A watertight construct in arthroscopic rotator cuff repair

• Published in: Journal of shoulder and elbow surgery 2012-05, Vol.21 (5), p.589-596
• Main Authors: Nassos, Jonathan T., MD, ElAttrache, Neal S., MD, Angel, Michael J., MD, Tibone, James E., MD, Limpisvasti, Orr, MD, Lee, Thay Q., PhD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Arthroscopy; Arthroscopy - methods; Biological and medical sciences; Biomechanical Phenomena; Bursa, Synovial - physiopathology; Bursa, Synovial - surgery; Cadaver; Diseases of the osteoarticular system; Endoscopy; Female; footprint; healing; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Orthopedics; repair; Rotator cuff; Rotator Cuff - physiopathology; Rotator Cuff - surgery; Rotator Cuff Injuries; Shoulder Joint - injuries; Shoulder Joint - surgery; Suture Techniques; synovial fluid; transosseous equivalent; Wound Healing
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2011.04.008

Background It is unknown which type of rotator cuff repair technique best isolates the healing zone interface from the synovial fluid environment. The purpose of this study was to determine the leakage area and pattern onto the rotator cuff footprint after 3 different rotator cuff repairs. Materials and methods Six fresh frozen cadaveric glenohumeral joints in each of 3 groups were injected with gelatin to a pressure of 103 mm Hg (∼2 psi) after 1 of 3 different rotator cuff repairs of a supraspinatus tear: (1) single-row repair (SR), (2) knotless transosseous equivalent repair (KTE), and (3) traditional transosseous equivalent repair (TTE), which uses medial tied knots. Specimens were cycled in external rotation and abduction and were cooled to allow the gelatin to solidify. The supraspinatus was dissected off the footprint and photographs were taken. Scion Image (Frederick, MD, USA) was used to quantify the area. Results The average area of leakage was 1.09 cm2 for the SR and 1.15 cm2 for the KTE. The TTE did not demonstrate any leakage. The pattern of leakage for the KTE was medial and central on the footprint, whereas the SR demonstrated leakage up to the tied knots. The difference in the area of leakage in the SR and KTE compared with the TTE was statistically significant. There was no difference in area of leakage between the SR and KTE. Conclusion A transosseous equivalent repair technique best prevents leakage onto the rotator cuff footprint compared with single-row and knotless repairs.