RESUMEN
Since the introduction of rotator cuff repair in the beginning of the 20th century, there have been significant advances in the surgical techniques and improvement in patient outcomes. However, controversy remains regarding the best method for tendon repair, including implant choice, ideal suture construct, and the potential benefits of supplemental biologic additives in order to achieve repair with the best opportunity for healing. The "SCOI Row" technique has been refined over three decades with extensive application and consistently good outcomes. Our technique uses a single row of anchors, triple loaded with a high-strength suture maximizing the number of sutures passed through the tendon to repair the rotator cuff arthroscopically. These anchors are placed 3-4 millimeters from the articular cartilage, providing strong anchorage and a low-tension repair. Debridement of devitalized tendon and only incorporating healthy tendon into the repair is imperative. The biology of the repair is enhanced with bone marrow vents created via microfracture of the greater tuberosity, forming the "Crimson Duvet" or bone marrow super-clot that will envelope the repair site. The bone marrow vents deliver marrow elements, including growth factors and mesenchymal cells that will help to regenerate the footprint of the rotator cuff. This repair construct has been evaluated biomechanically by other investigators and is favorable, as compared to dual row repairs. Our outcomes show greater than 90 % healing rate on postoperative magnetic resonance imaging and excellent patient-reported outcomes.
Asunto(s)
Lesiones del Manguito de los Rotadores , Anclas para Sutura , Fenómenos Biomecánicos , Humanos , Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/cirugía , Técnicas de Sutura , SuturasRESUMEN
PURPOSE: The primary purpose of this study was to evaluate the repair integrity on magnetic resonance imaging (MRI), and secondarily, clinical outcomes, of medium to large (2-4 cm) rotator cuff tears treated using an arthroscopic triple-loaded medially based single-row repair technique augmented laterally with bone marrow vents. METHODS: This is a retrospective outcomes study of patients with full-thickness medium to large (2-4 cm) rotator cuff tears repaired by 4 surgeons at a single institution over a 2-year period with a minimum of 24 months' follow-up. A single-row repair with tension-minimizing medially based triple-loaded anchors and laterally placed bone marrow vents was used. Patients completed a satisfaction and pain survey, the Western Ontario Rotator Cuff index questionnaire, and a Short Form-36 version 2 survey to evaluate clinical outcomes. MRI was obtained at a minimum of 24 months follow-up to assess repair integrity. RESULTS: A total of 64 males and 27 females with a mean age of 59.7 (range, 34-82) were included. The mean tear size was 2.6 cm in anteroposterior dimension, treated with a mean of 2.2 anchors. Eighty-three of 91 shoulders (91%) reported being completely satisfied with their result. The median Western Ontario Rotator Cuff score was 95.2% of normal, with a significant difference found between those with an intact repair and those with a full-thickness recurrent defect (median, 95.9% vs. 73.8%; P = .003). Postoperative MRI obtained at a median of 32 months (range, 24-48) demonstrated an intact repair in 84 of 91 shoulders (92%), with failure defined as a full-thickness defect of the tendon. CONCLUSIONS: Arthroscopic repair of medium to large rotator cuff tears using triple-loaded medially based single-row repair augmented with marrow vents resulted in a 92% healing rate by MRI and excellent patient-reported outcomes LEVEL OF EVIDENCE: Level IV, retrospective case series.
