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PubMed1997

Ultrasonic prenatal diagnosis of coronal suture synostosis.

The present study was designed to assess the utility and validity of standard prenatal ultrasonography in identifying individuals with coronal suture synostosis by examining sutural abnormalities before the development of secondary craniofacial dysmorphologies. An Accusson 128 XP ultrasound machine was used to scan the coronal sutures of 31 twenty-five-day-old fetuses (term = 31 days) from four timed-pregnant New Zealand White rabbits with simple, nonsyndromic craniosynostosis. Each mother was sedated with general anesthesia, and the gravid uterine horns were exposed via a laparotomy procedure. The fetal calvariae were examined using a no. 7 transducer at 7.0 mHz. Each coronal suture was scanned using ultrasonography by first identifying bregma (the anterior fontanelle) at the intersection of the sagittal, interfrontal, and coronal sutures and then following the coronal sutures laterally. Seventeen of the 31 fetuses were diagnosed with unilateral or bilateral coronal suture fusion. In fetuses with synostosis, the suture was echolucent and patent in the midline but then rapidly tapered off to fused bone as it progressed laterally. This finding is in accordance with the natural history of the synostotic foci and coronal suture fusion progression in these rabbits. In addition, the sagittal and interfrontal sutures in each synostotic rabbit appeared wider along their course compared with normal. This reflects early enhanced compensatory transverse growth resulting from the anteroposterior growth restrictions from coronal suture fusion. No other cranial shape abnormalities were recognizable at this stage of fetal development. The validity of the ultrasound diagnoses was tested by direct ex utero inspection of 9 of the 17 synostotic fetuses. Gross morphological examination showed that 8 of 9 rabbit fetuses (89%) had fused coronal sutures. Statistical analysis revealed no significant difference (chi 2 = 0.22, P > 0.05) between the diagnostic accuracy of standard ultrasonography and direct examination. In conclusion, we have shown that standard ultrasonography of the calvarial sutures, in the absence of other craniofacial malformations, may be a feasible method of diagnosing simple, nonsyndromic craniosynostosis in utero, a condition that is typically missed during routine prenatal ultrasonic screening examinations.

Animals↗
PubMed1997

Tissue response to suture materials implanted subcutaneously in a rabbit model.

We compared the tissue response to a nonabsorbable monofilamented suture made of expanded polytetrafluoroethylene (ePTFE), which has recently been introduced for use in plastic surgery, with the response to 10 other commercially available absorbable sutures and nonabsorbable monofilamented and multifilamented sutures. The sutures were used to secure a patch of ePTFE implanted in the dorsum of adult New Zealand White rabbits. At 30, 60, and 120 days after implantation, the tissue response to the sutures was assessed with respect to the number of foreign-body giant cells present, the thickness of the fibrous capsule that developed, and the general inflammatory response (n = 4 for each suture for each time period). Analysis of variance revealed that specific suture type was significantly associated with foreign-body giant cell count and fibrous capsule thickness. Tevdek had a significantly higher value for mean number of foreign-body giant cells. Silk and Tevdek had significantly thicker fibrous capsules, and ePTFE suture had a significantly thinner capsule. Absorbable sutures and nonabsorbable multifilamented sutures evoked a more extensive tissue response than monofilamented sutures; the differences between nonabsorbable monofilamented and nonabsorbable multifilamented sutures were significant for capsule thickness. In general, suture made of ePTFE produced a minimal tissue response. It should be a good choice for use in facial plastic surgery, in which excellent functional and aesthetic results are critical.

Animals↗
PubMed2003

Nasal tip sutures part I: the evolution.

Suture techniques for reshaping the nasal tip have been in use for many decades. However, the past two decades have been the most influential in the advancement of the procedures commonly used today. This report details the origin of the major tip suture techniques and tracks their evolution through the years. The early techniques in tip rhinoplasty share a basic principle: the sacrifice of lateral crus integrity to augment the middle and medial crural cartilage to gain tip projection and height. These techniques often disrupt the support mechanisms of the tip lobule, leading to undesirable postoperative results, including supratip fullness, tip asymmetry, tip drop, and an overoperated appearance. Modern nasal tip surgery is founded on the philosophy that suture placement does not simply secure partially excised sections of alar cartilage; rather it aims to directly reshape and reposition the various nasal tip components. The principal suturing methods available in the repertoire of today's rhinoplasty surgeon are the medial crural suture, the middle crura suture, the interdomal suture, the transdomal suture, the lateral crura suture, the medial crura anchor suture, the tip rotation suture, the medial crura footplate suture, and the lateral crura convexity control suture. This report acknowledges past contributions to nasal tip surgery and looks at the recent evolution of techniques commonly used today.

