Suturing the myotendinous junction in total hip arthroplasty: A biomechanical comparison of different stitching techniques

Giacomo Lionello, Roberta Fognani, Massimiliano Baleani, Alessandra Sudanese, Aldo Toni

Research output: Contribution to journalArticlepeer-review


Background The repair of the myotendinous junction following total hip arthroplasty is challenging as this region is the weakest part of the muscle structure. This study investigated the mechanical behaviour and the mode of failure of different suturing techniques of the myotendinous junction. A new asymmetrical stitch was compared to two widely used techniques, i.e. the simple stitch (two loops in parallel) and the figure-of-eight stitch. Methods The ovine triceps brachii myotendinous junction was selected as the experimental model. Each technique was sewn in muscle belly on one side and in a polyester belt (no-tendon configuration) or in thin tendon (full configuration) on the other side. The former was chosen to determine the grasping power of the stitch on the muscle despite the tendon quality, the latter to simulate a very thin gluteus medius tendon. Findings The new stitch showed a higher ultimate strength (+ 40%) compared to the two controls in the no-tendon configuration. In the full configuration, no significant increase was observed, although failure of the new stitch always occurred at the tendon side. Furthermore, the new stitch does not alter the stiffness of repair. Interpretation The new stitch has a higher grasping power on muscle belly than the single passing-through stitches thanks to the multiple fixation points, which better distribute the load in the tissue. However, such performance can be fully exploited only in the presence of good quality tendons.

Original languageEnglish
Pages (from-to)1077-1082
Number of pages6
JournalClinical Biomechanics
Issue number10
Publication statusPublished - Dec 1 2015


  • Mechanical
  • Muscle
  • Stiffness
  • Strength
  • Suture technique
  • Total hip replacement

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Biophysics


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