Knotless double-row SutureBridge rotator cuff repairs have improved self-reinforcement compared with double-row SutureBridge repairs with tied medial knots: a biomechanical study using an ovine model.

Abstract

BACKGROUND: In double-row SutureBridge (Arthrex, Naples, FL, USA) rotator cuff repairs, increasing tendon load may generate progressively greater compression forces at the repair footprint (self-reinforcement). SutureBridge rotator cuff repairs using tied horizontal mattress sutures medially may limit this effect compared with a knotless construct. MATERIALS AND METHODS: Rotator cuff repairs were performed in 9 pairs of ovine shoulders. One group underwent repair with a double-row SutureBridge construct with tied horizontal medial-row mattress sutures. The other group underwent repair in an identical fashion except that medial-row knots were not tied. Footprint contact pressure was measured at 0&#xb0; and 20&#xb0; of abduction under loads of 0 to 60 N. Pull-to-failure tests were then performed. RESULTS: In both repair constructs, each 10-N increase in rotator cuff tensile load led to a significant increase in footprint contact pressure (P&#x2009;<&#x2009;.0001). The rate of increase in footprint contact pressure was greater in the knotless construct (P&#x2009;<&#x2009;.00022; ratio, 1.69). The yield point approached the ultimate load to failure more closely in the knotless model than in the knotted construct (P&#x2009;=&#x2009;.00094). There was no difference in stiffness, ultimate failure load, or total energy to failure between the knotless and knotted techniques. CONCLUSION: In rotator cuff repair with a double-row SutureBridge configuration, self-reinforcement is seen in repairs with and without medial-row knots. Self-reinforcement is greater with the knotless technique.