Work

A biomechanical comparison of suture with a lateral plate and cerclage wire and suture constructs for lesser tuberosity osteotomy repair in stemless anatomic total shoulder arthroplasty

Year: 2026

Type: article

Abstract: Background There is 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 of the onto the stemless component. Using a custom subscapularis cryoclamp, each specimen was cycled from 10 to 100 N at 1 Hz 1000 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≥0.133). The Suture-Plate construct was approximately 20% stiffer than the Wire-Suture construct (p=0.033). 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 suture 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 is 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.

Source: Journal of Shoulder and Elbow Arthroplasty

DOI: 10.1016/j.jsea.2026.100099