Biomechanical evaluation of suture–tendon interface and tissue holding of three suture configurations in torn and degenerated versus intact human rotator cuffs

Wlk, M; Abdelkafy, Ashraf; Hexel, M; Krasny, Christian; Aigner, N; Meizer, R; Landsiedl, F

doi:10.1007/s00167-014-2988-3

Cited by 14 publications

(12 citation statements)

References 40 publications

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“…63 Similarly, cell apoptosis is seen throughout degenerated tendon, 64,65 with concurrent elevations in inflammatory and catabolic mediators. 66,67 These degenerative changes not only weaken the suture retention strength, thereby predisposing to surgical failure, 18 but also impair healing. Namely, it was recently reported that the severity of tendinosis, rather than tear size or fatty infiltration, was the greatest predictor of repair integrity at least 6 months after surgery.…”

Section: Mechanical Augmentation Of the Surgical Repairmentioning

confidence: 99%

“…1). 18 Novel surgical techniques have been developed in an effort to improve footprint coverage and reduce shear stresses at the suture-tendon interface, theoretically enhancing healing at the interface and reducing repair failure. 19,20 While these techniques have shown promise in studies with cadaveric specimens, clinical studies have not consistently found improvements in structural healing or functional outcomes.…”

Section: Introductionmentioning

confidence: 99%

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The Rotator Cuff Organ: Integrating Developmental Biology, Tissue Engineering, and Surgical Considerations to Treat Chronic Massive Rotator Cuff Tears

Rothrauff

Pauyo

Debski

et al. 2017

Tissue Engineering Part B: Reviews

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The torn rotator cuff remains a persistent orthopedic challenge, with poor outcomes disproportionately associated with chronic, massive tears. Degenerative changes in the tissues that comprise the rotator cuff organ, including muscle, tendon, and bone, contribute to the poor healing capacity of chronic tears, resulting in poor function and an increased risk for repair failure. Tissue engineering strategies to augment rotator cuff repair have been developed in an effort to improve rotator cuff healing and have focused on three principal aims: (1) immediate mechanical augmentation of the surgical repair, (2) restoration of muscle quality and contractility, and (3) regeneration of native enthesis structure. Work in these areas will be reviewed in sequence, highlighting the relevant pathophysiology, developmental biology, and biomechanics, which must be considered when designing therapeutic applications. While the independent use of these strategies has shown promise, synergistic benefits may emerge from their combined application given the interdependence of the tissues that constitute the rotator cuff organ. Furthermore, controlled mobilization of augmented rotator cuff repairs during postoperative rehabilitation may provide mechanotransductive cues capable of guiding tissue regeneration and restoration of rotator cuff function. Present challenges and future possibilities will be identified, which if realized, may provide solutions to the vexing condition of chronic massive rotator cuff tears.

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Section: Mechanical Augmentation Of the Surgical Repairmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Rotator Cuff Organ: Integrating Developmental Biology, Tissue Engineering, and Surgical Considerations to Treat Chronic Massive Rotator Cuff Tears

Rothrauff

Pauyo

Debski

et al. 2017

Tissue Engineering Part B: Reviews

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“…The suture–tendon/ligament interface was identified as the critical limit to successful tendon/ligament repair. 41 High friction between sutures and tissues may cause pain and inflammation, then lead to a longer healing time. An ideal suture should have minimal suture-to-tissue friction force.…”

Section: Discussionmentioning

confidence: 99%

Polycaprolactone/ultra-high molecular weight polyethylene partially absorbable suture with improved mechanical performances for tendon and ligament repair

