Basic Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2020; 11(1): 10-17
Published online Jan 18, 2020. doi: 10.5312/wjo.v11.i1.10
Double-row repair of rotator cuff tears: Comparing tendon contact area between techniques
Shao Hui Allan Ng, Chung Hui James Tan
Shao Hui Allan Ng, Chung Hui James Tan, Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
Author contributions: Tan CHJ designed, directed and coordinated the research; Ng SHA performed the majority of the experiments and analysed the data; Ng SHA and Tan CHJ wrote the manuscript.
Institutional animal care and use committee statement: No human or live animal subjects were involved in this study. Use of animal tissues does not require IACUC approval if the tissues are obtained from commercial sources or from the Tissue Sharing Programme.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shao Hui Allan Ng, FRCS (Orth), MB, BCh, MRCS (Edin), MMed (Ortho), Doctor, Surgeon, Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore. ng.allan.sh@ktph.com.sg
Received: March 12, 2019
Peer-review started: March 20, 2019
First decision: June 11, 2019
Revised: August 30, 2019
Accepted: November 6, 2019
Article in press: November 6, 2019
Published online: January 18, 2020
Processing time: 304 Days and 13.3 Hours
ARTICLE HIGHLIGHTS
Research background

In rotator cuff repair surgery, the double-row technique is widely performed and remains one of the most commonly performed techniques. The double-row repair is traditionally performed using four suture anchors.

Research motivation

This study proves that the use of a 3-suture anchor construct is non-inferior to that of a 4-suture anchor construct in terms of footprint contact area. The use of a 3-suture anchor construct may potentially translate to significant reductions in surgical and anaesthetic times, as well as a reduction in healthcare costs in the long run. Future research studying the contact pressure and pull-out strength can be undertaken to validate further the use of a 3-suture anchor construct as a non-inferior alternative to the 4-suture anchor construct while achieving the abovementioned benefits.

Research objectives

The objective of our study was to demonstrate for the first time that there is no statistical difference in tendon to bone contact area when using a 3 or 4-suture anchor construct. By demonstrating so, it has introduced the possibility that the 3-anchor construct may be a comparable alternative to the standard 4-anchor construct in terms of efficacy. This study can be used in conjunction with future research comparing contact pressure and pull-out strength to further validate the use of 3-anchor construct over the traditional 4-anchor construct.

Research methods

Twenty-four fresh porcine shoulders without gross evidence of rotator cuff pathology were used. The use of a porcine model was chosen due to a previous study reporting the geometric and biomechanical similarities between the porcine infraspinatus tendon and the human supraspinatus tendon. Identical tears were created in these porcine shoulders over a 1.5 cm × 2.5 cm infraspinatus insertion footprint. Double-row repair techniques, with 3 to 4-suture anchors in different configurations, were employed for three control groups. Each group consisted of eight shoulders with identical repair configurations. Footprint contact areas of the repaired tendon against the tuberosity were determined using pressure sensitive Fujifilm placed between the tendon and tuberosity.

Research results

The study demonstrated for the first time that there is no statistical difference in tendon-to-bone contact area when using a 3 or 4-suture anchor construct. This study can be used in conjunction with future research comparing contact pressure and pull-out strength to further validate the use of 3-anchor construct over the traditional 4-anchor construct.

Research conclusions

The study found for the first time that there is no statistical difference in tendon-to-bone contact area when using a 3 or 4-suture anchor construct. It has hence introduced the possibility that the 3-anchor construct may be a comparable alternative to the traditional 4-anchor construct in terms of efficacy. This may potentially translate to shorter surgical times and lower healthcare costs with the use of fewer anchors without compromising tendon-to-bone healing of rotator cuff tears.

Research perspectives

This study introduces a new, alternative technique to the traditional 4-anchor construct that has been performed for years. This study can be used in conjunction with future research comparing contact pressure and pull-out strength to validate further the use of 3-anchor construct over the traditional 4-anchor construct.