Mayor presión y área de contacto en reparación transósea cruzada de Manguito Rotador versus reparación simple

Resumen

Objetivo Comparar la presión y el área de contacto en la interfase tendón-huella de una reparación realizada con suturas transóseas simples y cruzadas.

Métodos Se utilizaron doce hombros de cordero para simular una rotura de manguito rotador. Se midió el área de contacto en la interfase tendón-huella con láminas sensibles a presión; luego, se midió la presión con un sensor digital. Se registró la presión basal durante la aplicación de carga cíclica y al final de la intervención. Se compararon 2 reparaciones: 2 túneles transóseos con nudos simples (TOS; n = 6) y 2 túneles transóseos con nudos cruzados (TOC; n = 6), utilizando FiberWire #2. Se realizaron 1.400 ciclos, con una frecuencia 2,5 Hz y una carga de 5 N. Se utilizó la prueba de Mann-Whitney, y ae consideraron significativos valores de p < 0,05.

Resultados La reparación TOS presentó un 50,9 ± 12,7% de distribución de presiones en comparación con 72,2 ± 5,3% en la reparación TOC (p < 0,009). La presión promedio en la reparación TOS fue 0,7 ± 0,1 MPa en comparación con 1,1 ± 0,2 MPa en la reparación TOC (p < 0,007). La reparación TOS registró una presión basal de 5,3 ± 5,3 N, presión final de 3,8 ± 4,6 N, y una variación de 51,7 ± 38%. La reparación TOC registró una presión basal de 10,7 ± 1,8 N, presión final de 12,9 ± 8,7 N, y una variación de 114,9 ± 65,9% (p < 0,044; p < 0,022; y p < 0,017, respectivamente).

Conclusión La reparación TOC presenta mayor presión a nivel de la interfase tendón-hueso, menor pérdida de fuerza de contacto ante cargas cíclicas, y una mejor distribución de fuerza en la huella al comparar con la reparación TOS, lo que se podría traducir en mejor cicatrización tendínea.

Nivel de Evidencia Estudio de ciencia básica.

Palabras Clave

manguito de los rotadores - presión - sutura - técnicas de sutura - traumatismos de los tendones - tendones

Publication History

Received: 28 June 2020

Accepted: 06 August 2021

Publication Date:
22 December 2021 (online)

