Background The newly developed “transosseous-equivalent” (TOSE) rotator cuff repair technique is thought to incorporate several potential biologic and biomechanical advantages to rotator cuff healing. A previous study has shown that the TOSE fixation strength is equivalent to or greater than the conventional double-row (DR) technique; however, arthroscopic lateral fixation using the TOSE method is tedious and technically challenging.
Hypothesis The TOSE rotator cuff repair technique employing a knotless suture-locking device for lateral fixation will demonstrate superior loading biomechanics between tendon and tuberosity compared with the conventional double-row technique.
Methods Six matched-pairs of fresh-frozen cadaveric shoulders without gross evidence of rotator cuff pathology were used for this study. One specimen of each matched-pair underwent a supraspinatus tendon repair using the TOSE technique; the sutures were secured laterally using the PushLock device (Arthrex, Inc.). The contralateral limb underwent a conventional DR repair. All repairs were performed by the same surgeon. An Instron materials testing machine was used to test the biomechanics of the repair. Each specimen underwent a preload (10 N) followed by a cyclic load (10-180 N - 30 cycles) and a load to failure. Ultimate and yield strength, energy absorption, hysteresis, and linear stiffness data were collected.
Results The mean ultimate load to failure for the TOSE technique (380.8 ± 13.2 N) was significantly greater than that of the DR repair (285.5 ± 17.6 N, p = .0015). Energy absorbed to failure was also significantly greater for the TOSE repair (3,966.7 ± 297.4 Nmm) compared with the DR (1,236.2 ± 95.0 Nmm, p = .04). No statistical difference was found for yield strength, initial and linear stiffness, and hysteresis.
Conclusions The TOSE repair technique using the PushLock device for lateral fixation demonstrates improved ultimate strength and energy absorption characteristics compared with the conventional DR repair.
Clinical Relevance The TOSE rotator cuff repair technique has potential advantages for rotator cuff repair healing, including maximizing footprint-tendon contact, imparting compression on the tendon-bone interface, and generating a stronger repair. The original description and analysis of this technique included the use of a Bio-Tenodesis screw for lateral fixation. In comparison, the PushLock device is much easier and quicker to employ, while maintaining superior loading biomechanical strength. This study validates the use of the PushLock for lateral fixation in the TOSE rotator cuff repair technique.
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