title: Influence of Rotator Cuff Tear Size and Repair Technique on the Creation and Management of Dog Ear Deformities in a Transosseous-Equivalent Rotator Cuff Repair Model.
abstract: BACKGROUND
  Redundancies in the rotator cuff tissue, commonly referred to as "dog ear" deformities, are frequently encountered during rotator cuff repair. Knowledge of how these deformities are created and their impact on rotator cuff footprint restoration is limited.
  
  
  OBJECTIVE
  The goals of this study were to assess the impact of tear size and repair method on the creation and management of dog ear deformities in a human cadaveric model.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Crescent-shaped tears were systematically created in the supraspinatus tendon of 7 cadaveric shoulders with increasing medial to lateral widths (0.5, 1.0, and 1.5 cm). Repair of the 1.5-cm tear was performed on each shoulder with 3 methods in a randomized order: suture bridge, double-row repair with 2-mm fiber tape, and fiber tape with peripheral No. 2 nonabsorbable looped sutures. Resulting dog ear deformities were injected with an acrylic resin mixture, digitized 3-dimensionally (3D), and photographed perpendicular to the footprint with calibration. The volume, height, and width of the rotator cuff tissue not in contact with the greater tuberosity footprint were calculated using the volume injected, 3D reconstructions, and calibrated photographs. Comparisons were made between tear size, dog ear measurement technique, and repair method utilizing 2-way analysis of variance and Student-Newman-Keuls multiple-comparison tests.
  
  
  RESULTS
  Utilizing 3D digitized and injection-derived volumes and dimensions, anterior dog ear volume, height, and width were significantly smaller for rotator cuff repair with peripheral looped sutures compared with a suture bridge (P < .05) or double-row repair with 2-mm fiber tape alone (P < .05). Similarly, posterior height and width were significantly smaller for repair with looped peripheral sutures compared with a suture bridge (P < .05). Dog ear volumes and heights trended larger for the 1.5-cm tear, but this was not statistically significant.
  
  
  CONCLUSIONS
  When combined with a standard transosseous-equivalent repair technique, peripheral No. 2 nonabsorbable looped sutures significantly decreased the volume, height, and width of dog ear deformities, better restoring the anatomic footprint of the rotator cuff.
  
  
  CONCLUSIONS
  Dog ear deformities are commonly encountered during rotator cuff repair. Knowledge of a repair technique that reliably decreases their size, and thus increases contact at the anatomic footprint of the rotator cuff, will aid sports medicine surgeons in the management of these deformities.
authors.affiliation: Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA.
authors.forename: Lauren H
authors.initials: LH
authors.lastname: Redler
authors.affiliation: Vanderbilt Bone and Joint, Spring Hill, Tennessee, USA.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Byram
authors.affiliation: Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Luchetti
authors.affiliation: Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA.
authors.forename: Ying Lai
authors.initials: YL
authors.lastname: Tsui
authors.affiliation: The Carrell Clinic, Dallas, Texas, USA.
authors.forename: Todd C
authors.initials: TC
authors.lastname: Moen
authors.affiliation: Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Gardner
authors.affiliation: Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ahmad
keywords: FiberLink; SpeedBridge; SutureBridge; digitization; dog ear deformity; rotator cuff repair