Asunto(s)
Artroscopía/métodos , Médula Ósea/cirugía , Lesiones del Manguito de los Rotadores/cirugía , Manguito de los Rotadores/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Recurrencia , Estudios Retrospectivos , Rotura/cirugía , Hombro/cirugía , Técnicas de Sutura , Tendones/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Current surgical treatment options for partial-thickness tears (eg, takedown and repair, in situ repair) are limited by the degenerative nature of the underlying tendon and may require extensive intervention that can alter the anatomic footprint. The complexity of available techniques to address these issues led to the development of a resorbable collagen implant, which can be used to create a bioinductive repair of partial-thickness tears. METHODS: We prospectively enrolled 33 patients with chronic, degenerative, intermediate-grade (n = 12), or high-grade (n = 21) partial-thickness tears (11 articular, 10 bursal, 4 intrasubstance, and 8 hybrid) of the supraspinatus tendon in a multicenter study. After arthroscopic subacromial decompression without a traditional rotator cuff repair, a bioinductive implant was secured over the bursal surface of the tendon. Clinical outcomes were assessed using American Shoulder and Elbow Surgeons (ASES) and Constant-Murley scores (CMS) preoperatively and at 3 months, 1 year, and 2 years postoperatively. Magnetic resonance imaging was performed to assess postoperative tendon healing and thickness at the original tear site. RESULTS: At 2-year follow-up, mean ASES and CMS scores improved both clinically and statistically at 1 and 2 years, compared with baseline, for intermediate- and high-grade tears. There was magnetic resonance imaging evidence of new tissue fill-in within the original baseline tear in 100% of the intermediate-grade tears and 95% of the high-grade tears. In 90.9% of the intermediate-grade tears and 84.2% of the high-grade tears, this new tissue fill-in represented at least an additional 50% of the volume of the initial lesion. From baseline to 2-year follow-up, the mean tendon thickness increased by 1.2 mm (standard deviation, 1.3; P = .012) and 1.8 mm (standard deviation, 2.2; P = .003) in the intermediate- and high-grade tears, respectively. The analysis of tear grade and location revealed no statistically significant difference in the change in mean tendon thickness at any time point. One patient with a high-grade articular lesion demonstrated progression to a full-thickness tear; however, the patient was noncompliant and the injury occurred while shoveling snow 1 month after surgery. Neither tear location nor treatment of bicep pathology affected the ASES or CMS scores at any follow-up point. No serious adverse events related to the implant were reported. CONCLUSION: Final results from this 2-year prospective study indicate that the use of this resorbable bovine collagen implant for isolated bioinductive repair of intermediate- and high-grade partial-thickness rotator cuff tears of the supraspinatus is safe and effective, regardless of tear grade and location.
Asunto(s)
Lesiones del Manguito de los Rotadores , Animales , Artroscopía , Bovinos , Colágeno , Humanos , Imagen por Resonancia Magnética , Estudios Prospectivos , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/cirugía , Resultado del TratamientoRESUMEN
Rotator cuff repair can be challenging because of the compromised state of the tendon tissue. These challenges range from simply degenerative tendons to complete tendon loss in patients which can impair soft-tissue healing. Various grafts and patches are currently available to help address these challenges. The ideal solution for the treatment of irreparable rotator cuff tears or those prone to retear remains controversial. Sometimes augmentation with a patch is appropriate. However, at times a completely retracted and immobile tendon remnant is found. Reconstruction of the superior capsule has demonstrated promising results in several short-term series. The indications for these procedures, the optimal surgical technique, and their limitations are evolving. This chapter discusses the current literature related to bioinductive scaffolds, graft augmentation, graft interposition, and superior capsular reconstruction.
Asunto(s)
Lesiones del Manguito de los Rotadores/cirugía , Manguito de los Rotadores , Artroplastia , Humanos , Tendones , Cicatrización de HeridasRESUMEN
Osteoarthritis of the knee is extremely common and a growing source of disability. The current nonarthroplasty treatment options have afforded only limited benefit, and recently stem cell treatment has emerged as the newest minimally invasive option with great societal demand. While the demand is great, the evidence is limited. Stem cell use appears to be safe, but further good-quality research is needed to be able to routinely recommend this option for knee osteoarthritis treatment.
Asunto(s)
Células Madre Mesenquimatosas , Osteoartritis de la Rodilla , Cartílago , Humanos , Células Madre , EstañoRESUMEN
PURPOSE: This study evaluated the repair integrity and patient clinical outcomes following arthroscopic rotator cuff repair of medium to large rotator cuff tears using a single-row technique consisting of medially based, triple-loaded anchors augmented with bone marrow vents in the rotator cuff footprint lateral to the repair. METHODS: This is a retrospective study of 52 patients (53 shoulders) comprising 36 males and 16 females with a median age of 62 (range 44-82) with more than 24-month follow-up, tears between 2 and 4 cm in the anterior-posterior dimension and utilizing triple-loaded anchors. Mann-Whitney test compared Western Ontario Rotator Cuff (WORC) outcome scores between patients with healed and re-torn cuff repairs. Multivariate logistic regression analysed association of variables with healing status and WORC score. Cuff integrity was assessed on MRI, read by a musculoskeletal fellowship-trained radiologist. RESULTS: Magnetic resonance imaging (MRI) demonstrated an intact repair in 48 of 53 shoulders (91%). The overall median WORC score was 95.7 (range 27.6-100.0). A significant difference in WORC scores were seen between patients with healed repairs 96.7 (range 56.7-100.0) compared with a re-tear 64.6 (27.6-73.8), p < 0.00056. CONCLUSIONS: Arthroscopic repair of medium to large rotator cuff tears using a triple-loaded single-row repair augmented with bone marrow vents resulted in a 91% healing rate by MRI and excellent patient reported clinical outcomes comparable to similar reported results in the literature. LEVEL OF EVIDENCE: IV.
