Biomechanical Comparison of 4 Double-Row Suture-Bridging Rotator Cuff Repair Techniques Using Different Medial-Row Configurations

Purpose: Biomechanical comparison of different suture-bridge configurations of the medial row with respect to initial construct stability (time 0, porcine model). Methods: In 40 porcine fresh-frozen shoulders, the infraspinatus tendons were dissected from their insertions. All specimens were operated on by use of the suture-bridge technique, only differing in terms of the medial-row suture-grasping configuration, and randomized into 4 groups: (1) single-mattress (SM) technique, (2) double-mattress (DM) technique, (3) cross-stitch (CS) technique, and (4) double-pulley (DP) technique. Identical suture anchors were used for all specimens (medial: Bio-Corkscrew FT 5.5 [Arthrex, Naples, FL]; lateral: Bio-PushLock 3.5 [Arthrex]). All repairs were cyclically loaded from 10 to 60 N until 10 to 200 N (20-N stepwise increase after 50 cycles each) with a material testing machine. Forces at 3 and 5 mm of gap formation, mode of failure, and maximum load to failure were recorded. Results: The DM technique had the highest ultimate tensile strength (368.6 +/- 99.5 N) compared with the DP (248.4 +/- 122.7 N), SM (204.3 +/- 90 N), and CS (184.9 +/- 63.8 N) techniques (P = .004). The DM technique provided maximal force resistance until 3 and 5 mm of gap formation (90.0 +/- 18.1 N and 128.0 +/- 32.3 N, respectively) compared with the CS (72 +/- 8.9 N and 108 +/- 20.2 N, respectively), SM (66.0 +/- 8.9 N and 90.0 +/- 26.9 N, respectively), and DP (62.2 +/- 6.2 N and 71 +/- 13.2 N, respectively) techniques (P < .05 for each 3 and 5 mm of gap formation). The main failure mode was suture cutting through the tendon. Conclusions: Comparing the 4 different suture-bridge techniques, we found that modified application of suture-bridge repair with double medial mattress stitches significantly enhanced biomechanical construct stability at time 0 in this porcine ex vivo model. Clinical Relevance: This technique increases initial stability and resistance to suture cutting through the rotator cuff tendon after arthroscopic suture-bridge repair.