The use of suture-tape and suture-wire in arthroscopic rotator cuff repair: A comparative biomechanics study.

BACKGROUND: Rotator cuff repair surgery aims to create a secure, pressurized tendon-bone footprint to permit re-establishment of the fibrovascular interface and tendon healing. Flat-braided suture-tape is an alternative suture material to traditional suture-wire that has potential to reproduce a larger repair construct contact area. The objective of this study was to compare contact pressure, area as well as the mechanical fatigue strength between suture-wire and suture-tape Suture-bridge repair constructs in an ovine model. METHODS: Sixty lamb infraspinatus tendons were harvested and randomly allocated to three- and four-anchor Suture-bridge repairs performed using either suture-wire or suture-tape. Thirty-two specimens were cyclically loaded for 200 cycles in an Instron testing machine, while tendon gap formation was recorded using a high speed digital motion analysis system. Loading to failure was then performed to evaluate construct ultimate tensile strength and stiffness. The remaining 28 specimens were assessed for repair contact pressure and area using pressure-sensitive film. RESULTS: There was a significantly greater average tendon contact pressure (mean difference: 0.064 MPa, p = 0.04) and area (mean difference: 2.71 mm2, p = 0.03) in fiber-tape repair constructs compared to those in fiber-wire constructs for the three-anchor Suture-bridge configuration. The four-anchor suture-tape constructs had a significantly larger ultimate tensile strength than that of the four-anchor suture-wire constructs (mean difference: 56.4 N, p = 0.04). There were no significant differences in gap formation or stiffness between suture-tape and suture-wire constructs (p > 0.05). CONCLUSION: Suture-tape offers greater pressurised tendon-bone contact than suture-wire in three-anchor Suture-bridge repairs, while greater mechanical strength is achieved with the use of suture-tape in four-anchor Suture-bridge constructs.

Load response and gap formation in a single-row cruciate suture rotator cuff repair.

BACKGROUND: Double-row rotator cuff tendon repair techniques may provide superior contact area and strength compared with single-row repairs, but are associated with higher material expenses and prolonged operating time. The purpose of this study was to evaluate gap formation, ultimate tensile strength and stiffness of a single-row cruciate suture rotator cuff repair construct, and to compare these results with those of the Mason-Allen and SutureBridge repair constructs. METHODS: Infraspinatus tendons from 24 spring lamb shoulders were harvested and allocated to cruciate suture, Mason-Allen and SutureBridge repair groups. Specimens were loaded cyclically between 10 and 62 N for 200 cycles, and gap formation simultaneously measured using a high-speed digital camera. Specimens were then loaded in uniaxial tension to failure, and construct stiffness and repair strength were evaluated. RESULTS: Gap formation in the cruciate suture repair was significantly lower than that of the Mason-Allen repair (mean difference = 0.6 mm, P = 0.009) and no different from that of the SutureBridge repair (P > 0.05). Both the cruciate suture repair (mean difference = 15.7 N/mm, P = 0.002) and SutureBridge repair (mean difference = 15.8 N/mm, P = 0.034) were significantly stiffer than that of the Mason-Allen repair; however, no significant differences in ultimate tensile strength between repair groups were discerned (P > 0.05). CONCLUSION: The cruciate suture repair construct, which may represent a simple and cost-effective alternative to double-row and double-row equivalent rotator cuff repairs, has comparable biomechanical strength and integrity with that of the SutureBridge repair, and may result in improved construct longevity and tendon healing compared with the Mason-Allen repair.

A cruciate suture technique for rotator cuff repair.

PURPOSE: Re-establishment of the native footprint during rotator cuff repair is important for maximizing healing potential and fixation strength. The purpose of this study was to evaluate the contact area, contact pressure, stiffness and tensile strength of a new single-row cruciate suture repair and to compare these results to those of the Mason-Allen, double-row and transosseous repairs. METHODS: Infraspinatus tendons from fifty-six lamb shoulders were harvested and randomly assigned to cruciate suture, Mason-Allen, double-row and transosseous repair groups. Repairs were performed over pressure-sensitive film and footprint contact area and pressure measured. Repaired tendon specimens were also loaded in uniaxial tension, and ultimate tensile strength and stiffness measured. RESULTS: The cruciate suture repair established significantly greater footprint contact area compared to the Mason-Allen repair (mean difference = 101 mm(2), p = 0.003). The ultimate tensile strength and stiffness of the double-row repair was significantly higher than that of all other repair groups (p < 0.05). The average footprint contact pressure of the cruciate suture repair (0.78 MPa) was similar to that of the Mason-Allen (0.74 MPa) and double-row repairs (0.79 MPa). The ultimate tensile strength of the cruciate suture repair was significantly greater than that of the transosseous repair (mean difference 62.4 N, p = 0.002). CONCLUSION: The cruciate suture repair may improve strength and healing at the repaired tendon rotator cuff insertion relative to other single-row repair techniques. It may represent a faster, easier and more cost-effective alternative to double-row repairs.