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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Musculoskeletal Disorders 1/2015

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

BMC Musculoskeletal Disorders > Ausgabe 1/2015
Christopher G. Lenz, Karl Wieser, Georg Lajtai, Dominik C. Meyer
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12891-015-0794-9) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

CL carried out the testing of the instruments, participated in its coordination, performed the statistical analysis and drafted the manuscript. KW participated in the design, supported coordination, performed the statistical analysis and helped to draft the manuscript. GL participated in the design and implemention of the study. DM had the original idea, conceived of the study, and participated in its design and coordination and helped to draft the manuscript. All authors revised the manuscript critically for important intellectual content and have given final approval of the version to be published. All authors read and approved the final manuscript.



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.


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.


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.


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.
Additional file 1: Table S1. Listing and illustration of all instruments used in respect to separation and subdivision. The mean values in N/mm and area in mm2 are shown of each instrument as well as of comparison of Suture Retrievers and Suture Shuttles and straight and angled instruments within each group. Values marked with identical symbol were compared and showed significant differences. Instruments, which showed a significantly less force or lesion size of all Instruments in comparison to the Arthrex™ Penetrator Suture Retriever II® 15° Up (bold) are marked for Force in N/mm (+) and for the area in mm2 in comparison to the Smith & Nephews™ ArthroPierce® 45° Right (bold). (PDF 566 kb)
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