Anchor Design and Bone Mineral Density Affect the Pull-Out Strength of Suture Anchors in Rotator Cuff Repair

Tingart, Markus; Apreleva, Maria; Lehtinen, Janne; Zurakowski, David; Warner, Jon J.P.

doi:10.1177/0363546503262644

Cited by 171 publications

(143 citation statements)

References 19 publications

(80 reference statements)

Supporting

Mentioning

129

Contrasting

Unclassified

Order By: Relevance

“…Both biological and mechanical factors influence anchor performance. Many studies have examined the ''bio'' portion of pullout strength by investigating variables such as bone mineral density 21,22,32 ; our study should serve as a counterpart to study mechanical factors while blocking out biological variations by using a consistent test medium.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Bearing area: A new indication for suture anchor pullout strength?

Yakacki

Griffis

Poukalova

et al. 2009

Journal Orthopaedic Research

View full text Add to dashboard Cite

Studies performed to quantify the pullout strength of suture anchors have not adequately defined the basic device parameters that control monotonic pullout. The bearing area of a suture anchor can be used to understand and predict anchor pullout strength in a softbone model. First, conical-shaped test samples were varied in size and shape and tested for pullout in 5, 8, and 10 pcf sawbone models. Next, bearing area and pullout strength relationships developed from the test samples were validated against nine commercially available suture anchors, including the Mitek QuickAnchor and SpiraLok, Opus Magnum 2 , ArthroCare ParaSorb, and Arthrex BioCorkscrew. The samples showed a direct correlation between bearing area and pullout strength. Increased insertion depth was a secondary condition that also increased pullout strength. The pullout strength for the suture anchors followed the predicted trends of conical devices based on their individual bearing areas. For the 5 and 8 pcf models, only two and three devices, respectively, fell outside the predicted pullout strength range by more than a standard deviation. The use of a synthetic sawbone model was validated against the pullout strength of an Arthrex Corkscrew in five fresh-frozen cadaver humeral heads. The bearing area of a suture anchor can be used to predict the pullout strength independent of design in a soft-bone model. This work helps provide a foundation to understand the principles that affect the pullout strength of suture anchors. Keywords: suture anchors; pullout strength; soft bone; osteoporosis; bearing area Suture anchors are devices used to reattach a torn tendon to bone and are commonly used at active muscles sites. 1 These devices must possess good pullout strength so that rehabilitation can begin shortly after surgery. The pullout strengths of different types of anchors have been compared in a variety of bone models. [2][3][4][5][6][7][8] These studies have had significant clinical impact, but have not laid a foundation to understand basic design parameters controlling monotonic pullout. In some instances, studies were performed in healthy or hardbone models in which pullout is not the dominant mode of failure compared to suture breakage, device breakage, or tendon tearing. 9 Even when device pullout is the dominant failure mode, no fundamental understanding has emerged as to why some anchors perform better than others.In recent studies by Barber et al., 4,10 monotonic pull tests were performed on a range of suture anchors in a porcine model. Smaller sized suture anchors like the BioRaptor 2.9 and AxyaLoop/Parafix 3 mm devices mostly failed due to anchor pullout, while larger 5 to 6.5 mm devices like the SpiraLok, BioCorkscrews, and the AxyaLoop/ParaFix failed due to eyelet or suture breakage. Eyelet breakage was associated with polymer-based anchors; suture breakage was associated with titanium anchors. The study did not comprehensively assess pullout strength, as three modes of failure occurred due to the high bone density of the porc...

show abstract

Section: Discussionmentioning

confidence: 99%

“…[20][21][22] Pullout strength decreases significantly in osteoporotic bone which has poor bone mineral density. As pullout becomes the dominant mode of failure, anchor design will have an amplified impact on strength.…”

mentioning

confidence: 99%

Bearing area: A new indication for suture anchor pullout strength?

Yakacki

Griffis

Poukalova

et al. 2009

Journal Orthopaedic Research

View full text Add to dashboard Cite

show abstract

“…Fixation strength, particularly for bone anchors, depends, in large part on bone quality and device design. In a recent cadaver study of rotator cuff reattachment to the proximal humerus, Tingart et al 6 reported a positive correlation between cortical bone mineral density and the failure force of the suture anchor. We are unaware of any reports on the effect of bone quality on flexor tendon-bone repairs performed using 2 bone anchors.…”

Section: Introductionmentioning

confidence: 99%

Effect of Suture Material and Bone Quality on the Mechanical Properties of Zone I Flexor Tendon–Bone Reattachment With Bone Anchors

