Abstract
Previous experimental studies of failure of rotator cuff repair have involved a single pull to ultimate load. Such an experimental design does not represent the cyclic loading conditions experienced in vivo. We created 1 cm x 2 cm rotator cuff defects in 16 cadaver shoulders, repaired each defect with transosseous simple sutures, and cyclically loaded the repairs by a servohydraulic materials test system actuator at physiologic rates and loads (rate of 33 mm/sec to a load of 180 N.). A progressive gap was noted in each specimen, for a 100% rate of failure of the repairs. A 5 mm gap developed at an average of 25 cycles, and a 10 mm gap developed at an average of 188 cycles. The central suture always riffled first and by the largest magnitude. This study suggests that rotator cuff tears that are repaired with a 'tension overload' of a portion of the muscle-tendon units will undergo gradual failure with physiologic cyclic loading until the normal resting lengths of the muscle-tendon units are restored. This 'controlled failure' of the repairs may explain residual defects that have been demonstrated by ultrasonography and by arthrography in patients with 'successful' rotator cuff repairs. Clinical implications are that: 1) rotator cuff' tears should be repaired without tension if possible; and 2) transosseous bone tunnels should ideally extend distal to the weak metaphyseal bone so that purchase is obtained into cortical bone for greater fixation strength.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 172-176 |
| Number of pages | 5 |
| Journal | Arthroscopy |
| Volume | 13 |
| Issue number | 2 |
| DOIs | |
| State | Published - Apr 1997 |
| Externally published | Yes |
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Keywords
- Biomechanical testing
- Rotator cuff
- Rotator cuff repair
- Tendon repair
ASJC Scopus subject areas
- Orthopedics and Sports Medicine
- Surgery
Cite this
Cyclic loading of transosseous rotator cuff repairs : Tension overload as a possible cause of failure. / Burkhart, Stephen S.; Johnson, Todd C.; Wirth, Michael A.; Athanasiou, Kyriacos A.
In: Arthroscopy, Vol. 13, No. 2, 04.1997, p. 172-176.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Cyclic loading of transosseous rotator cuff repairs
T2 - Tension overload as a possible cause of failure
AU - Burkhart, Stephen S.
AU - Johnson, Todd C.
AU - Wirth, Michael A.
AU - Athanasiou, Kyriacos A.
PY - 1997/4
Y1 - 1997/4
N2 - Previous experimental studies of failure of rotator cuff repair have involved a single pull to ultimate load. Such an experimental design does not represent the cyclic loading conditions experienced in vivo. We created 1 cm x 2 cm rotator cuff defects in 16 cadaver shoulders, repaired each defect with transosseous simple sutures, and cyclically loaded the repairs by a servohydraulic materials test system actuator at physiologic rates and loads (rate of 33 mm/sec to a load of 180 N.). A progressive gap was noted in each specimen, for a 100% rate of failure of the repairs. A 5 mm gap developed at an average of 25 cycles, and a 10 mm gap developed at an average of 188 cycles. The central suture always riffled first and by the largest magnitude. This study suggests that rotator cuff tears that are repaired with a 'tension overload' of a portion of the muscle-tendon units will undergo gradual failure with physiologic cyclic loading until the normal resting lengths of the muscle-tendon units are restored. This 'controlled failure' of the repairs may explain residual defects that have been demonstrated by ultrasonography and by arthrography in patients with 'successful' rotator cuff repairs. Clinical implications are that: 1) rotator cuff' tears should be repaired without tension if possible; and 2) transosseous bone tunnels should ideally extend distal to the weak metaphyseal bone so that purchase is obtained into cortical bone for greater fixation strength.
AB - Previous experimental studies of failure of rotator cuff repair have involved a single pull to ultimate load. Such an experimental design does not represent the cyclic loading conditions experienced in vivo. We created 1 cm x 2 cm rotator cuff defects in 16 cadaver shoulders, repaired each defect with transosseous simple sutures, and cyclically loaded the repairs by a servohydraulic materials test system actuator at physiologic rates and loads (rate of 33 mm/sec to a load of 180 N.). A progressive gap was noted in each specimen, for a 100% rate of failure of the repairs. A 5 mm gap developed at an average of 25 cycles, and a 10 mm gap developed at an average of 188 cycles. The central suture always riffled first and by the largest magnitude. This study suggests that rotator cuff tears that are repaired with a 'tension overload' of a portion of the muscle-tendon units will undergo gradual failure with physiologic cyclic loading until the normal resting lengths of the muscle-tendon units are restored. This 'controlled failure' of the repairs may explain residual defects that have been demonstrated by ultrasonography and by arthrography in patients with 'successful' rotator cuff repairs. Clinical implications are that: 1) rotator cuff' tears should be repaired without tension if possible; and 2) transosseous bone tunnels should ideally extend distal to the weak metaphyseal bone so that purchase is obtained into cortical bone for greater fixation strength.
KW - Biomechanical testing
KW - Rotator cuff
KW - Rotator cuff repair
KW - Tendon repair
UR - http://www.scopus.com/inward/record.url?scp=0030900130&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0030900130&partnerID=8YFLogxK
U2 - 10.1016/S0749-8063(97)90151-1
DO - 10.1016/S0749-8063(97)90151-1
M3 - Article
VL - 13
SP - 172
EP - 176
JO - Arthroscopy - Journal of Arthroscopic and Related Surgery
JF - Arthroscopy - Journal of Arthroscopic and Related Surgery
SN - 0749-8063
IS - 2
ER -