THE STRENGTH OF SUTURE CONFIGURATIONS IN ARTHROSCOPIC ROTATOR CUFF REPAIR

Abstract

Given that there is limited time available to the surgeon in arthroscopic rotator cuff repair, how is the time best spent? Should he place one Modified Mason-Allen, two mattress or four simple sutures? This study reverses current thought. In an in-vitro biomechanical single pull to failure study we compared the ultimate tensile strength of simple, mattress and grasping sutures passed with an arthroscopic suture passer (Surgical Solutions Express-Sew). The aim was to determine which suture configurations would most simply, repeatably and reliably repair the rotator cuff. The ultimate tensile strength and mode of failure of six different suture configurations was repeatedly tested on a validated porcine rotator cuff tendon model, using a standard suture material (Number 2 Fiberwire) passed with the Surgical Solutions Express-sew, in a Hounsfield type H20K-W digital tensometer. Standardising the number of suture passes to four, the strongest construct was two mattress sutures (Mean 169N), followed by single Modified Kessler (Mean 161N), four simple sutures (Mean 155N) and finally a single Mason Allen suture (Mean 140N). Suture configurations involving two passes were all weaker than those with four (one way analysis of variance p=0.026), even when Number 2 Fibertape was used to augment strength. These results show little difference in strength for varying complexity of four pass suture passage (one way analysis of variance p=0.61). In simple terms there is no demonstrable difference in the strength of construct whether the surgeon uses four simple, two mattress or one grasping suture. This study allows the surgeon to justify using the simplest configuration of suture passage that works in his hands in order to obtain a reliable and repeatable repair of the rotator cuff arthroscopically.