2015 ISAKOS Biennial Congress Paper #0

A Biomechanical Evaluation of the Efficacy Of Suture Tape Augmentation for Subscapularis Peel Repair

Ian James Wellington, MD, Farmington, Connecticut UNITED STATES
Cory Hewitt, MD, Hartford, CT UNITED STATES
Benjamin C Hawthorne, BS, Newington, Connecticut UNITED STATES
Michael R. Mancini, BS, Rocky Hill, CT UNITED STATES
Caitlin G Dorsey, BS, Farmington, Connecticut UNITED STATES
Julio Quintana, BA, Greenwich, CT UNITED STATES
Michael Talamo, BS, greenwich UNITED STATES
ELIFHO OBOPILWE, ME, BSc, Farmington, Connecticut UNITED STATES
Mark P. Cote, PT, DPT, MSCTR, Farmington, CT UNITED STATES
Augustus D. Mazzocca, MS, MD, Waltham, MA UNITED STATES
Paul Sethi, MD, Greenwich, CT UNITED STATES

Uconn Hospital and Orthopaedic & Neurosurgery Specialists, Farmington, CT, UNITED STATES

FDA Status Cleared

Summary: Augmentation of subscapularis peel with two inverted mattress suture tapes significantly increases the strength of the repair.

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Abstract:

Background

Repair of the subscapularis tendon following anatomic total shoulder arthroplasty (aTSA) is important to restore the function of the shoulder. Failure of a subscapularis repair construct can result in difficulty with internal rotation and an increased likelihood of dislocation. While suture tape has been demonstrated to be an efficacious augment for tendonous repairs elsewhere in the body, it has not been investigated as a technique for augmenting subscapularis peel repairs. The purpose of this study is to determine the biomechanical efficacy of suture tape augmentation for the repair of a subscapularis peel.

Methods

Twelve human cadaveric shoulders underwent a subscapularis peel. Specimens were randomly split into two groups: one which underwent repair using three Mason-Allen sutures (control) and one which underwent the control repair with augmentation using two suture tapes placed in an inverted mattress fashion and secured to the proximal humerus using a suture anchor (augment). Shoulders underwent biomechanical testing to compare repair displacement with cyclic loading, load at ultimate failure, and construct stiffness.

Results

There were no significant differences in displacement after cyclic loading between the two repair groups at the superior (p=.87), middle (p=.47), or inferior (p=.77) portions of the subscapularis tendon. Load to failure was significantly greater in the augment group (585.1N ± 81.8) than in the control group (358.5N ± 97.4; p=.001). Stiffness was also greater in the augment group (71.8N/mm ± 13.7) when compared with the control group (48.7N/mm ± 5.7; p=.003).

Conclusions

Subscapularis peel repair with augmentation via two inverted mattress suture tapes secured with an anchor in the proximal humerus conferred significantly greater load at ultimate failure and construct stiffness when compared to a traditional repair using three Mason-Allen sutures.