Biomechanical validation of rotator cuff repair techniques and considerations for a "technical efficiency ratio"

Biomechanical studies are commonly used to validate new or modified rotator cuff repair techniques. Additional knots, more tendon suture passes, and obligatory suture management requirements are often the "cost" for improved biomechanical results. This cost can amount to increased technical difficulty and surgical times. However, technical ease or difficulty as a measurable variable has not been quantified. A basic measure for technical ease would allow surgeons the ability to objectively assess and compare rotator cuff repair practicality and potentially help in the design of future studies to standardize repair techniques alongside biomechanical measures. A proposed rotator cuff repair "technical efficiency ratio" is defined as follows: (No. of knots + No. of tendon suture passes + No. of suture limbs)/No. of pilot holes created. This can give a measure of "work" or utility achieved per fixation point created for a particular type of repair (e.g., single or double row), with a smaller number representing relatively more efficiency per anchor or fixation point used. If repairs validated in the laboratory are too cumbersome to perform in vivo from a practical standpoint, technical ease should be a prerequisite measure, and the success of a repair technique should not necessarily be based on biomechanics alone.