Intraosseous Suture Abrasion according to the Angle of the Transosseous Tunnel in Rotator Cuff Footprint

Resumen

Objetivo Comparar el desgaste óseo generado por la abrasión de una carga cíclica entre túneles clásicos oblicuos y perpendiculares. Nuestra hipótesis es la de que el túnel oblicuo presenta un menor desgaste óseo por abrasión cíclica comparado con el túnel perpendicular.

Métodos Ocho hombros congelados de cordero fueron usados para el estudio biomecánico. En cada húmero proximal, dos túneles (oblicuo y perpendicular) fueron generados en la tuberosidad mayor. Se utilizó un sistema de tracción cíclica para traccionar hacia atrás y adelante una sutura trenzada en tensión a través del túnel, midiendo la distancia entre la entrada y la salida de la sutura en el túnel antes y después del proceso de ciclado como medida de perdida de tensión de la sutura. El resultado principal es el cambio de la distancia entre la entrada y la salida de la sutura en el túnel después del ciclado para estimar el desgaste óseo dentro del túnel. Para el análisis estadístico, se utilizó la prueba U de Mann-Whitney. Se consideraron significativos valores de p < 0,05.

Resultados Los túneles perpendiculares tuvieron un 23,24 ±  7,44% de pérdida de longitud, y los túneles oblicuos, 7,76 ±  4,32%. La diferencia de pérdida de longitud fue significativa (p = 0,0003).

Conclusión La abrasión ósea generada por el movimiento cíclico de la sutura en el túnel transóseo está influenciada por la geometría del túnel. El desgaste óseo es menor en un túnel oblicuo comparado con un túnel perpendicular.

Nivel de Evidencia Estudio de ciencia básica.

Abstract

Objective To compare the bone wear generated by the abrasion of a cyclic load between classic oblique and perpendicular tunnels. Our hypothesis is that the oblique tunnel is submitted to less cyclic abrasion bone wear compared with the perpendicular tunnel.

Methods Eight fresh-frozen lamb shoulders were used for biomechanical testing. In each proximal humerus, two tunnels (one oblique and one perpendicular) were drilled at the greater tuberosity. We used a cyclic traction system to pull back and forth a braided suture under tension through the tunnel, measuring the distance between the entry and exit points of the suture within the tunnel before and after the cyclic process to release the tension in the suture. The main outcome was the percentage of change in the distance between the entry and exit points of the suture within the tunnel before and after cyclic abrasion to estimate the degree of bone wear inside the tunnel. For the statistical analysis, the Mann-Whitney U test was used. Values of p < 0.05 were considered significant.

Results The perpendicular bone tunnels had 23.24 ±  7.44% decrease in length, and the oblique bone tunnels, 7.76 ±  4.32%. The difference in the decrease in length was significant (p = 0.0003).

Conclusion The bone abrasion caused by the cyclical movement of the suture in the bone tunnel was influenced by the shape of the tunnel. Bone wear was lower with an oblique tunnel compared with a perpendicular tunnel.

Level of Evidence Basic Science Study.

Keywords

rotator cuff - suture - suture techniques - tendon injuries - tendons - bone tunnel wear - suture abrasion - cyclic abrasion

Publication History

Received: 28 August 2020

Accepted: 06 August 2021

Article published online:
22 December 2021

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