Christopher Adams, MD, (Naples, FL) performs both a single-row and double-row SpeedBridge™ rotator cuff repair on the same cadaveric shoulder and then compares the footprint reconstruction of each technique. Dr. Adams shows that the single-row repair leaves the footprint relatively uncovered, similar to a PASTA lesion, while the knotless SpeedBridge repair is able to completely reconstruct the footprint.

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VID1-00807-EN | C | Single Row vs SpeedBridge™ Rotator Cuff Repair: The PASTA Effect

Christopher Adams

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Single Row vs SpeedBridge™ Rotator Cuff Repair: The PASTA Effect

Shoulder

Procedure

The SpeedBridge double-row technique is used to repair a rotator cuff tear using a fully threaded SwiveLock® anchor combined with FiberTape® suture to create a quick and secure construct with no knots and only two suture-passing steps. The SpeedBridge double-row technique uses FiberTape suture with three times the contact area compared to a standard #2 FiberWire® suture.1 It provides a broad footprint that can be helpful for repairs to degenerative cuff tissue for which tissue pull-through may be a concern.
Reference
1. Arthrex, Inc. LA0239A. Naples, FL; 2008.
Please note that certain bio (PLLA) anchors and screws are not available for sale in EMEA.

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Knotless Double-Row Rotator Cuff Repair Scientific Update As the understanding of anatomy and techniques has improved, rotator cuff repair has advanced from single-row to double-row repair. A double-row repair is the current gold standard for restoration of anatomy, biomechanical strength, and postoperative healing. Initial double-row repairs consisted of two independent rows of anchors. The advancement of knotless technology provided the ability to create suture-bridging constructs in which sutures from the medial anchors were secured laterally with knotless anchors to create linked constructs. Initially, these constructs were created by first tying knots medially, and then bringing the remaining limbs out to additional anchors. However, completely knotless double-row constructs such as the SpeedBridge™ repair can be created and have biomechanical and clinical advantages over knot-tying constructs.1-8 Biomechanically, knotless repairs appear to be more reliable and increase the self-reinforcing phenomenon of a double-row rotator cuff repair in which the tendon is compressed across the footprint under load.1-3 Clinically, a knotless technique reduces operative time and leads to equivalent or improved healing rates compared to knotted repairs.The same studies also support a lower retear rate for a doublerow versus single-row.4-8 Biomechanical Studies Hanypsiak BT, DeLong JM, Simmons L, Lowe W, Burkhart S Knot strength varies widely among expert arthroscopists. Am J Sports Med. 2014;42(8):19781984. doi:10.1177/0363546514535554 73 expert surgeons were asked to tie 5 knots using their preferred knot Mean load to failure was 231 N; however, the range was 29 N to 360 N, and the standard deviation of the individual surgeon ranged from 6 N to 133 N Variability persisted regardless of whether the surgeon performed more or less than 200 arthroscopic cuff repairs per year Only 37% of surgeons had an average load to failure within 20% of the mean, and only 18% of the individual knots had a load to failure within 20% of the mean Takeaway: There is considerable variability BOTH between surgeons and within knots tied by surgeons using their go-to knot. Denard PJ, Adams CR, Fischer NC, Piepenbrink M, Knotless fixation is stronger and less variable than knotted constructs in securing a suture loop. Orthop J Sports Med. 2018;6(5):2325967118774000. doi:10.1177/2325967118774000 34 surgeons completed suture loops either by tying knots or creating a knotless construct with a 5.5 SwiveLock® anchor and #2 FiberWire® or FiberTape® suture Load to failure was the highest with the knotless FiberTape technique (276 N compared to 161 N/151 N; P < .001) Load to 3 mm of displacement (indicating loss of loop security) was higher with the FiberTape technique (199 N) compared to the knotless FiberWire technique (90 N; P < .001) and knotted FiberWire technique (59 N; P < .001). The difference between the knotless FiberWire and knotted FiberWire technique was also significant (P = .024). Variability based on an F-test for variance was highest in the knotted group Wijdicks CA Takeaway: Based on the assessment of multiple surgeons, a knotless technique leads to improved construct strength, loop security, and reliability compared to a knotted technique. Parameters are improved with FiberTape suture compared to #2 suture. Park MC, McGarry MH, Gunzenhauser RC, Benefiel MK, Park CJ, Does transosseous-equivalent rotator cuff repair biomechanically provide a “selfreinforcement” effect compared with single-row repair? J Shoulder Elbow Surg. 2014;23(12):1813-1821. doi:10.1016/j.jse.2014.03.008 Biomechanical study of 10 matched pairs of cadavers comparing a single-row repair to a linked double-row repair with #2 suture (SutureBridge™ repair). Contact properties were measured as the supraspinatus was loaded (0, 20, 40, 60, and 80 N). Contact area, contact pressure, and peak contact pressure were all higher with the linked double-row repair Contact pressure increased with a progressive supraspinatus load and increased with a higher slope in the double-row repair compared to the single-row repair, indicating self-reinforcement Lee TQ Takeaway: Linked double-row repairs demonstrate self-reinforcing properties whereby the repair is pressurized when subjected to medial load. This may improve clinical healing. Smith GCS, Bouwmeester TM, Lam PH 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;26(12):2206-2212. doi:10.1016/j. jse.2017.06.045 Biomechanical study of 9 matched pairs of ovine shoulders comparing a SutureBridge double-row repair with medial knots to a completely knotless technique (no medial knots). Footprint contact pressure was measured with progressive load (0 N-60 N) Load-to-failure was equivalent between the groups Footprint contact pressure increased under load in both groups; however, the progression (slope) in contact pressure was greater in the knotless group Takeaway: Self-reinforcement of a linked double-row repair may be higher with a completely knotless technique. Park MC, Peterson AB, McGarry MH, Park CJ, Lee TQ Knotless transosseous-equivalent rotator cuff repair improves biomechanical selfreinforcement without diminishing footprint contact compared with medial knotted repair. Arthroscopy. 2017;33(8):1473-1481. doi:10.1016/j.arthro.2017.03.021 Biomechanical study of 8 matched pairs comparing SpeedBridge repair with SpeedBridge repair with addition of medial knots (2 mattress sutures). Footprint contact pressure was measured with progressive load. Self-reinforcement, measured as the slope of contact pressure under load, was greater with the knotless construct Medial knots show an adverse biomechanical effect by inhibiting self-reinforcement Takeaway: Further support for the concept that self-reinforcement of a linked double-row repair may be higher with a completely knotless technique. Clinical Studies Rhee YG, Cho NS, Parke CS Arthroscopic rotator cuff repair using modified mason-allen medial row stitch: knotless versus knot-tying suture bridge technique. Am J Sports Med. 2012;40(11):2440-2447. doi:10.1177/0363546512459170 Prospective evaluation of 110 arthroscopic rotator cuff double-row repairs of mediumsized tears, of which 51 were repaired with a completely knotless technique and 59 had medial knots Mean follow-up was 21 to 22 months Based on postoperative MRI, healing was 94% in the knotless group compared to 81% in the group with medial knots (P < .001) There were no medial failures in the knotless group, whereas 8 of 11 failures in the knotted group were medial (type II) failures Takeaway: A completely knotless technique may improve healing and decrease medial failures compared to a double-row technique with medial knots. Johannsen, AM Arner, JW Elrick, BP Nolte PC, Minimum 10-year outcomes of primary