title: Biomechanical validation of load-sharing rip-stop fixation for the repair of tissue-deficient rotator cuff tears.
abstract: BACKGROUND
  Poor-quality tendon is one of the most difficult problems the surgeon must overcome in achieving secure fixation during rotator cuff repair. A load-sharing rip-stop construct (LSRS) has recently been proposed as a method for improving fixation strength, but the biomechanical properties of this construct have not yet been examined.
  
  
  OBJECTIVE
  To compare the strength of the LSRS construct to that of single-row fixation for rotator cuff repair.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Rotator cuff tears were created in 6 cadaveric matched-pair specimens and repaired with a single row or an LSRS. In the LSRS repair, a 2-mm suture tape was placed as an inverted mattress stitch in the rotator cuff, and sutures from 2 anchors were placed as simple stitches that passed medial to the suture tape. The suture tape limbs were secured with knotless anchors laterally before sutures were tied from the medial anchors. Displacement was observed with video tracking after cyclic loading, and specimens were loaded to failure.
  
  
  RESULTS
  The mean load to failure was 371 ± 102 N in single-row repairs compared with 616 ± 185 N in LSRS repairs (P = .031). There was no difference in displacement with cyclic loading between the groups (3.3 ± 0.8 mm vs. 3.5 ± 1.1 mm; P = .561). In the single-row group, 4 of 6 failures occurred at the suture-tendon interface. In the LSRS group, only 1 failure occurred at the suture-tendon interface.
  
  
  CONCLUSIONS
  The ultimate failure load of the LSRS construct for rotator cuff repair was 1.7 times that of a single-row construct in a cadaveric model.
  
  
  CONCLUSIONS
  The LSRS rotator cuff repair construct may be useful in the repair of difficult tears such as massive tears, medial tears, and tears with tendon loss.
authors.affiliation: Patrick J. Denard, 2780 E Barnett Rd, Suite 200, Medford, OR 97530, USA. pjdenard@gmail.com.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Burkhart
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Denard
authors.forename: John
authors.initials: J
authors.lastname: Konicek
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Hanypsiak
mesh_terms: D001696:Biomechanical Phenomena; D002102:Cadaver; D006801:Humans; D008297:Male; D008875:Middle Aged; D017006:Rotator Cuff / Q000503:physiopathology / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D053441:Suture Anchors; D013536:Suture Techniques
keywords: arthroscopic rotator cuff repair; biomechanics; rip-stop repair; single-row repair