Asunto(s)
Artroscopía/métodos , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Trasplante de Médula Ósea , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Estudios Retrospectivos , Manguito de los Rotadores/diagnóstico por imagen , Manguito de los Rotadores/fisiopatología , Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/fisiopatología , Anclas para Sutura , Técnicas de Sutura , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
PURPOSE: To determine whether an association exists between a biconcave medial tibial plateau and complex medial meniscus tears. METHODS: A consecutive series of stable knees undergoing arthroscopy were evaluated retrospectively with the use of preoperative magnetic resonance imaging (MRI), radiographs, and arthroscopy documented by intraoperative videos. Investigators independently performed blinded reviews of the MRI or videos. Based on the arthroscopy findings, medial tibial plateaus were classified as either biconcave or not biconcave. A transverse coronal plane ridge, separating the front of the tibial plateau from the back near the inner margin of the posterior body of the medial meniscus, was defined as biconcave. The medial plateau slope was calculated with MRI sagittal views. General demographic information, body mass index, and arthroscopically confirmed knee pathology were recorded. RESULTS: A total of 179 consecutive knees were studied from July 2014 through August 2015; 49 (27.2%) biconcave medial tibial plateaus and 130 (72.8%) controls were identified at arthroscopy. Complex medial meniscus tears were found in 103. Patients with a biconcave medial tibial plateau were found to have more complex medial meniscus tears (69.4%) than those without a biconcavity (53.1%) (P = .049) despite having lower body mass index (P = .020). No difference in medial tibial plateau slope was observed for biconcavities involving both cartilage and bone, bone only, or an indeterminate group (P = .47). CONCLUSIONS: Biconcave medial tibial plateaus were present in 27.4% of a consecutive series of patients undergoing knee arthroscopy. A biconcave medial tibial plateau was more frequently associated with a complex medial meniscus tear. LEVEL OF EVIDENCE: Level III, case-control study.
Asunto(s)
Meniscos Tibiales/patología , Lesiones de Menisco Tibial/patología , Adolescente , Adulto , Anciano , Artroscopía/métodos , Estudios de Casos y Controles , Epífisis/patología , Femenino , Humanos , Traumatismos de la Rodilla/cirugía , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/patología , Articulación de la Rodilla/cirugía , Imagen por Resonancia Magnética , Masculino , Meniscos Tibiales/diagnóstico por imagen , Meniscos Tibiales/cirugía , Menisco , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Factores de Riesgo , Rotura/patología , Tibia/diagnóstico por imagen , Tibia/patología , Lesiones de Menisco Tibial/diagnóstico por imagen , Lesiones de Menisco Tibial/cirugía , Adulto JovenRESUMEN
PURPOSE: To compare patient-reported outcomes and healing rates after open subpectoral and all-arthroscopic suprapectoral biceps tenodesis without the use of interference screws in patients with more than 2 years of follow-up. METHODS: Patients with at least 2 years of follow-up who underwent open subpectoral biceps tenodesis or all-arthroscopic suprapectoral biceps tenodesis without concomitant rotator cuff repair, labral repair, or Mumford procedure were considered for enrollment in the study. They were evaluated for visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and satisfaction with function and biceps contour. Ultrasonography was performed to evaluate the integrity of the tenodesis site and measure biceps muscle diameters on each arm. RESULTS: Forty-nine patients were eligible for our study and of these, 38 were able to participate. Twenty-three patients had open subpectoral biceps tenodesis and 15 received all-arthroscopic suprapectoral biceps tenodesis. The average follow-up time was 4.5 years (range 2-9.1 years). There were no significant differences in anterior shoulder pain VAS, ASES scores, or satisfaction rates. The average anterior shoulder VAS was 0.7 ± 1.1 for the open group and 0.9 ± 1.8 for the arthroscopic group (P = .74). The mean ASES score for the open group was 90.6 ± 11.4 and 91.4 ± 13.9 for the arthroscopic group (P = .69). All patients had an intact tenodesis site on ultrasonography and the ratio of operative to nonoperative biceps diameters was 100.2% ± 12.8% for the open group and 99.1% ± 10.8% for the arthroscopic group (P = .66). There were no infections and no brachial plexus injuries in either group. CONCLUSIONS: Open subpectoral biceps tenodesis and all-arthroscopic suprapectoral biceps tenodesis are both successful surgeries with consistently positive outcomes. Tenodesis can be performed in either location without interference screw fixation with durable, reliable results. LEVEL OF EVIDENCE: Level III, retrospective comparative trial.
