Suture loosening and its effect on tendon fixation in knotless double-row rotator cuff repairs

We have occasionally observed suture loosening in initial suture legs after final fixation of adjacent suture legs in the lateral row of rotator cuff repairs during arthroscopic rotator cuff repair with transosseous-equivalent suture-bridge constructs. We sought to determine how this occurred and what effects it had on tendon fixation stability.

Six pairs of fresh-frozen human shoulders were prepared with a simulated cuff defect. A suture-bridge repair was performed in each specimen with one of each pair randomized to one type of "knotless" lateral-row screw-in anchor and the other of the pair to a knotless push-in type. The repairs were cyclically loaded with 100 N for 1,000 cycles. Suture leg tensions were measured during the repair and after cycling. Lateral tendon laxity was measured before and after cycling. A pilot study on the effect of suture tension on the tendon contact footprint was also performed.

The initial suture legs did not show a decrease in tension after the second lateral-row anchor was secured. Tension of the suture legs after cycling showed that no one leg loosened more than another; however, they all loosened when compared with total suture tensions before cycling (0.1 to 1.0 mm, P = .008). There was no significant difference between suture tension changes for the 2 anchor types after cycling (P = .140). Although the lateral tendon laxity increased slightly (0.04 mm) after cycling, this was not significant (P = .245), nor was there a difference between anchor types.

Suture loosening occurred after cycling these rotator cuff repairs, but this did not appear to affect lateral tendon laxity for the 2 lateral anchor types studied, although medial tendon movement was observed.

Suture loosening after cycling the 2 transosseous-equivalent suture-bridge repairs studied could affect the area and pressure of tendon-bone contact.