arthroscopic transosseous-equivalent double-row rotator cuff repair. Am J Sports Med. 2021;49(8):2035-2041. doi:10.1177/03635465211015419 Retrospective evaluation of double-row rotator cuff repairs for full-thickness rotator cuff tears of 1 to 3 tendons (involving at least the supraspinatus) at one center Patient-reported outcomes (PROs) and need for revision were assessed for 91 repairs at a minimum of 10 years postoperatively 47 knotted repairs (SutureBridge™ repair) Rakowski DR, Horan MP, Millett PJ 44 knotless repairs (SpeedBridge™ repair) Only 5 patients (5.5%) required revision surgery Mean postoperative ASES score was 93 points Mean postoperative SANE score was 88 points Takeaway: Following a double-row repair of a full-thickness supraspinatus tear with a knotted or a knotless technique, there is a very low chance (~5%) of revision 10 years following repair. Pogorzelski J, Fritz EM, Horan MP, Katthagen JC, Hussain ZB, Godin JA, Millett PJ Minimum five-year outcomes and clinical survivorship for arthroscopic transosseousequivalent double-row rotator cuff repair. J Am Acad Orthop Surg. 2019;27(24):e1093-e1101. doi:10.5435/JAAOS-D-18-00519 Retrospective cohort study with a single surgeon Comparative analysis with patients who underwent arthroscopic rotator cuff repair (RCR) with a knotless tape bridge (TB) repair to those who had a knotted suture bridge (SB) repair technique at a minimum of 5 years of follow-up 192 shoulders were analyzed for a minimum of 5-year follow-up with a mean follow-up of 6.6 years For TB repairs, scores improved significantly (P < .001) and for SB repairs, all scores improved but only the ASES score and SF-12 PCS (P < .05) demonstrated statistical significance Postoperative clinical survivorship was 96.6% and 93.6% for knotted SB repairs and 96.7% and 93.9% for knotless TB repairs at 2 and 5 years Takeaway: Patients treated with double-row TOE RCR using either a knotted SB or knotless TB repair showed excellent clinical results in primary and revision cases and in small or large tears with low revision surgery rates. Takeaway: Patients who had TOE also showed significant improvements in patient-reported outcomes at 5 years postoperatively. Elbuluk AM, Coxe FR, Fabricant PD, Ramos NL, Alaia MJ, Jones KJ Does medial-row fixation technique affect the retear rate and functional outcomes after double-row transosseous-equivalent rotator cuff repair? Orthop J Sports Med. 2019;7(5):2325967119842881. doi:10.1177/2325967119842881 Systematic review of 32 studies comparing double-row repairs with and without knots 5 studies reported on completely knotless transosseous-equivalent (TOE) techniques, 25 reported on techniques with medial knots, and 2 reported on both Both techniques resulted in similar improvements in functional outcomes There was a downward trend in retear rates using a completely knotless technique Takeaway: While prospective studies are warranted, a completely knotless technique results in an equivalent functional outcome and perhaps decreased retearing compared to a knotted technique. Dornan GJ, Predictors of outcomes after arthroscopic transosseous equivalent rotator cuff repair in 155 cases: a propensity score weighted analysis of knotted and knotless self-reinforcing repair techniques at a minimum of 2 years. [published correction appears in Arch Orthop Trauma Surg. 2017;137(12):1761]. Arch Orthop Trauma Surg. 2017;137(10):1399-1408. doi:10.1007/ s00402-017-2750-7 Katthagen JC Retrospective review of 35 SutureBridge™ repairs (medial knots) to 102 knotless SpeedBridge™ repairs performed by a single surgeon No difference in functional outcome 52 patients had an MRI at a mean of 4.4 years postoperative Retear rate was 33% (4 of 12) in the knotted group, compared to 7.5% (3 of 40) in the SpeedBridge group Millett PJ, Espinoza C, Horan MP, Ho CP, Warth RJ, Takeaway: The SpeedBridge repair with 2 mm FiberTape® construct appears to reduce retear rates compared to a traditional SutureBridge with #2 suture and medial knots. Dukan R, Ledinot P, Donadio J, Boyer P Arthroscopic rotator cuff repair with a knotless suture bridge technique: functional and radiological outcomes after a minimum follow-up of 5 years. Arthroscopy. 