Mechanical strength of repairs of the rotator cuff

Abstract

We have studied the mechanical properties of several current techniques oftendon-to-bone suture employed in rotator-cuff repair. Non-absorbable braided polyester and absorbable polyglactin and polyglycolic acid sutures best combined ultimate tensile strength and stiffness. Polyglyconate and polydioxanone sutures failed only at high loads, but elongated considerably under moderate loads. We then compared the mechanical properties of nine different techniques of tendon grasping, using 159 normal infraspinatus tendons from sheep. The most commonly used simple stitch was mechanically poor: repairs with two or four such stitches failed at 184 N and 208 N respectively. A new modification of the Mason-Allen suture technique improved the ultimate tensile strength to 359 N for two stitches. Finally, we studied the mechanical properties of several methods of anchorage to bone using typically osteoporotic specimens. Single and even double transosseous sutures and suture anchor fixation both failed at low tensile loads (about 140 N). The use of a 2 mm thick, plate-like augmentation device improved the failure strength to 329 N. The mechanical properties ofmany current repair techniques are poor and can be greatly improved by using good materials, an improved tendon-grasping suture, and augmentation at the bone attachment.

Arthroscopic Medial Meniscus Posterior Root Fixation Using a Modified Mason-Allen Stitch

“…5 The modified Mason-Allen stitch is associated with reduced slippage and elongation of longitudinally oriented tendon fibers and increased tensile load. 7 The stitch also provides good initial holding strength and a large meniscus-bone contact area that improves healing potential. Because the main meniscus fibers are circumferential and tangentially oriented to the root insertion, the risk of premature suture pullout is reduced by the modified Mason-Allen stitch.…”

Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

“…After lateral release and excision of additional scar tissue, the knee was gently flexed to its limit and the position maintained for 1 minute to stretch the envelope. After implantation of the final components, the rectus tendon was repaired with a modified Mason-Allen knot [37], using a nonabsorbable suture (Ethibond No. 2, Ethicon, Somerville, MA, USA).…”

Open, Mini-open, and All-Arthroscopic Rotator Cuff Repair Surgery: Indications and Implications for Rehabilitation

“…Gerber et al 27 stated that "the ideal repair should have high initial strength, allow minimal gap formation and maintain stability until solid healing." As described above, there are numerous repair configurations and fixation methods that can be utilized to repair the torn rotator cuff tendon.…”

“…A locking-stitch technique, known as the modified Mason-Allen stitch, is also often used for better holding power, especially when the quality of the rotator cuff tissue is compromised. 27 Multiple other suture techniques and open repair suture and/or anchor configurations have been described.…”