Biomechanical Analysis of a Modified Mattress Configuration: The Cross-Mattress Suture

Abstract

Background A modification to the traditional horizontal mattress suture technique was developed for double-loaded anchors and named the cross-mattress suture. The sutures are placed similar to a traditional horizontal mattress suture; however, the limbs from the same pair of sutures are placed alternately. The present study aimed to compare the biomechanical stability of the cross-mattress suture with the simple and traditional horizontal mattress suture.Methods Eighteen fresh porcine infraspinatus tendons were divided into three different repair groups (the simple, the mattress or the cross-mattress group) and were fixed using a suture anchor loaded with two high-tension sutures. Maximum failure load was recorded. ResultsThe cross-mattress suture showed a significantly greater maximum load to failure. The average maximum load to failure was 23.0 N for the simple stitch, 35.1 N for the mattress and 67.7 N for the cross-mattress group. The maximum load to failure for the cross-mattress was greater than the simple (p < 0.05) and the mattress (p < 0.05). DiscussionThe results obtained in the present study indicate that the cross-mattress suture supports the greatest maximum failure load, and suggests that it is biomechanically superior to the traditional mattress or the simple suture configuration. It is easy, compact and reproducible.

Simple versus cross-mattress sutures for nondisplaced flaps of the maxillary molar region: a randomized controlled trial

“…The advantages of this technique include rapid and easy application [ 10 , 11 ]. On the other hand, the cross-mattress suture enjoys the highest maximum load at failure due to the geometrical suture passage pattern and is considered biomechanically superior to the simple suture [ 6 ]. One disadvantage of cross-mattress sutures can be the longer suturing duration because of its more complex configuration than the simple suture.…”

“…Another finding of our study was the significantly higher frequency of supplementary suture requirement in the simple group compared to the cross-mattress group, which may be due to the fact that suture opening can require less force in simple sutures. Similarly, Yamakado et al have shown that a stronger force is needed for cross-mattress suture opening [ 6 ]. Furthermore, mattress suturing is basically applied in areas where closure cannot be performed without tension [ 12 ].…”

“…Cross-mattress sutures are modified horizontal mattress sutures in which the sutures are crossed to provide stronger tissue bridges. In fact, after placing the knots, the two loops of this type of suture cross each other and, to some extent, overlap [ 6 ]. In this study, it was hypothesized that for nondisplaced flaps of the maxillary molar region, cross-mattress sutures would be comparable to simple sutures in terms of duration and that cross-mattress sutures would require fewer supplementary sutures and lead to lower bleeding on probing and better gingival index.…”