Friday, July 5, 2013

Rotator cuff repair: all sutures are not equal

Differential suture loading in an experimental rotator cuff repair.

The primary mechanism of failure of a rotator cuff repair attempt is suture tension overloading the ability of the tendon edge to resist pull out. Normally, of course, the rotator cuff tendon is attached to the tuberosity via millions of tiny but strong fibrils. Load applied to the tendon is shared among these many fibrils - like a parachute with many points of attachment to the canape

In a rotator cuff repair, even with the most modern methods, the points of attachment of the cuff to bone are few.

Noting that repairs of large rotator cuff tears often fail to heal because the suture pulls through the tendon, this study explored the loads applied by the suture to the tendon.

After a 4-suture supraspinatus repair with transosseous sutures, the arm was placed in 12 different positions. The tension in each suture was monitored using individual load cells.

This study demonstrated that loads applied to the repaired tendon were not shared equally among the sutures. When the arm was externally rotated relative to the plane of the scapula, the tension in the anterior suture was over 10 times that in the posterior suture (P < .001). When the arm was internally rotated, the tension in the posterior suture was over 10 times that in the anterior suture (P < .0005).

The authors concluded that suture tension could be concentrated in one of the repair sutures, increasing the risk of suture tension overload, especially in the presence of suboptimal quality of tendon tissue at the margin of the tear.

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