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The American Journal of Sports Medicine

Year: 2009  |  Volume: 37  |  Issue: 12  |  Page No.: 2427 - 2434

Biomechanical Analysis of a Knotless Transtendon Interimplant Mattress Repair for Partial-Thickness Articular-Sided Rotator Cuff Tears

M. C Park, B. J Jun, C. J Park, J. H Oh and T. Q. Lee



A transtendon interimplant mattress repair along the medial row for partial-thickness rotator cuff repairs has been described with clinical success. However, the biomechanical characteristics for such a repair have not been elucidated.


A knotless interimplant mattress repair may show improved or equivalent load and strain characteristics, compared with a repair using isolated mattress repairs over each of 2 anchors.

Study Design

Controlled laboratory study.


Seven matched pairs of human cadaveric shoulders were dissected. Articular-sided tears were created involving 50% of the supraspinatus footprint. In 7 shoulders, repairs were performed with mattress configurations isolated over each of 2 anchor sites (control group). In 7 contralateral shoulders, a knotless interimplant mattress suture configuration was employed creating bridging sutures between implants. For all specimens, a materials-testing machine was used to cyclically load each repair from 10 to 180 N for 30 cycles; each repair was then loaded to failure. A deformation rate of 1 mm per second was employed for all tests. A video-digitizing system was employed to quantitatively measure the gap formation and strain on the footprint area of the repair. For detecting gap formation, 7 matched pairs were necessary for achieving a power of at least 90%.


During cyclic loading, gap formation at the anterior tendon was significantly lower in the control group (P < .05) but did not exceed 0.5 mm. There were no significant differences for linear stiffness, hysteresis, and strain between the 2 constructs. During tensile load-to-failure testing, there were no significant differences at yield load between the control and knotless techniques (293.90 ± 132.72 N and 320.38 ± 237.01 N, respectively; P > .05). There were no differences for stiffness, ultimate load, and energy absorbed to failure between the 2 repairs (P > .05). Gap formation in 3 regions was not significantly different between groups at yield and ultimate loads (P > .05). The anterior regions of the repair were the first to fail in all constructs.


A transtendon interimplant mattress rotator cuff repair for partial articular-sided tendon tears involving 50% of the footprint has biomechanical characteristics similar to those of a repair employing 2 isolated mattress configurations. An interim-plant mattress repair can protect tendon strain; it also exhibits yield loads that exceed those typically experienced in the early postoperative period.

Clinical Relevance

A medial-row interimplant mattress repair configuration that is knotless may facilitate repair without compromising biomechanical characteristics.

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