Medial versus lateral supraspinatus tendon properties: implications for double-row rotator cuff repair.
Medial versus lateral supraspinatus tendon properties: implications for double-row rotator cuff repair.
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DOI：
10.1177/0363546510376817
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发表时间：
2010-12
期刊：
影响因子：
--
通讯作者：
Cole BJ
中科院分区：
文献类型：
--
作者：
Wang VM;Wang FC;McNickle AG;Friel NA;Yanke AB;Chubinskaya S;Romeo AA;Verma NN;Cole BJ
Rotator cuff repair re-tear rates range from 25-90% necessitating methods to improve repair strength. While numerous laboratory studies have compared single to double row fixation properties, little is known regarding regional (i.e., medial versus lateral) suture retention properties in both intact and torn tendons. A torn supraspinatus tendon will have reduced suture retention properties on the lateral aspect of the tendon compared to the more medial musculotendinous junction. Controlled Laboratory Study Human supraspinatus tendons (torn and intact) were randomly assigned for suture retention mechanical testing, ultrastructural collagen fibril analysis, or histology following suture pullout testing. For biomechanical evaluation, sutures were placed either at the musculotendinous junction (medial) or 10 mm from the free margin (lateral), and tendons were elongated to failure. Collagen fibril assessments were performed using transmission electron microscopy (TEM). Intact tendons showed no regional differences with respect to suture retention properties. In contrast, among torn tendons the medial region exhibited significantly higher stiffness and work values relative to the lateral region. For the lateral region, work to 10 mm displacement (1592±261 N-mm) and maximum load (265±44 N) for intact tendons were significantly higher (p<0.05) than those of torn tendons (1086±388 N-mm and 177±71 N, respectively). For medial suture placement, maximum load, stiffness and work of intact and torn tendons were similar (p>0.05). Regression analyses for the intact and torn groups revealed generally low correlations between donor age and the three biomechanical indices. For both intact and torn tendons, the mean fibril diameter and area density were greater in the medial region relative to the lateral (p≤0.05). In the lateral tendon, but not the medial region, torn specimens showed a significantly lower fibril area fraction (48.3±3.8%) than intact specimens (56.7±3.6%, p<0.05). Superior pullout resistance of medial placed sutures may provide a strain shielding effect for the lateral row following double row repair. Larger diameter collagen fibrils as well as greater fibril area fraction in the medial supraspinatus tendon may provide greater resistance to suture migration. While clinical factors such as musculotendinous integrity warrant strong consideration for surgical decision making, the present ultrastructural and biomechanical results appear to provide a scientific rationale for double-row rotator cuff repair where sutures are placed more medial at the muscle tendon junction.
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