Stitch positioning influences the suture hold in supraspinatus tendon repair

This study was designed to compare the pull-out strength of simple suture stitches in human supraspinatus tendons with respect to the position of the rotator cable. Fifty-four tests were performed on 6 intact, human supraspinatus tendons, to assess the cutout strength of a simple suture configuration in different positions; medial to, lateral to, or within the rotator cable. Tendon thickness was measured and correlated for each positioned suture. Suture positioning lateral to or in the rotator cable showed significantly lower suture retention properties compared with positioning the suture medial to the cable (p = 0.002). In all tested specimens, the central stitch in the row medial to the rotator cable provided the optimum retention properties (mean: 191 N; SD: +/- A 44; p < 0.01), even after correcting for tendon thickness. This study shows that it is desirable to identify the rotator cable and to pass sutures just medial to it, close to the middle of the tendon, which provided highest possible suture retention properties.