deperio J, Ehrensberger MT (2008) Influence of suture material on the biomechanical behavior of suture-tendon specimens: a controlled study in bovine rotator cuff. Am J Sports Med 36:907–912
doi: 10.1177/0363546508314793
Borbas P, Fischer L, Ernstbrunner L, Hoch A, Bachmann E, Bouaicha S et al (2021) High-strength suture tapes are biomechanically stronger than high-strength sutures used in rotator cuff repair. Arthrosc Sports Med Rehabil 3:e873–e880
doi: 10.1016/j.asmr.2021.01.029
Burkhart SS, Tehrany AM (2002) Arthroscopic subscapularis tendon repair: technique and preliminary results. Arthroscopy 18:454–463
doi: 10.1053/jars.2002.30648
Cole BJ, ElAttrache NS, Anbari A (2007) Arthroscopic rotator cuff repairs: an anatomic and biomechanical rationale for different suture-anchor repair configurations. Arthroscopy 23:662–669
doi: 10.1016/j.arthro.2007.02.018
Cummins CA, Murrell GA (2003) Mode of failure for rotator cuff repair with suture anchors identified at revision surgery. J Shoulder Elbow Surg 12:128–133
doi: 10.1067/mse.2003.21
Denard PJ, Burkhart SS (2013) Arthroscopic recognition and repair of the torn subscapularis tendon. Arthrosc Tech 2:e373-379
doi: 10.1016/j.eats.2013.05.007
Dyrna F, Beitzel K, Pauzenberger L, Dwyer CR, Obopilwe E, Mazzocca AD et al (2019) A superolaterally placed anchor for subscapularis “leading-edge” refixation: a biomechanical study. Arthroscopy 35:1306–1313
doi: 10.1016/j.arthro.2018.11.060
Ek ET, Perret MC, Borbas P (2020) Arthroscopic knotless repair of complete full-thickness tears of the subscapularis tendon through a single portal. Arthrosc Tech 9:e439–e443
doi: 10.1016/j.eats.2019.11.015
Fox JA, Noerdlinger M, Sasso LM, Romeo AA (2004) Arthroscopic subscapularis repair. In: Textbook of arthroscopy. Elsevier, Amsterdam, p 241257
Gerber C, Krushell RJ (1991) Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br 73:389–394
doi: 10.1302/0301-620X.73B3.1670434
Hapa O, Barber FA, Sunbuloglu E, Kocabey Y, Sarkalkan N, Baysal G (2011) Tendon-grasping strength of various suture configurations for rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 19:1749–1754
doi: 10.1007/s00167-010-1322-y
Hasler A, Boyce G, Schallberger A, Jost B, Catanzaro S, Gerber C (2019) Arthroscopic repair of isolated subscapularis tears: clinical outcome and structural integrity with a minimum follow-up of 4.6 years. J Shoulder Elbow Surg 28:2171–2180
doi: 10.1016/j.jse.2019.03.024
Katthagen JC, Vap AR, Tahal DS, Horan MP, Millett PJ (2017) Arthroscopic repair of isolated partial- and full-thickness upper third subscapularis tendon tears: minimum 2-year outcomes after single-anchor repair and biceps tenodesis. Arthroscopy 33:1286–1293
doi: 10.1016/j.arthro.2017.01.027
Keating JF, Waterworth P, Shaw-Dunn J, Crossan J (1993) The relative strengths of the rotator cuff muscles. A cadaver study. J Bone Joint Surg Br 75:137–140
doi: 10.1302/0301-620X.75B1.8421011
Kim SH, Oh I, Park JS, Shin SK, Jeong WK (2005) Intra-articular repair of an isolated partial articular-surface tear of the subscapularis tendon. Am J Sports Med 33:1825–1830
doi: 10.1177/0363546505278259
Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R (2007) Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am 89:1184–1193
doi: 10.2106/00004623-200706000-00005
Lafosse L, Van Raebroeckx A, Brzoska R (2006) A new technique to improve tissue grip: “the lasso-loop stitch.” Arthroscopy 22(1246):e1241-1243
Lee S, Mahar A, Bynum K, Pedowitz R (2005) Biomechanical comparison of bioabsorbable sutureless screw anchor versus suture anchor fixation for rotator cuff repair. Arthroscopy 21:43–47
doi: 10.1016/j.arthro.2004.09.020
Liodakis E, Dratzidis A, Kraemer M, Hurschler C, Krettek C, Hawi A et al (2016) The lasso-loop, lasso-mattress and simple-cinch stitch for arthroscopic rotator cuff repair: are there biomechanical differences? Arch Orthop Trauma Surg 136:1581–1585
doi: 10.1007/s00402-016-2540-7
Lorbach O, Trennheuser C, Kieb M, Efe T, Kohn D, Anagnostakos K (2016) Reconstruction of 25 and 50% subscapularis tears: a single anchor with a double-mattress suture is sufficient for the reconstruction. Knee Surg Sports Traumatol Arthrosc 24:3855–3862
doi: 10.1007/s00167-015-3767-5
Mazzocca AD, Bollier MJ, Ciminiello AM, Obopilwe E, DeAngelis JP, Burkhart SS et al (2010) Biomechanical evaluation of arthroscopic rotator cuff repairs over time. Arthroscopy 26:592–599
doi: 10.1016/j.arthro.2010.02.009
Park MC, Pirolo JM, Park CJ, Tibone JE, McGarry MH, Lee TQ (2009) The effect of abduction and rotation on footprint contact for single-row, double-row, and modified double-row rotator cuff repair techniques. Am J Sports Med 37:1599–1608
doi: 10.1177/0363546509332506
Ponce BA, Hosemann CD, Raghava P, Tate JP, Eberhardt AW, Lafosse L (2011) Biomechanical evaluation of 3 arthroscopic self-cinching stitches for shoulder arthroscopy: the lasso-loop, lasso-mattress, and double-cinch stitches. Am J Sports Med 39:188–194
doi: 10.1177/0363546510383394
Sgroi M, Kappe T, Ludwig M, Fuchs M, Dornacher D, Reichel H et al (2021) Are knotted or knotless techniques better for reconstruction of full-thickness tears of the superior portion of the subscapularis tendon? A study in cadaver. Clin Orthop Relat Res. https://doi.org/10.1097/CORR.0000000000001970
doi: 10.1097/CORR.0000000000001970
Simmer Filho J, Voss A, Pauzenberger L, Dwyer CR, Obopilwe E, Cote MP et al (2019) Footprint coverage comparison between knotted and knotless techniques in a single-row rotator cuff repair: biomechanical analysis. BMC Musculoskelet Disord 20:123
doi: 10.1186/s12891-019-2479-2
Turkel SJ, Panio MW, Marshall JL, Girgis FG (1981) Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint. J Bone Joint Surg Am 63:1208–1217
doi: 10.2106/00004623-198163080-00002
Urch E, Lin CC, Itami Y, Patel NA, McGarry MH, Limpisvasti O et al (2020) Improved rotator cuff footprint contact characteristics with an augmented repair construct using lateral edge fixation. Am J Sports Med 48:444–449
doi: 10.1177/0363546519888182