Biomechanical Analysis of a Modified Mattress Configuration: The Cross-Mattress Suture

Abstract

Background A modification to the traditional horizontal mattress suture technique was developed for double-loaded anchors and named the cross-mattress suture. The sutures are placed similar to a traditional horizontal mattress suture; however, the limbs from the same pair of sutures are placed alternately. The present study aimed to compare the biomechanical stability of the cross-mattress suture with the simple and traditional horizontal mattress suture. Methods Eighteen fresh porcine infraspinatus tendons were divided into three different repair groups (the simple, the mattress or the cross-mattress group) and were fixed using a suture anchor loaded with two high-tension sutures. Maximum failure load was recorded. Results The cross-mattress suture showed a significantly greater maximum load to failure. The average maximum load to failure was 23.0 N for the simple stitch, 35.1 N for the mattress and 67.7 N for the cross-mattress group. The maximum load to failure for the cross-mattress was greater than the simple (p < 0.05) and the mattress (p < 0.05). Discussion The results obtained in the present study indicate that the cross-mattress suture supports the greatest maximum failure load, and suggests that it is biomechanically superior to the traditional mattress or the simple suture configuration. It is easy, compact and reproducible.