The principle of margin convergence in rotator cuff repair as a means of strain reduction at the tear margin.

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Abstract

[Indexed for MEDLINE] 13. Arthrosc Tech. 2015 Sep 21;4(5):e457-61. doi: 10.1016/j.eats.2015.04.004. eCollection 2015 Oct. Modified Margin Convergence: Over-Under Lacing Suture Technique. Métais P(1), Lanzone R(2), Lim CK(1), Albino P(2), Carbone S(3). Author information: (1)Clinique La Châtaigneraie, Beaumont, Clermont-Ferrand, France. (2)Department of Orthopaedic and Traumatology, Sapienza University of Rome, Rome, Italy. (3)Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy. The principle of margin convergence can be applied to rotator cuff repair to enhance the security of fixation by decreasing the mechanical strain at the margins of the tear. We describe a suture technique, over-under lacing, that reproduces the same margin convergence, with equal tissue tension across the entire surface area of the cuff. A consecutive series of patients affected by massive U-shaped rotator cuff tears were treated by this repair technique. Preoperative diagnosis, tear assessment, and grading of fatty infiltration of the cuff muscles were based on arthro-computed tomography evaluation. The technique passes 2 sutures from the medial to lateral margin of the tear, with a knotless suture anchor for tendon-to-bone fixation. The proposed technique seems to reduce tensile strain on the repaired tendon, can reconstruct the rotator cuff cable, and can attain the balanced pull of the tendon in a medial-to-lateral fashion. The over-under lacing suture technique is both simple and reproducible. This technique may achieve the goals of margin convergence with satisfactory preliminary clinical results for patients with massive rotator cuff tears. DOI: 10.1016/j.eats.2015.04.004 PMCID: PMC4662059