• Referencias

• 1 Jancuska J, Matthews J, Miller T, Kluczynski MA, Bisson LJ. A Systematic Summary of Systematic Reviews on the Topic of the Rotator Cuff. Orthop J Sports Med 2018; 6 (09) 2325967118797891 DOI: 10.1177/2325967118797891.
• 2 Collin P, Colmar M, Thomazeau H. et al. Clinical and MRI Outcomes 10 Years After Repair of Massive Posterosuperior Rotator Cuff Tears. J Bone Joint Surg Am 2018; 100 (21) 1854-1863 DOI: 10.2106/JBJS.17.01190.
• 3 Collin P, Thomazeau H, Walch G. et al. Clinical and structural outcome twenty years after repair of isolated supraspinatus tendon tears. J Shoulder Elbow Surg 2019; 28 (01) 196-202 DOI: 10.1016/j.jse.2018.07.023.
• 4 Piper CC, Hughes AJ, Ma Y, Wang H, Neviaser AS. Operative versus nonoperative treatment for the management of full-thickness rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elbow Surg 2018; 27 (03) 572-576 DOI: 10.1016/j.jse.2017.09.032.
• 5 Rossi LA, Rodeo SA, Chahla J, Ranalletta M. Current Concepts in Rotator Cuff Repair Techniques: Biomechanical, Functional, and Structural Outcomes. Orthop J Sports Med 2019; 7 (09) 2325967119868674 DOI: 10.1177/2325967119868674.
• 6 Chona DV, Lakomkin N, Lott A. et al. The timing of retears after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2017; 26 (11) 2054-2059 DOI: 10.1016/j.jse.2017.07.015.
• 7 Haque A, Pal Singh H. Does structural integrity following rotator cuff repair affect functional outcomes and pain scores? A meta-analysis. Shoulder Elbow 2018; 10 (03) 163-169 DOI: 10.1177/1758573217731548.
• 8 Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 2004; 86 (02) 219-224 DOI: 10.2106/00004623-200402000-00002.
• 9 Caldow J, Richardson M, Balakrishnan S, Sobol T, Lee PV, Ackland DC. A cruciate suture technique for rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2015; 23 (02) 619-626 DOI: 10.1007/s00167-014-3474-7.
• 10 Desmoineaux P. Failed rotator cuff repair. Orthop Traumatol Surg Res 2019; 105 (1S) S63-S73 DOI: 10.1016/j.otsr.2018.06.012.
• 11 Cicak N, Klobucar H, Bicanic G, Trsek D. Arthroscopic transosseous suture anchor technique for rotator cuff repairs. Arthroscopy 2006; 22 (05) 565.e1-565.e6 DOI: 10.1016/j.arthro.2005.07.029.
• 12 Park MC, Cadet ER, Levine WN, Bigliani LU, Ahmad CS. Tendon-to-bone pressure distributions at a repaired rotator cuff footprint using transosseous suture and suture anchor fixation techniques. Am J Sports Med 2005; 33 (08) 1154-1159 DOI: 10.1177/0363546504273053.
• 13 Hohmann E, König A, Kat CJ, Glatt V, Tetsworth K, Keough N. Single- versus double-row repair for full-thickness rotator cuff tears using suture anchors. A systematic review and meta-analysis of basic biomechanical studies. Eur J Orthop Surg Traumatol 2018; 28 (05) 859-868 DOI: 10.1007/s00590-017-2114-6.
• 14 Apreleva M, Ozbaydar M, Fitzgibbons PG, Warner JJ. Rotator cuff tears: the effect of the reconstruction method on three-dimensional repair site area. Arthroscopy 2002; 18 (05) 519-526 DOI: 10.1053/jars.2002.32930.
• 15 Ma R, Chow R, Choi L, Diduch D. Arthroscopic rotator cuff repair: suture anchor properties, modes of failure and technical considerations. Expert Rev Med Devices 2011; 8 (03) 377-387 DOI: 10.1586/erd.11.4.
• 16 Kowalsky MS, Dellenbaugh SG, Erlichman DB, Gardner TR, Levine WN, Ahmad CS. Evaluation of suture abrasion against rotator cuff tendon and proximal humerus bone. Arthroscopy 2008; 24 (03) 329-334 DOI: 10.1016/j.arthro.2007.09.011.
• 17 Ntalos D, Huber G, Sellenschloh K. et al. All-suture anchor pullout results in decreased bone damage and depends on cortical thickness. Knee Surg Sports Traumatol Arthrosc 2020; ••• DOI: 10.1007/s00167-020-06004-6.
