Bioabsorbable Tricalcium Phosphate Bone Cement Strengthens Fixation of Suture Anchors

Abstract

Background Failure of suture anchor fixation in rotator cuff repair can occur at different interfaces. Prior studies show fixation at the bone-anchor interface can be augmented using polymethylmethacrylate (PMMA) cement, and screw fixation into bone can be strengthened using bioabsorbable tricalcium phosphate cement. Questions/purposes We wished to determine whether augmentation of suture anchor fixation using bioabsorbable tricalcium phosphate cement would increase pullout strength of suture anchors from bone and the number of cycles to failure, to determine the mode of failure after cement augmentation, and to compare strength and mode of failure with those after augmentation with PMMA.Methods We used 10 matched pairs of cadaveric proximal humeri and implanted a metal screw-type suture anchor in one side and on the other side injected tricalcium phosphate cement into the anchor holes before anchor placement. We tested all specimens to failure using a ramped cyclic loading protocol. Results Tricalcium phosphate cement augmentation increased the final load to failure by 29% and the number of cycles to failure by 20%. Visual inspection confirmed that failure occurred at the cement-bone interface. Conclusions Tricalcium phosphate cement appears to augment suture anchor fixation into bone, reducing the risk of anchor pullout and failure. Clinical Relevance When relying on suture anchor fixation in bone of questionable quality, we suggest considering augmentation of suture anchor fixation with bioabsorbable cement. This method also provides potential for bioabsorbability and may be more amenable to arthroscopic application.

Pull-out stability of anchors for rotator cuff repair is also increased by bio-absorbable augmentation: a cadaver study

“…Regarding bio-absorbable cement Oshtory et al have demonstrated that augmentation with calcium phosphate effects an increase by 29 % [9]. In the present study, the failure load could be enhanced by 66.8 % by the augmentation with fiber-reinforced calcium phosphate.…”

“…Regarding RC reconstruction the potential impairment of the footprint area has to be avoided. Oshtory et al could already show that augmentation of anchors with calcium phosphate cement also leads to a significant increase in failure load, but the increase was found to be much lower than the increase which occurred with PMMA [9]. In the recent past, efforts have been made to enhance the characteristics of biocompatible calcium phosphate cements by reinforcing them with fibers (e.g., polylactide/glycolide copolymer fibers).…”

Technical Developments: Zero Echo Time Imaging of the Shoulder: Enhanced Osseous Detail by Using MR Imaging

“…Ninety-five percent confidence intervals (CIs) on these estimators indicated fair to near-perfect agreement, with comparable agreement between raters and modalities. The agreements (22). Trabecular structure is not well visualized, owing to the spatial resolution relative to not available with standard MR pulse sequences.…”

Self-Setting Calcium Orthophosphate Formulations: Cements, Concretes, Pastes and Putties

“…The combination of a self-setting nature, biocompatibility, lack of any by-products and a great potential for replacement by bones make calcium orthophosphate cements, concretes, pastes and putties very promising materials for clinical and medical applications. In addition, they can easily be used by bone remodeling cells for reconstruction of damaged parts of bones [102,103,226,392,[470][471][472]. The ability to be molded in place also is a very important property because these formulations can easily be delivered into the desired place and can be fitted perfectly with bone defects [103].…”