Suture Placement Near the Musculotendinous Junction in the Supraspinatus

Abstract

Background:

Transosseous-equivalent rotator cuff repair has an increased incidence of medial rotator cuff failure compared with single-row repair. No studies have evaluated the influence of the proximity of the suture row to the musculotendinous junction (MTJ) on cyclic gapping and failure properties.

Hypothesis:

A single row of horizontal mattress sutures placed within the supraspinatus tendon lateral to the MTJ will experience less gap formation and higher failure loads than a similar suture row placed at the MTJ.

Study Design:

Controlled laboratory study.

Methods:

Paired supraspinatus tendons were isolated from human cadaveric specimens and resected at the tendon insertion to the humerus. Randomized within a pair, a single row of 4 horizontal mattress sutures was placed either in the tendon 5 mm lateral to the MTJ or at the MTJ. The tied sutures secured the tendon to a fixture that ensured consistent placement of the suture row in the tendon and static fixation of the row. The muscle belly was gripped in a cryoclamp, and a servohydraulic materials testing machine was used to provide uniaxial tensile deformation for 500 cycles at 1 Hz, followed by load to failure at 1 mm/s. Fiducial markers with video tracking were used to quantify gap formation at the suture line, while the materials testing machine recorded loading for the cyclic and failure tests.

Results:

During cyclic loading, both constructs experienced gross initial gap formation, followed by progressive gap formation that plateaued after cycle 200. The MTJ specimens had significantly higher mean cumulative gapping than the tendon specimens: 3.6 ± 1.0 mm versus 2.4 ± 0.6 mm, respectively (P = .012). The tendon specimens had significantly higher mean loads to failure than did the MTJ specimens: 567.1 ± 121.8 N versus 434.2 ± 148.1 N, respectively (P = .013). The mean failure displacement did not differ between groups for the tendon and MTJ: 5.7 ± 2.5 mm versus 4.5 ± 2.0 mm, respectively (P = .144).

Conclusion:

A horizontal suture row placed at the MTJ has inferior mechanical properties (increased gapping, decreased load support) as compared with a suture row placed 5 mm laterally within the tendon.

Clinical Relevance:

The integrity of rotator cuff repair may be compromised if sutures are placed too close to the MTJ.