Biomechanical evaluation of rotator cuff repairs in a sheep model: suture anchors using arthroscopic Mason-Allen stitches compared with transosseous sutures using traditional modified Mason-Allen stitches.
BACKGROUND
The optimal method for rotator cuff repair of the shoulder is not yet known. The aim of this study was to compare the time-dependent biomechanical properties of the traditional open transosseous suture technique and modified Mason-Allen stitches (group 1) versus the double-loaded suture anchors technique and so-called arthroscopic Mason-Allen stitches (group 2) in rotator cuff repair.


METHODS
Eighteen adult female sheep were randomized into two groups: in an open approach in which the released infraspinatus tendon was repaired with group 1, and with group 2. Animals were sacrificed at 6, 12, or 26 weeks; shoulders were harvested and magnetic resonance imaging was performed. Eight untreated contralateral shoulders served as controls. Tendons of 16 additional unpaired cadaver shoulder joints of adult female sheep were identically treated for analysis at time zero. In a biomechanical evaluation all specimens were loaded to failure at a constant displacement rate using a standard universal testing machine. The load-to-failure and stiffness of the healed bone-tendon interface were calculated.


RESULTS
Magnetic resonance imaging analysis showed cuff integrity in all cases, and no evidence of foreign body reaction to the anchors. Load-to-failure and stiffness data did not indicate any significant difference between the two treatment groups, neither at 6 weeks nor at 12 or 26 weeks. However, at time zero the group 2 had a higher load-to-failure in comparison to the group 1 (P<0.010), but there was no difference for the stiffness (P<0.121).


CONCLUSIONS
This in vivo study showed that, postoperatively, the group 2 technique provides superior stability and after healing would gain strength comparable to the group 1 technique.
Department of Orthopaedic Surgery, University Medical Center Göttingen, Georg-August University, Robert-Koch-Strasse 40, D-37075 Göttingen, Germany. michael.klinger@med.uni-goettingen.de
Hans-Michael
HM
Klinger
Gottfried H
GH
Buchhorn
Gabert
G
Heidrich
Enrico
E
Kahl
Mike H
MH
Baums
D020341:Absorbable Implants; D000818:Animals; D001696:Biomechanical Phenomena / Q000379:methods; D003198:Computer Simulation; D017076:Computer-Aided Design; D004195:Disease Models, Animal; D004548:Elasticity; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D008954:Models, Biological; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012756:Sheep; D013314:Stress, Mechanical; D053441:Suture Anchors; D013718:Tensile Strength