Schneeberger (2002) — Mechanical strength of arthroscopic rotator cuff repair techniques: an in vitro study.

Mechanical Strength of Arthroscopic Rotator Cuff Repair Techniques: an in Vitro Study.

·J Bone Joint Surg Am·2002·202 citations·Shoulder & Elbow

Cadaveric biomechanical study testing five bone anchors, five arthroscopic suturing devices, and two suture configurations (mattress vs. modified Mason-Allen) for arthroscopic rotator cuff repair, asking whether the modified Mason-Allen stitch — proven stronger in open repair — confers any mechanical advantage when performed arthroscopically with bone anchors.

Study Snapshot

Design

Cadaveric biomechanical study

Setting: Single center, Zürich

Funding: None

Objective

Determine whether modified Mason-Allen stitch improves arthroscopic rotator cuff repair strength over mattress stitch

Outcome(s)

Ultimate failure load (N) under cyclic loading

Subjects

5 cadaveric shoulder pairs (anchors); 10 pairs (stitch comparison)

5Mattress stitch + Revo screw
5Modified Mason-Allen + Revo screw
5 eachMattress or modified Mason-Allen + Bio-Statak

Inclusion

Macroscopically intact rotator cuffs
Shoulders with minimal or no osteoarthritis

Exclusion

Macroscopically abnormal tendons
Severe degenerative joint changes

Statistics

ANOVA repeated measuresBonferroni-Dunn post hocPaired t-testUnpaired t-test

Key Findings

All five bone anchors produced similar failure loads of 130–180 N, limited primarily by suture rupture at the anchor eyelet rather than anchor pullout; the PANALOK RC absorbable anchor had significantly greater subsidence under cyclic load (p = 0.003)
Every commercially available arthroscopic suturing device failed to reliably perform a modified Mason-Allen stitch on intact supraspinatus tendons; only a custom-modified Caspari punch (needle lengthened from 4.5 to 8 mm) succeeded
Arthroscopic modified Mason-Allen stitches were NOT stronger than mattress stitches — and were significantly weaker in the worst-case pairing (168 N vs. 228 N, p = 0.03, Bio-Statak vs. Revo screw)
Maximum arthroscopic repair strength reached ~230 N, falling short of the >300 N reported for open transosseous repairs — attributed to mandatory use of thinner number-2 sutures and bone anchors rather than augmented transosseous fixation

Clinical Relevance

When planning arthroscopic rotator cuff repair, mattress stitches with bone anchors provide fixation equivalent to or better than arthroscopic modified Mason-Allen stitches — do not assume the modified Mason-Allen advantage seen in open surgery translates to the arthroscopic setting.

For patients expected to load the repair early (high-demand, poor compliance), this data supports considering open repair until arthroscopic constructs with heavier suture materials and stronger fixation become available.

Supplemental

Mechanical Strength of Arthroscopic Rotator Cuff Repair Techniques: an in Vitro Study.

Schneeberger, Gerber, et al.·J Bone Joint Surg Am·2002·202 citations·Shoulder & Elbow

Mechanical Strength of Arthroscopic Rotator Cuff Repair Techniques: an in Vitro Study.

Study Snapshot

Key Findings

Clinical Relevance

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Mechanical Strength of Arthroscopic Rotator Cuff Repair Techniques: an in Vitro Study.

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Key Findings

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Mechanical Strength of Arthroscopic Rotator Cuff Repair Techniques: an in Vitro Study.

Study Snapshot

Key Findings

Clinical Relevance

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Mechanical Strength of Arthroscopic Rotator Cuff Repair Techniques: an in Vitro Study.

Study Snapshot

Key Findings

Clinical Relevance

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