Knotless double-row SutureBridge rotator cuff repairs have improved self-reinforcement compared with double-row SutureBridge repairs with tied medial knots: a biomechanical study using an ovine model

J Shoulder Elbow Surg. 2017 Dec;26(12):2206-2212. doi: 10.1016/j.jse.2017.06.045. Epub 2017 Sep 19.


Background: In double-row SutureBridge (Arthrex, Naples, FL, USA) rotator cuff repairs, increasing tendon load may generate progressively greater compression forces at the repair footprint (self-reinforcement). SutureBridge rotator cuff repairs using tied horizontal mattress sutures medially may limit this effect compared with a knotless construct.

Materials and methods: Rotator cuff repairs were performed in 9 pairs of ovine shoulders. One group underwent repair with a double-row SutureBridge construct with tied horizontal medial-row mattress sutures. The other group underwent repair in an identical fashion except that medial-row knots were not tied. Footprint contact pressure was measured at 0° and 20° of abduction under loads of 0 to 60 N. Pull-to-failure tests were then performed.

Results: In both repair constructs, each 10-N increase in rotator cuff tensile load led to a significant increase in footprint contact pressure (P < .0001). The rate of increase in footprint contact pressure was greater in the knotless construct (P < .00022; ratio, 1.69). The yield point approached the ultimate load to failure more closely in the knotless model than in the knotted construct (P = .00094). There was no difference in stiffness, ultimate failure load, or total energy to failure between the knotless and knotted techniques.

Conclusion: In rotator cuff repair with a double-row SutureBridge configuration, self-reinforcement is seen in repairs with and without medial-row knots. Self-reinforcement is greater with the knotless technique.

Keywords: Rotator cuff; SutureBridge; cuff repair; double row; repair; self-reinforcement.

Publication types

  • Comparative Study

MeSH terms

  • Animals
  • Biomechanical Phenomena
  • Disease Models, Animal
  • Movement
  • Pressure
  • Rotator Cuff / physiopathology*
  • Rotator Cuff / surgery
  • Rotator Cuff Injuries / surgery*
  • Sheep
  • Suture Techniques*
  • Sutures
  • Tensile Strength