The Effect of Greater Tuberosity Decortication (Biogrooves) on Rotator Cuff Fixation: A Biomechanical Study

Insufficient tendon-bone healing remains a major cause of rotator cuff repair failure. The inability to reestablish a native-like enthesis results in scar formation and inferior mechanics. From a biomechanical standpoint, maximizing footprint contact and minimizing micromotion are critical determinants of early repair stability. Current greater tuberosity preparation techniques are primarily directed toward smoothing the footprint surface and exposing marrow elements to enhance biologic integration; however, the biomechanical consequences of deliberately controlled surface geometry on tendon fixation strength remain undefined.

Controlled decortication channels, termed biogrooves, would reduce supraspinatus (SSP) tendon displacement and improve footprint contact area compared with standard double-row repair with a smooth surface.

Controlled laboratory study.

Six fresh-frozen cadaveric shoulders were acquired. The SSP of all specimens was sharply dissected from the humeral origin. Each specimen underwent a standard double-row repair on PCF-25 Sawbone blocks. Biogrooves that were 6-mm in width and isosceles cross-section were created with a high-speed conical rotary tool and were sequentially tested across 5 conditions: (1) no biogrooves, (2) one 2 mm-deep biogroove, (3) two 2 mm-deep biogrooves, (4) two 3 mm-deep biogrooves, and (5) one 3 mm-deep biogroove. Constructs were mounted on a servohydraulic testing machine and ramped to a single load of 70 N over 30 seconds. Tendon displacement was measured under tension, and ultrasound imaging assessed footprint infill. Repeated-measures analysis of variance with Bonferroni correction was used for comparisons.

All biogroove conditions significantly reduced tendon displacement compared with the no-biogroove condition (P < .05). Mean displacement decreased by 19.5% with one 2-mm biogroove (P = .010), 25.4% with two 2-mm biogrooves (P = .021), 31.1% with two 3-mm biogrooves (P = .001), and 31.8% with one 3-mm biogroove (P = .005). The single 3-mm biogroove demonstrated a 14.3% reduction in displacement compared with the 2-mm biogroove (P = .0459). Ultrasound confirmed complete tendon infill across all groove conditions.

Biogrooves reduced SSP tendon displacement and improved footprint conformity compared with standard double-row repair in this laboratory model. Groove depth was more influential than groove number, with a single 3-mm biogroove providing as much improvement as two 3-mm biogrooves.

Biogrooves enhance the mechanical environment for biologic healing.