Asunto(s)
Brazo/cirugía , Tornillos Óseos , Tendones/cirugía , Tenodesis/métodos , Brazo/diagnóstico por imagen , Artroscopía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Satisfacción del Paciente , Procedimientos de Cirugía Plástica/métodos , Estudios Retrospectivos , Dolor de Hombro/etiología , Resultado del TratamientoRESUMEN
PURPOSE: The purpose of this study was to evaluate the time zero cyclic and failure loading properties of a linked single-row rotator cuff repair compared with a standard simple suture single-row repair using triple-loaded suture anchors. METHODS: Eighteen human cadaveric shoulders from 9 matched pairs were dissected, and full-thickness supraspinatus tears were created. The tendon cross-sectional area was recorded. In each pair, one side was repaired with a linked single-row construct and the other with a simple suture single-row construct, both using 2 triple-loaded suture anchors. After preloading, specimens were cycled to 1 MPa of effective stress at 1 Hz for 500 cycles, and gap formation was recorded with a digital video system. Samples were then loaded to failure, and modes of failure were recorded. RESULTS: There was no statistical difference in peak gap formation between the control and linked constructs (3.6 ± 0.9 mm and 3.6 ± 1.2 mm, respectively; P = .697). Both constructs averaged below a 5-mm cyclic failure threshold. There was no statistical difference in ultimate load to failure between the control and linked repair (511.1 ± 139.0 N and 561.2 ± 131.8 N, respectively; P = .164), and both groups reached failure at loads similar to previous studies. Constructs failed predominantly via tissue tearing parallel to the medial suture line. CONCLUSIONS: The linked repair performed similarly to the simple single-row repair. Both constructs demonstrated high ultimate load to failure and good resistance to gap formation with cyclic loading, validating the time zero strength of both constructs in a human cadaveric model. CLINICAL RELEVANCE: The linked repair provided equivalent resistance to gap formation and failure loads compared with simple suture single-row repairs with triple-loaded suture anchors. This suggests that the linked repair is a simplified rip-stop configuration using the existing suture that may perform similarly to current rotator cuff repair techniques.
Asunto(s)
Lesiones del Manguito de los Rotadores/cirugía , Artropatía por Desgarro del Manguito de los Rotadores , Manguito de los Rotadores/cirugía , Técnicas de Sutura , Adolescente , Adulto , Anciano , Artroplastia , Fenómenos Biomecánicos , Cadáver , Estudios Transversales , Humanos , Laceraciones/cirugía , Masculino , Persona de Mediana Edad , Presión , Hombro/cirugía , Anclas para Sutura , Suturas , Tendones/patología , Tendones/cirugía , Adulto JovenRESUMEN
PURPOSE: To determine the effectiveness of proficiency-based progression (PBP) training using simulation both compared with the same training without proficiency requirements and compared with a traditional resident course for learning to perform an arthroscopic Bankart repair (ABR). METHODS: In a prospective, randomized, blinded study, 44 postgraduate year 4 or 5 orthopaedic residents from 21 Accreditation Council for Graduate Medical Education-approved US orthopaedic residency programs were randomly assigned to 1 of 3 skills training protocols for learning to perform an ABR: group A, traditional (routine Arthroscopy Association of North America Resident Course) (control, n = 14); group B, simulator (modified curriculum adding a shoulder model simulator) (n = 14); or group C, PBP (PBP plus the simulator) (n = 16). At the completion of training, all subjects performed a 3 suture anchor ABR on a cadaveric shoulder, which was videotaped and scored in blinded fashion with the use of previously validated metrics. RESULTS: The PBP-trained group (group C) made 56% fewer objectively assessed errors than the traditionally trained group (group A) (P = .011) and 41% fewer than group B (P = .049) (both comparisons were statistically significant). The proficiency benchmark was achieved on the final repair by 68.7% of participants in group C compared with 36.7% in group B and 28.6% in group A. When compared with group A, group B participants were 1.4 times, group C participants were 5.5 times, and group C(PBP) participants (who met all intermediate proficiency benchmarks) were 7.5 times as likely to achieve the final proficiency benchmark. CONCLUSIONS: A PBP training curriculum and protocol coupled with the use of a shoulder model simulator and previously validated metrics produces a superior arthroscopic Bankart skill set when compared with traditional and simulator-enhanced training methods. CLINICAL RELEVANCE: Surgical training combining PBP and a simulator is efficient and effective. Patient safety could be improved if surgical trainees participated in PBP training using a simulator before treating surgical patients.
