Tuesday, January 22, 2013

Rotator cuff repair - in vitro study

Biomechanical evaluation of augmentation of suture-bridge supraspinatus repair with additional anterior fixation

This study explored the stiffness, yield load, ultimate load and energy absorbed in cadaveric shoulder pairs in which a normal tendon was incised and then repaired with either a standard suture-bridge technique or a suture-bridge repair with an additional anterior fixation consisting of a 4.5-mm suture anchor. No differences were found between the 2 groups.

As the authors point out, this study illustrations the many limitations of using cadaver models to study cuff repair. The tendons incised were normal, no representative of the torn tendons we are challenged to get to heal. The study only evaluated initial fixation, when, as previous posts have shown, the failure of cuff repairs happens weeks later.  The repair was carried out without any tension in contrast to the clinical situation. The repair was tested the repair only in one position. Only one variation on the method was investigated.

At least 400,000 rotator cuff repairs are performed each year. There is no better 'model' of rotator cuff repair than that. Wouldn't it be better to divert the energy and money spent on animal and cadaver studies to seeking the results on this huge clinical series to see what is working in the treatment of rotator cuff lesions and what is not? Imagine.


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