This controlled cadaveric study measured contact area and contact pressure at the tendon-bone interface for the three most common rotator cuff repair techniques. Using pressure-sensitive film in 10 shoulders, it compared transosseous, single-row, and double-row suture anchor fixation. It asks which construct best restores the supraspinatus footprint for healing.
The biomechanical case for double-row repair rests here: it restores the largest tendon-bone footprint, 42% more than transosseous and 60% more than single-row. Re-tear after cuff repair is multifactorial, but footprint restoration is a controllable variable. A broader, well-pressurized contact zone theoretically improves the environment for tendon-to-bone healing.
Know the trade-off each construct makes. Single-row gives high pressure over a tiny area with a dead zone between anchors. Transosseous gives a broad but low-pressure homogeneous zone. Double-row gives both broad area and high pressure. One practical pearl: because suture anchor pressure concentrates around the anchor, place anchors off the articular cartilage margin.
Remember this is a static cadaveric model without cyclic loading, and the optimal healing pressure remains unknown. Higher contact area does not by itself prove better clinical healing, which is why this debate continued in later clinical trials.
This controlled cadaveric study measured contact area and contact pressure at the tendon-bone interface for the three most common rotator cuff repair techniques. Using pressure-sensitive film in 10 shoulders, it compared transosseous, single-row, and double-row suture anchor fixation. It asks which construct best restores the supraspinatus footprint for healing.
The biomechanical case for double-row repair rests here: it restores the largest tendon-bone footprint, 42% more than transosseous and 60% more than single-row. Re-tear after cuff repair is multifactorial, but footprint restoration is a controllable variable. A broader, well-pressurized contact zone theoretically improves the environment for tendon-to-bone healing.
Know the trade-off each construct makes. Single-row gives high pressure over a tiny area with a dead zone between anchors. Transosseous gives a broad but low-pressure homogeneous zone. Double-row gives both broad area and high pressure. One practical pearl: because suture anchor pressure concentrates around the anchor, place anchors off the articular cartilage margin.
Remember this is a static cadaveric model without cyclic loading, and the optimal healing pressure remains unknown. Higher contact area does not by itself prove better clinical healing, which is why this debate continued in later clinical trials.