A Biomechanical Comparison of Different Suture Materials Used for Arthroscopic Shoulder Procedures

Taha, Mohy E.; Schneider, K.; Clarke, Elizabeth C.; O’Briain, D.; Smith, Margaret M.; Cunningham, Grégory; Cass, Benjamin; Young, Allan

doi:10.1016/j.arthro.2019.08.048

Cited by 26 publications

(21 citation statements)

References 19 publications

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“…In this context, the use of suture tapes instead of wires for knotless TOE repairs was proposed as they theoretically allowed a better distribution of compressive forces on the cuff, enhanced self-reinforcement [ 37 , 42 ] and showed a smaller abrasive effect than wires [ 6 , 15 , 18 , 28 , 30 , 53 ], but some authors found conflictive results [ 23 , 31 ]. Most probably, more stable constructs reduce retear rates, but those that occur are more serious and difficult to treat, therefore no clear gold standard technique has been established.…”

Section: Introductionmentioning

confidence: 99%

“…Literature comparing tapes and suture wires used in shoulder repairs settings is scarce and most of it is either focused on the mechanical properties of suture materials or explores its failure mechanism [ 15 , 18 , 53 ]. Very few studies evaluated the differences in terms of force, pressure and contact area and even fewer compared homogenous groups.…”

Section: Introductionmentioning

confidence: 99%

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Why are tapes better than wires in knotless rotator cuff repairs? An evaluation of force, pressure and contact area in a tendon bone unit mechanical model

et al. 2021

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Purpose Knotless repairs have demonstrated encouraging performance regarding retear rate reduction, but literature aiming at identifying the specific variables responsible for these results is scarce and conflictive. The purpose of this paper was to evaluate the effect of the material (tape or wire suture) and medial tendon passage (single or double passage) on the contact force, pressure and area at the tendon bone interface in order to identify the key factors responsible for this repairs´ success. Methods A specific knotless transosseous equivalent cuff repair was simulated using 2 tape or suture wire loaded medial anchors and 2 lateral anchors, with controlled lateral suture limb tension. The repair was performed in a previously validated sawbones® mechanical model. Testing analyzed force, pressure and area in a predetermined and constant size “repair box” using a Tekscan® sensor, as well as peak force and pressure, force applied by specific sutures and force variation along the repair box. Results Tapes generate lower contact force and pressure and double medial passage at the medial tendon is associated with higher contact area. Suture wires generate higher peak force and pressure on the repair and higher mean force in their tendon path and at the medial bearing row. Force values decrease from medial to lateral and from posterior to anterior independently of the material or medial passage. Conclusion Contrary to most biomechanical literature, suture tape use lowers the pressure and force applied at the tendon bone junction, while higher number of suture passage points medially increases the area of contact. These findings may explain the superior clinical results obtained with the use uf suture tapes because its smaller compressive effect over the tendon may create a better perfusion environment healing while maintaining adequate biomechanical stability.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Why are tapes better than wires in knotless rotator cuff repairs? An evaluation of force, pressure and contact area in a tendon bone unit mechanical model

et al. 2021

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“…The creep, stiffness, and extensibility of the sutures associated with the button used are not equal and should be considered in the future. 32 Cyclic loading of the suture under the control of the tensioner could be a reliable option and could be recommended for biomechanical performance of the button that is closer to that of the screw. 4,32 From a clinical standpoint, despite a short-term clinical comparative evaluation, we reported that a decrease in external rotation with the elbow at the side was significantly higher in the AL group.…”

Section: Discussionmentioning

confidence: 99%

“…32 Cyclic loading of the suture under the control of the tensioner could be a reliable option and could be recommended for biomechanical performance of the button that is closer to that of the screw. 4,32 From a clinical standpoint, despite a short-term clinical comparative evaluation, we reported that a decrease in external rotation with the elbow at the side was significantly higher in the AL group. This trend was already highlighted in the literature in a larger cohort study including arthroscopic double-button and screw Latarjet procedures.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Bone Fusion With Arthroscopic Double-Button Latarjet Versus Open-Screw Latarjet

