Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Arthroscopy. 2012 Feb;28(2):188-95. doi: 10.1016/j.arthro.2011.07.021. Epub 2011 Oct 27.
The purpose of this study was to compare tendon-bone footprint contact area over time under physiologic loads for 4 different rotator cuff repair techniques: single row (SR), triangle double row (DR), chain-link double row (CL), and diamondback double row (DBK).
A supraspinatus tear was created in 28 human cadavers. Tears were fixed with 1 of 4 constructs: SR, DR, CL, or DBK. Immediate post-repair measurements of pressurized contact area were taken in neutral rotation and 0° of abduction. After a static tensile load, pressurized contact area was observed over a 160-minute period after repair. Cyclic loading was then performed.
The DBK repair had the highest pressurized contact area initially, as well as the highest pressurized contact area and lowest percentage decrease in pressurized contact area after 160 minutes of testing. The DBK repair had significantly larger initial pressurized contact than CL (P = .003) and SR (P = .004) but not DR (P = .06). The DBK technique was the only technique that produced a pressurized contact area that exceeded the native footprint both at initial repair (P = .01) and after 160 minutes of testing (P = .01). DBK had a significantly larger mean pressurized contact area than all the repairs after 160 minutes of testing (P = .01). DBK had a significantly larger post-cyclic loading pressurized contact area than CL (P = .01) and SR (P = .004) but not DR (P = .07).
This study showed that a diamondback repair (a modification of the transosseous repair) can significantly increase the rotator cuff pressurized contact area in comparison with other standard rotator cuff repair constructs when there is sufficient tendon mobility to perform a double-row repair without excessive tension on the repair site.
The persistent pressurized contact area of a DBK repair may be desirable to enhance healing potential when there is sufficient tendon mobility to perform a double-row repair, particularly for large or massive rotator cuff tears where it is important to optimize footprint area and contact to encourage biologic healing.
本研究旨在比较 4 种不同肩袖修复技术（单排（SR）、三角双排（DR）、链式双排（CL）和菱形双排（DBK））在生理负荷下随时间变化的腱骨足迹接触面积。
在 28 个人体尸体标本上创建肩袖撕裂。用 1 种以下 4 种构建物固定撕裂：SR、DR、CL 或 DBK。在中立旋转和 0°外展时，立即进行修复后的加压接触面积测量。在静态拉伸负荷后，观察修复后 160 分钟内的加压接触面积。然后进行循环加载。
DBK 修复最初具有最高的加压接触面积，以及在 160 分钟测试后具有最高的加压接触面积和最低的加压接触面积百分比下降。DBK 修复的初始加压接触面积明显大于 CL（P =.003）和 SR（P =.004），但不大于 DR（P =.06）。DBK 技术是唯一一种在初始修复时（P =.01）和 160 分钟测试后（P =.01）产生的加压接触面积超过原生足迹的技术。DBK 在 160 分钟测试后，其平均加压接触面积明显大于所有修复术（P =.01）。DBK 在循环加载后的加压接触面积明显大于 CL（P =.01）和 SR（P =.004），但不大于 DR（P =.07）。
本研究表明，与其他标准肩袖修复结构相比，当有足够的肌腱活动性进行双排修复而不会对修复部位造成过度张力时，菱形修复（经骨修复的改良）可以显著增加肩袖的加压接触面积。
当有足够的肌腱活动性进行双排修复时，DBK 修复的持续加压接触面积可能是理想的，这可以增强愈合潜力，特别是对于大或巨大的肩袖撕裂，重要的是要优化足迹面积和接触面积，以促进生物愈合。
