Biomechanical validation of load-sharing rip-stop fixation for the repair of tissue-deficient rotator cuff tears

Am J Sports Med. 2014 Feb;42(2):457-62. doi: 10.1177/0363546513516602. Epub 2013 Dec 27.


Background: Poor-quality tendon is one of the most difficult problems the surgeon must overcome in achieving secure fixation during rotator cuff repair. A load-sharing rip-stop construct (LSRS) has recently been proposed as a method for improving fixation strength, but the biomechanical properties of this construct have not yet been examined.

Purpose: To compare the strength of the LSRS construct to that of single-row fixation for rotator cuff repair.

Study design: Controlled laboratory study.

Methods: Rotator cuff tears were created in 6 cadaveric matched-pair specimens and repaired with a single row or an LSRS. In the LSRS repair, a 2-mm suture tape was placed as an inverted mattress stitch in the rotator cuff, and sutures from 2 anchors were placed as simple stitches that passed medial to the suture tape. The suture tape limbs were secured with knotless anchors laterally before sutures were tied from the medial anchors. Displacement was observed with video tracking after cyclic loading, and specimens were loaded to failure.

Results: The mean load to failure was 371 ± 102 N in single-row repairs compared with 616 ± 185 N in LSRS repairs (P = .031). There was no difference in displacement with cyclic loading between the groups (3.3 ± 0.8 mm vs. 3.5 ± 1.1 mm; P = .561). In the single-row group, 4 of 6 failures occurred at the suture-tendon interface. In the LSRS group, only 1 failure occurred at the suture-tendon interface.

Conclusion: The ultimate failure load of the LSRS construct for rotator cuff repair was 1.7 times that of a single-row construct in a cadaveric model.

Clinical relevance: The LSRS rotator cuff repair construct may be useful in the repair of difficult tears such as massive tears, medial tears, and tears with tendon loss.

Keywords: arthroscopic rotator cuff repair; biomechanics; rip-stop repair; single-row repair.

Publication types

  • Validation Study

MeSH terms

  • Biomechanical Phenomena
  • Cadaver
  • Humans
  • Male
  • Middle Aged
  • Rotator Cuff / physiopathology
  • Rotator Cuff / surgery*
  • Rotator Cuff Injuries*
  • Suture Anchors
  • Suture Techniques*