The Strength of Suture Configurations in Arthroscopic Rotator Cuff Repair

Purpose: This study evaluated the strength of different suture configurations with the use of a recently introduced arthroscopic suture passer (ExpressSew; Surgical Solutions, Valencia, CA). Methods: The ultimate tensile strength and mode of failure of each suture configuration were repeatedly tested on a validated porcine rotator cuff tendon model, with the use of standard suture material (No. 2 FiberWire [Arthrex, Naples, FL]) passed with ExpressSew and tested on a Hounsfield digital tensiometer type H20K-W (Tinius Olsen, Hersham, PA). Results: The strongest construct was 2 mattress sutures (mean, 169 N; standard deviation, 56.1 N); this was followed in strength by a single modified Kessler suture (mean, 161 N; standard deviation, 16.9 N), 4 simple sutures (mean, 155 N; standard deviation, 27.3 N), and finally, a single Mason-Allen suture (mean, 140 N; standard deviation, 28.6 N). Conclusions: Study results show little difference in strength for varying complexities of suture configurations. In simple terms, no demonstrable difference was seen in the strength of construct, whether the surgeon used 4 simple sutures, 2 mattress sutures, or 1 grasping suture. Clinical Relevance: This study allows the surgeon to justify use of the simplest configuration of suture passage that works in his hands, for the purpose of attaining a reliable and repeatable repair of the rotator cuff through arthroscopic methods.