A novel double-row rotator cuff repair exceeds strengths of conventional repairs

Double-row rotator cuff repairs are becoming popular because of their ability to improve initial ultimate failure load for full-thickness rotator cuff tears, especially in middle-aged to elderly patients. We hypothesized a quasi-double-row repair using a combination of transosseous sutures, anchors, and double knots (TOAK technique) would exceed the clinically relevant 250-N load threshold and the initial mean ultimate failure loads of anchor-only and transosseous suture-only fixation. In simulated full-thickness supraspinatus tears in cadavers (mean age, 62 years; range, 50-77 years), failure loads of two repair techniques were compared with a TOAK repair using sutures and bioabsorbable anchors. Radiographic densitometry was conducted on all humeral heads. Testing was performed at 6 mm per minute in 18 bones in the following three groups (n = 6 per group): (1) transosseous suture-only with weave-type stitch and single-knot fixation; (2) anchor-only with horizontal mattress stitch and single-knot fixation; and (3) TOAK. The mean ultimate failure load was 238 N for the transosseous suture-only group and 215 N for the anchor-only group. Although the bones had lower density, TOAK specimens failed at 55% to 67% higher loads (mean, 404 N) than the other groups. These data support further evaluation of the TOAK technique for full-thickness supraspinatus tears in middle-aged to elderly patients.