A biomechanical comparison of su5ture with a lateral plate and cerclage wire and suture constructs for lesser tuberosity osteotomy repair in stemless anatomic total shoulder arthroplasty
6 affiliations
- 1Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
- 2School of Medicine, University of California, Riverside, CA, USA
- 3Department of Surgery, University of Washington, Seattle, WA, USA
- 4Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- 5Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
- 6Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Sciences Center-Campbell Clinic, Memphis, TN, USA
Abstract
Background: There are limited biomechanical data on lesser tuberosity osteotomy (LTO) repair techniques in the setting of stemless implants. The risk of LTO nonunion from inadequate compression and/or resultant bone fragment micromotion may be mitigated by biomechanically improved repair techniques. The purpose of this study was therefore to evaluate the biomechanical properties of a suture with a lateral plate construct (suture-plate) when compared to a cerclage wire construct (wire-suture) in the setting of stemless implants.
Methods: Thirteen matched pairs of human cadaveric shoulders were dissected and the lesser tuberosity osteotomized. In each pair, the LTO was repaired with a suture-plate construct on one side and a wire-suture construct on the contralateral side. Both constructs utilized suture fixation through the suture slots onto the stemless component. Using a custom subscapularis cryoclamp, each specimen was cycled from 10 to 100 N at 1 Hz 1,000 times. Cyclic gap formation was recorded using a digital video system. Each specimen was then loaded to failure with load, displacement, construct stiffness, and mode being recorded. Statistical analyses compared the paired suture-plate and wire-suture constructs.
Results: There were no differences between constructs in LTO dimensions, cyclic gap formation, failure load, or failure displacement between constructs (P ≥ .133). The suture-plate construct was approximately 20% stiffer than the wire-suture construct (P = .033). The most frequent failure mode in the suture-plate group was due to suture tearing (5/13, 38%), whereas the wire-suture group's most common failure mode was due to fractures through the bone tunnels created for the wires (10/13, 77%).
Conclusion: In this controlled laboratory study, there were no differences in gap formation and failure load between the suture with a lateral plate and cerclage wire constructs, suggesting that there may be no differences in time-zero fixation, and environments for in vivo LTO healing rates may exist. However, the decreased stiffness and increased number of bone tunnel failures seen in the cerclage wire-suture construct suggest that sutures with plate constructs may be more resilient at higher loads, and in patients with weaker bone, lower the risk for fracturing of the bone tunnels. While clinical data are needed to definitively prove this observation, LTO repair with a suture and lateral plate construct may provide a biomechanically superior repair to a cerclage wire-suture repair in the setting of stemless anatomic total shoulder arthroplasty.
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BibTeX
@article{christy2026biomechanical,
title = {{A biomechanical comparison of su5ture with a lateral plate and cerclage wire and suture constructs for lesser tuberosity osteotomy repair in stemless anatomic total shoulder arthroplasty}},
author = {Kyle B. Christy and Randall A. Arroyo and Mitchell S. Kirkham and Peter N. Chalmers and Robert Z. Tashjian and Heath B. Henninger and Christopher D. Joyce and Maarouf A. Saad},
journal = {Journal of Shoulder and Elbow Arthroplasty},
year = {2026},
month = sep,
doi = {10.1016/j.jsea.2026.100099},
url = {https://doi.org/10.1016/j.jsea.2026.100099},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - A biomechanical comparison of su5ture with a lateral plate and cerclage wire and suture constructs for lesser tuberosity osteotomy repair in stemless anatomic total shoulder arthroplasty
AU - Kyle B. Christy
AU - Randall A. Arroyo
AU - Mitchell S. Kirkham
AU - Peter N. Chalmers
AU - Robert Z. Tashjian
AU - Heath B. Henninger
AU - Christopher D. Joyce
AU - Maarouf A. Saad
PY - 2026
DA - 2026/09/30
JO - Journal of Shoulder and Elbow Arthroplasty
DO - 10.1016/j.jsea.2026.100099
UR - https://doi.org/10.1016/j.jsea.2026.100099
AB - Background: There are limited biomechanical data on lesser tuberosity osteotomy (LTO) repair techniques in the setting of stemless implants. The risk of LTO nonunion from inadequate compression and/or resultant bone fragment micromotion may be mitigated by biomechanically improved repair techniques. The purpose of this study was therefore to evaluate the biomechanical properties of a suture with a lateral plate construct (suture-plate) when compared to a cerclage wire construct (wire-suture) in the setting of stemless implants. Methods: Thirteen matched pairs of human cadaveric shoulders were dissected and the lesser tuberosity osteotomized. In each pair, the LTO was repaired with a suture-plate construct on one side and a wire-suture construct on the contralateral side. Both constructs utilized suture fixation through the suture slots onto the stemless component. Using a custom subscapularis cryoclamp, each specimen was cycled from 10 to 100 N at 1 Hz 1,000 times. Cyclic gap formation was recorded using a digital video system. Each specimen was then loaded to failure with load, displacement, construct stiffness, and mode being recorded. Statistical analyses compared the paired suture-plate and wire-suture constructs. Results: There were no differences between constructs in LTO dimensions, cyclic gap formation, failure load, or failure displacement between constructs (P ≥ .133). The suture-plate construct was approximately 20% stiffer than the wire-suture construct (P = .033). The most frequent failure mode in the suture-plate group was due to suture tearing (5/13, 38%), whereas the wire-suture group's most common failure mode was due to fractures through the bone tunnels created for the wires (10/13, 77%). Conclusion: In this controlled laboratory study, there were no differences in gap formation and failure load between the suture with a lateral plate and cerclage wire constructs, suggesting that there may be no differences in time-zero fixation, and environments for in vivo LTO healing rates may exist. However, the decreased stiffness and increased number of bone tunnel failures seen in the cerclage wire-suture construct suggest that sutures with plate constructs may be more resilient at higher loads, and in patients with weaker bone, lower the risk for fracturing of the bone tunnels. While clinical data are needed to definitively prove this observation, LTO repair with a suture and lateral plate construct may provide a biomechanically superior repair to a cerclage wire-suture repair in the setting of stemless anatomic total shoulder arthroplasty.
SN - 2471-5492
ER -