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Upper Limb: T. D. Boehm, A. Werner, S. Radtke, T. Mueller, S. Kirschner, and F. Gohlke The effect of suture materials and techniques on the outcome of repair of the rotator cuff: A PROSPECTIVE, RANDOMISED STUDY J Bone Joint Surg Br 2005; 87-B: 819-823 [Abstract] [Full text] [PDF]

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Response to Mr Pai from Professor Gohlke and Dr Boehm

Frank E Gohlke, TD Boehm   (16 August 2005)

Reaching more definite conclusions on the optimum method of repair of the rotator cuff

Sunil K Pai   (12 July 2005)

Response to Mr Pai from Professor Gohlke and Dr Boehm 16 August 2005
Frank E Gohlke, Professor of Orthopaedic Surgery Koenig-Ludwig-House, University of Wuerzburg, TD Boehm Send letter to journal: Re: Response to Mr Pai from Professor Gohlke and Dr Boehm f-gohlke.klh{at}mail.uni-wuerzburg.de Frank E Gohlke, et al.	Sir, We did explain in our paper that the diameter of the sutures is slightly different. Nevertheless the biomechanical properties (especially the tensile strength and stiffness) are comparable because of the mean difference in the strengths of the materials within the first six weeks (PDS 230 N at surgery with a decrease of 50%, Ethibond 160 Nm) and the difference during the manufacturing process (braiding). For ethical reasons suture material has to be certified and acceptable for this kind of surgery. Braided PDS suture material of 0.7 mm is not certified as suture material. Taking into account the fact that the combination of resorbable material and a less effective suture technique (based on in vitro data) would have a significant influence on the clinical outcome we were very surprised that our hypothesis could not be proven. The first suture technique with PDS (which was used in our hospital for more than five years and then abandoned for economic reasons) was expected to be inferior to the second (which was used afterwards). Therefore we established a prospective randomised study in order to analyse the outcome. Our conclusion was 'that although basic science studies support the use of special suture techniques and non-absorbable materials, their advantages are unproven in the clinical setting in terms of both clinical outcome and rate of recurrence.' We feel that two aspects are speculative but important when drawing conclusions for clinical practice. Firstly, biological factors such as vascularity and healing potential are probably more important for the clinical outcome than hitherto expected. Secondly, the effect of suture material and technique are less important for the clinical outcome and rate of recurrence than expected. For statistical reasons a much greater sample would be mandatory in order to prove small size effects. We expected to detect a medium effect size, and therefore in our power analysis the group size was set at 50 patients. F. GOLKE, MD, PhD D. BOEHM, MD University of Wuerzenburg, Wuerzenburg, Germany.
Reaching more definite conclusions on the optimum method of repair of the rotator cuff 12 July 2005
Sunil K Pai, Research Fellow in Orthopaedics Wrightington Hospital, Wigan, UK. Send letter to journal: Re: Reaching more definite conclusions on the optimum method of repair of the rotator cuff sunilkumarpai{at}doctors.org.uk Sunil K Pai	Sir, I read this article with interest. However, I felt that the authors' conclsuions were inacccurate. Firstly, they compared repair techniques using sutures of different materials: a 0.7 mm diameter No.3 Ethibond and a 1.0 mm diameter polydioxanone (PDS) cord. Should not the study have used either a single type of suture (Ethibond or PDS) and compared the effectiveness of the two methods of repair, thus controlling one factor while varying the other? Or to be more comprehensive, compared both methods of repair with both suture types? This may have allowed the reader to draw more meaningful conclusions from the study. S. K. PAI, MA, MBB Chir, MRCS(Ed) Wrightington Hospital, Wigan, UK.