A watertight construct in arthroscopic rotator cuff repair.

BACKGROUND: It is unknown which type of rotator cuff repair technique best isolates the healing zone interface from the synovial fluid environment. The purpose of this study was to determine the leakage area and pattern onto the rotator cuff footprint after 3 different rotator cuff repairs. MATERIALS AND METHODS: Six fresh frozen cadaveric glenohumeral joints in each of 3 groups were injected with gelatin to a pressure of 103 mm Hg (∼2 psi) after 1 of 3 different rotator cuff repairs of a supraspinatus tear: (1) single-row repair (SR), (2) knotless transosseous equivalent repair (KTE), and (3) traditional transosseous equivalent repair (TTE), which uses medial tied knots. Specimens were cycled in external rotation and abduction and were cooled to allow the gelatin to solidify. The supraspinatus was dissected off the footprint and photographs were taken. Scion Image (Frederick, MD, USA) was used to quantify the area. RESULTS: The average area of leakage was 1.09 cm(2) for the SR and 1.15 cm(2) for the KTE. The TTE did not demonstrate any leakage. The pattern of leakage for the KTE was medial and central on the footprint, whereas the SR demonstrated leakage up to the tied knots. The difference in the area of leakage in the SR and KTE compared with the TTE was statistically significant. There was no difference in area of leakage between the SR and KTE. CONCLUSION: A transosseous equivalent repair technique best prevents leakage onto the rotator cuff footprint compared with single-row and knotless repairs.

Biomechanical evaluation of segmental occipitoatlantoaxial stabilization techniques.

STUDY DESIGN: Biomechanical study using human cadaveric cervical spines. OBJECTIVE: To evaluate the construct stability of 3 different segmental occipitoatlantoaxial (C0-C1-C2) stabilization techniques. SUMMARY OF BACKGROUND DATA: Different C0-C1-C2 stabilization techniques are used for unstable conditions in the upper cervical spine, all with different degrees of risk to the vertebral artery. Techniques with similar stability but less risk to the vertebral artery may be advantageous. METHODS: Six human cadaveric cervical spines (C0-C5) (age: 74 +/- 5.0 years) were used. After testing the intact spines, instability was created by transecting the transverse and alar ligaments. The spines were instrumented from the occiput to C2 using 3 different techniques which varied in their attachment to C2. All spines had 6 screws placed into the occiput along with lateral mass screws at C1. The 3 variations used in attachment to C2 were (1) C2 crossing laminar screws, (2) C2 pedicle screws, and (3) C1-C2 transarticular screws. The C1 lateral mass screws were removed before placement of the C1-C2 transarticular screws. Range of motion across C0-C2 was measured for each construct. The data were analyzed using repeated measures ANOVA. The following post hoc comparisons were made: (1) intact spine versus each of the 3 techniques, (2) laminar screw technique versus the pedicle screw technique, and (3) laminar screw technique versus the transarticular screw technique. The level of significance was alpha = 0.01 (after Bonferroni correction for 5 comparisons). RESULTS: All 3 stabilization techniques significantly decreased range of motion across C0-C2 compared to the intact spine (P < 0.01). There was no statistical difference among the 3 stabilization methods in flexion/extension and axial rotation. In lateral bending, the technique using C2 crossing laminar screws demonstrated a trend toward increased range of motion compared to the other 2 techniques. CT scans in both axial and sagittal views demonstrated greater proximity to the vertebral artery in the pedicle and transarticular screw techniques compared to the crossing laminar screw technique. CONCLUSION: Occipitoatlantoaxial stabilization techniques using C2 crossing laminar screws, C2 pedicles screws, and C1-C2 transarticular screws offer similar biomechanical stability. Using the C2 crossing laminar screw technique may offer an advantage over the other techniques due to the reduction of the risk to the vertebral artery during C2 screw placement.

Arthroscopic rotator cuff repair with biceps tendon augmentation.

Arthroscopic rotator cuff repair has become an increasingly popular treatment for rotator cuff tears. For orthopedic surgeons, treating large to massive rotator cuff tears is challenging in many ways. Patients with this pathology do not have the same healing rates and clinical outcomes as patients with smaller tears. Some surgeons have augmented repair with collagen-based grafts, but the success of this method has been limited. The same patient population may have concomitant biceps tendon pathology. Biceps tenotomy and biceps tenodesis are procedures in the surgeon's treatment armamentarium. Rotator cuff repair and biceps tenodesis or tenotomy are commonly performed simultaneously. In this article, we describe a technique that incorporates biceps tenodesis into double-row rotator cuff repair with the goal of providing more collagen and, ultimately, more healing potential.