Skip to main content
SpringerLink
Log in

Effect of single- and double-row rotator cuff repair at the tendon-to-bone interface: preliminary results using an in vivo sheep model

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The clinical superiority of the double-row technique is still a subject of controversial debate in rotator cuff repair. We hypothesised that the expression of different collagen types will differ between double-row and single-row rotator cuff repair indicating a faster healing response by the double-row technique.

Materials and methods

Twenty-four mature female sheep were randomly assembled to two different groups in which a surgically created acute infraspinatus tendon tear was fixed using either a modified single- or double-row repair technique. Shoulder joints from female sheep cadavers of identical age, bone maturity, and weight served as untreated control cluster. Expression of type I, II, and III collagen was observed in the tendon-to-bone junction along with recovering changes in the fibrocartilage zone after immunohistological tissue staining at 1, 2, 3, 6, 12, and 26 weeks postoperatively.

Results

Expression of type III collagen remained positive until 6 weeks after surgery in the double-row group, whereas it was detectable for 12 weeks in the single-row group. In both groups, type I collagen expression increased after 12 weeks. Type II collagen expression was increased after 12 weeks in the double-row versus single-row group. Clusters of chondrocytes were only visible between week 6 and 12 in the double-row group.

Conclusions

The study demonstrates differences regarding the expression of type I and type III collagen in the tendon-to-bone junction following double-row rotator cuff repair compared to single-row repair. The healing response in this acute repair model is faster in the double-row group during the investigated healing period.

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

Similar content being viewed by others

References

  1. Pauly S, Gerhardt C, Chen J, Scheibel M (2010) Single versus double-row repair of the rotator cuff: does double-row repair with improved anatomical and biomechanical characteristics lead to better clinical outcome? Knee Surg Sports Traumatol Arthrosc 18:1718–1729

    Article  PubMed  Google Scholar 

  2. Wall LB, Keener JD, Brophy RH (2009) Double-row vs single-row rotator cuff repair: a review of the biomechanical evidence. J Shoulder Elbow Surg 18:933–941

    Article  PubMed  Google Scholar 

  3. Kumagai J, Sarkar K, Uhthoff HK (1994) The collagen types in the attachment zone of rotator cuff tendons in the elderly: an immunohistochemical study. J Rheumatol 21:2096–2100

    CAS  PubMed  Google Scholar 

  4. Benjamin M, Toumi H, Ralphs JR, Bydder G, Best TM, Milz S (2006) Where tendons and ligaments meet bone: attachment sites (‘entheses’) in relation to exercise and/or mechanical load. J Anat 208:471–490

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Galatz L, Rothermich S, VanderPloeg K, Petersen B, Sandell L, Thomopoulos S (2007) Development of the supraspinatus tendon-to-bone insertion: localized expression of extracellular matrix and growth factor genes. J Orthop Res 25:1621–1628

    Article  PubMed  Google Scholar 

  6. Baums MH, Spahn G, Buchhorn GH, Schultz W, Hofmann L, Klinger H-M (2012) Biomechanical and magnetic resonance imaging evaluation of a single- and double-row rotator cuff repair in an in vivo sheep model. Arthroscopy 28:769–777

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  8. Klinger HM, Koelling S, Baums MH, Kahl E, Steckel H, Smith MM, Schultz W, Miosge N (2009) Cell biological and biomechanical evaluation of two different fixation techniques for rotator cuff repair. Scand J Med Sci Sports 19:329–337

    Article  PubMed  Google Scholar 

  9. Lewis CW, Schlegel TF, Hawkins RJ, James SP, Turner AS (1999) Comparison of tunnel suture and suture anchor methods as a function of time in a sheep model. Biomed Sci Instrum 35:403–408

    CAS  PubMed  Google Scholar 

  10. Lewis CW, Schlegel TF, Hawkins RJ, James SP, Turner AS (2001) The effect of immobilization on rotator cuff healing using modified Mason-Allen stitches: a biomechanical study in sheep. Biomed Sci Instrum 37:263–268

    CAS  PubMed  Google Scholar 

  11. Scheibel MT, Habermeyer P (2003) A modified Mason-Allen technique for rotator cuff repair using suture anchors. Arthroscopy 19:330–333

    Article  PubMed  Google Scholar 

  12. Burkhart SS (1995) The deadman theory of suture anchors: observations along a south Texas fence line. Arthroscopy 11:119–123

    Article  CAS  PubMed  Google Scholar 

  13. Cummins CA, Murrell GA (2003) Mode of failure for rotator cuff repair with suture anchors identified at revision surgery. J Shoulder Elbow Surg 12:128–133

    Article  PubMed  Google Scholar 

  14. Kjaer M (2004) Role of extracellular matrix in adaptation of tendon and skeletal muscle to mechanical loading. Physiol Rev 84:649–698

    Article  CAS  PubMed  Google Scholar 

  15. Williams IF, McCullagh KG, Silver IA (1984) The distribution of types I and III collagen and fibronectin in the healing equine tendon. Connect Tissue Res 12:211–227