• 18 Godry H, Jettkant B, Seybold D, Venjakob AJ, Bockmann B. Pullout strength and failure mode of industrially manufactured and self-made all-suture anchors: a biomechanical analysis. J Shoulder Elbow Surg 2020; 29 (07) 1479-1483
• 19 Imam MA, Abdelkafy A. Outcomes following arthroscopic transosseous equivalent suture bridge double row rotator cuff repair: a prospective study and short-term results. SICOT J 2016; 2: 7 DOI: 10.1051/sicotj/2015041.
• 20 Flanagin BA, Garofalo R, Lo EY. et al. Midterm clinical outcomes following arthroscopic transosseous rotator cuff repair. Int J Shoulder Surg 2016; 10 (01) 3-9 DOI: 10.4103/0973-6042.174511.
• 21 Garofalo R, Castagna A, Borroni M, Krishnan SG. Arthroscopic transosseous (anchorless) rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2012; 20 (06) 1031-1035 DOI: 10.1007/s00167-011-1725-4.
• 22 Benson EC, MacDermid JC, Drosdowech DS, Athwal GS. The incidence of early metallic suture anchor pullout after arthroscopic rotator cuff repair. Arthroscopy 2010; 26 (03) 310-315 DOI: 10.1016/j.arthro.2009.08.015.
• 23 Chillemi C, Mantovani M. Arthroscopic trans-osseous rotator cuff repair. Muscles Ligaments Tendons J 2017; 7 (01) 19-25 DOI: 10.11138/mltj/2017.7.1.019.
• 24 Tauber M, Koller H, Resch H. Transosseous arthroscopic repair of partial articular-surface supraspinatus tendon tears. Knee Surg Sports Traumatol Arthrosc 2008; 16 (06) 608-613 DOI: 10.1007/s00167-008-0532-z.
• 25 Campbell TM, Lapner P, Dilworth FJ. et al. Tendon contains more stem cells than bone at the rotator cuff repair site. J Shoulder Elbow Surg 2019; 28 (09) 1779-1787 DOI: 10.1016/j.jse.2019.02.008.
• 26 Kida Y, Morihara T, Matsuda K. et al. Bone marrow-derived cells from the footprint infiltrate into the repaired rotator cuff. J Shoulder Elbow Surg 2013; 22 (02) 197-205 DOI: 10.1016/j.jse.2012.02.007.
• 27 Burkhart SS, Adams CR, Burkhart SS, Schoolfield JD. A biomechanical comparison of 2 techniques of footprint reconstruction for rotator cuff repair: the SwiveLock-FiberChain construct versus standard double-row repair. Arthroscopy 2009; 25 (03) 274-281 DOI: 10.1016/j.arthro.2008.09.024.
• 28 Andres BM, Lam PH, Murrell GA. Tension, abduction, and surgical technique affect footprint compression after rotator cuff repair in an ovine model. J Shoulder Elbow Surg 2010; 19 (07) 1018-1027 DOI: 10.1016/j.jse.2010.04.005.
• 29 Mahar AT, Moezzi DM, Serra-Hsu F, Pedowitz RA. Comparison and performance characteristics of 3 different knots when tied with 2 suture materials used for shoulder arthroscopy. Arthroscopy 2006; 22 (06) 614.e1-614.e2 DOI: 10.1016/j.arthro.2006.02.005.
• 30 Wüst DM, Meyer DC, Favre P, Gerber C. Mechanical and handling properties of braided polyblend polyethylene sutures in comparison to braided polyester and monofilament polydioxanone sutures. Arthroscopy 2006; 22 (11) 1146-1153 DOI: 10.1016/j.arthro.2006.06.013.
• 31 Ng SHA, Tan CHJ. Double-row repair of rotator cuff tears: Comparing tendon contact area between techniques. World J Orthop 2020; 11 (01) 10-17 DOI: 10.5312/wjo.v11.i1.10.
• 32 Hinse S, Ménard J, Rouleau DM, Canet F, Beauchamp M. Biomechanical study comparing 3 fixation methods for rotator cuff massive tear: Transosseous No. 2 suture, transosseous braided tape, and double-row. J Orthop Sci 2016; 21 (06) 732-738 DOI: 10.1016/j.jos.2016.07.001.
• 33 Tuoheti Y, Itoi E, Yamamoto N. et al. Contact area, contact pressure, and pressure patterns of the tendon-bone interface after rotator cuff repair. Am J Sports Med 2005; 33 (12) 1869-1874 DOI: 10.1177/0363546505278256.
• 34 Urita A, Funakoshi T, Horie T, Nishida M, Iwasaki N. Difference in vascular patterns between transosseous-equivalent and transosseous rotator cuff repair. J Shoulder Elbow Surg 2017; 26 (01) 149-156 DOI: 10.1016/j.jse.2016.06.010.