Skip to main content
SpringerLink
Log in

Reconstruction of 25 and 50 % subscapularis tears: a single anchor with a double-mattress suture is sufficient for the reconstruction

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Evaluation of the biomechanical performance of repairs of 25 % (Fox/Romeo II) and 50 % (Fox/Romeo III) full-thickness subscapularis tears using a single-suture anchor.

Methods

Six pairs of human cadaver specimens were used for the testing. Artificial subscapularis tears were created in order to simulate a 25 % (6) and a 50 % (6) full-thickness tear. The reconstructions were made with a double-loaded suture anchor (5.5-mm Bio-Corkscrew with two No. 2 Fiberwire) creating a double-mattress suture repair. Reconstructions were cyclically loaded from 10 to 60 N. The load was increased stepwise up to 100 and 180 N. Cyclic displacement (means + standard dev.) as well as load-to-failure was determined, and mode of failure was recorded.

Results

In the reconstructed shoulders at 60 N, a mean cyclic displacement of 3.2 ± 0.7 mm was found in the 25 % tear, 2.6 ± 0.6 mm in the 50 % tear. At 100 N, 5.1 ± 1.2 mm was seen in the 25 % tear and 4.3 ± 0.3 mm in the 50 % tear. At highest load of 180 N, 7.6 ± 2.2 mm was recorded in the 25 % tear, 6.5 ± 0.8 mm was found in the 50 % tear. Ultimate failure load was 486 ± 167 N in the 25 % tear and 455 ± 213 N in the 50 % tear. Statistically significant differences between the tested repairs were seen neither in cyclic displacement nor in ultimate failure loads (p > 0.05). Mode of failure revealed bone fractures and anchor pull-out as major cause in the 25 % group, whereas failure of the suture–tendon interface was the major cause of failure in the 50 % group.

Conclusions

Subscapularis repair using a single double-loaded suture anchor revealed similar biomechanical performance in 25 % compared to 50 % full-thickness subscapularis tears. With increased tear size, however, an optimized suture–tendon interface seems to become more relevant in order to decrease failure rate of the repair.

Clinical relevance

A single double-loaded suture anchor provides sufficient biomechanical strength even in Fox/Romeo grade III tears of the subscapularis tendon. However, a modified suture configuration is recommended, especially in grade III tears as the suture–tendon interface is the weakest point of the construct.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Ahmad CS, Wing D, Gardner TR, Levine WN, Bigliani LU (2007) Biomechanical evaluation of subscapularis repair used during shoulder arthroplasty. J Shoulder Elbow Surg 16:S59–S64

    Article  PubMed  Google Scholar 

  2. Arai R, Sugaya H, Mochizuki T, Nimura A, Moriishi J, Akita K (2008) Subscapularis tendon tear: an anatomic and clinical investigation. Arthroscopy 24:997–1004

    Article  PubMed  Google Scholar 

  3. Aydin N, Kocaoglu B, Guven O (2010) Single-row versus double-row arthroscopic rotator cuff repair in small- to medium-sized tears. J Shoulder Elbow Surg 19:722–725

    Article  PubMed  Google Scholar 

  4. Barber FA, Herbert MA, Schroeder FA, Ziz-Jacobo J, Mays MM, Rapley JH (2010) Biomechanical advantages of triple-loaded suture anchors compared with double-row rotator cuff repairs. Arthroscopy 26:316–323

    Article  PubMed  Google Scholar 

  5. Bartl C, Imhoff AB (2007) Management of isolated subscapularis tendon tears. Orthopade 36:848–854

    Article  CAS  PubMed  Google Scholar 

  6. Bennett WF (2001) Subscapularis, medial, and lateral head coracohumeral ligament insertion anatomy. Arthroscopic appearance and incidence of “hidden” rotator interval lesions. Arthroscopy 17:173–180

    Article  CAS  PubMed  Google Scholar 

  7. Burkhart SS, Brady PC (2006) Arthroscopic subscapularis repair: surgical tips and pearls A to Z. Arthroscopy 22:1014–1027

    Article  PubMed  Google Scholar 

  8. Burkhart SS, Johnson TC, Wirth MA, Athanasiou KA (1997) Cyclic loading of transosseous rotator cuff repairs: tension overload as a possible cause of failure. Arthroscopy 13:172–176

    Article  CAS  PubMed  Google Scholar 

  9. Burks RT, Crim J, Brown N, Fink B, Greis PE (2009) A prospective randomized clinical trial comparing arthroscopic single- and double-row rotator cuff repair: magnetic resonance imaging and early clinical evaluation. Am J Sports Med 37:674–682

    Article  PubMed  Google Scholar 

  10. Charousset C, Grimberg J, Duranthon LD, Bellaiche L, Petrover D (2007) Can a double-row anchorage technique improve tendon healing in arthroscopic rotator cuff repair?: a prospective, nonrandomized, comparative study of double-row and single-row anchorage techniques with computed tomographic arthrography tendon healing assessment. Am J Sports Med 35:1247–1253

