Skip to main content
SpringerLink
Log in

Biomechanical evaluation of a single-row versus double-row repair for complete subscapularis tears

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

Abstract

The purpose of the study was to compare a single-row repair and a double-row repair technique for the specific characteristics of a complete subscapularis lesion. Ten pairs of human cadaveric shoulder human shoulder specimens were tested for stiffness and ultimate tensile strength of the intact tendons in a load to failure protocol. After a complete subscapularis tear was provoked, the specimens were assigned to two treatment groups: single-row repair (1) and a double-row repair using a “suture bridge” technique (2). After repair cyclic loading a subsequent load to failure protocol was performed to determine the ultimate tensile load, the stiffness and the elongation behaviour of the reconstructions. The intact subscapularis tendons had a mean stiffness of 115 N/mm and a mean ultimate load of 720 N. The predominant failure mode of the intact tendons was a tear at the humeral insertion site (65%). The double-row technique restored 48% of the ultimate load of the intact tendons (332 N), while the single-row technique revealed a significantly lower ultimate load of 244 N (P = 0.001). In terms of the stiffness, the double-row technique showed a mean stiffness of 81 N/mm which is significantly higher compared to the stiffness of the single-row repairs of 55 N/mm (P = 0.001). The double-row technique has been shown to be stronger and stiffer when compared to a conventional single-row repair. Therefore, this technique is recommended from a biomechanical point of view irrespectively if performed by an open or arthroscopic approach.

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

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. Bennett WF (2003) Arthroscopic repair of isolated subscapularis tears: a prospective cohort with 2- to 4-year follow-up. Arthroscopy 19:131–143

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  4. 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

    CAS  PubMed  Google Scholar 

  5. 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 

  6. Cole BJ, Elattrache NS, Anbari A (2007) Arthroscopic rotator cuff repairs: an anatomic and biomechanical rationale for different suture-anchor repair configurations. Arthroscopy 23:662–669

    PubMed  Google Scholar 

  7. Curtis AS, Burbank KM, Tierney JJ, Scheller AD, Curran AR (2006) The insertional footprint of the rotator cuff: an anatomic study. Arthroscopy 22:609

    Article  PubMed  Google Scholar 

  8. D’Addesi LL, Anbari A, Reish MW, Brahmabhatt S, Kelly JD (2006) The subscapularis footprint: an anatomic study of the subscapularis tendon insertion. Arthroscopy 22:937–940

    PubMed  Google Scholar 

  9. 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 

  10. Edwards TB, Walch G, Sirveaux F, Mole D, Nove-Josserand L, Boulahia A, Neyton L, Szabo I, Lindgren B (2005) Repair of tears of the subscapularis. J Bone Joint Surg Am 87:725–730

    Article  PubMed  Google Scholar 

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

  12. Fuchs B, Gilbart MK, Hodler J, Gerber C (2006) Clinical and structural results of open repair of an isolated one-tendon tear of the rotator cuff. J Bone Joint Surg Am 88:309–316

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  14. Halder A, Zobitz ME, Schultz E, An KN (2000) Structural properties of the subscapularis tendon. J Orthop Res 18:829–834

    Article  CAS  PubMed  Google Scholar 

  15. Hughes RE, An KN (1996) Force analysis of rotator cuff muscles. Clin Orthop Relat Res 7:5–83

    Google Scholar 

  16. Ide J, Tokiyoshi A, Hirose J, Mizuta H (2007) Arthroscopic repair of traumatic combined rotator cuff tears involving the subscapularis tendon. J Bone Joint Surg Am 89:2378–2388

    Article  PubMed  Google Scholar 

  17. Kim DH, Elattrache NS, Tibone JE, Jun BJ, DeLaMora SN, Kvitne RS, Lee TQ (2006) Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair. Am J Sports Med 34:407–414

    Article  CAS  PubMed  Google Scholar 

  18. 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 

  19. Lo IK, Burkhart SS (2003) The etiology and assessment of subscapularis tendon tears: a case for subcoracoid impingement, the roller-wringer effect, and TUFF lesions of the subscapularis. Arthroscopy 19:1142–1150

    Article  PubMed  Google Scholar 

  20. 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 

  21. 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

    Article  PubMed  Google Scholar 

  22. Maier D, Jaeger M, Suedkamp NP, Koestler W (2007) Stabilization of the long head of the biceps tendon in the context of early repair of traumatic subscapularis tendon tears. J Bone Joint Surg Am 89:1763–1769

    Article  PubMed  Google Scholar 

  23. 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 

  24. Neviaser RJ, Neviaser TJ, Neviaser JS (1988) Concurrent rupture of the rotator cuff and anterior dislocation of the shoulder in the older patient. J Bone Joint Surg Am 70:1308–1311

    CAS  PubMed  Google Scholar 

  25. Park MC, Elattrache NS, Ahmad CS, Tibone JE (2006) “Transosseous-equivalent” rotator cuff repair technique. Arthroscopy 22:1360–1365

    PubMed  Google Scholar 

  26. Park MC, Elattrache NS, Tibone JE, Ahmad CS, Jun BJ, Lee TQ (2007) Part I: Footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elbow Surg 16:461–468

    Article  PubMed  Google Scholar 

  27. 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 

  28. 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 

  29. Richards DP, Burkhart SS, Campbell SE (2005) Relation between narrowed coracohumeral distance and subscapularis tears. Arthroscopy 21:1223–1228

    Article  PubMed  Google Scholar 

  30. Richards DP, Burkhart SS, Tehrany AM, Wirth MA (2007) The subscapularis footprint: an anatomic description of its insertion site. Arthroscopy 23:251–254

    Article  PubMed  Google Scholar 

  31. 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 

  32. Smith CD, Alexander S, Hill AM, Huijsmans PE, Bull AM, Amis AA, De Beer JF, Wallace AL (2006) A biomechanical comparison of single and double-row fixation in arthroscopic rotator cuff repair. J Bone Joint Surg Am 88:2425–2431

    Article  PubMed  Google Scholar 

  33. Tingart MJ, Apreleva M, Zurakowski D, Warner JJ (2003) Pullout strength of suture anchors used in rotator cuff repair. J Bone Joint Surg Am 85-A:2190–2198

    PubMed  Google Scholar 

  34. 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 

  35. Weiler A, Hoffmann RF, Bail HJ, Rehm O, Sudkamp NP (2002) Tendon healing in a bone tunnel. Part II: Histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy 18:124–135

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hannover Medical School, Anna von Borries Str. 1-6, 30625, Hannover, Germany

    Mathias Wellmann, Hazibullah Waizy & Christoph Becher

  2. Department of Traumatology, Hand- and Reconstructive Surgery, University Hospital Muenster, Waldeyerstr. 1, 48149, Muenster, Germany

    Philipp Wiebringhaus, Ina Lodde & Michael J. Raschke

  3. Department of Traumatology, Martin-Luther-Hospital Berlin, Caspar-Theyß-Straße 27, 14193, Grunewald, Berlin, Germany

    Wolf Petersen

Authors
  1. Mathias Wellmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philipp Wiebringhaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ina Lodde
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hazibullah Waizy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christoph Becher
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael J. Raschke
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wolf Petersen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mathias Wellmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wellmann, M., Wiebringhaus, P., Lodde, I. et al. Biomechanical evaluation of a single-row versus double-row repair for complete subscapularis tears. Knee Surg Sports Traumatol Arthrosc 17, 1477–1484 (2009). https://doi.org/10.1007/s00167-009-0890-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-009-0890-1

Keywords

Search

Navigation