The Journal of Bone and Joint Surgery (American). 2006;88:2425-2431.
doi:10.2106/JBJS.E.00697
© 2006 The Journal of Bone and Joint Surgery, Inc.
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A Biomechanical Comparison of Single and Double-Row Fixation in Arthroscopic Rotator Cuff Repair

Christopher D. Smith, MBBS1, Susan Alexander, PhD1, Adam M. Hill, PhD2, Pol E. Huijsmans, MD3, Anthony M.J. Bull, PhD2, Andrew A. Amis, DSc4, Joe F. De Beer, MMed(Orthop)3 and Andrew L. Wallace, PhD, FRACS1

1 The Shoulder Unit, Hospital of St. John and St. Elizabeth, 60 Grove End Road, London NWB 9NH, United Kingdom
2 Department of Bioengineering, Imperial College London, Mechanical Engineering Building, Exhibition Road, London SW7 2AZ, United Kingdom. E-mail address for A.M.J. Bull: a.bull{at}imperial.ac.uk
3 Cape Shoulder Institute, P.O. Box 15741, Panorama 7506, South Africa
4 Departments of Musculoskeletal Surgery and Mechanical Engineering, Imperial College London, London SW7 2AZ, United Kingdom

Investigation performed at Imperial College, London, United Kingdom

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The optimal method for arthroscopic rotator cuff repair is not yet known. The hypothesis of the present study was that a double-row repair would demonstrate superior static and cyclic mechanical behavior when compared with a single-row repair. The specific aims were to measure gap formation at the bone-tendon interface under static creep loading and the ultimate strength and mode of failure of both methods of repair under cyclic loading.

Methods: A standardized tear of the supraspinatus tendon was created in sixteen fresh cadaveric shoulders. Arthroscopic rotator cuff repairs were performed with use of either a double-row technique (eight specimens) or a single-row technique (eight specimens) with nonabsorbable sutures that were double-loaded on a titanium suture anchor. The repairs were loaded statically for one hour, and the gap formation was measured. Cyclic loading to failure was then performed.

Results: Gap formation during static loading was significantly greater in the single-row group than in the double-row group (mean and standard deviation, 5.0 ± 1.2 mm compared with 3.8 ± 1.4 mm; p < 0.05). Under cyclic loading, the double-row repairs failed at a mean of 320 ± 96.9 N whereas the single-row repairs failed at a mean of 224 ± 147.9 N (p = 0.058). Three single-row repairs and three double-row repairs failed as a result of suture cut-through. Four single-row repairs and one double-row repair failed as a result of anchor or suture failure. The remaining five repairs did not fail, and a midsubstance tear of the tendon occurred.

Conclusions: Although more technically demanding, the double-row technique demonstrates superior resistance to gap formation under static loading as compared with the single-row technique.

Clinical Relevance: A double-row reconstruction of the supraspinatus tendon insertion may provide a more reliable construct than a single-row repair and could be used as an alternative to open reconstruction for the treatment of isolated tears.


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