Zhang

Luan

et al. 2020

Textile Research Journal

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Orthopedic suture, as an implantable surgical device for skeletal and soft tissue connection, is vital in tendon or ligament injury repair. Resorbable therapy approaches exhibit excellent biocompatibility in the field of suture materials but lack a long-term fixation effect in orthopedic treatment. Herein, this study focused on a series of partially absorbable orthopedic sutures, which were composed of absorbable polycaprolactone (PCL) multifilament and non-absorbable ultra-high molecular weight polyethylene (UHMWPE) multifilament. Comprehensive in vitro mechanical evaluations were conducted to probe the relationship between material composition and mechanical properties of the sutures. The results showed that the partially absorbable sutures, especially P/U = 50/50 and P/U = 25/75, exhibited significant improvements in mechanical properties compared to single-material sutures. The tensile strength of P/U = 50/50 and P/U = 25/75 was 180.99 and 210.91 N, respectively, which was about two times higher than that of absorbable PCL suture P/U = 100/0 (62.42 N). Furthermore, their suture-to-suture friction force was 1.89 times and 2.51 times that of non-absorbable UHMWPE suture P/U = 0/100, respectively, which guaranteed good knot security. Compared with the clinically used orthopedic suture Ethibond (110 N), P/U = 50/50 and P/U = 25/75 also presented superior tensile properties. Notably, P/U = 50/50 and P/U = 25/75 had similar tensile curves to that of the native tendon/ligament, which might be beneficial to tissue healing. Moreover, the R2 of Eyring's model to simulate the creep curves of each suture was higher than 0.99, which indicated that Eyring's model could be used in predicting the long-term creep behavior of the sutures.

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“…A custom-made software program on a personal computer was used to control the desired force, the cycle speed, and the number of cycles. First, each model was subjected to a 5 N preload and a cyclic load of 5-30 N at 0.6 mm/s for 20 cycles (Ma et al, 2004;Mihata et al, 2011;Wlk et al, 2015). The tendon model was then subjected to simple tensile loading at 0.6 mm/s until reaching failure (Millett et al, 2017).…”

Section: Biomechanical Testingmentioning

confidence: 99%

Biomechanical analysis of four different medial row configurations of suture bridge rotator cuff repair

Senju

Okada

Takeuchi

et al. 2019

Clinical Biomechanics

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Background: Rotator cuff tendon rupture after suture bridge repair occasionally occurs at the medial row, with remnant tendon tissue remaining at the footprint. While concentrated medial row stress is suspected to be involved in such tears, the optimal suture bridge technique remains controversial. Methods: This study aimed to investigate the construct strength provided by suture bridge techniques having four different medial row configurations using artificial materials (n = 10 per group): Group 1, four-hole (two stitches per hole) knotless suture bridge; Group 2, eight-hole (one stitch per hole) parallel knotless suture bridge; Group 3, eight-hole non-parallel knotless suture bridge; and Group 4, eight-hole knot-tying suture bridge. Each construct underwent cyclic loading from 5 to 30 N for 20 cycles, followed by tensile testing to failure. The ultimate failure load and linear stiffness were measured. Findings: Group 2 had the highest ultimate failure load (mean 160.54 N, SD 6.40) [Group 4 (mean 150.21 N, SD 9.76, p = 0.0138), Group 3 (mean 138.80 N, SD 7.18, p < 0.0001), and Group 1 (mean 129.35 N, SD 4.25, p < 0.0001)]. The linear stiffness of Group 2 (mean 9.32 N/mm, SD 0.25) and Group 4 (mean 9.72 N/mm, SD 0.40) was significantly higher (p = 0.0032) than that of Group 1 (mean 8.44 N/mm, SD 0.29) and Group 3 (mean 8.61 N/mm, SD 0.31). Interpretation: In conclusion, increasing the number of suture-passed holes, arranging the holes in parallel, and a knotless technique improved the failure load following suture bridge repair.

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Biomechanical evaluation of suture–tendon interface and tissue holding of three suture configurations in torn and degenerated versus intact human rotator cuffs

Abstract: Clinicians better use repair techniques that grasp greater tissue volume (e.g. MCS, modified Mason-Allen cross bridge, double-row cross bridge, etc.) when repairing the torn and degenerated rotator cuffs.

Cited by 14 publications

References 40 publications

The Rotator Cuff Organ: Integrating Developmental Biology, Tissue Engineering, and Surgical Considerations to Treat Chronic Massive Rotator Cuff Tears

The Rotator Cuff Organ: Integrating Developmental Biology, Tissue Engineering, and Surgical Considerations to Treat Chronic Massive Rotator Cuff Tears

Polycaprolactone/ultra-high molecular weight polyethylene partially absorbable suture with improved mechanical performances for tendon and ligament repair

Biomechanical analysis of four different medial row configurations of suture bridge rotator cuff repair

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