    Article  PubMed  Google Scholar 

  11. Denard PJ, Ladermann A, Burkhart SS (2011) Double-row fixation of upper subscapularis tears with a single suture anchor. Arthroscopy 27:1142–1149

    Article  PubMed  Google Scholar 

  12. Deutsch A, Altchek DW, Veltri DM, Potter HG, Warren RF (1997) Traumatic tears of the subscapularis tendon. Clinical diagnosis, magnetic resonance imaging findings, and operative treatment. Am J Sports Med 25:13–22

    Article  CAS  PubMed  Google Scholar 

  13. Fox J, Romeo AA (2003) Arthroscopic subscapularis repair. Annual Meeting of the American Academy of Orthpedic Surgeons, New Orleans

    Google Scholar 

  14. Franceschi F, Ruzzini L, Longo UG, Martina FM, Zobel BB, Maffulli N, Denaro V (2007) Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: a randomized controlled trial. Am J Sports Med 35:1254–1260

    Article  PubMed  Google Scholar 

  15. Gerber C, Hersche O, Farron A (1996) Isolated rupture of the subscapularis tendon. J Bone Joint Surg Am 78:1015–1023

    Article  CAS  PubMed  Google Scholar 

  16. Gerber C, Schneeberger AG, Beck M, Schlegel U (1994) Mechanical strength of repairs of the rotator cuff. J Bone Joint Surg Br 76:371–380

    CAS  PubMed  Google Scholar 

  17. Gerber C, Schneeberger AG, Perren SM, Nyffeler RW (1999) Experimental rotator cuff repair. A preliminary study. J Bone Joint Surg Am 81:1281–1290

    Article  CAS  PubMed  Google Scholar 

  18. Gerhardt C, Hug K, Pauly S, Marnitz T, Scheibel M (2012) Arthroscopic single-row modified mason-allen repair versus double-row suture bridge reconstruction for supraspinatus tendon tears: a matched-pair analysis. Am J Sports Med 40:2777–2785

    Article  PubMed  Google Scholar 

  19. Grasso A, Milano G, Salvatore M, Falcone G, Deriu L, Fabbriciani C (2009) Single-row versus double-row arthroscopic rotator cuff repair: a prospective randomized clinical study. Arthroscopy 25:4–12

    Article  PubMed  Google Scholar 

  20. Hughes RE, An KN (1996) Force analysis of rotator cuff muscles. Clin Orthop Relat Res 330:75–83

    Article  Google Scholar 

  21. Katthagen JC, Jensen G, Muller T, Voigt C, Lill H (2012) Subscapularis tendon lesions. Anatomy, diagnosis and importance of arthroscopic treatment. Unfallchirurg 115:817–827

    Article  CAS  PubMed  Google Scholar 

  22. Kim SJ, Jung M, Lee JH, Park JH, Chun YM (2014) Arthroscopic repair of a significant (>50 %) partial-thickness subscapularis tear concomitant with a full-thickness supraspinatus tear: technical considerations for subscapularis repair (transtendon technique versus tear completion). J Shoulder Elbow Surg. doi:10.1016/j.jse.2014.10.009

    PubMed Central  Google Scholar 

  23. Koh KH, Kang KC, Lim TK, Shon MS, Yoo JC (2011) Prospective randomized clinical trial of single-versus double-row suture anchor repair in 2- to 4-cm rotator cuff tears: clinical and magnetic resonance imaging results. Arthroscopy 27:453–462

    Article  PubMed  Google Scholar 

  24. Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R (2007) Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am 89:1184–1193

    Article  PubMed  Google Scholar 

  25. Longo UG, Berton A, Marinozzi A, Maffulli N, Denaro V (2012) Subscapularis tears. Med Sport Sci. 57:114–121

    Article  PubMed  Google Scholar 

  26. Lorbach O, Anagnostakos K, Vees J, Kohn D, Pape D (2010) Three-dimensional evaluation of the cyclic loading behavior of different rotator cuff reconstructions. Arthroscopy 26:S95–105

    Article  PubMed  Google Scholar 

  27. Lorbach O, Bachelier F, Vees J, Kohn D, Pape D (2008) Cyclic loading of rotator cuff reconstructions: single-row repair with modified suture configurations versus double-row repair. Am J Sports Med 36:1504–1510

    Article  PubMed  Google Scholar 

  28. Lorbach O, Kieb M, Raber F, Busch LC, Kohn D, Pape D (2012) Comparable biomechanical results for a modified single-row rotator cuff reconstruction using triple-loaded suture anchors versus a suture-bridging double-row repair. Arthroscopy 28:178–187

    Article  PubMed  Google Scholar 

  29. Lorbach O, Kieb M, Raber F, Kohn D, Pape D (2013) Three-dimensional evaluation of cyclic displacement in single-row and double-row rotator cuff reconstructions under a static external rotation. Am J Sports Med 1:153–162

