Cyclic loading of rotator cuff repairs: A comparison of bioabsorbable tacks with metal suture anchors and transosseous sutures.
OBJECTIVE
The purposes of the study were (1) to compare rotator cuff repair strengths after cyclic loading of 2 bioabsorbable nonsuture-based tack-type anchors, transosseous sutures, and a metal suture-based anchor, and (2) to correlate bone mineral density with mode of failure and cycles to failure. We hypothesized that specimens with a lower bone density would fail through bone at a lower number of cycles independent of the method of cuff fixation.


METHODS
Ex vivo biomechanical study.


METHODS
Standardized full-thickness rotator cuff defects were created in 30 fresh-frozen cadaveric shoulders that were randomized to 1 of 4 repair groups: transosseous sutures; Mitek Super suture anchors (Mitek Surgical Products, Westwood, MA); smooth bioabsorbable 8-mm Suretacs (Acufex, Smith & Nephew Endoscopy, Mansfield, MA); or spiked bioabsorbable 8-mm Suretacs (Acufex). All repairs were cyclically loaded from 10 to 180 N; the numbers of cycles to 50% (gap, 5 mm) and 100% (gap, 10 mm) failure were recorded.


RESULTS
In comparing the repair groups, we found only 1 significant difference: the number of cycles to 100% failure was significantly higher (P <.05) for the smooth bioabsorbable tack than for the transosseous suture group. There were no statistically significant (P </=.05) differences in bone mineral densities with regard to each specimen's mode of failure.


CONCLUSIONS
Our results suggested that immediate postoperative fixation provided by bioabsorbable tacks was similar to that provided by Mitek anchors and more stable than that provided by transosseous sutures. Therefore, the immediate postoperative biomechanical strength of bioabsorbable tacks seems comparatively adequate for fixation of selected small rotator cuff tears. However, additional evaluation in an animal model to examine degradation characteristics and sustained strength of repair is recommended before clinical use.
Goradia
V K
VK
Department of Orthopaedic Surgery, The Union Memorial Hospital, Baltimore, Maryland, U.S.A.
Mullen
D J
DJ
Boucher
H R
HR
Parks
B G
BG
O'Donnell
J B
JB
D020341:Absorbable Implants; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D002102:Cadaver; D004868:Equipment Failure; D006801:Humans; D006811:Humerus / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D011897:Random Allocation; D017006:Rotator Cuff / Q000601:surgery*; D013536:Suture Techniques; D016474:Weight-Bearing