Biomechanical testing of small versus large lesser tuberosity osteotomies: effect on gap formation and ultimate failure load

Fishman, Matthew P.; Budge, Matthew D.; Moravek, James E.; Mayer, M; Kurdziel, Michael D.; Baker, Kevin C.; Wiater, J. Michael

doi:10.1016/j.jse.2013.06.024

Cited by 25 publications

(46 citation statements)

References 22 publications

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“…51 The mode of failure, whether due to tendon, muscular, or osseous insufficiency did not show a statistically significant trend among the repair techniques. 51,53 Tendon and bone failure occurred with approximately equal frequencies after SSC tenotomy, whereas osseous failure was the predominant cause after LTO. 53 Based on these results with similar or slightly better biomechanical properties, and bearing in mind potentially superior healing of the bone-to-bone repair in vivo, the LTO approach may be favorable.…”

Section: Ssc Repair Techniquesmentioning

confidence: 83%

“…50 Contrarily, other biomechanical investigations found no significant difference in tendon elongation or failure loading among the repair techniques and suggested in vivo healing rates as the durability-determining factor. [51][52][53] Gap formation was, however, tested to be significantly greater after tenotomy versus LTO techniques and the LTO approach yielded a better SSC repair integrity. 51 The mode of failure, whether due to tendon, muscular, or osseous insufficiency did not show a statistically significant trend among the repair techniques.…”

Section: Ssc Repair Techniquesmentioning

confidence: 97%

“…[51][52][53] Gap formation was, however, tested to be significantly greater after tenotomy versus LTO techniques and the LTO approach yielded a better SSC repair integrity. 51 The mode of failure, whether due to tendon, muscular, or osseous insufficiency did not show a statistically significant trend among the repair techniques. 51,53 Tendon and bone failure occurred with approximately equal frequencies after SSC tenotomy, whereas osseous failure was the predominant cause after LTO.…”

Section: Ssc Repair Techniquesmentioning

confidence: 97%

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Subscapularis Insufficiency: What’s All the Fuss About?

Böhm

Scheibel

Lädermann

2018

Journal of Shoulder and Elbow Arthroplasty

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There has been increase attention to the surgical treatment of the subscapularis (SSC) tendon with risk of postoperative dysfunction and early failures following shoulder arthroplasty. Studies investigating the clinical results after shoulder arthroplasty indicate that SSC tendon detachment or incision techniques and rehabilitation concepts may impair SSC recovery and consequently the postoperative function. In response to these results, technical modifications have been proposed and evaluated anatomically, biomechanically, and clinically. The aim of this article is to give an overview of current SSC takedown approaches, subsequent repair techniques, and postoperative rehabilitation protocols as well as to present the diagnostic algorithm and clinical impacts of the increasingly acknowledged condition of SSC insufficiency following shoulder arthroplasty procedures.

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Section: Ssc Repair Techniquesmentioning

confidence: 83%

Section: Ssc Repair Techniquesmentioning

confidence: 97%

Section: Ssc Repair Techniquesmentioning

confidence: 97%

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Subscapularis Insufficiency: What’s All the Fuss About?

Böhm

Scheibel

Lädermann

2018

Journal of Shoulder and Elbow Arthroplasty

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“…Our results for the 4 suture repair are more similar to Giuseffi et al, 4 who also used #2 suture and reported mean a load to failure of 447 N for an LTO repair with sutures passed around the humeral stem. Similarly, Fishman et al 3 reported a load to failure of 375 N using 4 #2 sutures passed around the stem as well as an additional titanium cable.…”

Section: Discussionmentioning

confidence: 93%

“…Each specimen was cycled at a rate of 1 Hz from 10 to 100 N for 500 cycles and then pulled to failure at 33 mm/s. We chose 500 cycles based on previous biomechanical studies examining the subscapularis in TSA 3, 8. Displacement was recorded using video tracking.…”

Section: Methodsmentioning

confidence: 99%

A Tensionable Method for Subscapularis Repair after Shoulder Arthroplasty

2018

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BackgroundThis study compared the biomechanical properties of a new lesser tuberosity (LTO) repair with a tensionable construct with suture tape and preplaced racking hitches vs. a traditional LTO repair using 4 high-strength sutures. The hypothesis was that there would be no difference between the 2 constructs.MethodsLTO repairs were performed on 6 matched, paired cadaveric shoulders after placement of an uncemented humeral stem. The LTO in group 1 was repaired with 4 high-strength #2 sutures, each passed individually through the subscapularis tendon. The LTO in group 2 was repaired with 2 suture tape loops with a preplaced racking hitch knot and 2 passes through the subscapularis tendon. All sutures were passed around the humeral stem before passing through the subscapularis tendon. The specimens then underwent cyclic displacement and load-to-failure testing.ResultsLoad to failure was 209.6 ± 71.2 N in group 1 compared with 502.8 ± 168.6 N in group 2 (P = .018). There was no difference in displacement between the 2 groups. All failures in group 1 occurred by knot slippage. The mode of failure in group 2 was tendon tearing in 5 of 6 cases.ConclusionA simplified LTO repair with suture tape and compression bridge and a preplaced half racking knot achieves favorable biomechanical properties in a technically efficient manner that may be useful clinically.

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