Rotator cuff repair failure in vivo: a radiostereometric measurement study

Baring, Toby; Cashman, Peter P.M.; Reilly, Peter; Emery, Roger; Amis, Andrew A.

doi:10.1016/j.jse.2011.04.010

Cited by 30 publications

(23 citation statements)

References 16 publications

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“…Data on longitudinal retention of mechanical strength is usually available over a limited time frame from the suture manufacturer. Yet, a thorough description of the suture’s mechanical behavior (e.g., stiffness, hysteresis) over a time frame relevant to musculoskeletal injuries has not been reported, despite the fact that substantial changes of these properties with suture degradation is certain [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

Two-month longitudinal study of mechanical properties of absorbable sutures used in orthopedic surgery

2016

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BackgroundThis is the first study assessing the properties of large-diameter degradable sutures relevant for orthopedic applications over the course of in vitro incubation for 2 months. The data we present here provide guidance to the orthopedic surgeon in predicting the long-term performance of suture materials used everyday in surgical practice.MethodsFive different absorbable (Vicryl, Maxon, Monocryl, PDS II, Vicryl rapide) and one non-absorbable (Ethibond) suture materials were tested. Measurements were made at five time points during the 56 days of incubation under physiological conditions (37.0 ± 0.02 °C; pH 7.4 ± 0.2). The following variables were recorded: load to failure, strain at maximal load as elongation normalized to original length, stiffness as the ratio of load to displacement on the linear proportion of the stress strain curve, and hysteresis as area under the curve of the stress strain curve.ResultsVicryl was the strongest fiber on day 0 (195 N); however, by day 42, the tensile strength of the suture reduced to 14 N. Between days 14 and 28, PDS II (171 N) and Maxon (182 N) sustained the highest loads. Monocryl (p = 0.003) and Maxon (p < 0.001) showed an increasing strain with time, whereas Vicryl (p = 0.002) and Vicryl rapide (p = 0.007) revealed an increasing material stiffness. Furthermore, both Vicryl (p = 0.053) and Monocryl (p < 0.001) had an increasing hysteresis with ongoing degradation. Maxon, PDS II, and Ethibond showed stable material properties during the 2 months.ConclusionsThe three absorbable sutures Vicryl, PDS II, and Maxon could sustain higher loads during the first 2 weeks than the non-absorbable Ethibond. Unexpectedly, Maxon and PDS II maintained their elastic properties in spite of their proceeding degradation and loss of tensile strength.

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Section: Introductionmentioning

confidence: 99%

Two-month longitudinal study of mechanical properties of absorbable sutures used in orthopedic surgery

2016

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“…35,36 Baring et al 35 used metal suture markers to measure tendon retraction in ten patients after RCR. They noted that tendon retraction occurs during the second and third postoperative months when patients undergo the most intense physical therapy.…”

Section: What Is "Healing"?mentioning

confidence: 99%

Rotator cuff repair: challenges and solutions

Amini

Ricchetti

Iannotti³

et al. 2015

ORR

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Each year, 250,000 rotator cuff repairs are performed in the United States at a cost of $3 billion. Despite advancements in repair techniques and rehabilitation, 20%-70% of repairs continue to undergo structural failure; however, there is a poor correlation between clinical and structural outcomes, both before and after surgery. "Failure in continuity", or retraction of the repair site without a structural defect, is likely a common phenomenon after rotator cuff repair, and this retraction of the myotendinous unit and interposing scar tissue may be one explanation for the discordance between clinical and structural outcomes. Scaffolds, both synthetic and biologic, have shown promise in both augmentation of repairs and interposition of irreparable tears, but most studies are small retrospective case series without control groups. Future efforts will need to determine the ideal indications for use, methods of application, and comparative effectiveness between the devices. Platelet-rich plasma also has potential to improve rotator cuff healing, but current limitations include the significant variation in preparation methods, biologic makeup, and application methods. Future work may help us understand whether application of platelet-rich plasma and its growth factors should be done at the time of surgery or later during a more advanced stage of healing. Regardless of the device or technique, mechanical and/or biologic augmentation of rotator cuff repairs requires the surgeon to be technically proficient in its use and aware of its associated increased operative time and cost. In order to justify the use of these technologies and their associated incremental cost, we must demonstrate efficacy in improving both clinical and structural outcomes.

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“…Studies in the past have looked at the mechanical causes of failure (Davidson and Rivenburgh, 2000;Gerber et al, 1994;Riley et al, 1994), such as the strength of different suturing techniques and the way in which sutures may cut through the tendon when under load (Baring et al, 2011). Studies in the past have looked at the mechanical causes of failure (Davidson and Rivenburgh, 2000;Gerber et al, 1994;Riley et al, 1994), such as the strength of different suturing techniques and the way in which sutures may cut through the tendon when under load (Baring et al, 2011).…”

Section: Commplete Case Study: Rotator Cuff Tendonsmentioning

confidence: 99%