Effects of Tendon Viscoelasticity on the Distribution of Forces Across Sutures in a Model of Tendon-To-Bone Repair


Tears to the rotator cuff typically require surgical repair. These repairs often culminate in re-tearing when sutures break through the tendon in the weeks following repair. Although numerous studies have been performed to identify suturing strategies that reduce this risk by balancing forces across sutures, none have accounted for how the viscoelastic nature of tendon influences load sharing. With the aim of providing insight into this problem, we studied how tendon viscoelasticity, tendon stiffness, and suture anchor spacing affect this balancing of forces across sutures. Results from a model of a three-row sutured re-attachment demonstrated that optimized distributions of suture stiffnesses and of the spacing of suture anchors can balance the forces across sutures to within a few percent, even when accounting for tendon viscoelasticity. Non-optimized distributions resulted in concentrated force, typically in the outermost sutures. Results underscore the importance of accounting for viscoelastic effects in the design of tendon-to-bone repairs.


Mechanical and Aerospace Engineering


This work was supported by the National Science Foundation, Grant CMMI 1548571.

Keywords and Phrases

Biomechanics; Biomedical; Orthopedics; Rotator Cuff Tear; Tendon to Bone Attachment

International Standard Serial Number (ISSN)


Document Type

Article - Journal

Document Version


File Type





© 2022 Elsevier, All rights reserved.

Publication Date

15 Aug 2022