Biomechanical Comparison of a Single-Row versus Double-Row Suture Anchor Technique for Rotator Cuff Repair

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Abstract
Background: Reestablishment of the native footprint during rotator cuff repair has been suggested as an important criterion for optimizing healing potential and fixation strength. Hypothesis: A double-row rotator cuff footprint repair will demonstrate superior biomechanical properties compared with a single-row repair. Study Design: Controlled laboratory study. Methods: In 9 matched pairs of fresh-frozen cadaveric shoulders, the supraspinatus tendon from 1 shoulder was repaired with a double-row suture anchor technique: 2 medial anchors with horizontal mattress sutures and 2 lateral anchors with simple sutures. The tendon from the contralateral shoulder was repaired using a single lateral row of 2 anchors with simple sutures. Each specimen underwent cyclic loading from 10 to 180 N for 200 cycles, followed by tensile testing to failure. Gap formation and strain over the footprint area were measured using a video digitizing system; stiffness and failure load were determined from testing machine data. Results: Gap formation for the double-row repair was significantly smaller (P< .05) when compared with the single-row repair for the first cycle (1.67 ± 0.75 mm vs 3.10 ± 1.67 mm, respectively) and the last cycle (3.58 ± 2.59 mm vs 7.64 ± 3.74 mm, respectively). The initial strain over the footprint area for the double-row repair was nearly one third (P< .05) the strain of the single-row repair. Adding a medial row of anchors increased the stiffness of the repair by 46% and the ultimate failure load by 48% (P< .05). Conclusion: Footprint reconstruction of the rotator cuff using a double-row repair improved initial strength and stiffness and decreased gap formation and strain over the footprint when compared with a single-row repair. Clinical Relevance: To achieve maximal initial fixation strength and minimal gap formation for rotator cuff repair, reconstructing the footprint attachment with 2 rows of suture anchors should be considered.

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