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CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2021; 62(03): e168-e173
DOI: 10.1055/s-0041-1740095
Artículo Original | Original Article

Intraosseous Suture Abrasion according to the Angle of the Transosseous Tunnel in Rotator Cuff Footprint

Artikel in mehreren Sprachen: español | English
Julio José Contreras 
1   Unidad de Hombro y Codo, Instituto Traumatológico, Santiago de Chile, Chile
,
Rodrigo Liendo 
2   Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
,
Andrés Meza 
3   Ortopedia y Traumatología, Hospital Claudio Vicuña, San Antonio, Valparaíso, Chile
,
Francisco Soza 
2   Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
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Resumen

Objetivo Comparar el desgaste óseo generado por la abrasión de una carga cíclica entre túneles clásicos oblicuos y perpendiculares. Nuestra hipótesis es la de que el túnel oblicuo presenta un menor desgaste óseo por abrasión cíclica comparado con el túnel perpendicular.

Métodos Ocho hombros congelados de cordero fueron usados para el estudio biomecánico. En cada húmero proximal, dos túneles (oblicuo y perpendicular) fueron generados en la tuberosidad mayor. Se utilizó un sistema de tracción cíclica para traccionar hacia atrás y adelante una sutura trenzada en tensión a través del túnel, midiendo la distancia entre la entrada y la salida de la sutura en el túnel antes y después del proceso de ciclado como medida de perdida de tensión de la sutura. El resultado principal es el cambio de la distancia entre la entrada y la salida de la sutura en el túnel después del ciclado para estimar el desgaste óseo dentro del túnel. Para el análisis estadístico, se utilizó la prueba U de Mann-Whitney. Se consideraron significativos valores de p < 0,05.

Resultados Los túneles perpendiculares tuvieron un 23,24 ±  7,44% de pérdida de longitud, y los túneles oblicuos, 7,76 ±  4,32%. La diferencia de pérdida de longitud fue significativa (p = 0,0003).

Conclusión La abrasión ósea generada por el movimiento cíclico de la sutura en el túnel transóseo está influenciada por la geometría del túnel. El desgaste óseo es menor en un túnel oblicuo comparado con un túnel perpendicular.

Nivel de Evidencia Estudio de ciencia básica.

Abstract

Objective To compare the bone wear generated by the abrasion of a cyclic load between classic oblique and perpendicular tunnels. Our hypothesis is that the oblique tunnel is submitted to less cyclic abrasion bone wear compared with the perpendicular tunnel.

Methods Eight fresh-frozen lamb shoulders were used for biomechanical testing. In each proximal humerus, two tunnels (one oblique and one perpendicular) were drilled at the greater tuberosity. We used a cyclic traction system to pull back and forth a braided suture under tension through the tunnel, measuring the distance between the entry and exit points of the suture within the tunnel before and after the cyclic process to release the tension in the suture. The main outcome was the percentage of change in the distance between the entry and exit points of the suture within the tunnel before and after cyclic abrasion to estimate the degree of bone wear inside the tunnel. For the statistical analysis, the Mann-Whitney U test was used. Values of p < 0.05 were considered significant.

Results The perpendicular bone tunnels had 23.24 ±  7.44% decrease in length, and the oblique bone tunnels, 7.76 ±  4.32%. The difference in the decrease in length was significant (p = 0.0003).

Conclusion The bone abrasion caused by the cyclical movement of the suture in the bone tunnel was influenced by the shape of the tunnel. Bone wear was lower with an oblique tunnel compared with a perpendicular tunnel.

Level of Evidence Basic Science Study.

Keywords

rotator cuff - suture - suture techniques - tendon injuries - tendons - bone tunnel wear - suture abrasion - cyclic abrasion


