Transosseous-equivalent rotator cuff repair: a systematic review on the biomechanical importance of tying the medial row.
OBJECTIVE
Double-row and transosseous-equivalent repair techniques have shown greater strength and improved healing than single-row techniques. The purpose of this study was to determine whether tying of the medial-row sutures provides added stability during biomechanical testing of a transosseous-equivalent rotator cuff repair.


METHODS
We performed a systematic review of studies directly comparing biomechanical differences.


RESULTS
Five studies met the inclusion and exclusion criteria. Of the 5 studies, 4 showed improved biomechanical properties with tying the medial-row anchors before bringing the sutures laterally to the lateral-row anchors, whereas the remaining study showed no difference in contact pressure, mean failure load, or gap formation with a standard suture bridge with knots tied at the medial row compared with knotless repairs.


CONCLUSIONS
The results of this systematic review and quantitative synthesis indicate that the biomechanical factors ultimate load, stiffness, gap formation, and contact area are significantly improved when medial knots are tied as part of a transosseous-equivalent suture bridge construct compared with knotless constructs. Further studies comparing the clinical healing rates and functional outcomes between medial knotted and knotless repair techniques are needed.


CONCLUSIONS
This review indicates that biomechanical factors are improved when the medial row of a transosseous-equivalent rotator cuff is tied compared with a knotless repair. However, this has not been definitively proven to translate to improved healing rates clinically.
Division of Sports Medicine, Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois 60612, USA. nathanmall@yahoo.com
Nathan A
NA
Mall
Andrew S
AS
Lee
Jaskarndip
J
Chahal
Geoffrey S
GS
Van Thiel
Anthony A
AA
Romeo
Nikhil N
NN
Verma
Brian J
BJ
Cole
D000818:Animals; D001696:Biomechanical Phenomena; D006801:Humans; D017006:Rotator Cuff / Q000503:physiopathology / Q000601:surgery*; D053441:Suture Anchors; D013536:Suture Techniques; D013708:Tendon Injuries / Q000503:physiopathology / Q000601:surgery*