A Weaving Rip-Stop Technique Leads to a Significantly Increased Load to Failure and Reduction in Suture-Tendon Cut-Through in a Biomechanical Model of Rotator Cuff Repair

Ryan A Neeley; Miguel A Diaz; R Allen Gorman 2nd; Mark A Frankle; Mark A Mighell

doi:10.1016/j.asmr.2021.04.005

A Weaving Rip-Stop Technique Leads to a Significantly Increased Load to Failure and Reduction in Suture-Tendon Cut-Through in a Biomechanical Model of Rotator Cuff Repair

Arthrosc Sports Med Rehabil. 2021 Aug 6;3(5):e1263-e1272. doi: 10.1016/j.asmr.2021.04.005. eCollection 2021 Oct.

Authors

Ryan A Neeley¹, Miguel A Diaz², R Allen Gorman 2nd², Mark A Frankle¹, Mark A Mighell¹

Affiliations

¹ Florida Orthopaedic Institute, Tampa, Florida, U.S.A.
² Foundation for Orthopaedic Research & Education, Tampa, Florida, U.S.A.

Abstract

Purpose: To present an alternative arthroscopic rip-stop technique with a single suture tape weaved through the tendon from anterior to posterior and to biomechanically test its strength against a control technique consisting of a single-row repair with simple sutures.

Methods: This was a controlled biomechanical study. Dissection and harvesting of the supraspinatus muscle-tendon unit were performed along the cable in 9 matched-pair cadaveric shoulders. Samples were divided into 2 groups: simple suture repair only (SSR) and simple suture repair with rip-stop (SSPR). Biomechanical testing was performed with an initial preload, followed by cyclic loading and then ramp to failure. Peak-to-peak displacement, stiffness (in newtons per millimeter), load at failure (in newtons), and failure mechanism were recorded. Data were compared using the paired-sample t test.

Results: The average peak-to-peak displacement for SSR samples was not significantly different from that of SSPR samples (P = .96). Similarly, elongation in the SSR and SSPR groups was not significantly different (P = .82). Stiffness was significantly different between the SSR and SSPR groups (P = .0054): SSR samples were less stiff than SSPR samples. Moreover, SSR samples failed at significantly lower forces than did SSPR samples (P = .028). A larger percentage of failures occurred due to tendon cut-through among SSR samples versus suture breakage among SSPR samples.

Conclusions: An alternative rip-stop technique is presented in this biomechanical model that may assist surgeons to better deal with difficult rotator cuff repairs. Weaving a suture tape as a rip-stop can increase stiffness, achieve higher failure loads when compared with simple suture repair with no rip-stop, and reduce tendon cut-through.

Clinical relevance: This study provides insight into a variation of rip-stop stitch techniques that may help solve the clinical problem of failure occurring at the suture-tendon interface, specifically tendon cut-through.