    Article  CAS  PubMed  Google Scholar 

  16. Williams IF, Heaton A, McCullagh KG (1982) Connective tissue composition of the equine sarcoid. Equine Vet J 14:305–310

    Article  CAS  PubMed  Google Scholar 

  17. Hildebrand KA, Frank CB (1998) Scar formation and ligament healing. Can J Surg 41:425–429

    CAS  PubMed Central  PubMed  Google Scholar 

  18. Sakai H, Koibuchi N, Ohtake H, Tamai K, Fukui N, Oda H, Saotome K (2001) Type I and type III procollagen gene expressions in the early phase of ligament healing in rabbits: an in situ hybridization study. J Orthop Res 19:132–135

    Article  CAS  PubMed  Google Scholar 

  19. Nelson CO, Sileo MJ, Grossman MG, Serra-Hsu F (2008) Single-row modified mason-allen versus double-row arthroscopic rotator cuff repair: a biomechanical and surface area comparison. Arthroscopy 24:941–948

    Article  PubMed  Google Scholar 

  20. Baums MH, Spahn G, Steckel H, Fischer A, Schultz W, Klinger HM (2009) Comparative evaluation of the tendon-bone interface contact pressure in different single- versus double-row suture anchor repair techniques. Knee Surg Sports Traumatol Arthrosc 17:1466–1472

    Article  PubMed Central  PubMed  Google Scholar 

  21. Koh KH, Kang KC, Lim TK, Shon MS, Yoo JC (2001) 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  Google Scholar 

  22. 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 

  23. Nho SJ, Slabaugh MA, Seroyer ST, Grumet RC, Wilson JB, Verma NN, Romeo AA, Bach BR Jr (2009) Does the literature support double-row suture anchor fixation for arthroscopic rotator cuff repair? A systematic review comparing double-row and single-row suture anchor configuration. Arthroscopy 25:1319–1328

    Article  PubMed  Google Scholar 

  24. Park MC, Tibone JE, ElAttrache NS, Ahmad CS, Jun BJ, Lee TQ (2007) Part II: biomechanical assessment for a footprint-restoring transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elbow Surg 16:469–476

    Article  PubMed  Google Scholar 

  25. Tuoheti Y, Itoi E, Yamamoto N, Seki N, Abe H, Minagawa H, Okada K, Shimada Y (2005) Contact area, contact pressure, and pressure patterns of the tendon-bone interface after rotator cuff repair. Am J Sports Med 33:1869–1874

    Article  PubMed  Google Scholar 

  26. Gerber C, Meyer DC, Frey E, von Rechenberg B, Hoppeler H, Frigg R, Jost B, Zumstein MA (2009) Reversion of structural muscle changes caused by chronic rotator cuff tears using continuos musculotendinous traction. An experimental study in sheep. J Shoulder Elbow Surg 18:163–171

    Article  PubMed  Google Scholar 

  27. Rodeo SA, Potter HG, Kawamura S, Turner AS, Kim HJ, Atkinson BL (2007) Biologic augmentation of rotator cuff tendon-healing with use of a mixture of osteoinductive growth factors. J Bone Joint Surg Am 89:2485–2497

    Article  PubMed  Google Scholar 

  28. Seeherman HJ, Archambault JM, Rodeo SA, Turner AS, Zekas L, D’Augusta D, Li XJ, Smith E, Wozney JM (2008) rhBMP-12 accelerates healing of rotator cuff repairs in a sheep model. J Bone Joint Surg Am 90:2206–2219

    Article  PubMed  Google Scholar 

  29. Soslowsky LJ, Carpenter JE, DeBano CM, Banerji I, Moalli MR (1996) Development and use of an animal model for investigation on rotator cuff disease. J Shoulder Elbow Surg 5:383–392

    Article  CAS  PubMed  Google Scholar 

  30. MacGillivray JD, Fealy S, Terry MA, Koh JL, Nixon AJ, Warren RF (2006) Biomechanical evaluation of rotator cuff defect model augmented with a bioresorbable scaffold in goats. J Shoulder Elbow Surg 15:639–644

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Aukamm Klinik GmbH, Clinic for Orthopaedic Surgery and Orthopaedic Rheumatology, Leibnizstr. 21, 65191, Wiesbaden, Germany

    M. H. Baums

  2. Department of Orthopaedic Surgery, University of Göttingen Medical Center (UMG), Georg-August-University, Göttingen, Germany

    M. H. Baums, H.-M. Klinger & S. Lakemeier

  3. Department of Prosthodontics, Research Group of Oral Biology and Tissue Regeneration, University of Göttingen Medical Center (UMG), Georg-August-University, Göttingen, Germany

    B. Schminke, A. Posmyk & N. Miosge

Authors
  1. M. H. Baums
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Schminke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Posmyk
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Miosge
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H.-M. Klinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Lakemeier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. H. Baums.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baums, M.H., Schminke, B., Posmyk, A. et al. Effect of single- and double-row rotator cuff repair at the tendon-to-bone interface: preliminary results using an in vivo sheep model. Arch Orthop Trauma Surg 135, 111–118 (2015). https://doi.org/10.1007/s00402-014-2118-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-014-2118-1

Keywords

Search

Navigation