Supraspinatus tendon transosseous vs anchor repair surgery: a comparative study of mechanical recovery in the rabbit
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(2020) 15:585
RESEARCH ARTICLE
Open Access
Supraspinatus tendon transosseous vs anchor repair surgery: a comparative study of mechanical recovery in the rabbit Joaquim Chaler1,2, Hakim Louati3,4, Hans K. Uhthoff3,4 and Guy Trudel3,5*
Abstract Background: Supraspinatus (SSP) tendon ruptures requiring surgical repair are common. Arthroscopic suture anchor fixation has gradually replaced transosseous repair in supraspinatus tendon tear. Our objective was to compare mechanical properties between transosseous and anchor supraspinatus repair in the first 6 postoperative weeks in a rabbit model. Methods: One hundred and fifty-two rabbits had one supraspinatus tendon repaired either with an anchor suture 1 week after detachment or with transosseous sutures. Rabbits were euthanized at 0, 1, 2, 4 or 6 postoperative weeks. Experimental and contralateral tendons (304 tendons) were mechanically tested to failure. Data are expressed as percent of contralateral. Results: Anchor repair had higher loads to failure compared to transosseous repair, at immediate repair (week 0, 52 ± 21% vs 25 ± 17%, respectively; p = 0.004) and at 1 postoperative week (64 ± 32% vs 28 ± 10%; p = 0.003) with no difference after 2 weeks. There was no difference in stiffness. Transosseous repairs showed higher rates of midsubstance failures compared to anchor repairs at 1 (p = 0.004) and 2 postoperative weeks (p < 0.001). Both transosseous and anchor repairs restored supraspinatus mechanical properties after 4 postoperative weeks. Conclusion: Anchor repair provided better initial tensile strength while transosseous repair led to a faster normalization (namely, midsubstance) of the mode of failure. Research to optimize supraspinatus repair may need to consider the advantages from both surgical approaches. Keywords: Supraspinatus tendon, Mechanical testing, Tendon injuries, Animal model, Rotator cuff, Rehabilitation
Background Rotator cuff repair is one of the most commonly performed upper limb surgery [1, 2]. The past decades have seen a major shift in surgical technique not only from open to arthroscopic but also from transosseous to anchor repair [3]. Clinical studies and meta-analyses have * Correspondence: [email protected] 3 Bone and Joint Research Laboratory, The Ottawa Hospital Research Institute, 451 Smyth Road, Ottawa, Ontario K1H 5M2, Canada 5 Division of Physical Medicine and Rehabilitation, Department of Medicine, Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada Full list of author information is available at the end of the article
found no superiority of one repair technique over the other with regards to functional outcome, pain scores, re-tear rate, or incidence of adhesive capsulitis [4–7]. But patient-based outcomes of pain, strength, range of motion, stability, or medical imaging indirectly assess tendon strength. Data on the restoration of mechanical strength after tendon to bone attachment with each surgical technique are necessary to produce evidence-based recommendations. Directly assess
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