The Journal of Bone and Joint Surgery (American). 2006;88:403-410.
doi:10.2106/JBJS.D.02887
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Biomechanical Evaluation of Arthroscopic Rotator Cuff Repairs: Double-Row Compared with Single-Row Fixation

C. Benjamin Ma, MD1, Lyn Comerford, MSc2, Joseph Wilson, MD2 and Christian M. Puttlitz, PhD3

1 Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MU 320W, San Francisco, CA 94143-0728. E-mail address for C.B. Ma: maben{at}orthosurg.ucsf.edu
2 Orthopaedic Biomechanics Laboratory, San Francisco General Hospital, 1001 Potrero Avenue, #3A36, San Francisco, CA 94110
3 Department of Mechanical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, CO 80523

Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, and the Orthopaedic Biomechanics Laboratory, San Francisco General Hospital, San Francisco, California

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: Recent studies have shown that arthroscopic rotator cuff repairs can have higher rates of failure than do open repairs. Current methods of rotator cuff repair have been limited to single-row fixation of simple and horizontal stitches, which is very different from open repairs. The objective of this study was to compare the initial cyclic loading and load-to-failure properties of double-row fixation with those of three commonly used single-row techniques.

Methods: Ten paired human supraspinatus tendons were split in half, yielding four tendons per cadaver. The bone mineral content at the greater tuberosity was assessed. Four stitch configurations (two-simple, massive cuff, arthroscopic Mason-Allen, and double-row fixation) were randomized and tested on each set of tendons. Specimens were cyclically loaded between 5 and 100 N at 0.25 Hz for fifty cycles and then loaded to failure under displacement control at 1 mm/sec. Conditioning elongation, peak-to-peak elongation, ultimate tensile load, and stiffness were measured with use of a three-dimensional tracking system and compared, and the failure type (suture or anchor pull-out) was recorded.

Results: No significant differences were found among the stitches with respect to conditioning elongation. The mean peak-to-peak elongation (and standard error of the mean) was significantly lower for the massive cuff (1.1 ± 0.1 mm) and double-row stitches (1.1 ± 0.1 mm) than for the arthroscopic Mason-Allen stitch (1.5 ± 0.2 mm) (p < 0.05). The ultimate tensile load was significantly higher for double-row fixation (287 ± 24 N) than for all of the single-row fixations (p < 0.05). Additionally, the massive cuff stitch (250 ± 21 N) was found to have a significantly higher ultimate tensile load than the two-simple (191 ± 18 N) and arthroscopic Mason-Allen (212 ± 21 N) stitches (p < 0.05). No significant differences in stiffness were found among the stitches. Failure mechanisms were similar for all stitches. Rotator cuff repairs in the anterior half of the greater tuberosity had a significantly lower peak-to-peak elongation and higher ultimate tensile strength than did repairs on the posterior half.

Conclusions: In this in vitro cadaver study, double-row fixation had a significantly higher ultimate tensile load than the three types of single-row fixation stitches. Of the single-row fixations, the massive cuff stitch had cyclic and load-to-failure characteristics similar to the double-row fixation. Anterior repairs of the supraspinatus tendon had significantly stronger biomechanical behavior than posterior repairs.

Clinical Relevance: The results of this study support the concept that double-row fixation can improve the initial fixation strength of arthroscopic rotator cuff repairs.


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