Humans↗
PubMed2006

Nanostructural and nanomechanical properties of synostosed postnatal human cranial sutures.

Craniosynostosis represents a heterogeneous cluster of congenital disorders and manifests as premature ossification of one or more cranial sutures. Cranial sutures serve to enable calvarial growth and function as joints between skull bones. The mechanical properties of synostosed cranial sutures are of vital importance to their function and yet are poorly understood. The present study was designed to characterize the nanostructural and nanomechanical properties of synostosed postnatal sagittal and metopic sutures. Synostosed postnatal sagittal sutures (n = 5) and metopic sutures (n = 5) were obtained from craniosynostosis patients (aged 9.1 +/- 2.8 months). The synostosed sutural samples were prepared for imaging and indentation on both the endocranial and ectocranial surfaces with the cantilever probe of an atomic force microscopy. Analysis of the nanotopographic images indicated robust variations in sutural surface characteristics with localized peaks and valleys. In 5 x 5 mum scan sizes, the surface roughness of the synostosed metopic suture was significantly greater (223.6 +/- 93.3 nm) than the synostosed sagittal suture (142.9 +/- 80.3 nm) (P < 0.01). The Young's modulus of the synostosed sagittal suture at 0.7 +/- 0.2 MPa was significantly higher than the synostosed metopic suture at 0.5 +/- 0.1 MPa (P < 0.01). These data suggest that various synostosed cranial sutures may have different structural and mechanical characteristics.

Biomechanical Phenomena↗
PubMed2004

A scanning electron microscope study of plaque accumulation on silk and PVDF suture materials in oral mucosa.

AIM: To examine plaque accumulation on silk and polyvinylidene fluoride (PVDF) sutures at different time intervals. METHODOLOGY: Twenty-one male albino rabbits received sutures under general and local anaesthesia. After 3, 5 and 7 days sutures were removed and processed for scanning electron microscope (SEM) observation. The Friedman and the Wilcoxon tests were used to compare contamination on PVDF and silk suture materials at different time intervals. RESULTS: At all time intervals, the whole surface of silk sutures was covered with a thick layer of bacterial plaque and debris. Microorganisms and blood cells on the surface and between the filaments of the silk suture material were observed. Light debris appeared around the knot area of PVDF sutures after 3 days. At 5 and 7 days, contamination could be seen in scattered areas along the suture material. The average contaminated area was smaller on PVDF suture materials, which were removed at 5 than at 7 days after insertion. At 3 days, PVDF sutures showed significantly less contamination than at 5 and 7 days (P = 0.002). There were statistically significant differences between silk and PVDF sutures at 3, 5 and 7 days. CONCLUSION: SEM observation showed that PVDF sutures were contaminated less than silk sutures at 3, 5 and 7 days.

Animals↗
PubMed2005

Tissue reactions to sutures in the presence and absence of anti-infective therapy.

BACKGROUND: In the oral cavity, sutures are placed within tissues of high vascularity in a moist environment with infectious potential. The objective of this study was to evaluate tissue reactions at silk and expanded polytetrafluoroethylene (ePTFE) sutures in the presence and absence of anti-infective therapy (AT). METHODS: Thirty-six sutures were placed within the mandibular keratinized gingiva in six Beagle dogs. Each animal received one braided silk (4-0) and one ePTFE (CV-5) suture in contra-lateral jaw quadrants at 14, 7, and 3 days prior to biopsy. Three animals received daily AT including topical 2% chlorhexidine solution and a systemic broad-spectrum antibiotic. Biopsy specimens allowed histometric analysis of tissue reactions along the central part of the suture loop including the area of perisutural epithelium, ratio inflammatory cells (ICs)/epithelial cells and IC/fibroblasts, and presence/absence of bacterial plaque in the suture track. RESULTS: A perisutural epithelial sheath was forming within 3 days. The cross-sectional area of the epithelium increased with time for both suture materials (p=0.003) but was particularly pronounced for the silk sutures in the absence of AT. Clusters of IC were present in the perisutural connective tissue and epithelium. Over time, a more prominent increase in IC/fibroblasts was evident for the silk sutures in the absence of AT. The pooled material revealed a significantly higher IC/fibroblast ratio for silk compared with ePTFE sutures (p=0.017). Bacterial plaque influx was detected in 6/9 silk and 0/9 ePTFE suture channels in the presence, and 6/6 and 3/6 suture channels, respectively, in the absence of AT. CONCLUSIONS: AT may reduce biofilm formation and inflammation along the suture track. Braided silk, however, elicits more severe tissue reactions than ePTFE regardless of infection control.