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Artroscopía/educación , Competencia Clínica , Internado y Residencia , Entrenamiento Simulado/métodos , Adulto , Artroscopía/normas , Curriculum , Educación de Postgrado en Medicina , Humanos , Masculino , Persona de Mediana Edad , América del Norte , Ortopedia/educación , Estudios Prospectivos , Hombro/cirugía , Articulación del Hombro/cirugía , Anclas para SuturaRESUMEN
BACKGROUND: A novel arthroscopic technique allows for intraosseous tendon placement in biceps tenodesis using bone tunnels and suture while avoiding the expense of an implant. No biomechanical characterization exists for this construct. METHODS: Tensile tests were used to compare a suture-only biceps tenodesis technique (arthroscopic biceps intraosseous tenodesis [ABIT]) with interference screws in 7 pairs of cadaveric shoulders. The ABIT used a modified finger-trap suture method to secure the tendon to itself through an intraosseous bone tunnel. Interference screw placement followed the manufacturer's protocol for implantation. An open technique was used to provide consistency during laboratory preparation. RESULTS: During cyclic loading, the screws were significantly stiffer (P = .040) but dissipated more energy (P = .002). During failure loading, suture-only specimens showed significantly greater failure loads (P < .001) and deformation (P = .046). The failure mechanism for the ABIT method was tendon elongation with progressive tensioning and slippage of the tendon through the suture mass. No complete tendon failure occurred for the ABIT. Gross tendon failure occurred in all interference screw tests at the bone-tendon-screw interface. No screw or suture failed in any biceps tendon test. CONCLUSION: The ABIT construct showed significantly higher failure loads and deformation compared with interference screws. The comparable stiffness after cycling of both constructs suggests that micromotion at the bone-tendon interface is similar, which-in addition to the intraosseous fixation-may be important in promoting healing. The ABIT construct was found to absorb and restore more energy (hysteresis), suggesting potential for greater tendon preservation, which may translate into improved construct longevity. The suture-only method can eliminate the expense of an implant.
Asunto(s)
Traumatismos de los Tendones/cirugía , Tendones/cirugía , Tenodesis/métodos , Anciano , Artroscopía , Fenómenos Biomecánicos , Tornillos Óseos , Cadáver , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hombro/cirugía , Técnicas de Sutura , Traumatismos de los Tendones/fisiopatología , Tendones/fisiopatologíaRESUMEN
PURPOSE: To compare the likelihood of spiral fracture of the humerus using torsional load to failure after intraosseous biceps tenodesis at the position of the arthroscopic suprapectoral tenodesis versus the subpectoral meta-diaphyseal location. METHODS: Eight matched pairs of humeri were dissected. Unicortical tenodesis holes were drilled, either at the bottom of the bicipital groove (group 1) or just below the pectoralis major tendon insertion (subpectoral) in the humeral diaphysis (group 2). Tenodesis was performed in a 7-mm bone tunnel, with suture fixation distal to this site using 2 separate 2-mm holes, secured with No. 2 polyester suture. Each humerus was potted in plaster and mounted to a hydraulic torsional load frame, consistent with previously validated models for creating humeral spiral fractures. External rotation torque was applied to each humerus distally until fracture occurred. The paired t test was used to compare the 2 groups. RESULTS: Fracture occurred at the subpectoral cortical drill hole in all 8 specimens in group 2. In group 1, only 2 fractures occurred through the tenodesis hole, with spiral fracture resulting in the diaphysis of the humerus in 6 of 8 specimens. Average torque to failure measured 31.35 Nm in group 1 and 25.08 Nm in group 2; the difference was statistically significant (P < .0001). CONCLUSIONS: Subpectoral cortical drill holes for biceps tenodesis were shown to be a stress riser for humeral spiral fracture. Suprapectoral cortical drill holes were shown to be significantly less of a stress riser. The amount of torque required to fracture the humerus through the subpectoral drill holes was less than with the suprapectoral drill holes. Only 2 fractures occurred through the suprapectoral tenodesis holes, and significantly more torque was required to create these fractures. CLINICAL RELEVANCE: Clinically, the difference between suprapectoral and subpectoral tenodesis fracture potential should be considered when selecting a tenodesis location.
