This paper reports the effect of different repair types on the contact area and contact pressure in model using fresh frozen sheep infraspinatus tendon detachment. It showed little difference between double row and suture bridge techniques, whereas the triple row had greater contact surface area and greater contact pressure.
The goal of the study was to explore better methods for addressing large cuff tears, noting the high recurrence rates for arthroscopic repairs of such tears (reference 6, reference 13, reference 24).
Our concern is that a primary determinant of repair failure - especially in large chronic tears - is the quality and quality of the tendon to be repaired. As H.L.McLaughlin stated in 1962, "the wise surgeon, realizing that he may find little but rotten cloth to sew, will operate only by necessity and make a carefully guarded prognosis."
When sutures are placed under tension in tissue of suboptimal quality, there is a risk of creep of the suture through the tendon after the repair is complete due to suture tension overload. This creep can result in loss of contact between the tendon and the bone and an increased risk of repair failure.
By contrast, the tongue in groove repair allows for some tendon slippage without loss of contact. This is a tried and true method, suggested in 1931 by Philip D. Wilson in his article "COMPLETE RUPTURE OF THE SUPRASPINATUS TENDON" JAMA. 1931;96(6):433-439 and shown in the figure below in Codman's book.
----
If you have suggestions for topics you'd like us to address in this blog, please send an email to
shoulderarthritis@uw.edu
Use the "Search the Blog" box to the right to find other topics of interest to you.
You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.
If you have suggestions for topics you'd like us to address in this blog, please send an email to
shoulderarthritis@uw.edu
Use the "Search the Blog" box to the right to find other topics of interest to you.
You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.
file://localhost/Users/matsen/Pictures/iPhoto%20Library/Previews/2012/10/26/20121026-185440/IMG_4165.jpg
