Triple-row technique reduces gap formation and elongation compared with the suture-bridge technique

Area of Science:

• Orthopedic Surgery
• Biomechanical Engineering
• Sports Medicine

Background:

• The suture-bridge (SB) technique is a common method for rotator cuff repair.
• High re-tear rates indicate a need for improved rotator cuff repair constructs.
• The triple-row (TR) technique offers potential for enhanced tendon stabilization.

Purpose of the Study:

• To compare the mechanical properties of the suture-bridge (SB) and triple-row (TR) rotator cuff repair techniques.
• To evaluate gap formation, cyclic elongation, and ultimate failure load for different TR configurations (TR-DS, TR-DM, TR-MA) against the SB technique.

Main Methods:

• Developed 11 rotator cuff repair models using a 3D humeral bone and silicone tendon.
• Tested four repair constructs: SB, TR-double-simple (TR-DS), TR-double-horizontal mattress (TR-DM), and TR-Mason-Allen (TR-MA).
• Performed cyclic loading (10-100 N for 200 cycles) followed by load-to-failure testing (1 mm/s).

Main Results:

• All TR techniques demonstrated significantly less gap formation and cyclic elongation compared to SB repair (p < 0.001 and p ≤ 0.006, respectively).
• No significant difference was observed in the ultimate failure load between SB and TR repairs.
• TR-MA showed superior mechanical properties, though differences among TR constructs were not significant.

Conclusions:

• TR rotator cuff repair significantly improves initial stability by reducing gap formation and elongation compared to SB repair.
• These biomechanical advantages suggest TR repair may be beneficial when enhanced initial stability is a primary goal in rotator cuff repair.