Biomechanical evaluation of an arthroscopic transosseous repair as a revision option for failed rotator cuff surgery.

BACKGROUND: The number of revision rotator cuff cases is increasing. Theliterature is lacking guidance or biomechanical evaluation for fixation strength in a revision case scenario. Therefore, the aim of the study was to providebiomechanical data investigating primary fixation strength of a transosseoustechnique after anchor pullout failure of a single row reconstruction. It washypothesized that an arthroscopic transosseous repair system as a procedure forrotator cuff revisions is providing equivalent stability compared to a primarysingle row suture anchor fixation due to change of fixation site.METHODS: Eight matched pairs (n = 16) of fresh frozen human shoulders weretested. The paired specimen shoulders were randomly divided into two repairgroups (A single row and B primary transosseous repair). The potted specimenswere mounted onto the Servohydraulic test system. Both groups were tested undercyclic loading followed by load to failure testing. Suture anchor repairshoulders (group A) that were tested to failure underwent a revision transosseousrepair and were subsequently tested again using the same setup and protocol(group C).RESULTS: The mean native footprint areas did not show a significant differencebetween groups. The reconstructed footprint area showed a significantly greatercoverage in favor of the transosseous repair. Ultimate load to failure ofreconstructions with the primary anchor fixation (344.73 N ± 63.19) and theprimary transosseous device (375.36 N ± 70.27) was not significantly highercompared to the revision repair (332.19 N ± 119.01 p = 0.45, p = 0.53).CONCLUSION: The tested transosseous anchor device is a suitable option to widely used suture anchors, providing equivalent fixation properties even in a revision case scenario.LEVEL OF EVIDENCE: Basic Science Study, Biomechanics.