Biomechanical Comparison of Onlay Distal Biceps Tendon Repair: All-Suture Anchors Versus Titanium Suture Anchors

Abstract

Background: A rupture of the distal biceps tendon is the most common tendon rupture of the elbow and has received increased attention in the past few years. Newly developed all-suture anchors have the potential to minimize surgical trauma and the risk of adverse events because of the use of flexible drills and smaller drill diameters. Purpose/Hypothesis: The purpose was to biomechanically compare all-suture anchors and titanium suture anchors for distal biceps tendon repair in cadaveric specimens. The hypothesis was that all-suture anchors would show no differences in load to failure or displacement under cyclic loading compared with titanium suture anchors. Study Design: Controlled laboratory study. Methods: Sixteen unpaired, fresh-frozen human cadaveric elbows were randomized to 2 groups, which underwent onlay distal biceps tendon repair with 2 anchors. Bone mineral density at the radial tuberosity was evaluated in each specimen. In the first group, distal biceps tendon repair was performed using all-suture anchors. In the second group, titanium suture anchors were applied. After cyclic loading for 3000 cycles, the repair constructs were loaded to failure. The peak load to failure as well as repair construct stiffness and mode of failure were determined. Results: The mean (±SD) peak load was 293.53 ± 122.15 N for all-suture anchors and 280.02 ± 69.34 N for titanium suture anchors ( P = .834); mean stiffness was 19.78 ± 2.95 N/mm and 19.30 ± 4.98 N/mm, respectively ( P = .834). The mode of failure was anchor pullout for all specimens during load to failure. At the proximal position, all-suture anchors showed a displacement of 1.53 ± 0.80 mm, and titanium suture anchors showed a displacement of 0.81 ± 0.50 mm ( P = .021) under cyclic loading. At the distal position, a displacement of 1.86 ± 1.04 mm for all-suture anchors and 1.53 ± 1.15 mm for titanium suture anchors was measured ( P = .345). A positive correlation between bone mineral density and load to failure was observed ( r = 0.605; P = .013). Conclusion: All-suture anchors were biomechanically equivalent at time zero to titanium suture anchors for onlay distal biceps tendon repair. While the proximally placed all-suture anchors demonstrated greater displacement than titanium suture anchors, the comparable displacement at the distal position as well as the similar load and mechanism of failure make this difference unlikely to be clinically significant. Clinical Relevance: All-suture anchors performed similarly to titanium suture anchors for onlay distal biceps tendon repair at time zero and represent a reasonable alternative.

Scar Quality Examination Comparing Titanium Coated Suture Material and Non-Coated Suture Material on Flap Donor sites in Reconstructive Surgery

“…Notwithstanding, our findings can be seen as consistent with the advantages of coating suture material with chemicals [11][12][13][14][15][16] or metal legions, like the prevention of surgical site infections [17][18][19][20]. They were also in accordance with beneficial qualities of titanium in medical products, like excellent bone to implant bonding, high biocompatibility due to low allergic potential, resistance to corrosion and limited complications like wound dehiscence, infection and pain [21][22][23][24][25][26][27].…”

“…Titanium coated suture material brings forward as equally adequate results in scar quality and wound healing in flap surgery donor sites as non-titanium-coated suture material. The coating of medical products in general with titanium seems to have a positive impact on wound healing and provides decreased complications like wound dehiscence and surgical site infection [25][26][27]. Nevertheless, the utilization of titanium coated suture material on flap surgery donor sites, even in patients with comorbidities or immunocompromization, will not be superior to non-titanium-coated suture material.…”

“…Titanium as a metal legion is renowned for excellent bone to implant bonding [21,22], high biocompatibility due to low allergic potential [23], resistance to corrosion [24] and limited complications like wound dehiscence, infection and pain [25][26][27]. Therefore, titanium is commonly used for medical products, whether it be as orthopedic implants [28], titanium clips in cardiology and neurology [29][30][31], auditory ossicle replacements [32], endoprosthetic surgery and osteosynthesis in dentistry [24,33], nickel-titanium wire for closure in cleft lip procedures [25] , titanium surgical tacks in gynecology [34] or as titanium coated meshes in abdominoplasty [35][36][37][38].…”

Scar quality examination comparing titanium coated suture material and non-coated suture material on flap donor sites in reconstructive surgery

“…Titanium coated suture material brings forward as equally adequate results in scar quality and wound healing in ap surgery donor sites as non-titanium-coated suture material. The coating of medical products in general with titanium seems to have a positive impact on wound healing and provides decreased complications like wound dehiscence and surgical site infection [25][26][27]. Nevertheless, the utilization of titanium coated suture material on ap surgery donor sites, even in patients with comorbidities or immunocompromization, will not be superior to non-titanium-coated suture material.…”

Mini-Open Distal Biceps Tendon Repair Using All-Suture Anchors

“… 2 , 13 In addition, all-suture anchors have been shown to have a decreased complication rate, likely due to unicortical drilling and decreased hardware prominence. 14 Finally, the current method uses suture anchors that are preloaded with sutures attached to 4 needles, allowing for quicker and more efficient surgery ( Table 1 ).…”