Improving medial footprint coverage in double row cuff repair using FiberTape

Completed Research

Improving medial footprint coverage in double row cuff repair using FiberTape

Background    

The optimal rotator cuff repair aims to recreate the anatomy of native tendon. This involves establishing the footprint provided that there is enough tendon excursion.

The success of any repair is dependent on anchor to bone fixation, suture-to-tendon fixation, abrasion resistance of the suture and suture strength. FiberTape has been designed to provide increased tissue cut-through resistance to prevent cuff repair failure.

Rationale

We hypothesized that this increased fracture results in the FiberTape dragging the tendon laterally and adversely affecting tendon-footprint contact. Our aim was to compare our standard FiberTape repairs with a modified technique.

Objectives

The objective of this study was to evaluate the ability of FiberTape to recreate footprint tendon to bone contact at the footprint.

Design

This was an observational cadaveric study.

Study Procedure

We created full thickness supraspinatus tears in 5 cadavers and each tendon was repaired using two different ways. Both groups had the same repair configuration with the difference being in the way the FiberTape is handled after being passed through the cuff. In Group 1 (Standard) we handled the FiberTape using our standard technique. Medial row PushLock anchors loaded with FiberTape were inserted at the medial aspect of the footprint. The FiberTape was then passed using a Scorpion suture passer (Arthrex; Naples, Florida). The FiberTapes then were crossed over and loaded onto SwiveLock for lateral row fixation at maximal tension. In Group 2 (FiberTape cinched), after the FiberTape was passed through the tendon, a knotpusher was used to cinch the FiberTape down with the aim of dragging further tape through tendon substance. The FiberTapes were then crossed over in standard fashion and loaded onto SwiveLock for lateral row fixation at maximal tension. Ultra Super Low Pressure Fuji Prescale film (Average pressure range 0.20-0.60 MPa; Fuji Photo Film Co Ltd, Tokyo, Japan) was used to measure the average contact area and the contact pressure across the suprasinatus footprint. We marked the bursal interface between the FiberTape and tendon after the standard repair. We then made a further mark on the FiberTape after completing the repair using the cinching technique. The distance between the marks was measured and represented the length of redundant FiberTape that could be pulled through from the undersurface of the cuff by the second method (cinching).

In addition to measuring the length of redundant tape, we further evaluated 2 cadavers with each repair type to allow visual inspection of the undersurface of each repair. Here, with the repair construct in situ, the repaired tendons were cut at the musculotendinous junction to expose the undersurface of the repair.

Ethics and Governance

Results

The length of redundant FiberTape pulled through from each suture after cinching was on average 6.1mm (range, 3 to 10mm). In the remaining 2 cadavers tested, we subjectively observed poor footprint coverage with exposed footprint and obvious suture material in specimens that were not cinched in contrast to better approximation of cuff to medial aspect of footprint with our cinching technique.

These results supported the hypothesis that tendon can be approximated to the medial row of the footprint better when using a modified cinching technique for knotless repairs using FiberTape suture. There was a significant difference in the length of FiberTape that was pulled through the tendon after cinching down medially.

While our study demonstrated better approximation of the tendon to the medial anchor row and therefore more anatomic footprint restoration, further studies are necessary to evaluate any potential beneficial effect of this on tendon healing and clinical outcomes.

References

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sydney-shoulder-research-institute-projects

Lead Investigator:

Dr Benjamin Cass

Commenced:

2014

Completed:

2014

Published:

Techniques in Shoulder & Elbow Surgery (2015 Sep;16(3):74-78)

Presented:

SECEC Annual Congress (Milan, Italy), September 2015
Royal North Shore Hospital Shoulder Symposium, September 2015
Australian Orthopaedic Association conference (Brisbane), October 2015

Category:

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