Biomechanical Comparison Of A Novel Suture Configuration As An Alternative Single-Row Repair Technique For Rotator Cuff Repair

Background Arthroscopic techniques of rotator cuff repair are constantly evolving. Although biomechanically stronger, doublerow repair techniques have not been proven to be clinically superior. There are also situations where double-row techniques are not suitable and/or indicated. In these circumstances typical single-row sutures used are the simple suture or the modified Mason-Allen suture. We describe an alternative single-row suture technique – the ‘Down Under Suture Technique’ (DUST). We hypothesise that this suture has an improved tendon-to-bone contact area and pull-out strength than the established alternatives. Methods In a controlled laboratory study, 1cm tears of the infraspinatus tendon were created in 42 fresh frozen porcine shoulders. The tears were repaired using either a simple suture, a modified Mason-Allen suture or a DUST suture. The tendon-to-bone contact area was measured and compared in 15 shoulders, and suture pull-out strength was measured in the remaining 27 specimens. Results The DUST suture achieved a tendon-to-bone contact area of 122 mm, significantly higher than that achieved by the MasonAllen (48 mm, p=0.008) and simple suture (51 mm, p=0.01). Suture pull-out strength was 191N, significantly higher than the simple suture (97N, p=0.028), but not significantly higher than the Mason-Allen suture (127N, p=0.22). Conclusions We conclude that the DUST has favourable biomechanical properties when compared to other single-row suture techniques. It is a useful arthroscopic alternative where a single row cuff repair is needed.