RESUMEN
Most shoulder instability repairs are performed with single-loaded suture anchors. Recent reports have shown that there is increased stress on both the glenoid labrum and suture anchor when sutures from single-loaded anchors are passed through the capsule and labrum. This report describes a novel technique for shoulder instability repair using double-loaded suture anchors in the glenoid. The first primary stitch is passed through the labrum only and then tied, shifting the tissue superiorly. The second stitch is passed inferiorly through the patulous capsule in addition to the labrum with a pinch-tuck technique. This technique distributes the tension on the labral repair and creates a fold to protect and shield the primary labral repair. Just as flat sheets are folded and tucked underneath a mattress to form a "hospital corner," this procedure applies a similar principle to the labrum and capsule of the shoulder. This technique is applicable for any type of shoulder instability repair, including Bankart lesions, posterior labral tears, and multidirectional instability, that requires the use of suture anchors.
Asunto(s)
Artroscopía/métodos , Inestabilidad de la Articulación/cirugía , Articulación del Hombro/cirugía , Anclas para Sutura , Humanos , Cápsula Articular/cirugía , Lesiones del Hombro , Técnicas de SuturaRESUMEN
BACKGROUND: The purpose of this study was to evaluate the initial fixation of a transosseous-equivalent rotator cuff repair and an interlinked medial repair, quantifying the cyclic and failure loading properties of each construct. METHODS: Twenty-four human cadaveric shoulders from 12 matched pairs were dissected, and full-thickness supraspinatus tears were created. In each pair, 1 side was repaired with a transosseous-equivalent repair (control) and the other, with an interlinked repair. All specimens were cycled to 1 MPa of effective stress at 1 Hz for 500 cycles, and gap formation was recorded with a digital video system. All samples were then loaded to failure, and the ultimate load and displacement and modes of failure were recorded. RESULTS: The interlinked repair showed a decrease in the amount of construct gapping after cycle 50 and in peak construct gapping compared with the control group (control, 3.4 ± 0.9 mm; interlinked, 2.5 ± 0.8 mm; P = .048). The interlinked repair also showed a higher ultimate load to failure (control, 318.7 ± 77.9 N; interlinked, 420.6 ± 93.7 N; P = .007). No other significant differences were detected between constructs for preparation or testing metrics. CONCLUSIONS: The interlinked repair, in which 1 continuous suture linked the medial anchors, showed decreased construct gapping and increased ultimate load to failure compared with the control construct. This study establishes the biomechanical validity of the new interlinked repair construct compared with a previously validated construct.
RESUMEN
We conducted a study to evaluate in vivo tension applied to the rotator cuff tendon positioned at the medial versus lateral footprint during arthroscopic rotator cuff repair. We evaluated 20 consecutive patients who underwent arthroscopic rotator cuff repair. During repair, a grasper was inserted through a lateral portal, and a digital weigh scale was attached. The tendon was grasped and translated to the medial footprint, and tension recorded. After a relaxation period, the tendon edge was translated to the lateral footprint, and tension recorded. Mean (SD) tension was 0.41 (0.33) pound when tendons were positioned at the medial footprint and 2.21 (1.20) pounds when they were positioned at the lateral footprint, representing a 5.4-fold difference (P < .0001). For smaller tears (≤ 20 mm anterior-posterior), 7.6 times less tension was applied to the tendons when pulled to the medial versus lateral footprint. For larger tears, 4.1 times less tension was applied to the tendons when pulled to the medial versus lateral footprint. This study demonstrated a significant, 5.4-fold increase in tension when the tendon edge was reduced to the lateral as opposed to the medial footprint in vivo.
Asunto(s)
Artroscopía/métodos , Manguito de los Rotadores/fisiopatología , Traumatismos de los Tendones/fisiopatología , Artroscopía/efectos adversos , Fenómenos Biomecánicos , Humanos , Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores , Traumatismos de los Tendones/cirugíaRESUMEN
Patients with multidirectional glenohumeral instability without a Bankart lesion represent a challenging group. Arthroscopic pancapsular plication affords the surgeon flexibility to correct the degree and direction of laxity in the multidirectionally unstable patient. This technique can be combined with suture anchors if needed to correct capsulolabral defects in patients with more advanced lesions. The mainstay of treatment for MDI remains conservative. In resistant cases, however, arthroscopic management can be performed safely and efficaciously, now with documented extended success in an active patient population.