STRENGTH OF FIXATION WITH TRANSOSSEOUS SUTURES IN ROTATOR CUFF REPAIR

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.