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Optimal Fixation Method for Rotator Cuff Repair

Rotator cuff tears (RCTs) are often repaired with surgery. The torn tendon is reattached to the bone and allowed to heal. Too much motion at the site of repair can cause failure of the repair. This is the first study to compare motion at the tendon-bone interface after two different methods of repair.

There are two commonly used ways to hold the tendon in place until healing occurs. This is called fixation. The first is with suture anchors. The second involves threading the suture through a tunnel drilled in the bone. This method is called transosseous suture repair.

Surgeons at Columbia University used cadavers to compare the results of these two fixation methods. First they cut the supraspinatus tendon where it attaches to the shoulder. This simulates a RCT. Then they used one of the two repair operations to fix the rupture. The arm was rotated in and out 10 times while digital photos were taken.

Special imaging software was used to analyze the photos. The researchers were able to show how much motion occurs between the tendon and bone during these motions. They found the transosseous repair had the best fixation. Too much motion can disrupt the healing tissue.

The authors conclude the transosseous suture repair is a stronger fixation method, especially for shoulder internal rotation. They point out they only studied these two approaches. There are many variations on surgery for RCTs. More study is needed to find the best way to repair the torn rotator cuff that enhances healing. Limiting interface motion seems to be a key factor.

References: Christopher S. Ahmad, MD et al. Tendon-Bone Interface Motion in Transosseous Suture and Suture Anchor Rotator Cuff Repair Techniques. In The American Journal of Sports Medicine. November 2005. Vol. 33. No. 11. Pp. 1667-1672.

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