Publikationsverlauf

Eingereicht: 28. August 2020

Angenommen: 06. August 2021

Artikel online veröffentlicht:
22. Dezember 2021

© 2021. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referencias

  • 1 Reilly P, Macleod I, Macfarlane R, Windley J, Emery RJ. Dead men and radiologists don't lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence. Ann R Coll Surg Engl 2006; 88 (02) 116-121
    CrossrefPubMedSuche in Google Scholar
  • 2 Yamamoto A, Takagishi K, Osawa T. et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg 2010; 19 (01) 116-120
    CrossrefPubMedSuche in Google Scholar
  • 3 Vaishnav S, Millett PJ. Arthroscopic rotator cuff repair: scientific rationale, surgical technique, and early clinical and functional results of a knotless self-reinforcing double-row rotator cuff repair system. J Shoulder Elbow Surg 2010; 19 (2, Suppl): 83-90
    CrossrefPubMedSuche in Google Scholar
  • 4 Gerber C, Schneeberger AG, Beck M, Schlegel U. Mechanical strength of repairs of the rotator cuff. J Bone Joint Surg Br 1994; 76 (03) 371-380
    CrossrefPubMedSuche in Google Scholar
  • 5 Kowalsky MS, Dellenbaugh SG, Erlichman DB, Gardner TR, Levine WN, Ahmad CS. Evaluation of suture abrasion against rotator cuff tendon and proximal humerus bone. Arthroscopy 2008; 24 (03) 329-334
    CrossrefPubMedSuche in Google Scholar
  • 6 Gartsman GM, Khan M, Hammerman SM. Arthroscopic repair of full-thickness tears of the rotator cuff. J Bone Joint Surg Am 1998; 80 (06) 832-840
    CrossrefPubMedSuche in Google Scholar
  • 7 Burkhart SS, Danaceau SM, Pearce Jr CE. Arthroscopic rotator cuff repair: Analysis of results by tear size and by repair technique-margin convergence versus direct tendon-to-bone repair. Arthroscopy 2001; 17 (09) 905-912
    CrossrefPubMedSuche in Google Scholar
  • 8 Murray Jr TF, Lajtai G, Mileski RM, Snyder SJ. Arthroscopic repair of medium to large full-thickness rotator cuff tears: outcome at 2- to 6-year follow-up. J Shoulder Elbow Surg 2002; 11 (01) 19-24
    CrossrefPubMedSuche in Google Scholar
  • 9 Flurin P-H, Landreau P, Gregory T. et al. Cuff Integrity After Arthroscopic Rotator Cuff Repair: Correlation With Clinical Results in 576 Cases. Arthroscopy 2007; 23 (04) 340-346
    CrossrefPubMedSuche in Google Scholar
  • 10 Sugaya H, Maeda K, Matsuki K, Moriishi J. Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study. J Bone Joint Surg Am 2007; 89 (05) 953-960
    CrossrefPubMedSuche in Google Scholar
  • 11 Wolf EM, Pennington WT, Agrawal V. Arthroscopic rotator cuff repair: 4- to 10-year results. Arthroscopy 2004; 20 (01) 5-12
    CrossrefPubMedSuche in Google Scholar
  • 12 Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 2004; 86 (02) 219-224
    CrossrefPubMedSuche in Google Scholar
  • 13 Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal?. J Bone Joint Surg Am 2005; 87 (06) 1229-1240
    CrossrefPubMedSuche in Google Scholar
  • 14 Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL. Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elbow Surg 2006; 15 (03) 290-299
    CrossrefPubMedSuche in Google Scholar
  • 15 Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am 1986; 68 (08) 1136-1144
    CrossrefPubMedSuche in Google Scholar
  • 16 Iannotti JP, Bernot MP, Kuhlman JR, Kelley MJ, Williams GR. Postoperative assessment of shoulder function: a prospective study of full-thickness rotator cuff tears. J Shoulder Elbow Surg 1996; 5 (06) 449-457
    CrossrefPubMedSuche in Google Scholar
  • 17 Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg 2003; 12 (06) 550-554
    CrossrefPubMedSuche in Google Scholar
  • 18 Lafosse L, Brozska R, Toussaint B, Gobezie R. The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique. J Bone Joint Surg Am 2007; 89 (07) 1533-1541
    CrossrefPubMedSuche in Google Scholar
  • 19 Park MC, ElAttrache NS, Tibone JE, Ahmad CS, Jun BJ, Lee TQ. Part I: Footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elbow Surg 2007; 16 (04) 461-468
    CrossrefPubMedSuche in Google Scholar
  • 20 Ahmad CS, Stewart AM, Izquierdo R, Bigliani LU. Tendon-bone interface motion in transosseous suture and suture anchor rotator cuff repair techniques. Am J Sports Med 2005; 33 (11) 1667-1671
    CrossrefPubMedSuche in Google Scholar
  • 21 Apreleva M, Özbaydar M, Fitzgibbons PG, Warner JJP. Rotator cuff tears: the effect of the reconstruction method on three-dimensional repair site area. Arthroscopy 2002; 18 (05) 519-526
    CrossrefPubMedSuche in Google Scholar
  • 22 Kuroda S, Ishige N, Mikasa M. Advantages of arthroscopic transosseous suture repair of the rotator cuff without the use of anchors. Clin Orthop Relat Res 2013; 471 (11) 3514-3522
    CrossrefPubMedSuche in Google Scholar
  • 23 Black EM, Austin LS, Narzikul A, Seidl AJ, Martens K, Lazarus MD. Comparison of implant cost and surgical time in arthroscopic transosseous and transosseous equivalent rotator cuff repair. J Shoulder Elbow Surg 2016; 25 (09) 1449-1456
