Unicortical button fixation provides higher strength compared with transosseous repair for subscapularis tendon in total shoulder arthroplasty
Issued Date
2024-01-01
Resource Type
ISSN
10582746
eISSN
15326500
Scopus ID
2-s2.0-85211041955
Pubmed ID
39218347
Journal Title
Journal of Shoulder and Elbow Surgery
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Shoulder and Elbow Surgery (2024)
Suggested Citation
Ganokroj P., Garcia A.R., Hollenbeck J.F.M., Whalen R.J., Brown J.R., Drumm A., McBride T.J., Suppauksorn S., Jildeh T.R., Provencher M.T. Unicortical button fixation provides higher strength compared with transosseous repair for subscapularis tendon in total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery (2024). doi:10.1016/j.jse.2024.07.019 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/102357
Title
Unicortical button fixation provides higher strength compared with transosseous repair for subscapularis tendon in total shoulder arthroplasty
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Subscapularis tendon (SSc) dysfunction after total shoulder arthroplasty (TSA) results in poor functional outcomes. There have been numerous SSc repair constructs tested biomechanically and clinically; however, none has been demonstrated as superior. Newer techniques and implants have emerged but have not been fully tested. Hypothesis: We hypothesized that the unicortical button (UB) fixation would provide significantly improved restoration of the anatomic footprint and biomechanical properties compared with transosseous (TO) repair of the SSc. Methods: A digital footprint of SSc humeral insertion was obtained in 6 pairs of fresh-frozen cadaveric shoulders using a 3-dimensional digitizer. A complete SSc tear was created, and each pair of shoulders was randomized to either SSc repair with UB or TO repair. Each specimen underwent a cyclic loading protocol, followed by pull to failure. The failure load, elongation at failure, gapping failure, number of cycles until failure, the load at key gapping points (1 mm, 3 mm, 5 mm, and 10 mm), and the failure mode were recorded using high-resolution video recording. Three-dimensional surfaces of the insertion footprint and repair site were obtained, and surface areas were calculated using a custom MATLAB script and laser scanner. Paired t tests were conducted to compare differences between the 2 repair groups. Results: Failure load was significantly higher in the UB group (382.4 N ± 56.5 N) than in the TO group (253.6 N ± 103.4 N, P = .005). TO repair provided higher gapping at failure (28.8 mm ± 8.2 mm) than UB repair (10.4 mm ± 6.8 mm, P = .0017). UB repair had significantly higher load at the 1-mm, 5-mm, and 10-mm gapping than TO repair, with P = .042, P = .033, and P = .0076, respectively. There were no significant differences in elongation failure, the difference in footprint area from native to repair states, or the percentage of the restored footprint area between the groups (P = .26, P = .18, and P = .21, respectively). Conclusions: The UB fixation showed a significantly lower gap at failure, higher failure load and number of cycles until failure, and higher gap loads than the traditional TO repair for SSc. Although more clinical research is necessary, the UB fixation that uses cortical bone presents promising results.