Animals↗
PubMed2001

Endocranial vascular patterns in a familial rabbit model of coronal suture synostosis.

OBJECTIVE: The present study investigates the potential relationship between craniosynostosis and any changes in endocranial vasculature. The hypothesis that crania from rabbits with familial, nonsyndromic coronal suture synostosis and crania from rabbits with experimental immobilization of the coronal suture are associated with altered form of the middle meningeal vessels and dural venous sinuses is tested. DESIGN: Silicone rubber endocasts from 14 adult New Zealand white rabbits (Oryctolagus cuniculus) with familial nonsyndromic coronal suture synostosis (five with bilateral coronal suture synostosis and nine with unilateral coronal suture synostosis) were made to assess middle meningeal vessel and dural venous sinus form. For comparative purposes, endocasts were made from 25 rabbits with normal, patent coronal sutures and 10 rabbits with experimental immobilization of the coronal suture. Impressions of the dural venous sinuses were assessed for depth and width. The area of the confluens of sinuses was also assessed. Impressions of the middle meningeal vessels were assessed for depth, width, and degree of convolution. For width of the dural venous sinuses and area of the confluens of sinuses, comparisons among groups were made with a one-way analysis of variance (ANOVA). For depth of the dural venous sinuses and impressions of the middle meningeal vessels, comparisons among groups were made using a Kruskal-Wallis one-way ANOVA. RESULTS: Crania with familial coronal suture synostosis had significantly (p <.05) reduced posterior dural venous sinus dimensions when compared with both crania from rabbits with experimental immobilization of the coronal suture and rabbits with normal coronal sutures. Crania with both coronal suture synostosis and experimental immobilization had significant increases in dimensions of the middle meningeal vessels relative to normal crania. In addition, casts from rabbits with unicoronal suture synostosis showed marked asymmetry in the dural venous sinuses. CONCLUSIONS: These results support the hypothesis that craniosynostosis is associated with alterations in endocranial vasculature. These changes are most likely a secondary response to synostosis rather than a causal factor and may reflect increased intracranial pressure, decreased intracranial volume, and local accumulations and reductions of cerebrospinal fluid in the posterior region of the skull and immediately deep to the coronal suture.

Analysis of Variance↗
PubMed2006

Significance of differences in patency among cranial sutures.

OBJECTIVE: To evaluate the gross external characteristics of the coronal, lambdoid, and sagittal sutures in human cadaver skulls and determine if a difference exists in terms of patency, sex, and age. METHODS: The coronal, lambdoid, and sagittal sutures were described using a modified grading scale to quantify sutural patency. An open suture was graded as 0, a fused suture as 1, and an obliterated suture as 2, 3, or 4, depending on the extent of obliteration. RESULTS: Thirty-six skulls were examined, including 17 female and 19 male (age range, 56-101 y). When compared with the sagittal suture, the lambdoid suture was significantly more likely to be patent and least likely to be obliterated. No significant difference in suture grades was found between female and male skulls, and no significant difference was found between age and suture grade. CONCLUSION: The prolonged patency of the lambdoid suture may be due to external forces, such as the greater number of muscles affecting the lambdoid suture when compared with the sagittal suture.

Age Factors↗
PubMed1979

[An experimental study on the regeneration of the peripheral nerve--adaptation of the funiculus at the sutured site (author's transl)].

