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Influence of Rotator Cuff Tear Size and Repair Technique on the Creation and Management of Dog Ear Deformities in a Transosseous-Equivalent Rotator Cuff Repair Model.

Redler LH, Byram IR, Luchetti TJ, Tsui YL, Moen TC, Gardner TR, Ahmad CS - Orthop J Sports Med (2014)

Bottom Line: The volume, height, and width of the rotator cuff tissue not in contact with the greater tuberosity footprint were calculated using the volume injected, 3D reconstructions, and calibrated photographs.Similarly, posterior height and width were significantly smaller for repair with looped peripheral sutures compared with a suture bridge (P < .05).Dog ear volumes and heights trended larger for the 1.5-cm tear, but this was not statistically significant.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA.

ABSTRACT

Background: Redundancies in the rotator cuff tissue, commonly referred to as "dog ear" deformities, are frequently encountered during rotator cuff repair. Knowledge of how these deformities are created and their impact on rotator cuff footprint restoration is limited.

Purpose: The goals of this study were to assess the impact of tear size and repair method on the creation and management of dog ear deformities in a human cadaveric model.

Study design: Controlled laboratory study.

Methods: Crescent-shaped tears were systematically created in the supraspinatus tendon of 7 cadaveric shoulders with increasing medial to lateral widths (0.5, 1.0, and 1.5 cm). Repair of the 1.5-cm tear was performed on each shoulder with 3 methods in a randomized order: suture bridge, double-row repair with 2-mm fiber tape, and fiber tape with peripheral No. 2 nonabsorbable looped sutures. Resulting dog ear deformities were injected with an acrylic resin mixture, digitized 3-dimensionally (3D), and photographed perpendicular to the footprint with calibration. The volume, height, and width of the rotator cuff tissue not in contact with the greater tuberosity footprint were calculated using the volume injected, 3D reconstructions, and calibrated photographs. Comparisons were made between tear size, dog ear measurement technique, and repair method utilizing 2-way analysis of variance and Student-Newman-Keuls multiple-comparison tests.

Results: Utilizing 3D digitized and injection-derived volumes and dimensions, anterior dog ear volume, height, and width were significantly smaller for rotator cuff repair with peripheral looped sutures compared with a suture bridge (P < .05) or double-row repair with 2-mm fiber tape alone (P < .05). Similarly, posterior height and width were significantly smaller for repair with looped peripheral sutures compared with a suture bridge (P < .05). Dog ear volumes and heights trended larger for the 1.5-cm tear, but this was not statistically significant.

Conclusion: When combined with a standard transosseous-equivalent repair technique, peripheral No. 2 nonabsorbable looped sutures significantly decreased the volume, height, and width of dog ear deformities, better restoring the anatomic footprint of the rotator cuff.

Clinical relevance: Dog ear deformities are commonly encountered during rotator cuff repair. Knowledge of a repair technique that reliably decreases their size, and thus increases contact at the anatomic footprint of the rotator cuff, will aid sports medicine surgeons in the management of these deformities.

No MeSH data available.


Related in: MedlinePlus

(A and B) Setup. The scapula is clamped, soft tissues dissected, and a suture/pulley construct used to maintain constant tension on the rotator cuff.
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fig1-2325967114529257: (A and B) Setup. The scapula is clamped, soft tissues dissected, and a suture/pulley construct used to maintain constant tension on the rotator cuff.

Mentions: Specimens were mounted upright in standard fashion via a vice clamp to the scapula. Skin, superficial fat, and the deltoid were dissected from the scapula, clavicle, and proximal humerus to reveal the rotator cuff musculature and its tendon insertions. The acromion was removed at its base, and the clavicle was excised for improved visualization of the rotator cuff tendons. A nonabsorbable suture was placed in running, locking fashion into the muscle belly of the supraspinatus for approximately 6 cm, beginning just medial to the musculotendinous junction. The free ends of the suture were tied and draped over a pulley, and a 200-g weight was applied to provide constant tension on the rotator cuff repairs (Figure 1, A and B). A 7-mm drill hole was made from lateral to medial 8 cm distal to the greater tuberosity for passage of traction sutures used to reduce the cuff to the lateral footprint in the tear creation portion of the protocol (Figure 2).


