Arthroscopic suture retrievers and shuttles: A biomechanical investigation of the force required for tendon penetration and defect size

Abstract

Background: To compare instruments designed for arthroscopic suture handling during arthroscopic rotator cuff repair, to assess the force needed to penetrate the tendon, and to evaluate the residual defect size. Methods: Twenty-one instruments were each tested ten times on thawed sheep infraspinatus tendons. The force needed to pierce the tendon with each instrument was measured using a custom setup. Bone wax plates were used to make the perforation marks visible and to quantify the lesions each instrument created. Results: The force to pierce a tendon had a range of 5.6-18.5 N/mm. Within the group of suture retrievers, the angled instruments required in average 85 % higher forces than straight instruments. The lesion area had a range of 2-7 mm2. Suture retrievers produced significantly larger lesion sizes compared with suture shuttles. Conclusion: For the identical task of passing a suture through a tendon, differences exist regarding the ease of tendon penetration and potential damage to the tendon for different tools. The design, function, and resulting lesion size may be relevant and important for surgical handling and to avoid excess structural damage to the tendon. These results suggest that choosing the most appropriate tools for arthroscopic suture stitching influences the ease of handling and final integrity of the tissue. Level of evidence: Mechanical evaluation of surgical devices.