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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.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).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

Lateral row anchors were inserted 1.5 cm lateral to the rotator cuff footprint, spaced 1 cm apart.
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fig4-2325967114529257: Lateral row anchors were inserted 1.5 cm lateral to the rotator cuff footprint, spaced 1 cm apart.

Mentions: This repair was performed with 2 4.5-mm PEEK Corkscrew FT suture anchors medially and 2 knotless 4.75-mm SwiveLock anchors (Arthrex) laterally. The medial row anchors were placed at the lateral edge of the articular margin of the humeral head evenly spaced from anterior to posterior (1 cm apart in the 3-cm tear space) at 45° relative to the footprint surface (deadman angle20). The medial row sutures were passed in a horizontal mattress fashion 1 cm medial to the lateral edge of the rotator cuff tear, centered over each corresponding suture anchor. Both medial row knots were tied with a sliding double half-hitch knot first, followed by 3 alternating simple half-hitches. One limb from each suture anchor was threaded through each of the 2 lateral knotless anchors. The lateral row anchors were then inserted 1.5 cm lateral to the rotator cuff footprint, spaced 1 cm apart (Figure 4). If a specimen was randomized to either of the 2 SpeedBridge arms prior to the SutureBridge, 5.5-mm PEEK Corkscrew FT suture anchors were substituted for the 4.5-mm medial suture anchors to accommodate the larger medial anchor holes from the previously placed 4.75-mm anchors.


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)

Lateral row anchors were inserted 1.5 cm lateral to the rotator cuff footprint, spaced 1 cm apart.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

fig4-2325967114529257: Lateral row anchors were inserted 1.5 cm lateral to the rotator cuff footprint, spaced 1 cm apart.
Mentions: This repair was performed with 2 4.5-mm PEEK Corkscrew FT suture anchors medially and 2 knotless 4.75-mm SwiveLock anchors (Arthrex) laterally. The medial row anchors were placed at the lateral edge of the articular margin of the humeral head evenly spaced from anterior to posterior (1 cm apart in the 3-cm tear space) at 45° relative to the footprint surface (deadman angle20). The medial row sutures were passed in a horizontal mattress fashion 1 cm medial to the lateral edge of the rotator cuff tear, centered over each corresponding suture anchor. Both medial row knots were tied with a sliding double half-hitch knot first, followed by 3 alternating simple half-hitches. One limb from each suture anchor was threaded through each of the 2 lateral knotless anchors. The lateral row anchors were then inserted 1.5 cm lateral to the rotator cuff footprint, spaced 1 cm apart (Figure 4). If a specimen was randomized to either of the 2 SpeedBridge arms prior to the SutureBridge, 5.5-mm PEEK Corkscrew FT suture anchors were substituted for the 4.5-mm medial suture anchors to accommodate the larger medial anchor holes from the previously placed 4.75-mm anchors.

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.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).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