Influence of Rotator Cuff Tear Size and Repair Technique on the Creation and Management of Dog Ear Deformities in a Transosseous-Equivalent Rotator Cuff Repair Model.

Redler LH, Byram IR, Luchetti TJ, Tsui YL, Moen TC, Gardner TR, Ahmad CS - Orthop J Sports Med (2014)

(A and B) Setup. The scapula is clamped, soft tissues dissected, and a suture/pulley construct used to maintain constant tension on the rotator cuff.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555599&req=5

fig1-2325967114529257: (A and B) Setup. The scapula is clamped, soft tissues dissected, and a suture/pulley construct used to maintain constant tension on the rotator cuff.
Mentions: Specimens were mounted upright in standard fashion via a vice clamp to the scapula. Skin, superficial fat, and the deltoid were dissected from the scapula, clavicle, and proximal humerus to reveal the rotator cuff musculature and its tendon insertions. The acromion was removed at its base, and the clavicle was excised for improved visualization of the rotator cuff tendons. A nonabsorbable suture was placed in running, locking fashion into the muscle belly of the supraspinatus for approximately 6 cm, beginning just medial to the musculotendinous junction. The free ends of the suture were tied and draped over a pulley, and a 200-g weight was applied to provide constant tension on the rotator cuff repairs (Figure 1, A and B). A 7-mm drill hole was made from lateral to medial 8 cm distal to the greater tuberosity for passage of traction sutures used to reduce the cuff to the lateral footprint in the tear creation portion of the protocol (Figure 2).

Bottom Line: The volume, height, and width of the rotator cuff tissue not in contact with the greater tuberosity footprint were calculated using the volume injected, 3D reconstructions, and calibrated photographs.Similarly, posterior height and width were significantly smaller for repair with looped peripheral sutures compared with a suture bridge (P < .05).Dog ear volumes and heights trended larger for the 1.5-cm tear, but this was not statistically significant.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA.

ABSTRACT

Background: Redundancies in the rotator cuff tissue, commonly referred to as "dog ear" deformities, are frequently encountered during rotator cuff repair. Knowledge of how these deformities are created and their impact on rotator cuff footprint restoration is limited.

Purpose: The goals of this study were to assess the impact of tear size and repair method on the creation and management of dog ear deformities in a human cadaveric model.

Study design: Controlled laboratory study.

Methods: Crescent-shaped tears were systematically created in the supraspinatus tendon of 7 cadaveric shoulders with increasing medial to lateral widths (0.5, 1.0, and 1.5 cm). Repair of the 1.5-cm tear was performed on each shoulder with 3 methods in a randomized order: suture bridge, double-row repair with 2-mm fiber tape, and fiber tape with peripheral No. 2 nonabsorbable looped sutures. Resulting dog ear deformities were injected with an acrylic resin mixture, digitized 3-dimensionally (3D), and photographed perpendicular to the footprint with calibration. The volume, height, and width of the rotator cuff tissue not in contact with the greater tuberosity footprint were calculated using the volume injected, 3D reconstructions, and calibrated photographs. Comparisons were made between tear size, dog ear measurement technique, and repair method utilizing 2-way analysis of variance and Student-Newman-Keuls multiple-comparison tests.

Results: Utilizing 3D digitized and injection-derived volumes and dimensions, anterior dog ear volume, height, and width were significantly smaller for rotator cuff repair with peripheral looped sutures compared with a suture bridge (P < .05) or double-row repair with 2-mm fiber tape alone (P < .05). Similarly, posterior height and width were significantly smaller for repair with looped peripheral sutures compared with a suture bridge (P < .05). Dog ear volumes and heights trended larger for the 1.5-cm tear, but this was not statistically significant.

Conclusion: When combined with a standard transosseous-equivalent repair technique, peripheral No. 2 nonabsorbable looped sutures significantly decreased the volume, height, and width of dog ear deformities, better restoring the anatomic footprint of the rotator cuff.

Clinical relevance: Dog ear deformities are commonly encountered during rotator cuff repair. Knowledge of a repair technique that reliably decreases their size, and thus increases contact at the anatomic footprint of the rotator cuff, will aid sports medicine surgeons in the management of these deformities.

No MeSH data available.


Related in: MedlinePlus