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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

(A) Digitizing the rotator cuff. (B) Digitized rotator cuff. An unsmoothed representation of the rotator cuff and dog ears. (C) Smoothed 3-dimensional digitization. Surface curves were traced, lofted, and smoothed with Rhinoceros software.
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fig6-2325967114529257: (A) Digitizing the rotator cuff. (B) Digitized rotator cuff. An unsmoothed representation of the rotator cuff and dog ears. (C) Smoothed 3-dimensional digitization. Surface curves were traced, lofted, and smoothed with Rhinoceros software.

Mentions: Immediately following each successive tear creation as well as after each of the 3 repair techniques of the 1.5-cm tear, the rotator cuff tissue and greater tuberosity footprint were digitized using the MicroScribe 3D system via creation of point clouds. Digitization was performed by a single member of the research team in a systematic fashion, using a probe to outline the rotator cuff with multiple medial to lateral lines starting anteriorly and moving posteriorly (Figure 6A). The boundaries of the rotator cuff footprint were then outlined systematically starting with the medial border, followed by the lateral cuff edge, then finally the greater tuberosity footprint edge (Figure 6B). Surface curves were traced, lofted, and smoothed with Rhinoceros software (McNeel North America, Seattle, Washington, USA) to create 3-dimensional volumetric representations of each repair (Figure 6C). Dog ear height, width, and volume of rotator cuff tissue not in contact with the greater tuberosity footprint were calculated for the anterior and posterior dog ear in each repair. Dog ear height and width were then measured from the calibrated photographs of the specimens previously described (Figure 7).


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) Digitizing the rotator cuff. (B) Digitized rotator cuff. An unsmoothed representation of the rotator cuff and dog ears. (C) Smoothed 3-dimensional digitization. Surface curves were traced, lofted, and smoothed with Rhinoceros software.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

fig6-2325967114529257: (A) Digitizing the rotator cuff. (B) Digitized rotator cuff. An unsmoothed representation of the rotator cuff and dog ears. (C) Smoothed 3-dimensional digitization. Surface curves were traced, lofted, and smoothed with Rhinoceros software.
Mentions: Immediately following each successive tear creation as well as after each of the 3 repair techniques of the 1.5-cm tear, the rotator cuff tissue and greater tuberosity footprint were digitized using the MicroScribe 3D system via creation of point clouds. Digitization was performed by a single member of the research team in a systematic fashion, using a probe to outline the rotator cuff with multiple medial to lateral lines starting anteriorly and moving posteriorly (Figure 6A). The boundaries of the rotator cuff footprint were then outlined systematically starting with the medial border, followed by the lateral cuff edge, then finally the greater tuberosity footprint edge (Figure 6B). Surface curves were traced, lofted, and smoothed with Rhinoceros software (McNeel North America, Seattle, Washington, USA) to create 3-dimensional volumetric representations of each repair (Figure 6C). Dog ear height, width, and volume of rotator cuff tissue not in contact with the greater tuberosity footprint were calculated for the anterior and posterior dog ear in each repair. Dog ear height and width were then measured from the calibrated photographs of the specimens previously described (Figure 7).

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