PMID- 28520458
OWN - NLM
STAT- MEDLINE
DCOM- 20180312
LR  - 20181202
IS  - 1552-3365 (Electronic)
IS  - 0363-5465 (Linking)
VI  - 45
IP  - 10
DP  - 2017 Aug
TI  - Anchored Transosseous-Equivalent Versus Anchorless Transosseous Rotator Cuff 
      Repair: A Biomechanical Analysis in a Cadaveric Model.
PG  - 2364-2371
LID - 10.1177/0363546517706136 [doi]
AB  - BACKGROUND: The original approach for the repair of torn rotator cuffs involved 
      an open technique with sutures passing through the greater tuberosity and tendon. 
      The development of suture anchors allowed for an all-arthroscopic approach with 
      anchor configurations attempting to re-create a transosseous fixation pattern. 
      Presently, an arthroscopic approach can be combined with a transosseous suture 
      configuration without using anchors. PURPOSE: To evaluate cyclic loading, 
      ultimate load to failure, and the failure mechanisms of transosseous-equivalent 
      (TOE) repair with anchors and anchorless transosseous (AT) repair of rotator cuff 
      tears. STUDY DESIGN: Controlled laboratory study. METHODS: Supraspinatus tears 
      (25 mm) were created in 20 fresh-frozen, human cadaveric shoulders, which were 
      randomized to TOE or AT repair (10 in each group, paired experimental design). 
      Biomechanical testing was performed with an initial preload, cyclic loading, and 
      load to failure. Optical markers were used to monitor gap formation in 3 planes, 
      and the failure mode was recorded. Paired t tests were used to make comparisons 
      of biomechanical parameters between the groups. Multinomial logistic regression 
      was used to compare failure modes between the groups. Significance was set to 
      .05. RESULTS: The TOE group had a significantly higher mean (+/-SD) ultimate 
      failure load (578.5 +/- 123.8 N) than the AT group (468.7 +/- 150.9 N) ( P = .034). 
      The TOE group also had a significantly less mean first-cycle excursion (2.97 +/- 
      1.97 mm) than the AT group (4.70 +/- 2.04 mm) ( P = .046). There were no 
      significant differences between the groups in cyclic elongation or linear 
      stiffness during cyclic loading. Primary modes of failure were a type 2 tendon 
      tear with medial tendon disruption in the TOE group (7/10) and a type 1 tendon 
      tear with lateral tendon disruption in the AT group (6/10). CONCLUSION: TOE 
      repair resulted in a significantly higher mean failure load compared with AT 
      repair in a cadaveric model. The most common modes of failure were a type 2 
      tendon tear in the TOE group and a type 1 tendon tear in the AT group. CLINICAL 
      RELEVANCE: A higher mean failure load in TOE versus AT constructs may come at the 
      cost of a less favorable failure mode adjacent to medial anchors at the 
      musculotendinous junction, potentially making revision difficult.
FAU - Kilcoyne, Kelly G
AU  - Kilcoyne KG
AD  - William Beaumont Army Medical Center, El Paso, Texas, USA.
FAU - Guillaume, Stanley G
AU  - Guillaume SG
AD  - Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, 
      Maryland, USA.
FAU - Hannan, Catherine V
AU  - Hannan CV
AD  - Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, 
      Maryland, USA.
FAU - Langdale, Evan R
AU  - Langdale ER
AD  - Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, 
      Maryland, USA.
FAU - Belkoff, Stephen M
AU  - Belkoff SM
AD  - Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, 
      Maryland, USA.
FAU - Srikumaran, Uma
AU  - Srikumaran U
AD  - Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, 
      Maryland, USA.
LA  - eng
PT  - Journal Article
DEP - 20170518
PL  - United States
TA  - Am J Sports Med
JT  - The American journal of sports medicine
JID - 7609541
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Arthroplasty/instrumentation/*methods
MH  - Biomechanical Phenomena
MH  - Cadaver
MH  - Female
MH  - Humans
MH  - Male
MH  - Rotator Cuff/chemistry/surgery
MH  - Rotator Cuff Injuries/*surgery
MH  - Suture Anchors
MH  - Suture Techniques
MH  - Sutures
MH  - Tendons/surgery
OTO - NOTNLM
OT  - arthroscopic bone tunnels
OT  - biomechanical testing
OT  - rotator cuff repair
OT  - transosseous equivalent
EDAT- 2017/05/19 06:00
MHDA- 2018/03/13 06:00
CRDT- 2017/05/19 06:00
PHST- 2017/05/19 06:00 [pubmed]
PHST- 2018/03/13 06:00 [medline]
PHST- 2017/05/19 06:00 [entrez]
AID - 10.1177/0363546517706136 [doi]
PST - ppublish
SO  - Am J Sports Med. 2017 Aug;45(10):2364-2371. doi: 10.1177/0363546517706136. Epub 
      2017 May 18.