title: Suture spanning augmentation of single-row rotator cuff repair: a biomechanical analysis.
abstract: BACKGROUND
  This in vitro study evaluated the biomechanical benefit of adding spanning sutures to single-row rotator cuff repair.
  
  
  METHODS
  Mechanical testing was performed to evaluate 9 pairs of cadaveric shoulders with complete rotator cuff repairs, with a single-row technique used on one side and the suture spanning technique on the other. The spanning technique included sutures from 2 lateral anchors securing tendon near the musculotendinous junction, spanning the same anchor placement from single-row repair. The supraspinatus muscle was loaded to 100 N at 0.25 Hz for 100 cycles, followed by a ramp to failure. Markers and a video tracking system measured anterior and posterior gap formation across the repair at 25-cycle intervals. The force at which the stiffness decreased by 50% and 75% was determined. Data were compared using paired t-tests.
  
  
  RESULTS
  One single-row repair failed at <25 cycles. Both anterior and posterior gap distances tended to be 1 to 2 mm larger for the single-row repairs than for the suture spanning technique. The difference was statistically significant at all cycles for the posterior gap formation (P ≤ .02). The trends were not significant for the anterior gap (P ≥ .13). The loads at which the stiffness decreased by 50% and 75% did not differ significantly between the 2 types of repair (P ≥ .10).
  
  
  CONCLUSIONS
  The suture spanning technique primarily improved posterior gap formation. Decreased posterior gap formation could reduce failure rates for rotator cuff repair.
authors.affiliation: Department of Orthopedic Surgery, Cleveland Clinic Akron General, Akron, OH, USA.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Early
authors.affiliation: Department of Research, Cleveland Clinic Akron General, Akron, OH, USA. Electronic address: john.elias@akrongeneral.org.
authors.forename: John J
authors.initials: JJ
authors.lastname: Elias
authors.affiliation: Department of Orthopedic Surgery, Cleveland Clinic Akron General, Akron, OH, USA.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Lippitt
authors.affiliation: Department of Research, Cleveland Clinic Akron General, Akron, OH, USA.
authors.forename: Danielle E
authors.initials: DE
authors.lastname: Filipkowski
authors.affiliation: University of California, Los Angeles, CA, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Pedowitz
authors.affiliation: Cornerstone Orthopedics, Wheat Ridge, CO, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Ciccone
mesh_terms: D001696:Biomechanical Phenomena; D002102:Cadaver; D006801:Humans; D000070636:Rotator Cuff Injuries / Q000601:surgery*; D053441:Suture Anchors; D013536:Suture Techniques
keywords: Rotator cuff; biomechanical testing; gap formation; in vitro; massive tear; repair