Summary of Literature
|
Reference |
Test Type |
Single |
Double |
Comments |
|
Cummins et al Arthroscopy 2005[1] |
Tensile Strength test sheep Supraspinatus |
2 suture anchors double loaded and a simple stitch suture pattern = 212 +/- 39 N; P < .001 |
5 suture anchors in a double-row configuration, single loaded, that grasped the tendon with mattress stitches = 336 +/- 59 N; P < .001 |
“the initial load to failure of a rotator cuff repair may be increased by increasing the number of suture anchors, the number of sutures per anchor, or using suture patterns that grab more adjacent tendon fibers” |
|
Mazzoca et al. Am J Sports Med, 2005 [2] |
load to failure |
No difference |
|
“Double-row techniques provide a larger footprint width; although not addressed by this study, such a factor may improve the biological quality of repair.” – Why? |
|
|
cyclic displacement |
No difference |
| |
|
|
anatomical footprint |
|
Larger | |
|
Tuoheti et al. Am J Sports Med, 2005 [3] |
Contact area |
|
60% greater |
|
|
|
Contact pressure |
16% (P = .03) |
18% (P = .014) |
|
|
Brady et al. Arthroscopy 2006 [4] |
Footprint coverage at repair measure with depth gauge |
|
50% greater coverage of footprint |
|
|
Kim et al. Am J Sports Med 2006 [5] |
cyclic loading from 10 to 180 N for 200 cycles, followed by tensile testing to failure. |
|
|
|
|
|
Gap formation Last cycle |
3.10 +/- 1.67 mm 7.64 +/- 3.74 mm |
1.67 +/- 0.75 mm 3.58 +/- 2.59 mm (P < .05) |
|
|
|
Strain |
|
initial strain over the footprint area for the double-row repair was nearly one third (P < .05) |
|
|
|
Stiffness |
|
Increased by 46% |
|
|
|
Ultimate failure load |
|
Increased by 48% |
|
|
Ma et al. JBJSA 2006 [6] |
cyclically loaded between 5 and 100 N at 0.25 Hz for fifty cycles and then loaded to failure under displacement control at 1 mm/sec |
|
|
Failure mechanisms were similar for all stitches |
|
|
Elongation |
No significant differences were found among the stitches with respect to conditioning elongation. The mean peak-to-peak elongation (and standard error of the mean) was significantly lower for the massive cuff (1.1 +/- 0.1 mm) and double-row stitches (1.1 +/- 0.1 mm) than for the arthroscopic Mason-Allen stitch (1.5 +/- 0.2 mm) (p < 0.05) | ||
|
|
The ultimate tensile load |
191 +/- 18 N (2 simple) 250 +/- 21 N (massive cuff) |
287 +/- 24 N (p < 0.05) | |
|
|
Stiffness |
No difference | ||
|
Meier JSES 2006 [7] |
Footprint area |
46% |
100% |
“may provide a tendon-bone interface better suited for biologic healing and restoring normal anatomy” |
|
Meier Arthroscopy 2006 [8] |
5 N to 180 N at a rate of 33 mm/sec. The test was stopped when complete failure (repair site gap of 10 mm) or a total of 5,000 cycles was attained |
|
|
address some deficiencies in current methods by increasing the strength of the repair, potentially leading to improved healing rates |
|
|
Cycles to failure |
798.3 +/- 73.28 |
>5,000 | |
|
|
Fixation strength |
|
Stronger (p<0.001) | |
|
Smith et al. JBJSA 2006 [9] |
loaded statically for one hour, and the gap formation was measured. Cyclic loading to failure was then performed |
|
|
Three single-row repairs and three double-row repairs failed as a result of suture cut-through. Four single-row repairs and one double-row repair failed as a result of anchor or suture failure |
|
|
Gap formation |
5.0 +/- 1.2 mm |
3.8 +/- 1.4 mm | |
|
|
Cyclic loading to failure |
224 +/- 147.9 N |
320 +/- 96.9 N (p = 0.058) | |
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CLINICAL STUDIES |
Functional Score |
Imaging |
| |
|
Charousset et al. 2007 [11] |
Clinical, controlled prospective trial of 60 patients with Constant score and CT arthrography |
Constant score: Single row improved from 53.6 to 82.7 Double row improved from 56.6 to 80.7 (p<0.05) |
CT Arthrography: Watertight healing was obtained in 77.4% of the cases in the double-anchorage group and in 60% of the cases in the single-anchorage group, this difference was not significant |
No significant difference between single and double row. |
|
Franceschi et al. 2007 [10] |
Clinical, controlled prospective trial of 60 patients with UCLA score and MR arthrography |
No difference in UCLA scores |
MR arthrography in single row goup showed intact tendons in 14 patients, partial-thickness defects in 10 patients, and full-thickness defects in 2 patients. In the double row group, magnetic resonance arthrography showed an intact rotator cuff in 18 patients, partial-thickness defects in 7 patients, and full-thickness defects in 1 patient. |
No significant difference between single and double row. |
REFERENCES:
1. Cummins, C.A., et al., Rotator cuff repair: an ex vivo analysis of suture anchor repair techniques on initial load to failure. Arthroscopy, 2005. 21(10): p. 1236-41.
2. Mazzocca, A.D., et al., Arthroscopic single-row versus double-row suture anchor rotator cuff repair. Am J Sports Med, 2005. 33(12): p. 1861-8.
3. Tuoheti, Y., et al., Contact area, contact pressure, and pressure patterns of the tendon-bone interface after rotator cuff repair. Am J Sports Med, 2005. 33(12): p. 1869-74.
4. Brady, P.C., P. Arrigoni, and S.S. Burkhart, Evaluation of residual rotator cuff defects after in vivo single- versus double-row rotator cuff repairs. Arthroscopy, 2006. 22(10): p. 1070-5.
5. Kim, D.H., et al., Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair. Am J Sports Med, 2006. 34(3): p. 407-14.
6. Ma, C.B., et al., Biomechanical evaluation of arthroscopic rotator cuff repairs: double-row compared with single-row fixation. J Bone Joint Surg Am, 2006. 88(2): p. 403-10.
7. Meier, S.W. and J.D. Meier, Rotator cuff repair: the effect of double-row fixation on three-dimensional repair site. J Shoulder Elbow Surg, 2006. 15(6): p. 691-6.
8. Meier, S.W. and J.D. Meier, The effect of double-row fixation on initial repair strength in rotator cuff repair: a biomechanical study. Arthroscopy, 2006. 22(11): p. 1168-73.
9. Smith, C.D., et al., A biomechanical comparison of single and double-row fixation in arthroscopic rotator cuff repair. J Bone Joint Surg Am, 2006. 88(11): p. 2425-31.
10. Francesco Franceschi, Laura Ruzzini, Umile Giuseppe Longo, Francesca Maria Martina, Bruno Beomonte Zobel, Nicola Maffulli, and Vincenzo Denaro Equivalent Clinical Results of Arthroscopic Single-Row and Double-Row Suture Anchor Repair for Rotator Cuff Tears: A Randomized Controlled Trial. Am J Sports Med 2007 35: 1254-1260.
11. Christophe Charousset, Jean Grimberg, Louis Denis Duranthon, Laurance Bellaiche, and David Petrover. Can a Double-Row Anchorage Technique Improve Tendon Healing in Arthroscopic Rotator Cuff Repair?: A Prospective, Nonrandomized, Comparative Study of Double-Row and Single-Row Anchorage Techniques With Computed Tomographic Arthrography Tendon Healing Assessment. Am J Sports Med 2007 35: 1247-1253.
