The Medial Stitch in Transosseous-Equivalent Rotator Cuff Repair: Vertical or Horizontal Mattress?
Despite advances in surgical technique, rotator cuff repair retears continue to occur at rates of 10%, 22%, and 57% for small, medium, and large tears, respectively. A common mode of failure in transosseous-equivalent rotator cuff repairs is tissue pullout of the medial mattress stitch. While the medial mattress stitch has been studied extensively, no studies have evaluated a vertical mattress pattern placed near the musculotendinous junction in comparison with a horizontal mattress pattern.



Vertical mattress stitches will have higher load to failure and lower gapping compared with horizontal mattress stitches in a transosseous-equivalent rotator cuff repair.



Controlled laboratory study.



Double-row transosseous-equivalent rotator cuff repairs were performed in 9 pairs of human male cadaveric shoulders (mean age ± SD, 58 ± 10 years). One shoulder in each pair received a medial-row suture pattern using a vertical mattress stitch, and the contralateral shoulder received a horizontal mattress. Specimens were mounted in a materials testing machine and tested in uniaxial tensile deformation for cyclic loading (500 cycles at 1 Hz to 1.0 MPa of effective stress), followed by failure testing carried out at a rate of 1 mm/s. Construct gapping and applied loads were monitored continuously throughout the testing.



Vertical mattress sutures were placed in 5 right and 4 left shoulders. Peak cyclic gapping did not differ between vertical (mean ± SD, 2.8 ± 1.1 mm) and horizontal mattress specimens (3.0 ± 1.2 mm) (P = .684). Vertical mattress sutures failed at higher loads compared with horizontal mattress sutures (568.9 ± 140.3 vs 451.1 ± 174.3 N; P = .025); however, there was no significant difference in failure displacement (8.0 ± 1.6 vs 6.0 ± 2.1 mm; P = .092). Failure stiffness did not differ between the suture patterns (P = .204).



In transosseous-equivalent rotator cuff repairs near the musculotendinous junction, a vertical mattress suture used as the medial stitch has a higher load to failure but no difference in gapping compared with a horizontal mattress pattern.



A vertical mattress suture may offer enhanced strength of repair for transosseous-equivalent repairs.
Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.
Anthony
A
Montanez
Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.
Christopher A
CA
Makarewich
Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA Heath.Henninger@utah.edu Robert.Burks@hsc.utah.edu.
Robert T
RT
Burks
Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA Department of Bioengineering, University of Utah, Salt Lake City, Utah, USA Heath.Henninger@utah.edu Robert.Burks@hsc.utah.edu.
Heath B
HB
Henninger
D000368:Aged; D001696:Biomechanical Phenomena; D006801:Humans; D008297:Male; D008875:Middle Aged; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries / Q000601:surgery*; D012782:Shoulder / Q000601:surgery; D013536:Suture Techniques; D013537:Sutures; D013710:Tendons / Q000601:surgery; D014945:Wound Healing
biomechanics; failure; gapping; horizontal mattress; rotator cuff; transosseous-equivalent; vertical mattress