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Comparative Study
. 2010 Sep;130(9):1193-9.
doi: 10.1007/s00402-009-1036-0. Epub 2010 Jan 5.

Initial load-to-failure and failure analysis in single- and double-row repair techniques for rotator cuff repair

M H Baums  1 , G H Buchhorn, F Gilbert, G Spahn, W Schultz, H-M Klinger
Affiliations
Comparative Study

Initial load-to-failure and failure analysis in single- and double-row repair techniques for rotator cuff repair

M H Baums et al. Arch Orthop Trauma Surg. 2010 Sep.

Abstract

Aim: This experimental study aimed to compare the load-to-failure rate and stiffness of single- versus double-row suture techniques for repairing rotator cuff lesions using two different suture materials. Additionally, the mode of failure of each repair was evaluated.

Method: In 32 sheep shoulders, a standardized tear of the infraspinatus tendon was created. Then, n = 8 specimen were randomized to four repair methods: (1) Double-row Anchor Ethibond coupled with polyester sutures, USP No. 2; (2) Double-Row Anchor HiFi with polyblend polyethylene sutures, USP No. 2; (3) Single-Row Anchor Ethibond coupled with braided polyester sutures, USP No. 2; and (4) Single-Row Anchor HiFi with braided polyblend polyethylene sutures, USP No. 2. Arthroscopic Mason-Allen stitches were placed (single-row) and combined with medial horizontal mattress stitches (double-row). All specimens were loaded to failure at a constant displacement rate on a material testing machine.

Results: Group 4 showed lowest load-to-failure result with 155.7 +/- 31.1 N compared to group 1 (293.4 +/- 16.1 N) and group 2 (397.7 +/- 7.4 N) (P < 0.001). Stiffness was highest in group 2 (162 +/- 7.3 N/mm) and lowest in group 4 (84.4 +/- 19.9 mm) (P < 0.001). In group 4, the main cause of failure was due to the suture cutting through the tendon (n = 6), a failure case observed in only n = 1 specimen in group 2 (P < 0.001).

Conclusions: A double-row technique combined with arthroscopic Mason-Allen/horizontal mattress stitches provides high initial failure strength and may minimize the risk of the polyethylene sutures cutting through the tendon in rotator cuff repair when a single load force is used.

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Figures

Fig. 1
Fig. 1
Used double-row technique. The repair consists of two rows of suture anchor systems loaded with Ethibond® sutures (a). Arthroscopic Mason-Allen stitches and mattress stitches were used (b)
Fig. 2
Fig. 2
Used single-row technique. The repair consists of a row with two suture anchor systems; arthroscopic Mason-Allen stitches were used
Fig. 3
Fig. 3
Suture anchor configuration. To achieve approximately standardized conditions for all specimens, suture anchor systems were placed in a uniform manner (a) with help of a template (b)
Fig. 4
Fig. 4
Experimental set-up. Biomechanical loading tests were carried out on an electromechanical testing machine (Zwick 1445, Zwick-Roell, Ulm, Germany) (a). The proximal portion of the muscle was fastened in a tendon clamp (b; left hand: inner side, right hand: external side)
Fig. 5
Fig. 5
Mean load-to-failure (N). Mean load-to-failure was highest in group 2 and group 1. Group 4 only reached a mean of 155.7 ± 31.6 N (P < 0.001)
Fig. 6
Fig. 6
Mean stiffness (N/mm). Mean stiffness was highest in group 2 and 1. Both single-row groups (group 3 and 4) reached lowest values for stiffness (P < 0.001)
Fig. 7
Fig. 7
Failure mechanism. Sutures cutting through the tendon leaving suture material intact
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