Double Row Rotator Cuff Transosseous Equivalent Repair
Numerous biomechanical studies have demonstrated improved tendon to bone contact, increased footprint coverage, decreased gap formation, and increased mechanical strength with double-row configurations [1–5]. These favorable biomechanical properties are t
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Gonzalo Samitier and Emilio Calvo
20.1 Indications Numerous biomechanical studies have demonstrated improved tendon to bone contact, increased footprint coverage, decreased gap formation, and increased mechanical strength with double-row configurations [1–5]. These favorable biomechanical properties are thought to improve the healing process allowing an accelerated physical therapy. However, clinical evidence comparing the efficacy of single-row versus double-row repair has been inconsistent. Whereas some studies report no clinical differences [6, 7], others have shown significantly improved subjective, objective, or radiologic outcomes and decreased re-tear rate after double-row repair, especially for larger tears [8, 9]. The authors reserve initial nonsurgical treatment for those patients with chronic symptomatic tears that never tried conservative measures and those who remain asymptomatic, regardless of G. Samitier Upper Extremity and Sports Medicine Division, Department of Orthopaedic Surgery and Traumatology, Hospital General de Villalba, Madrid, Spain E. Calvo (*) Department of Orthopaedic Surgery and Traumatology, IS-Fundación Jiménez Díaz, Madrid, Spain Universidad Autónoma, Madrid, Spain e-mail: [email protected]
the size of the injury, as long as they have no pseudoparalysis; cuff tears tend to progress overtime and become more difficult to repair. Thus we do recommend to the patients with complete tears and relatively young age to do not delay consultation or surgery if symptoms and/or limitation return [10, 11]. For large tears in acute traumatic setting, we will offer surgery primarily in most cases. Our non-operative approach consists of guided physical therapy to keep a strong force couple. It is very common for these patients to have one or more subacromial corticosteroid injections along the process trying to reduce the inflammatory response and pain. We also favor conservative treatment for symptomatic low-demand elderly population, patients who are not willing to have surgery, and/or patients who are medically inadequate.
20.2 Operative Principles We usually recommend surgical treatment if conservative measures showed to be not effective over 8–12 weeks.
20.2.1 Strategy Single-row repair is reserved for small full- thickness tears and partial articular-sided tears with preserved lateral footprint. For midsize,
© ISAKOS 2019 A. B. Imhoff, F. H. Savoie III (eds.), Rotator Cuff Across the Life Span, https://doi.org/10.1007/978-3-662-58729-4_20
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large, and massive mobile reparable rotator cuff tears, the authors choose transosseous equivalent (TOE) double-row suture bridge technique mostly with medial-row tying. Described by Park et al. in 2006, the TOE double-row technique has demonstrated greater tendon to bone contact area and higher load to failure compared with other double-row configurations [12–15]. We favor medial-row knot tying over knotless repairs especially in delaminated tears where anatomic independent layer repair is intended using the lasso-loop technique. Previo
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