Lim WSR, Yew AKS, Lie H, Chou SM, Lie DTT. Rotator cuff repair with an interposition polypropylene mesh: A biomechanical ovine study. World J Orthop 2023; 14(5): 319-327 [PMID: 37304195 DOI: 10.5312/wjo.v14.i5.319]
Corresponding Author of This Article
Winston Shang Rong Lim, MBBS, Doctor, Department of Orthopaedic Surgery, Singapore General Hospital, Academia Level 4, Outram Road, Singapore 169856, Singapore. limshangrong@msn.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Basic Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. May 18, 2023; 14(5): 319-327 Published online May 18, 2023. doi: 10.5312/wjo.v14.i5.319
Rotator cuff repair with an interposition polypropylene mesh: A biomechanical ovine study
Winston Shang Rong Lim, Andy Khye Soon Yew, Hannah Lie, Siaw Meng Chou, Denny Tijauw Tjoen Lie
Winston Shang Rong Lim, Andy Khye Soon Yew, Hannah Lie, Denny Tijauw Tjoen Lie, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
Siaw Meng Chou, College of Engineering, Nanyang Technical University, Singapore 797101, Singapore
Author contributions: Lim WSR contributed to the data analysis and manuscript preparation; Lie H contributed to study conception, protocol development, specimen testing and manuscript preparation; Yew AKS contributed to study conception, protocol development, specimen testing and critical review of manuscript; Chou SM contributed to study conception, protocol development and critical review of manuscript; Lie DTT contributed to study conception, protocol development and manuscript preparation; and all authors have reviewed the final manuscript.
Institutional review board statement: This study involved the use of animal joints procured from a local abattoir and approval from our Institutional Animal Care and Use Committee was not required.
Institutional animal care and use committee statement: This study involved the use of animal joints procured from a local abattoir and approval from our Institutional Animal Care and Use Committee was not required.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No other data is available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Winston Shang Rong Lim, MBBS, Doctor, Department of Orthopaedic Surgery, Singapore General Hospital, Academia Level 4, Outram Road, Singapore 169856, Singapore. limshangrong@msn.com
Received: December 15, 2022 Peer-review started: December 15, 2022 First decision: March 14, 2023 Revised: March 31, 2023 Accepted: April 20, 2023 Article in press: April 20, 2023 Published online: May 18, 2023
Abstract
BACKGROUND
Chronic large to massive rotator cuff tears are difficult to treat and re-tears are common even after surgical repair. We propose using a synthetic polypropylene mesh to increase the tensile strength of rotator cuff repairs. We hypothesize that using a polypropylene mesh to bridge the repair of large rotator cuff tears will increase the ultimate failure load of the repair.
AIM
To investigate the mechanical properties of rotator cuff tears repaired with a polypropylene interposition graft in an ovine ex-vivo model.
METHODS
A 20 mm length of infraspinatus tendon was resected from fifteen fresh sheep shoulders to simulate a large tear. We used a polypropylene mesh as an interposition graft between the ends of the tendon for repair. In seven specimens, the mesh was secured to remnant tendon by continuous stitching while mattress stitches were used for eight specimens. Five specimens with an intact tendon were tested. The specimens underwent cyclic loading to determine the ultimate failure load and gap formation.
RESULTS
The mean gap formation after 3000 cycles was 1.67 mm in the continuous group, and 4.16 mm in the mattress group (P = 0.001). The mean ultimate failure load was significantly higher at 549.2 N in the continuous group, 426.4 N in the mattress group and 370 N in the intact group (P = 0.003).
CONCLUSION
The use of a polypropylene mesh is biomechanically suitable as an interposition graft for large irreparable rotator cuff tears.
Core Tip: Our ex-vivo ovine model demonstrates that the use of a polypropylene mesh is mechanically suitable as an interposition graft for large irreparable rotator cuff tears. Its use results in a repair that is at least as robust as an intact rotator cuff tendon. When paired with a continuous suturing technique, its resultant superior mechanical properties may potentially reduce re-tear rates after repairing large or massive rotator cuff tears.
