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The Journal of Bone and Joint Surgery 79:1064-8 (1997)
© 1997 The Journal of Bone and Joint Surgery, Inc.

Strength of Fixation with Transosseous Sutures in Rotator Cuff Repair*

GEORGE L. CALDWELL, JR., M.D.{dagger}, JON J. P. WARNER, M.D.{ddagger}, MARK D. MILLER, M.D.§, DOUGLAS BOARDMAN, M.D.{ddagger}, JEFFREY TOWERS, M.D.¶ and RICHARD DEBSKI, M.S.{ddagger}, PITTSBURGH, PENNSYLVANIA

Investigation performed at the Department of Orthopaedic Surgery, the Musculoskeletal Research Center, University of Pittsburgh, Pittsburgh

The effect of various configurations of placement of transosseous sutures on the immediate strength of fixation was studied in forty-five fresh-frozen humeri from cadavera of older individuals (mean age at the time of death, sixty-three years). The ultimate strength (the strength to failure) was significantly greater (p < 0.05) when the sutures were placed at sites more distal to the tip of the greater tuberosity or when the sutures were tied over a wider bone bridge. Cortical augmentation with use of a plastic button through which the transosseous sutures were tied increased the ultimate strength approximately 1.9-fold. The increase in the ultimate strength of the transosseous repair corresponded significantly with the increasing mean thickness of the cortical bone as the sutures were placed more distally along the lateral aspect of the humerus. We concluded that the strength of the fixation of a rotator cuff repair can be increased by placing the transosseous sutures at least ten millimeters distal to the tip of the greater tuberosity and by tying them over a bone bridge that is at least ten millimeters wide. When bone is very osteoporotic, cortical augmentation with a readily available plastic button strengthens the repair.


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