UNLABELLED: We consider it necessary to investigate the passage of axon through the sutured site, besides problems of misdirection, in order to understand the factors which affect the regeneration of the peripheral nerve. We performed the following experiments assuming that different situations occurring at sutured site is to be considered as mono-funiculus situation, and studied them mainly from the histological point of view. METHOD: Twenty-five adult hybrid dogs were used. We performed several different experiments, mentioned below, on the sciatic nerve, at about 3 cm below the greater trochanter with 9-0 monofilament nylon by microsurgical technique. The sciatic nerve was separated 4 cm away from the surrounding tissue, and only the peroneal nerve funiculus was isolated 2 cm away from the other funiculus and was cut at the center. Models of experiment. 1. Proper suture of both cut end...Optimum. 2. Suture by tension after excision of 1 cm in length...Tension, 3. Suture by compression...Compression, 4. Suture by shifting both cut ends about 1/2 of their surface...Offset, 5. Suture by buckling...Buckling, 6. Suture with gap of 5 mm after excision of 5 mm in length...Gap. Five weeks and ten weeks after the operation, the nerves were examined electrophysiologically and histologically. The nerve was stimulated at about 1 cm proximal to the sutured site directly using needle electrode, and the most distal part was searched for, where the nerve action potential was recorded. For the histological study, the nerve was sectioned longitudinally and transversely. These specimens were stained by H. E., Holmes' (for the axon), and L. F. B. method (for the myelin sheath). The regeneration of the nerve was classified into four grades, according to the number and the size of the axon passing through the sutured site, namely poor, fair, good, excellent. RESULTS: 1) The offset of the funiculus at the sutured site is the most important factor which disturbs the regeneration of the axon. 2) The influence of about 5 mm gap is not so big for the regeneration of the axon, compared to the severe offset. 3) The moderate tension which can be produced by the ordinary microsurgical suture does not much influence the regeneration of the axon, and the compression at the sutured site has not much influence to the nerve regeneration as long as the adaptation is good.

Animals↗
PubMed1981

Mechanical performance of polyglycolic acid and polyglactin 910 synthetic absorbable sutures.

The mechanical performance of polyglycolic acid and polyglactin 910 sutures has been assessed using standardized reproducible tests. The results of these studies demonstrated distinct differences in their performance that can be related, in part, to their structural configuration. The size of the 4-0 polyglactin suture was significantly larger than that of the 4-0 polyglycolic acid suture. Since the strength of any suture is proportional to its cross sectional area, the strength of unknotted and knotted polyglactin 910 sutures was signficantly greater than that of the polyglycolic acid sutures. The strength of both sutures was similarly diminished by the formation of the knot. When these sutures were added to tissue, the breaking strength was even further reduced. The rate of decline in breaking strength of the two absorbable sutures in healing skin wounds was comparable. These absorbable sutures displayed knot security with a two throw square knot, 1 = 1. The ability of these sutures to reach knot break with this knot configuration is characteristic of sutures in which the surface exhibits a high coefficient of friction. Their rough surface also caused them to drag through tissue, making difficult to adjust tension on a continuous running suture.

Absorption↗
PubMed2002

In vitro antimicrobial evaluation of Coated VICRYL* Plus Antibacterial Suture (coated polyglactin 910 with triclosan) using zone of inhibition assays.

BACKGROUND: In this study, coated polyglactin 910 suture with triclosan was evaluated for its ability to inhibit the growth of wild-type and methicillin-resistant Staphylococcus aureus and S. epidermidis using several in vitro models. METHODS: In the standard experimental procedure, sterile sutures were inoculated with bacteria, plated in semisolid culture media, incubated for 24 h, and examined for zones of inhibition surrounding the sutures. Sutures were pretreated by several methods prior to inoculation, these included: 24-h aqueous immersion, serial 7-day aqueous immersion, knotting, and passage through subcutaneous and fascial tissue. Sutures were also compared to determine if suture diameter had an effect on the zone of inhibition. RESULTS: Coated polyglactin 910 suture with triclosan inhibited growth of test organisms consistently over a range of suture diameters and treatment conditions. The antibacterial effect was robust and did not diminish when sutures were placed in an aqueous environment for up to 7 days. Knotted suture with triclosan inhibited bacterial colonization after replicate inoculation. The bacteria-free zone surrounding each knotted suture had a volume of 14.5 cm(3) for S. epidermidis and 17.8 cm(3) for S. aureus. Coated polyglactin 910 suture with triclosan continued to produce zones of inhibition after five and 10 passes through fascia and subcutaneous tissue. CONCLUSION: These data support the conclusion that coated polyglactin 910 suture with triclosan provides antimicrobial effect sufficient to prevent in vitro colonization by S. aureus and S. epidermidis.

Anti-Infective Agents, Local↗
PubMed1983

Biocidal braided sutures.