2019;35(7):20032011. doi:10.1016/j.arthro.2019.02.028 Prospective evaluation of knotless SpeedBridge™ repairs for supraspinatus tears at one center 68 patients were evaluated clinically at a minimum of 5 years postoperative MRI was performed to assess healing at 2 years postoperative ASES score improved 48 points to 87 points 88% of tendons were healed postoperatively Takeaway: A knotless SpeedBridge technique leads to excellent functional outcomes at a minimum of 5 years postoperative and has a healing rate of nearly 90% when used for single tendon tears. Burns KA, Robbins L, LeMarr AR, Childress AL, Rotator cuff repair with knotless technique is quicker and more cost-effective than knotted technique. Arthrosc Sports Med Rehabil. 2019;1(2):e123-e130. doi:10.1016/j.asmr.2019.09.005 Retrospective cohort study with 37 eligible patients undergoing arthroscopic rotator cuff repair performed by a single surgeon at an institution from 2 different 6-month periods of time 15 patients underwent a knotted suture bridge rotator cuff repair using Smith & Nephew Healicoil™ DL anchors 22 patients underwent a knotless suture bridge rotator cuff repair technique using Arthrex SpeedBridge™ repair with SwiveLock® anchors Operating room time also was reduced by approximately 40% (79.5 minutes for knotless; 121 minutes for knotted). Procedure time was 43.5 minutes for the knotless groups and 80 minutes for the knotted group. Operating room costs were significantly lower in the knotless group (MKL = $3788.40, MKT = $4262.90, P < .01) Morton DJ, Wilson ML Takeaway: Even though the knotless technique used more anchors and had a higher implant cost, it required less surgical procedure time and cost less overall than the knotted technique. Both had equivalent clinical results at short- and long-term follow-up. References 1. Park MC, McGarry MH, Gunzenhauser RC, Benefiel MK, Park CJ, Lee TQ. Does transosseous-equivalent rotator cuff repair biomechanically provide a “self-reinforcement” effect compared with single-row repair? J Shoulder Elbow Surg. 2014;23(12):1813-1821. doi:10.1016/j.jse.2014.03.008 2. Smith GCS, Bouwmeester TM, Lam PH. 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;26(12):2206-2212. doi:10.1016/j. jse.2017.06.045 3. Park MC, Peterson AB, McGarry MH, Park CJ, Lee TQ. Knotless transosseous-equivalent rotator cuff repair improves biomechanical self-reinforcement without diminishing footprint contact compared with medial knotted repair. Arthroscopy. 2017;33(8):1473-1481. doi:10.1016/j.arthro.2017.03.021 4. Rhee YG, Cho NS, Parke CS. Arthroscopic rotator cuff repair using modified Mason-Allen medial row stitch: knotless versus knot-tying suture bridge technique. Am J Sports Med. 2012;40(11):2440-2447. doi:10.1177/0363546512459170 5. Millett PJ, Espinoza C, Horan MP, et al. Predictors of outcomes after arthroscopic transosseous equivalent rotator cuff repair in 155 cases: a propensity score weighted analysis of knotted and knotless selfreinforcing repair techniques at a minimum of 2 years. Arch Orthop Trauma Surg. 2017;137(10):1399‐1408. doi:10.1007/s00402-017-2750-7 6. Elbuluk AM, Coxe FR, Fabricant PD, Ramos NL, Alaia MJ, Jones KJ. Does medial-row fixation technique affect the retear rate and functional outcomes after double-row transosseous-equivalent rotator cuff repair? Orthop J Sports Med. 2019;7(5):2325967119842881. doi:10.1177/2325967119842881 7. Dukan R, Ledinot P, Donadio J, Boyer P. Arthroscopic rotator cuff repair with a knotless suture bridge technique: functional and radiological outcomes after a minimum follow-up of 5 years. Arthroscopy. 2019;35(7):2003‐2011. doi:10.1016/j.arthro.2019.02.028 8. Burns KA, Robbins L, LeMarr AR, Childress AL, Morton DJ, Wilson ML. Rotator cuff repair with knotless technique is quicker and more cost-effective than knotted technique. Arthrosc Sports Med Rehabil. 2019;1(2):e123‐e130. doi:10.1016/j.asmr.2019.09.005 arthrex.com © 2021 Arthrex, Inc. All rights reserved. DOC1-000217-en-US_C