    CrossrefPubMedSuche in Google Scholar
  • 24 Garofalo R, Castagna A, Borroni M, Krishnan SG. Arthroscopic transosseous (anchorless) rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2012; 20 (06) 1031-1035
    CrossrefPubMedSuche in Google Scholar
  • 25 Seidl AJ, Lombardi NJ, Lazarus MD. et al. Arthroscopic Transosseous and Transosseous-Equivalent Rotator Cuff Repair: An Analysis of Cost, Operative Time, and Clinical Outcomes. Am J Orthop 2016; 45 (07) E415-E420
    PubMedSuche in Google Scholar
  • 26 Kummer FJ, Hahn M, Day M, Meislin RJ, Jazrawi LM. A laboratory comparison of a new arthroscopic transosseous rotator cuff repair to a double row transosseous equivalent rotator cuff repair using suture anchors. Bull Hosp Jt Dis (2013) 2013; 71 (02) 128-131
    PubMedSuche in Google Scholar
  • 27 Park MC, Cadet ER, Levine WN, Bigliani LU, Ahmad CS. Tendon-to-bone pressure distributions at a repaired rotator cuff footprint using transosseous suture and suture anchor fixation techniques. Am J Sports Med 2005; 33 (08) 1154-1159
    CrossrefPubMedSuche in Google Scholar
  • 28 Tauber M, Koller H, Resch H. Transosseous arthroscopic repair of partial articular-surface supraspinatus tendon tears. Knee Surg Sports Traumatol Arthrosc 2008; 16 (06) 608-613
    CrossrefPubMedSuche in Google Scholar
  • 29 Yamaguchi K, Levine WN, Marra G, Galatz LM, Klepps S, Flatow EL. Transitioning to arthroscopic rotator cuff repair: the pros and cons. Instr Course Lect 2003; 52: 81-92
    PubMedSuche in Google Scholar
  • 30 Fleega BA. Arthroscopic transhumeral rotator cuff repair: Giant needle technique. Arthroscopy 2002; 18 (02) 218-223
    CrossrefPubMedSuche in Google Scholar
  • 31 Black EM, Lin A, Srikumaran U, Jain N, Freehill MT. Arthroscopic transosseous rotator cuff repair: technical note, outcomes, and complications. Orthopedics 2015; 38 (05) e352-e358
    CrossrefPubMedSuche in Google Scholar
  • 32 Mahar AT, Moezzi DM, Serra-Hsu F, Pedowitz RA. Comparison and performance characteristics of 3 different knots when tied with 2 suture materials used for shoulder arthroscopy. Arthroscopy 2006; 22 (06) 614.e1-614.e2
    CrossrefPubMedSuche in Google Scholar
  • 33 Wüst DM, Meyer DC, Favre P, Gerber C. Mechanical and handling properties of braided polyblend polyethylene sutures in comparison to braided polyester and monofilament polydioxanone sutures. Arthroscopy 2006; 22 (11) 1146-1153
    CrossrefPubMedSuche in Google Scholar
  • 34 Rossouw DJ, McElroy BJ, Amis AA, Emery RJH. A biomechanical evaluation of suture anchors in repair of the rotator cuff. J Bone Joint Surg Br 1997; 79 (03) 458-461
    CrossrefPubMedSuche in Google Scholar
  • 35 Goradia VK, Rochat MC, Kida M, Grana WA. Natural history of a hamstring tendon autograft used for anterior cruciate ligament reconstruction in a sheep model. Am J Sports Med 2000; 28 (01) 40-46
    CrossrefPubMedSuche in Google Scholar
  • 36 Pinczewski LA, Clingeleffer AJ, Otto DD, Bonar SF, Corry IS. Integration of hamstring tendon graft with bone in reconstruction of the anterior cruciate ligament. Arthroscopy 1997; 13 (05) 641-643
    CrossrefPubMedSuche in Google Scholar
  • 37 Rodeo SA, Arnoczky SP, Torzilli PA, Hidaka C, Warren RF. Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog. J Bone Joint Surg Am 1993; 75 (12) 1795-1803
    CrossrefPubMedSuche in Google Scholar
  • 38 Weiler A, Peine R, Pashmineh-Azar A, Abel C, Südkamp NP, Hoffmann RFG. Tendon healing in a bone tunnel. Part I: Biomechanical results after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy 2002; 18 (02) 113-123
    CrossrefPubMedSuche in Google Scholar
  • 39 Baums MH, Spahn G, Steckel H, Fischer A, Schultz W, Klinger H-M. Comparative evaluation of the tendon-bone interface contact pressure in different single- versus double-row suture anchor repair techniques. Knee Surg Sports Traumatol Arthrosc 2009; 17 (12) 1466-1472
    CrossrefPubMedSuche in Google Scholar
  • 40 Lee TQ. Current biomechanical concepts for rotator cuff repair. Clin Orthop Surg 2013; 5 (02) 89-97
    CrossrefPubMedSuche in Google Scholar
  • 41 Gupta H, Mishra P, Kataria H. et al. Optimal Angle of the Bone Tunnel for Avoiding Axillary Nerve Injuries During Arthroscopic Transosseous Rotator Cuff Repair: A Magnetic Resonance Imaging-Based Simulation Study. Orthop J Sports Med 2018; 6 (11) 2325967118806295
    Suche in Google Scholar
  • 42 Bronsnick D, Pastor A, Peresada D, Amirouche F, Solitro GF, Goldberg BA. Is Arthroscopic Transosseous Rotator Cuff Repair Strength Dependent on the Tunnel Angle?. Orthop J Sports Med 2019; 7 (06) 2325967119848667
    Suche in Google Scholar
  • 43 Andres BM, Lam PH, Murrell GA. Tension, abduction, and surgical technique affect footprint compression after rotator cuff repair in an ovine model. J Shoulder Elbow Surg 2010; 19 (07) 1018-1027
    CrossrefPubMedSuche in Google Scholar