A biomechanical study on suture anchor insertion angle: Which is better, 90° or 45°?

Nagamoto, Hideaki; Yamamoto, Nobuyuki; Sano, Hirotaka; Itoi, Eiji

doi:10.1016/j.jos.2016.08.010

Cited by 15 publications

(32 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Tingart et al reported that the volumetric bone mineral density of the humeral GT ranged from 0.10 ± 0.03 to 0.18 ± 0.04 g/cm 3 in a cadaveric study [26]; accordingly, polyurethane foam with a density of 0.16 g/cm 3 was selected. In addition, the 2-mm-thick cortical bone was chosen in accordance with a previous study [7].…”

Section: Methodsmentioning

confidence: 99%

“…2 braided sutures were used for biomechanical testing. As suggested in previous studies [7, 27], the original sutures were replaced with the braided polyethylene lines (No.8 Jigging PE; Amika, Japan) to avoid suture breakage during biomechanical testing. A total of 40 suture anchors were used, with each suture anchor randomly assigned to one of the following four groups: decortication with anchor inserted at 45° (D-45 group), decortication with anchor inserted at 90° (D-90 group), non-decortication with anchor inserted at 45° (N-45 group), and non-decortication with anchor inserted at 90° (N-90 group), as illustrated in Fig.…”

Section: Methodsmentioning

confidence: 99%

“…Techniques involving suture anchors have become prevalent for securing soft tissues to the bone in different parts of the body [1–5], the most common site of which is the shoulder [6–8]. Although various suture anchors have been developed and evaluated [9, 10], their fixation strengths are affected by several factors, including the design, bone density, insertion depth, and insertion angle [6, 7, 9–13]. In 1995, Burkhart introduced the “deadman” theory, which concerns the trigonometric calculation of the suture-anchor insertion angle [14].…”

Section: Introductionmentioning

confidence: 99%

“…In 1995, Burkhart introduced the “deadman” theory, which concerns the trigonometric calculation of the suture-anchor insertion angle [14]. Since then, a number of biomechanical studies have tested the theory [6, 7, 15–19]; however, results have been inconsistent, leaving the optimal suture-anchor insertion angle open to debate. Itoi et al comprehensively evaluated their laboratory data against previous studies and concluded that the insertion angles of 45° and 90° were the strongest for threadless and threaded anchors, respectively [20, 21].…”

Section: Introductionmentioning

confidence: 99%

“…Despite the insertion angle of suture anchors having been discussed in various biomechanical models [6, 7, 15–19], whether the insertion-angle strength is affected by decortication remains unclear. The purpose of this study was to compare the pullout strengths of threaded suture anchors inserted at 45° and 90° into decorticated and non-decorticated synthetic bone models.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

When deadman theory meets footprint decortication: a suture anchor biomechanical study

et al. 2019

View full text Add to dashboard Cite

Background The optimal insertion angle for suture anchor insertion has long been of great interest. Although greater tuberosity decortication is commonly performed during rotator cuff repair, the effect of decortication on the suture anchor insertion angle remains unclear. The purpose of this study was to compare the pullout strength of threaded suture anchors inserted at 45° and 90° in decorticated and non-decorticated synthetic bone models. Methods Two kinds of synthetic bones were used to simulate the decorticated and non-decorticated conditions, for which 40 metallic suture anchors were used. Anchors were inserted at 45° and 90° in both decorticated and non-decorticated models and tested under cyclic loading followed by load-to-failure testing. The number of completed cycles, ultimate failure load, and failure modes was recorded. Results In the decorticated model, the ultimate failure load of anchors inserted at 45° (67.5 ± 5.3 N) was significantly lower than that of anchors inserted at 90° (114.1 ± 9.8 N) ( p < 0.001). In the non-decorticated model, the ultimate failure load of anchors inserted at 45° (591.8 ± 58 N) was also significantly lower than that of anchors inserted at 90° (724.9 ± 94 N) ( p = 0.003). Due to the diverse failure modes in the non-decorticated model, specimens with a failure mode of suture anchor pullout were analyzed in greater detail, with results showing a significantly larger pullout strength for anchors inserted at 90° (781.6 ± 53 N) than anchors inserted at 45° (648.0 ± 43 N) ( p = 0.025). Conclusion Regardless of decortication, the pullout strength of anchors inserted at 90° was greater than those inserted at 45°. The clinical relevance is that inserting suture anchors at 90° is recommended due to the significantly larger ultimate failure load in both decorticated and non-decorticated bones.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%