Biomechanical Comparison of Synthetic Polytetrafluoroethylene (PTFE) vs Human Dermal Allograft (HDA), 2 vs 3 Glenoid Anchors, and Suture vs Minitape in Superior Capsule Reconstruction

Abstract

Background: Superior capsule reconstruction (SCR) is an option for the treatment of massive, irreparable rotator cuff tears. However, which materials yield the strongest constructs remains undetermined. Purposes: We sought to investigate whether SCR with polytetrafluoroethylene (PTFE) or human dermal allograft (HDA), 2 or 3 glenoid anchors, and suture or minitape resulted in better failure load properties at the patch-glenoid interface. Methods: We conducted a biomechanical study in 30 glenoid-sided SCR repairs in Sawbones models divided into 5 groups. Each was pulled to failure to assess mode of failure, peak load (N), stiffness (N/mm), yield load (N), peak energy (N m), and ultimate energy (N m). The 5 groups were as follows: group 1—PTFE, 2 anchors, and suture; group 2—PTFE, 2 anchors, and minitape; group 3—HDA, 2 anchors, and suture; group 4—HDA, 2 anchors, and minitape; group 5—PTFE, 3 anchors, and minitape. Results: Repairs failed by button-holing of suture/minitape. Group 5 had greater peak load, stiffness, yield load, and peak energy (384 ± 62 N; 24 ± 3 N/mm; 343 ± 42 N; 4 ± 2 N m) than group 3 (226 ± 67 N; 16 ± 4 N/mm; 194 ± 74 N; 2 ± 1 N m) or group 4 (274 ± 62 N; 17 ± 4 N/mm; 244 ± 50 N; 2 ± 1 N m) and greater ultimate energy (8 ± 3 N m) than all other groups. Conclusions: This biomechanical study of SCR repairs in Sawbones models found that yield load was greater in PTFE than HDA, 3 anchors were better than 2, and minitape was no better than suture.

Biomechanical and morphological comparison of two interposition graft rotator cuff repair techniques

“…Studies have shown that patients treated with interposition rotator cuff repairs experienced significant improvements in clinical outcome scores that were maintained a decade postoperatively 2,3 . The use of synthetic polytetrafluoroethylene (PTFE) has been validated in the treatment of irreparable rotator cuff tears, and has been shown to possess superior load‐to‐failure properties when compared with conventional human dermal allograft 4 . However, the best technique of securing grafts, irrespective of material, to the torn tendon edge has yet to be determined.…”

“…2,3 The use of synthetic polytetrafluoroethylene (PTFE) has been validated in the treatment of irreparable rotator cuff tears, and has been shown to possess superior load-to-failure properties when compared with conventional human dermal allograft. 4 However, the best technique of securing grafts, irrespective of material, to the torn tendon edge has yet to be determined.…”

Reliability of a Novel Preoperative Protocol for Determining Graft Sizes for Superior Capsular Reconstruction Using Plain Film Radiography

“…Fascia lata was the original graft material used. However, biomechanical studies have found human dermal allograft and synthetic polytetrafluoroethylene (PTFE) provide comparable structural properties [ 17 , 18 , 19 ]. Furthermore, patch grafts circumvent the need to harvest autografts and the associated donor site morbidity [ 17 , 20 , 21 ].…”