Once sutures become contaminated it is difficult for local tissue defenses or antibiotics to eliminate the bacteria and prevent infection. Impregnation of sutures with antibiotics before implantation is one way to prevent bacterial seeding of the suture surface. In this study, braided silk and Dacron sutures were impregnated with the antibiotic complex, neomycin palmitate. Using our standard wound model in the mouse, the efficacy of these biocidal sutures was determined in the presence of Staphylococcus aureus, Escherichia coli, Proteus mirabilis, and Pseudomonas aeruginosa. Implantation of these biocidal sutures into tissue contaminated with 10(7) organisms resulted in substantially decreased numbers of bacteria as compared with that of tissue receiving control sutures. In most cases, the tissue bacterial counts in the presence of biocidal sutures were also considerably lower than that for similarly contaminated tissue without a suture. Consequently, the presence of the neomycin palmitate eliminated the infection-potentiating effect of the suture. The therapeutic benefit of the biocidal sutures was related to the dose of antibiotic complex and was not adversely affected by delaying suture implantation.

Animals↗
PubMed2006

Optimum surgical suture material and methods to obtain high tensile strength at knots: problems of conventional knots and the reinforcement effect of adhesive agent.

BACKGROUND: Strong suture material and a firmly tight knot that never loosens are necessary for tendon suture, but the appropriate combination of suture materials and the methods to make a knot are matters of uncertainty. METHODS: The tensile strength of four conventional tendon suture materials (Surgilon, Ethibond, Ethilon, PDS II) and newly developed FiberWire were examined. An experienced orthopedic surgeon formed surgical knots with USP2 wire (0.5-0.599 mm in diameter) by making loops and then pulled them at 20 mm/min using Instron. RESULTS: With the conventional surgical suture method (the addition of one throw on a surgeon's knot), Surgilon proved to have the highest tensile strength (163.6 +/- 6.5 N). Other suture materials, when tied under the same conditions, slipped and did not reach the ultimate tensile strength. When four additional throws were made, FiberWire provided the highest tensile strength (316.6 +/- 12.2 N) among the five suture materials tested (others were 140-200 N). When an adhesive agent, cyanoacrylate, was applied to a knot, PDS II provided the highest tensile strength (182.0 +/- 10.1 N). CONCLUSIONS: Our study suggests three suitable combinations of suture materials and methods for suture knot formation, depending on the site of surgery, that provide optimum treatment outcomes. Surgilon provides the most stable strength for general suture techniques. FiberWire is the strongest suture material for a site where a large number of throws is clinically possible. PDS II provides a strong suture when combined with cyanoacrylate reinforcement.

Adhesives↗
PubMed2005

Late dislocation of scleral-sutured posterior chamber intraocular lenses.

PURPOSE: To examine a recent series of late scleral-sutured posterior chamber intraocular lens (PCIOL) dislocations to identify possible causes and preventive measures. SETTING: Price Vision Group, Indianapolis, Indiana, USA. METHODS: In this retrospective non-comparative interventional case series, 5 consecutive patients received treatment for dislocated scleral-sutured PCIOLs between July 2002 and March 2004. Dislocated lenses were resutured or replaced with another scleral-sutured PCIOL. RESULTS: Dislocation of scleral-sutured PCIOLs occurred 7 to 14 years after implantation. Four dislocations were spontaneous, and 1 was precipitated by trauma. In each case, the suture affixing 1 or both haptics failed. There was no evidence that the suture had eroded through the tissue or that the knot had untied. Microscopic analysis of an explanted IOL with remnants of the suture attached showed localized degradation and cracking of the polypropylene suture material where it had been embedded in the scleral tissue. CONCLUSION: Suture-fixated PCIOLs can dislocate due to degradation of the suture material over time. The use of larger diameter (9-0 instead of 10-0) polypropylene suture material and placement of the haptic and sutures in the ciliary sulcus to promote attachment of scar tissue may enhance the long-term stability of scleral-fixated PCIOLs.

Adult↗
PubMed2006

Evaluation of a novel knotless self-anchoring suture material for urinary tract reconstruction.

