title: Suturing the myotendinous junction in total hip arthroplasty: A biomechanical comparison of different stitching techniques.
abstract: BACKGROUND
  The repair of the myotendinous junction following total hip arthroplasty is challenging as this region is the weakest part of the muscle structure. This study investigated the mechanical behaviour and the mode of failure of different suturing techniques of the myotendinous junction. A new asymmetrical stitch was compared to two widely used techniques, i.e. the simple stitch (two loops in parallel) and the figure-of-eight stitch.
  
  
  METHODS
  The ovine triceps brachii myotendinous junction was selected as the experimental model. Each technique was sewn in muscle belly on one side and in a polyester belt (no-tendon configuration) or in thin tendon (full configuration) on the other side. The former was chosen to determine the grasping power of the stitch on the muscle despite the tendon quality, the latter to simulate a very thin gluteus medius tendon.
  
  
  RESULTS
  The new stitch showed a higher ultimate strength (+40%) compared to the two controls in the no-tendon configuration. In the full configuration, no significant increase was observed, although failure of the new stitch always occurred at the tendon side. Furthermore, the new stitch does not alter the stiffness of repair.
  
  
  CONCLUSIONS
  The new stitch has a higher grasping power on muscle belly than the single passing-through stitches thanks to the multiple fixation points, which better distribute the load in the tissue. However, such performance can be fully exploited only in the presence of good quality tendons.
authors.affiliation: Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Lionello
authors.affiliation: Laboratorio Prometeo, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Fognani
authors.affiliation: Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy. Electronic address: baleani@tecno.ior.it.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Baleani
authors.affiliation: Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Sudanese
authors.affiliation: Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy; Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Toni
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001696:Biomechanical Phenomena; D004195:Disease Models, Animal; D018482:Muscle, Skeletal / Q000503:physiopathology / Q000601:surgery*; D012756:Sheep; D013536:Suture Techniques; D013710:Tendons / Q000503:physiopathology / Q000601:surgery*
keywords: Mechanical; Muscle; Stiffness; Strength; Suture technique; Total hip replacement