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    Biomechanical Comparison of Tibial Eminence Fracture Fixation With High-Strength Suture, EndoButton, and Suture Anchor
    (W B Saunders Co-Elsevier Inc, 2012) Hapa, Onur; Barber, F. Alan; Suner, Ganim; Ozden, Raif; Davul, Serkan; Bozdag, Ergun; Sunbuloglu, Emin
    Purpose: To biomechanically compare anterior cruciate ligament (ACL) tibial bony avulsion fixation by suture anchors, EndoButtons (Smith & Nephew, Andover, MA), and high-strength sutures subjected to cyclic loading. Methods: Type III tibial eminence fractures were created in 49 ovine knees, and 7 different types of repairs were performed. Each repair group contained 7 specimens. The repair groups were as follows: No. 2 FiberWire (Arthrex, Naples, FL); No. 2 UltraBraid (Smith & Nephew); No. 2 MaxBraid (Arthrotek, Warsaw, IN); No. 2 Hi-Fi (ConMed Linvatec, Largo, FL); No. 2 OrthoCord (DePuy Mitek, Raynham, MA); Ti-Screw suture anchor (Arthrotek); and titanium EndoButton. These constructs were cyclically loaded (500 cycles, 0 to 100 N, 1 Hz) in the direction of the native ACL and loaded to failure (100 mm/min). Endpoints included ultimate failure load (in Newtons); pullout stiffness (in Newtons per millimeter); cyclic displacement (in millimeters) after 100 cycles, between 100 and 500 cycles, and after 500 cycles; and mode of failure. Bone density testing was performed in all knees. Results: Bone density was not different among the groups. The EndoButton group had a higher ultimate failure load than the FiberWire, UltraBraid, Hi-Fi, and suture anchor groups (P < .05). The MaxBraid and OrthoCord groups had higher failure loads than the suture anchor group (P < .05). The MaxBraid group also had a higher failure load than the Hi-Fi group (P < .05). Stiffness was not statistically different for the various tested constructs. After 100 cycles, the EndoButton group had less displacement than the FiberWire, UltraBraid, MaxBraid, and Hi-Fi groups (P < .05). The suture anchor group had less displacement than the Hi-Fi and FiberWire groups (P < .05). The displacements of the different tested constructs between 100 and 500 cycles and total displacements after 500 cycles were not statistically different. The predominant failure mode was suture rupture. Conclusions: Under cyclic loading conditions in an ovine model, EndoButton fixation of tibial eminence fractures provided greater initial fixation strength than suture anchor fixation or fixation with various high-strength sutures except for OrthoCord. Clinical Relevance: During initial cyclic loading of ACL tibial eminence fractures, the strength of the repair construct should be taken into consideration because conventional suture repair even with ultrahighmolecular-weight polyethylene sutures may not provide enough strength.
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    Tendon-grasping strength of various suture configurations for rotator cuff repair
    (Springer, 2011) Hapa, Onur; Barber, F. Alan; Sunbuloglu, Emin; Kocabey, Yavuz; Sarkalkan, Nazli; Baysal, Gokhan
    The purpose of the present study is to evaluate the mechanical performance and initial strength of the arthroscopic Mason-Allen, double mattress, inclined Mason-Allen, and lasso loop stitch configurations. Using 36 sheep infraspinatus tendons, tendon widths and thicknesses were measured with a digital caliper to confirm standardization of the tendons. Four different stitch configurations (Mason-Allen, inclined Mason-Allen, double mattress, and lasso loop) were biomechanically tested with cyclic loading followed by load to failure testing. The cyclic elongation, peak-to-peak displacement, ultimate tensile strength, stiffness, and mode of failure were recorded. Mean tendon widths and thicknesses were statistically the same. The lasso loop (0.7 +/- A 0.1 mm) demonstrated a mean cyclic elongation greater than the Mason-Allen (0.5 +/- A 0.3 mm) and double mattress (0.5 +/- A 0.3 mm) groups (P = 0.011; P = 0.013). No differences were found in ultimate failure load, stiffness, and peak-to-peak displacement for the Mason-Allen (mean 99 +/- A 42 N, 39 +/- A 9 N/mm, 0.6 +/- A 0,1 mm), inclined Mason-Allen (113 +/- A 52 N, 44 +/- A 14 N/mm, 0.5 +/- A 0.1 mm), double mattress stitch (119 +/- A 68 N, 45 +/- A 10 N/mm, 0.5 +/- A 0.1 mm), or lasso loop (100 +/- A 38 N, 42 +/- A 7 N/mm, 0.5 +/- A 0.1 mm) groups (n.s.). Each specimen failed at the suture-tendon interface. Three specimens (two Mason-Allen and one inclined Mason-Allen) failed during cyclic testing. Conventional Mason-Allen configuration can be applied with double-loaded suture anchor safely. Recent modifications of the configurations offer no biomechanical advantage.