OBJECTIVES: To evaluate a novel prototype self-anchoring suture (SAS) material that incorporates unidirectional "barbs" designed to grip and approximate tissue without the need for suture ligation for urinary tract reconstructive procedures. METHODS: The in vitro failure strength of various porcine tissue approximations with SAS was compared with the strength of similar approximations with standard ligated suture. For in vivo analysis, 3 pigs underwent laparoscopic pyeloplasty with SAS on one side and 2-0 Vicryl suture on the contralateral side. Nine pigs underwent bladder neck anastomoses (BNA) performed with SAS (n = 3) and standard ligated interrupted suturing (n = 3) or standard ligated running suturing (n = 3). The operative times were compared. One week after surgery, the integrity of each anastomosis was evaluated radiographically and histopathologically. RESULTS: The in vitro analysis revealed no statistically different (P = 0.22) failure forces between the approximations performed with SAS (13.2 +/- 2.6 N) and standard suture (14.1 +/- 3.1 N). The in vitro analysis revealed no difference in operative times for the pyeloplasties (P = 0.72) or BNA (P = 0.31). None of the 1-week postoperative radiographic studies revealed extravasation. The histopathologic analysis revealed more fibrotic reaction associated with the SAS BNA procedures (P <0.01). CONCLUSIONS: Self-anchoring suture secures tissue approximations at loads equivalent to tissue approximations with standard tied suture. Self-anchoring suture obviates the need for knot tying and provides a watertight anastomosis. With laparoscopic knot tying experience, anastomotic time with SAS and standard suture do not differ. Self-anchoring suture might induce more fibrosis. Long-term follow-up evaluation will be required before clinical application.

Animals↗
PubMed1997

The role of sutures and fibrin sealant in wound healing.

Sutures and fibrin sealant are important surgical aids for facilitating wound closure and creating an optimal setting for wound healing. Most commonly, sutures are used to close wounds because suture material provides the mechanical support necessary to sustain closure. A wide variety of suturing material is available, and the surgeon can choose among sutures with a range of attributes to find the one best suited to his or her needs. Considerations when choosing an appropriate suture for wound closure and healing include strength of suture, holding power of tissue, absorbability, risk of infection, and inflammatory reaction associated with the suture material. Other factors to be considered include type of incision, suturing technique, and appearance of wound site. Fibrin sealant, in contrast, is a biologic tissue adhesive that can function as a useful adjunct to sutures. Fibrin sealant can be used in conjunction with sutures or tape to promote optimal wound integrity, or it can be used independently to seal wound sites where sutures cannot control bleeding or would aggravate bleeding. This adhesive can effectively seal tissue planes and eliminate potential spaces. Fibrin sealant has been used clinically in many surgical applications, although an FDA-approved commercially available product does not yet exist in the United States. Clinically, fibrin sealant has resulted in a low rate of infection and has promoted healing. Further study is needed to determine the best fibrin sealant mixtures both to achieve hemostasis and to encourage healing. It may even be desirable to use different sealant formulations for particular clinical situations.

Fibrin Tissue Adhesive↗
PubMed1998

Mechanical strengths of tendon sutures. An in vitro comparative study of six techniques.

A comparative study of six tendon suturing techniques (1. Modified Kessler + simple epitendinous running suture; 2. Modified Kessler + Halsted epitendinous suture; 3. "Six strand" suture; 4. "Interlocking" suture; 5. "Cross stitch" suture; 6. simple epitendinous running suture) was carried out by evaluating strength in relation to the beginning of separation between the tendon stumps, a 3 mm separation and rupture in porcine flexor tendons. The technique most resistant to initial separation was the modified Kessler + Halsted epitendinous suture followed by the "Six strand" suture. The "Six strand" suture was the most resistant to the 3 mm separation and rupture followed by the modified Kessler + Halsted epitendinous suture. Despite the greater resistance to rupture of the "Six strand" technique, we conclude that modified Kessler + Halsted epitendinous suture showed the best overall performance and was easier to use.

Animals↗
PubMed1996

Tissue fixation security in transosseous rotator cuff repairs: a mechanical comparison of simple versus mattress sutures.

The primary purpose of this investigation was to compare tissue fixation security by simple sutures versus mattress sutures in transosseous rotator cuff repair. These two repair techniques were each performed in 17 human cadaver shoulders, with two bone tunnels being used for the repair by two simple sutures and two other bone tunnels being used for the repair by one mattress suture. The repairs were loaded to failure in a servohydraulic materials test system. Rotator cuff repair by simple sutures was found to be significantly stronger than repair by mattress sutures (P = .0007). The average ultimate load to failure for the simple suture construct (189.62 N) was 39.72% greater than that for the mattress suture construct (135.71 N). Most of the failures occurred by suture breakage at the knot. Load-sharing by multiple suture tails and multiple knots in the simple suture configuration likely contributed to its superior strength characteristics compared with the mattress suture configuration.

Biomechanical Phenomena↗