Knotless Double-Row Rotator Cuff Repair Scientific Update

SpeedBridge™ Double-Row Technique

4.75 mm BioComposite SpeedBridge Implant System w/SCORPION-Multifire Needle Includes two 4.75 mm BioComposite SwiveLock C Anchors w/one Preloaded FiberTape Loop (1 Blue, 1 White/Black) for Medial Row, two 4.75 BioComposite SwiveLock Anchors for Lateral Row, Disposable Punch, and SCORPION-Multifire Needle

SpeedBridge-Implantatsystem, 4.75 mm x 19.1 mm, mit SCORPION-multifire-Nadel

SpeedBridge Implant System with SCORPION-multifire Needle 4.75 x 19.1 mm

Finished Product

SPEEDBRG IMP SYS W/BIO-COMP SWVLK &amp; NDL

4.75/5.5 mm BioComposite SpeedBridge Implant System w/Scorpion Needle Includes two 4.75 mm BioComposite SwiveLock C anchors w/ one preloaded FiberTape Loop (1 Blue, 1 White/Black) for medial row, two 5.5 mm BioComposite SwiveLock C anchors for lateral row, disposable punch, and SCORPION-multifire needle.

SpeedBridge-Implantatsystem, 4.75/5.5 mm x 19.1 mm, mit SCORPION-multifire-Nadel

SpeedBridge Implant System with SCORPION-multifire Needle 4.75/5.5 x 19.1 mm

4.75/5.5 mm PEEK SpeedBridge Implant System SP (self-punching) Includes two 4.75 mm PEEK SwiveLock C anchors w/one preloaded FiberTape Loop (1 blue, 1 white/black) for medial row, two 5.5 mm PEEK SwiveLock SP (self-punching) anchors for lateral row, and disposable punch

SpeedBridge-Implantate- und Verbrauchsartikelkit mit PEEK Swivelock SP, steril, IM

SpeedBridge Implant System with PEEK SwiveLock SP

4.75 mm PEEK SpeedBridge Implant System Includes two 4.75 mm PEEK SwiveLock C anchors w/ one preloaded FiberTape Loop (1 Blue, 1 White/Black) for medial row, two 4.75 mm PEEK SwiveLock C anchors for lateral row, and disposable punch

SpeedBridge-Implantate und Verbrauchsartikelkit mit PEEK SwiveLock, steril, IM

SpeedBridge Implant System with PEEK SwiveLock Anchors

4.75/5.5 mm BioComposite SpeedBridge Implant System SP (self-punching) Includes two 4.75 mm BioComposite SwiveLock C anchors w/ one preloaded FiberTape Loop (1 blue, 1 white/black) for medial row, two 5.5 mm BioComposite SwiveLock SP (self-punching) anchors for lateral row, and disposable punch

SpeedBridge BioComposite Swivelock SP Implantate und VerbrauchsartikelSet, steril, IM

SpeedBridge Implant System with BioComposite Swivelock SP

Sistema de implante SpeedBridge con SwiveLock SP de BioComposite

Kit de implante SpeedBridge com BioComposite Swivelock SP

4.75 mm BioComposite SpeedBridge Implant System Includes two 4.75 mm BioComposite SwiveLock C anchors w /one preloaded FiberTape Loop (1 Blue, 1 White/Black) for medial row, two 4.75 mm BioComposite SwiveLock C for lateral row, and disposable punch

SpeedBridge BioComposite Swivelock Implantate und Verbrauchsartikel Set, steril, IM

SpeedBridge Implant System with BioComposite Swivelock

Sistema de implante SpeedBridge con SwiveLock de BioComposite

Kit de implante SpeedBridge com BioComposite Swivelock

Child (D)

Product

Maximize OR convenience and efficiency with the SpeedBridge implant system, which contains the implants and sutures required to complete a SpeedBridge rotator cuff repair in a single, sterile tray. The BioComposite SpeedBridge implant systems include 4.75 mm vented BioComposite SwiveLock® anchors with preloaded FiberTape® loops, which ease suture passage for the medial row, and 4.75 mm BioComposite SwiveLock C or 5.5 mm BioComposite SwiveLock SP (self-punching) anchors for the lateral row. For convenience, the required punch is also included in the sterile package.

Single Row vs SpeedBridge™ Rotator Cuff Repair: The PASTA Effect

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