Gl. Caldwell et al., STRENGTH OF FIXATION WITH TRANSOSSEOUS SUTURES IN ROTATOR CUFF REPAIR, Journal of bone and joint surgery. American volume, 79A(7), 1997, pp. 1064-1068
The effect of various configurations of placement of transosseous sutu
res on the immediate strength of fixation was studied in forty-five fr
esh-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 wer
e placed at sites more distal to the tip of the greater tuberosity or
when the sutures were tied over a wider bone bridge, Cortical augmenta
tion with use of a plastic button through which the transosseous sutur
es were tied increased the ultimate strength approximately 1.9-fold. T
he increase in the ultimate strength of the transosseous repair corres
ponded significantly with the increasing mean thickness of the cortica
l bone as tile sutures were placed more distally along the lateral asp
ect of the humerus. We concluded that the strength of the fixation of
a rotator cuff repair can be increased by placing the transosseous sut
ures at least ten millimeters distal to the tip of the greater tuberos
ity and by tying them over a bone bridge that is at least ten millimet
ers wide. When bone is very osteoporotic, cortical augmentation with a
readily available plastic button strengthens the repair.