Bonnevialle

Girard

Martinel³

et al. 2021

Am J Sports Med

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Background: Recently, arthroscopic double-button Latarjet (AL) has provided an alternative to conventional open Latarjet (OL) in the treatment of anterior shoulder instability with glenoid bone loss. Therefore, theoretically, the faster fusion is obtained, the sooner return to sports under safe conditions can occur. The emerging flexible fixation of the bone block has clearly offered a new approach to achieve bone fusion. However, the period required to achieve this goal remains controversial. Purpose/Hypothesis: The purpose was to compare computed tomography (CT) scan results of AL and OL in the early postoperative period. It was hypothesized that the bone block fusion with AL would require a longer time than that with OL. Study Design: Cohort study; Level of evidence, 3. Methods: In a retrospective 1-year study, the authors compared 17 primary double-button AL to 22 primary 2-screw OL procedures indicated for anterior shoulder instability in patients with an Index Severity Instability Score >3 points. These patients were reviewed with a CT scan at 1 day, 3 months, and 6 months postoperatively. The characteristics for the 2 groups were comparable. CT scans aimed to analyze graft position, bone contact area with the scapula, and fusion at 3 and 6 months. Clinical assessment was based on the Walch-Duplay and Rowe scores. Results: The mean preoperative Index Severity Instability Score was 5.3 ± 1.9 points, with a mean anterior glenoid bone loss of 9.1% ± 4.6%. At 3 months, the rates of fusion were 41% and 100% for the AL and OL groups, respectively ( P < .001). This rate increased to 70% in the AL group at 6 months ( P = .006). In the axial and sagittal planes, there was no difference in graft position between the AL group and the OL group. The bone block was longer and there was a more extensive bone contact area in the OL group (AL, 131 mm2 vs OL, 223 mm2; P < .001). At 6 months of follow-up, no significant difference in clinical scores was noted between the groups: Walch-Duplay score, 93.0 ± 10.9 points versus 91.8 ± 12.5 points ( P = .867); and Rowe score, 99.0 ± 2.2 points versus 95.0 ± 8.4 points ( P = .307) for the AL and OL groups, respectively. Conclusion: AL required more time to achieve bone block fusion than OL. This finding should be taken into account when considering this procedure for patients in a hurry to return to sports involving the shoulder.

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“…2 suture. Taha et al 38 compared the viscoelastic properties, including stiffness, creep and deformation (plastic and elastic), of two high-strength tape designs to four round suture designs. Under static and dynamic conditions, their findings demonstrated overall superior results with tape sutures over most round sutures.…”

Section: Discussionmentioning

confidence: 99%

Mechanical Comparison of High-Strength Tape Suture Versus High-Strength Round Suture

Ensminger

McIff

Vopat

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To compare knot and loop characteristics of commonly used high-strength tapes and high-strength round sutures. Methods: Twenty tied 30-mm loops were prepared for using suture-knot combinations of 4 common arthroscopic knots or a hand-tied surgeon's knot and 7 sutures. Two tapes (BroadBand, SutureTape) and three no. 2 sutures (MaxBraid, FiberWire, DynaCord) were compared. Two additional larger tape sutures (FiberTape, PermaTape) not commonly tied arthroscopically were included in the hand-tied group. Each suture-knot combination was evaluated for loop integrity (single load to a specified elongation), knot security (plastic loop deformation with cyclic testing), loop security, and knot volume. Data were compared using analysis of variance followed by Tukey-Kramer post hoc tests.Results: BroadBand and SutureTape demonstrated superior loop integrity compared to most no. 2 suture-knot combinations. FiberTape (430.48 AE 89.00 N) and PermaTape (545.16 AE 95.09 N) required significantly greater force to undergo 3 mm of displacement than all other hand-tied sutures (P < .001). All suture-knot configurations demonstrated significant plastic deformation (cyclic elongation) over 1000 cycles (P < 0.001). DynaCord displayed the best loop security except when paired with the Duncan loop. Overall, BroadBand and SutureTape had lower knot volumes compared to all other sutures. Conclusion: This study exhibits the ability of narrow tape sutures to provide reliable tissue apposition and fixation in multiple suture-knot configurations, while decreasing the potential adverse effects accompanying knot prominence. Generally, BroadBand and SutureTape demonstrated an ideal balance of mechanical characteristics to achieve the optimal suture-knot construct among those tested. Dynacord displayed superior loop security and performed best among round sutures. PermaTape and FiberTape showed greater loop integrity, albeit to the detriment of loop security and knot volume. Clinical Relevance: When securing a rotator cuff repair construct with a knot, one should have a basic understanding of the mechanical properties of the suture and knot being used to provide the best possible repair. This study will provide information about the mechanical characteristics of commonly used high-strength tape suture knots and loops to help determine what knot type may provide the best overall construct.

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A Biomechanical Comparison of Different Suture Materials Used for Arthroscopic Shoulder Procedures

Cited by 26 publications

References 19 publications

Why are tapes better than wires in knotless rotator cuff repairs? An evaluation of force, pressure and contact area in a tendon bone unit mechanical model

Why are tapes better than wires in knotless rotator cuff repairs? An evaluation of force, pressure and contact area in a tendon bone unit mechanical model

Short-Term Bone Fusion With Arthroscopic Double-Button Latarjet Versus Open-Screw Latarjet

Mechanical Comparison of High-Strength Tape Suture Versus High-Strength Round Suture

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