    Article  Google Scholar 

  30. Lorbach O, Trennheuser C, Kohn D, Anagnostakos K (2014) The biomechanical performance of a new forked knotless biceps tenodesis compared to a knotless and suture anchor tenodesis. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3365-y

    Google Scholar 

  31. Ma CB, Comerford L, Wilson J, Puttlitz CM (2006) Biomechanical evaluation of arthroscopic rotator cuff repairs: double-row compared with single-row fixation. J Bone Joint Surg Am 88:403–410

    PubMed  Google Scholar 

  32. Ma HL, Chiang ER, Wu HT, Hung SC, Wang ST, Liu CL, Chen TH (2012) Clinical outcome and imaging of arthroscopic single-row and double-row rotator cuff repair: a prospective randomized trial. Arthroscopy 28:16–24

    Article  CAS  PubMed  Google Scholar 

  33. Mahar A, Tamborlane J, Oka R, Esch J, Pedowitz RA (2007) Single-row suture anchor repair of the rotator cuff is biomechanically equivalent to double-row repair in a bovine model. Arthroscopy 23:1265–1270

    Article  PubMed  Google Scholar 

  34. Nich C, Dhiaf N, Di SM, Augereau B (2014) Does partial tear repair of adjacent tendons improve the outcome of supraspinatus tendonfull-thickness tear reinsertion? Orthop Traumatol Surg Res 100:721–726

    Article  CAS  PubMed  Google Scholar 

  35. Nove-Josserand L, Hardy MB, Leandro Nunes OR, Carrillon Y, Godeneche A (2012) Clinical and structural results of arthroscopic repair of isolated subscapularis tear. J Bone Joint Surg Am 94:e125

    Article  PubMed  Google Scholar 

  36. Nove-Josserand L, Levigne C, Noel E, Walch G (1994) Isolated lesions of the subscapularis muscle. Apropos of 21 cases. Rev Chir Orthop Repar Appar Mot 80:595–601

    CAS  Google Scholar 

  37. Park MC, Idjadi JA, Elattrache NS, Tibone JE, McGarry MH, Lee TQ (2008) The effect of dynamic external rotation comparing 2 footprint-restoring rotator cuff repair techniques. Am J Sports Med 36:893–900

    Article  PubMed  Google Scholar 

  38. Park MC, Jun BJ, Park CJ, Ahmad CS, Elattrache NS, Lee TQ (2007) The biomechanical effects of dynamic external rotation on rotator cuff repair compared to testing with the humerus fixed. Am J Sports Med 35:1931–1939

    Article  PubMed  Google Scholar 

  39. Saridakis P, Jones G (2010) Outcomes of single-row and double-row arthroscopic rotator cuff repair: a systematic review. J Bone Joint Surg Am 92:732–742

    Article  PubMed  Google Scholar 

  40. Van den Berghe GR, Nguyen B, Patil S, D’Lima DD, Mahar A, Pedowitz R, Hoenecke HR (2008) A biomechanical evaluation of three surgical techniques for subscapularis repair. J Shoulder Elbow Surg 17:156–161

    Article  PubMed  Google Scholar 

  41. van der Zwaal P, Schuller L, Urlings TA, Coerkamp EG, van Arkel ER, van der List MP (2013) Clinical outcome and structural integrity of all-arthroscopic repair of degenerative subscapularis tendon tears. Knee Surg Sports Traumatol Arthrosc 21:1620–1625

    Article  PubMed  Google Scholar 

  42. Wellmann M, Wiebringhaus P, Lodde I, Waizy H, Becher C, Raschke MJ, Petersen W (2009) Biomechanical evaluation of a single-row versus double-row repair for complete subscapularis tears. Knee Surg Sports Traumatol Arthrosc 17:1477–1484

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Saarland University, Kirrberger Str, Geb. 37, 66421, Homburg (Saar), Germany

    Olaf Lorbach, Christian Trennheuser, Dieter Kohn & Konstantinos Anagnostakos

  2. Department of Orthopaedic and Trauma Surgery, Klinikum Ernst von Bergmann, Potsdam/Bad Belzig, Germany

    Matthias Kieb

  3. Department of Orthopaedic Surgery, Marburg University, Marburg, Germany

    Turgay Efe

Authors
  1. Olaf Lorbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christian Trennheuser
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthias Kieb
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Turgay Efe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dieter Kohn
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Konstantinos Anagnostakos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Olaf Lorbach.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lorbach, O., Trennheuser, C., Kieb, M. et al. Reconstruction of 25 and 50 % subscapularis tears: a single anchor with a double-mattress suture is sufficient for the reconstruction. Knee Surg Sports Traumatol Arthrosc 24, 3855–3862 (2016). https://doi.org/10.1007/s00167-015-3767-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3767-5

Keywords

Search

Navigation