Abstract
Traditionally rotator cuff has been repaired to bone using bone tunnels. However these are the weakest link (Gerber 1994), are time consuming to construct, and may cheese-wire leading to gap formation at the intended repair site. We have developed a novel technique which overcomes these traditional problems.
The first method was a laboratory study. Pull out studies were performed using a Monsanto tensiometer on the strength of bone tunnels of varying lengths from 1 to 4cm, reinforcing devices such as the cuff-link and finally the capstan screw.
In the second method, the technique was used in 30 consecutive rotator cuff repairs to determine whether the perceived advantages were real.
Laboratory study. The bone tunnels failed at 16N to 153N (dependent upon the length of the bone tunnel). In our studies augmentation with the cuff-link device failed to significantly increase pull out strength. The capstan screw never pulled out, the simulating the suture failing at an average of 900N. In 30 consecutive rotator repairs the screw was deemed quick and easy to use. There was one insertional problem but no problems once implanted.
This novel form of fixation of the rotator cuff allows as many sutures as are needed to be run to a single powerful screw in a similar manner to the cords in a parachute leading down to the parachute harness. The method is simple, quick, inexpensive and attractive. It allows the creation of a large footpint of insertion for even the largest of tears, compared with the spot welds of traditional methods and, because of its massive strength, allows a degree of tolerance against the best intentioned but ill judged excesses of the patient or therapist.
The abstracts were prepared by Mr Roger Emery. Correspondence should be addressed to him at the British Orthopaedic Association, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PN
