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First published on July 21, 2006, doi:10.1177/0363546506289701
This version was published on November 1, 2006
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The American Journal of Sports Medicine 34:1832-1838 (2006)
© 2006 American Orthopaedic Society for Sports Medicine

Biomechanical Comparison of Traditional and Locked Suture Configurations for Arthroscopic Repairs of the Rotator Cuff

Anil K. Koganti, MD*,{dagger}, Gregory J. Adamson, MD{dagger}, Colin S. Gregersen, MS{ddagger}, Marilyn M. Pink, PhD, PT{dagger} and James A. Shankwiler, MD{dagger}

From the {dagger} Congress Medical Associates, Inc, Pasadena, California, and {ddagger} dj Orthopedics, Inc, Vista, California

* Address correspondence to Anil K. Koganti, MD, University of Texas Southwestern Medical Center, Department of Orthopaedic Surgery, 5323 Harry Hines Blvd, Dallas, TX 75390-8883 (e-mail: anil.koganti{at}utsouthwestern.edu).

Background: The optimal suture configuration for arthroscopic rotator cuff repairs is controversial. "Locked" suture configurations, which use a combination of simple and transverse suture loops, have demonstrated better fixation strength than have traditional simple and horizontal mattress techniques.

Purpose: To compare traditional arthroscopic suture configurations to locked arthroscopic configurations in ability to resist gap formation under cyclic loading.

Study Design: Controlled laboratory study.

Methods: Crescent-shaped defects were created at the infraspinatus tendon insertion in 32 bovine shoulders. Four arthroscopic suture configurations were tested (8 specimens in each group): simple (group 1), horizontal mattress (group 2), locked mattress (group 3), and locked inverted mattress (group 4). A metal corkscrew suture anchor doubly loaded with No. 2 Fiberwire suture was used for the repairs. A cyclic loading protocol with application of forces from 10 to 180 N for a maximum of 2500 cycles was used. The number of cycles required to form gaps of 5 mm and 10 mm was recorded.

Results: The locked mattress configuration (group 3) outperformed all other groups in resisting 5-mm gap formation (P < .0001), requiring a mean of 628 cycles in comparison to 65, 193, and 197 cycles for groups 1, 2, and 4, respectively. Both locked configurations (groups 3 and 4) were superior to traditional simple and horizontal mattress configurations in resisting 10-mm gap formation.

Conclusion: The locked mattress suturing technique (group 3) provided the most secure tendon fixation of all arthroscopic configurations tested.

Clinical Relevance: The use of locked suture configurations for arthroscopic rotator cuff repairs may enhance tendon fixation and limit gap formation in the early postoperative period.

Key Words: rotator cuff repair • suture configuration • arthroscopic • locked




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