Double-row repair of rotator cuff tears: Comparing tendon contact area between techniques

BACKGROUND: In rotator cuff repair surgery, the double-row technique is widely performed. Studies have shown that with increased contact area and pressure between tendon and bone interface, better healing is promoted. AIM: To assess the different suture configurations with the double-row technique and how this influences the contact area of the rotator cuff tendon to bone. METHODS: This was a controlled laboratory study where identical tears were created in 24 fresh 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 (2 medial, 2 lateral vs 2 medial, 1 lateral vs 1 medial, 2 lateral), 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. RESULTS: The mean contact area between tendon and insertion footprint from the imprinted Fujifilm was obtained using computer software. The contact area measured from a standard 4-suture anchor double row repair was 75.1 ± 9.3 mm(2), whereas areas obtained for the 2 lateral - 1 medial and 2 medial - 1 lateral anchor configurations were 72.9 ± 5.2 mm(2) and 75.0 ± 4.9 mm(2) respectively. No statistical significance was noted between the three groups. CONCLUSION: In the technique of double-row repair, using a 3-suture anchor configuration may offer a non-inferior alternative to the standard 4-anchor construct in terms of efficacy. This may also result in overall cost reduction and shorter surgical time.