title: The strength of suture configurations in arthroscopic rotator cuff repair.
abstract: OBJECTIVE
  This study evaluated the strength of different suture configurations with the use of a recently introduced arthroscopic suture passer (ExpressSew; Surgical Solutions, Valencia, CA).
  
  
  METHODS
  The ultimate tensile strength and mode of failure of each suture configuration were repeatedly tested on a validated porcine rotator cuff tendon model, with the use of standard suture material (No. 2 FiberWire [Arthrex, Naples, FL]) passed with ExpressSew and tested on a Hounsfield digital tensiometer type H20K-W (Tinius Olsen, Hersham, PA).
  
  
  RESULTS
  The strongest construct was 2 mattress sutures (mean, 169 N; standard deviation, 56.1 N); this was followed in strength by a single modified Kessler suture (mean, 161 N; standard deviation, 16.9 N), 4 simple sutures (mean, 155 N; standard deviation, 27.3 N), and finally, a single Mason-Allen suture (mean, 140 N; standard deviation, 28.6 N).
  
  
  CONCLUSIONS
  Study results show little difference in strength for varying complexities of suture configurations. In simple terms, no demonstrable difference was seen in the strength of construct, whether the surgeon used 4 simple sutures, 2 mattress sutures, or 1 grasping suture.
  
  
  CONCLUSIONS
  This study allows the surgeon to justify use of the simplest configuration of suture passage that works in his hands, for the purpose of attaining a reliable and repeatable repair of the rotator cuff through arthroscopic methods.
authors.affiliation: Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon EX2 5DW, England. cdwhiteza@hotmail.com
authors.forename: Clive D
authors.initials: CD
authors.lastname: White
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Bunker
authors.forename: Robert M
authors.initials: RM
authors.lastname: Hooper
mesh_terms: D000818:Animals; D001182:Arthroscopy; D004868:Equipment Failure; D023421:Models, Animal; D013536:Suture Techniques; D013537:Sutures; D013552:Swine; D013710:Tendons / Q000601:surgery*; D013718:Tensile Strength