Original Article
Effect of Suture Size and Type on Bone Cutout in Transosseous Tendon Repairs

https://doi.org/10.1016/j.arthro.2009.08.020Get rights and content

Purpose

We compared bone cutout of polyester and polyblend suture in 2 suture sizes with static and cyclic loading in a Sawbone model (Pacific Research Laboratories, Vashon, WA).

Methods

Polyester and polyblend sutures in both No. 2 and No. 5 sizes were placed through transosseous tunnels in closed-cell polyurethane foam and tied over the bar of an electromechanical load frame at a fixed height. Seven sutures in each group were pulled at a rate of 1 mm/s until bone cutout occurred. Another set of 28 sutures were cyclically loaded at increasing loads until failure.

Results

With static and cyclic loads, No. 5 polyester suture (Ethibond; Ethicon, Somerville, NJ) and No. 5 polyblend suture (FiberWire; Arthrex, Naples, FL) had a higher cutout load than the No. 2 sutures (P < .001). No. 2 polyblend suture had a higher static failure load than No. 2 polyester suture (P = .02). With cyclic loading, No. 2 polyblend suture had a higher load to cutout than No. 2 polyester suture (P = .01), and No. 5 polyblend suture had a higher load to cutout than No. 5 polyester suture (P = .003).

Conclusions

No. 2 sutures showed bone cutout at lower forces under static and cyclic loading as compared with No. 5 sutures in this Sawbone model, and no decrease in performance with regard to bone cutout was noted with polyblend as compared with polyester.

Clinical Relevance

No. 5 polyester or polyblend suture may be preferable to No. 2 suture to avoid bone cutout in tendon-to-bone repair, and No. 5 polyblend may be preferable to No. 5 polyester to avoid bone cutout.

Section snippets

Methods

A Sawbone model of standardized closed-cell polyurethane foam of 15 psi (103 kPa) (FR-3715; General Plastics Manufacturing, Tacoma, WA) was used as a testing model. The compressive strength of the polyurethane foam at 23.9°C (75°F) was 5,017 kPa. A standard No. 2008-11 Richard Allan free needle (Richard Allan Medical, Worcestershire, England) was used to create 2-cm tunnels. To create the tunnel, a point was marked 1 cm in from the top edge and 1 cm down on the adjacent side. The curved needle

Results

There was no slippage in the knots during loading based on visual observation of the marks placed on the suture before testing.

With static loading, 1 No. 2 polyester suture broke at a peak load of 128 N and the remaining 6 pulled out of the tunnel. The broken suture was not included in the analysis. All 7 sutures in the remaining groups pulled out of the tunnel. The mean load to cutout (± SD) was as follows: No. 2 polyblend, 124.4 ± 9.1 N; No. 2 polyester, 114 ± 5.2 N; No. 5 polyblend, 171.7 ±

Discussion

A trend toward arthroscopic rotator cuff repair has driven the focus of development to suture anchors or similar devices, but the transosseous tunnel technique is still a viable treatment option. Successful rotator cuff repair is dependent on a myriad of factors. Gladstone et al.3 showed that fatty infiltration, particularly in the infraspinatus, has a significant effect on outcome scores and strength after rotator cuff repair. The effect of suture type on outcomes with poor tissue quality has

Conclusions

No. 2 sutures showed bone cutout at lower forces under static and cyclic loading as compared with No. 5 sutures in this Sawbone model, and no decrease in performance with regard to bone cutout was noted with polyblend as compared with polyester.

Acknowledgment

The authors thank Lyn Camire, E.L.S., from their department for editorial support.

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The authors report no conflict of interest.

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