Matsuzaki¹,

Zaegel²,

Gelberman³

et al. 2008

The Journal of Hand Surgery

View full text Add to dashboard Cite

Purpose-To compare the initial biomechanical properties of zone I flexor tendon to bone repairs performed using pull-out and anchor techniques and to investigate the effect of bone quality and suture materials on the strength of anchor repairs.Methods-Using computed tomography, we measured bone mineral density and cortical thickness of the distal phalanx of 60 cadaver fingers (mean age, 77 years). Flexor digitorum profundus tendons were then transected at their insertion sites and repaired using a 4-strand grasping suture and either pull-out or anchor fixation. For pull-out repair (n = 20), the suture strands (Supramid 3-0; S. Jackson, Inc., Alexandria, VA) were passed through the distal phalanx and tied over a dorsal button. For anchor repair, 2 bone anchors were inserted into the distal phalanx, and tendons were grasped using either Supramid (n = 21), Ethibond (Ethicon, Inc., Somerville, NJ; n = 10), or FiberWire suture (Arthrex Inc., Naples, FL; n = 9) (all 3-0). Mechanical properties of the repaired tendon-bone constructs were determined in linear, load-tofailure loading and correlated with bone characteristics.Results-The FiberWire-anchor repair group had the best combination of mechanical properties, with ultimate force to failure no different from the pull-out repairs but with greater stiffness and reduced displacement. Pull-out suture repairs had significantly higher ultimate force-to-failure values than did Ethibond-anchor and Supramid-anchor repairs (p < .01). However, pull-out repairs had significantly reduced stiffness and greater displacement at 20 N force than did anchor repairs from all groups (p < .05). Both bone mineral density and cortical thickness correlated significantly with ultimate force (p < .01). Almost all anchors pulled out for bone mineral density below 420 mg/cm3 or cortical thickness less than0.31 mm, which occurred only for specimens aged greater than75 years.Conclusions-The mechanical properties of the double Mitek bone anchors were sensitive to both suture material and bone quality. FiberWire-anchor repairs provided the best combination of mechanical properties. Pull-out suture repairs had good strength but poor stiffness. Anchor fixation may be contraindicated in patients greater than 75 years because of poor bone quality.Copyright © 2008 by the American for Surgery of the Hand. All rights Corresponding author: Hironori Matsuzaki, MD, Department of Orthopaedic Surgery, Tsubame Rosai Hospital, 633 Sawatari, Tsubame-shi, Niigata 959-1228 Japan; hiro-mat@fa2.so-net.ne.jp.. The objective of tendon-bone repair is to re-establish direct tendon-bone contact with adequate initial strength to maintain contact during rehabilitation and healing. The initial mechanical properties of tendon-bone repairs performed using anchors are limited by the strength of the anchor fixation or the suture. Fixation strength, particularly for bone anchors, depends, in large part on bone quality and device design. In a recent cadaver study of rotator cuff reattachment to the proximal humerus, Tingar...

show abstract

“…In einer anderen Kadaverstudie wurde der lokoregionäre Knochendichte-Gehalt im Bereich des Tuberculum majus quantitativ bestimmt [36]. Im Gegensatz zu Meyer et al [29] fand sich hier ein signifikant höherer spongiöser Knochendichte-Gehalt im posteroproximalen verglichen mit dem antero-bzw.…”

Section: Sehneninsertionunclassified

“…medioproximalen Anteil des Tuberculum majus. Allerdings korrelierten die maximalen Ausreißkräfte der verwendeten Fadenankersysteme nicht mit dem lokoregionären spongiösen Knochendichte-Gehalt, sondern zeigten eher eine Abhängigkeit vom lokoregionären kortikalen Knochendichte-Gehalt [36]. Hier ließen sich im anterobzw.…”

Section: Sehneninsertionunclassified

Biologische und biomechanische Grundlagen der arthroskopischen Rotatorenmanschettenrekonstruktion

Brucker

Jost

2007

Arthroskopie

View full text Add to dashboard Cite

Anchor Design and Bone Mineral Density Affect the Pull-Out Strength of Suture Anchors in Rotator Cuff Repair

Abstract: Suture anchors should be placed in the proximal-anterior and -middle parts of the greater tuberosity. In the distal parts, biodegradable hook-like anchors should be used with caution.

Cited by 171 publications

References 19 publications

Bearing area: A new indication for suture anchor pullout strength?

Bearing area: A new indication for suture anchor pullout strength?

Effect of Suture Material and Bone Quality on the Mechanical Properties of Zone I Flexor Tendon–Bone Reattachment With Bone Anchors

Biologische und biomechanische Grundlagen der arthroskopischen Rotatorenmanschettenrekonstruktion

Contact Info

Product

Resources

About