title: Suture placement near the musculotendinous junction in the supraspinatus: implications for rotator cuff repair.
abstract: BACKGROUND
  Transosseous-equivalent rotator cuff repair has an increased incidence of medial rotator cuff failure compared with single-row repair. No studies have evaluated the influence of the proximity of the suture row to the musculotendinous junction (MTJ) on cyclic gapping and failure properties.
  
  
  OBJECTIVE
  A single row of horizontal mattress sutures placed within the supraspinatus tendon lateral to the MTJ will experience less gap formation and higher failure loads than a similar suture row placed at the MTJ.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Paired supraspinatus tendons were isolated from human cadaveric specimens and resected at the tendon insertion to the humerus. Randomized within a pair, a single row of 4 horizontal mattress sutures was placed either in the tendon 5 mm lateral to the MTJ or at the MTJ. The tied sutures secured the tendon to a fixture that ensured consistent placement of the suture row in the tendon and static fixation of the row. The muscle belly was gripped in a cryoclamp, and a servohydraulic materials testing machine was used to provide uniaxial tensile deformation for 500 cycles at 1 Hz, followed by load to failure at 1 mm/s. Fiducial markers with video tracking were used to quantify gap formation at the suture line, while the materials testing machine recorded loading for the cyclic and failure tests.
  
  
  RESULTS
  During cyclic loading, both constructs experienced gross initial gap formation, followed by progressive gap formation that plateaued after cycle 200. The MTJ specimens had significantly higher mean cumulative gapping than the tendon specimens: 3.6±1.0 mm versus 2.4±0.6 mm, respectively (P=.012). The tendon specimens had significantly higher mean loads to failure than did the MTJ specimens: 567.1±121.8 N versus 434.2±148.1 N, respectively (P=.013). The mean failure displacement did not differ between groups for the tendon and MTJ: 5.7±2.5 mm versus 4.5±2.0 mm, respectively (P=.144).
  
  
  CONCLUSIONS
  A horizontal suture row placed at the MTJ has inferior mechanical properties (increased gapping, decreased load support) as compared with a suture row placed 5 mm laterally within the tendon.
  
  
  CONCLUSIONS
  The integrity of rotator cuff repair may be compromised if sutures are placed too close to the MTJ.
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Raj S
authors.initials: RS
authors.lastname: Kullar
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Reagan
authors.affiliation: Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Kolz
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA Robert.Burks@hsc.utah.edu heath.henninger@utah.edu.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Burks
authors.affiliation: Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA Scientific Computing and Imaging Institute, Department of Bioengineering, University of Utah, Salt Lake City, Utah, USA Robert.Burks@hsc.utah.edu heath.henninger@utah.edu.
authors.forename: Heath B
authors.initials: HB
authors.lastname: Henninger
mesh_terms: D000368:Aged; D001178:Arthroplasty / Q000379:methods*; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D006801:Humans; D006811:Humerus / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017006:Rotator Cuff / Q000601:surgery*; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D013536:Suture Techniques; D013537:Sutures; D017211:Treatment Failure
keywords: musculotendinous junction; rotator cuff; supraspinatus; transosseous-equivalent repair