Calcium Phosphate Bone Void Filler Increases Threaded Suture Anchor Pullout Strength: A Biomechanical Study

Diaz, Miguel; Branch, Eric A.; Paredes, Luis A.; Oakley, Emily; Baker, Christopher E.

doi:10.1016/j.arthro.2019.12.003

Cited by 7 publications

(3 citation statements)

References 27 publications

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“…Impaired ingrowth of SAs or healing of the enthesis consequently lead to loosening, pullout, or failure of RCR [ 9 – 11 ]. To improve biomechanical properties of the initial SA fixation, local SA augmentation techniques using polymethylmethacrylate [ 40 – 42 ], bone cement [ 42 , 43 ], or calcium phosphate [ 42 , 44 , 45 ] are published. However, such augmentation techniques are not commonly performed in clinical practice [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Biomechanical properties of a suture anchor system from human allogenic mineralized cortical bone matrix for rotator cuff repair

Schanda

Obermayer–Pietsch

Sommer

et al. 2022

BMC Musculoskelet Disord

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Background Suture anchors (SAs) made of human allogenic mineralized cortical bone matrix are among the newest developments in orthopaedic and trauma surgery. Biomechanical properties of an allogenic mineralized suture anchor (AMSA) are not investigated until now. The primary objective was the biomechanical investigation of AMSA and comparing it to a metallic suture anchor (MSA) and a bioabsorbable suture anchor (BSA) placed at the greater tuberosity of the humeral head of cadaver humeri. Additionally, we assessed the biomechanical properties of the SAs with bone microarchitecture parameters. Methods First, bone microarchitecture of 12 fresh frozen human cadaver humeri from six donors was analyzed by high-resolution peripheral quantitative computed tomography. In total, 18 AMSAs, 9 MSAs, and 9 BSAs were implanted at a 60° angle. All three SA systems were systematically implanted alternating in three positions within the greater tuberosity (position 1: anterior, position 2: central, position 3: posterior) with a distance of 15 mm to each other. Biomechanical load to failure was measured in a uniaxial direction at 135°. Results Mean age of all specimens was 53.6 ± 9.1 years. For all bone microarchitecture measurements, linear regression slope estimates were negative which implies decreasing values with increasing age of specimens. Positioning of all three SA systems at the greater tuberosity was equally distributed (p = 0.827). Mean load to failure rates were higher for AMSA compared to MSA and BSA without reaching statistical significance between the groups (p = 0.427). Anchor displacement was comparable for all three SA systems, while there were significant differences regarding failure mode between all three SA systems (p < 0.001). Maximum load to failure was reached in all cases for AMSA, in 44.4% for MSA, and in 55.6% for BSA. Suture tear was observed in 55.6% for MSA and in 22.2% for BSA. Anchor breakage was solely seen for BSA (22.2%). No correlations were observed between bone microarchitecture parameters and load to failure rates of all three suture anchor systems. Conclusions The AMSA showed promising biomechanical properties for initial fixation strength for RCR. Since reduced BMD is an important issue for patients with chronic rotator cuff lesions, the AMSA is an interesting alternative to MSA and BSA. Also, the AMSA could improve healing of the enthesis.

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Section: Discussionmentioning

confidence: 99%

Biomechanical properties of a suture anchor system from human allogenic mineralized cortical bone matrix for rotator cuff repair

Schanda

Obermayer–Pietsch

Sommer

et al. 2022

BMC Musculoskelet Disord

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“…While this model attempted to replicate ACL reconstruction with human soft tissue grafts, it did not use cadaveric bone for the tibia and instead used a Sawbones model to replicate bone. Use of a synthetic model could potentially alter biomechanical strength, but this model was chosen to mirror that previously used in the literature for a baseline comparison (7,19,20). That said, future studies can use natural bone to evaluate if the synthetic material had any influence on the testing results.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Interference Screw versus Cement Fixation in Anterior Cruciate Ligament Soft Tissue Grafts: A Biomechanical Study

Patel,

Kadkoy,

Helbig

et al. 2023

J Knee Surg

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INTRODUCTION: Shortcomings of fixation has been reported as a source of graft failure in ACL reconstruction. While interference screws have long been used as fixation devices for ACL reconstruction, they are not without complication. Previous studies have highlighted the use of bone void filler as a fixation method, however no biomechanical comparisons using soft tissue grafts with interference screws exist to our knowledge. The purpose of this study is the studies to evaluate the fixation strength of a calcium phosphate cement bone void filler compared to screw fixation in an ACL reconstruction bone replica model with human soft tissue grafts. METHODS: 10 ACL grafts were constructed using semitendinosus and gracilis tendons harvested from 10 donors. Grafts were affixed with either an 8-10mmx23mm PEEK interference screw (n=5) or with approximately 8mL of calcium phosphate cement (n=5) into open cell polyurethane blocks. Graft constructs were tested to failure in cyclic loading under displacement control at a rate of 1mm per second. RESULTS: When compared to screw construct, cement construct showed a 978% higher load at yield, 228% higher load at failure, 181% higher displacement at yield, 233% higher work at failure, and a 545% higher stiffness. Normalized data for the screw constructs relative to the cement constructs from the same donor showed 14±11% load at yield, 54±38% load at failure, and 172±14% graft elongation. DISCUSSION: The results of this study indicate that cement fixation of ACL grafts may result in a stronger construct compared to the current standard of fixation with interference screws. This method could potentially reduce the incidence of complications associated with interface screw placement such as bone tunnel widening, screw migration and screw breakage.

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“…In contrast, bone quality has received less attention [10,11]. Soft tissue or bony xation failure before healing is one of the most common failure mechanisms and represents a signi cant effect on outcomes [12] . In order to augment anchor pullout strength during the operation, the use of cement, increasing the size of the implant, or even stacking multiple anchors have been introduced [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Preliminary evaluation of the clinical efficacy of salmon calcitonin nasal spray in patients with rotator cuff tears after arthroscopic repair: a retrospective study

Lyu

et al. 2023

Preprint

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Background Rotator cuff tears (RCTs) are the most common shoulder disorder, which can be effectively treated by arthroscopic technique. However, the re-tear rates following rotator cuff repair range from 10% in small tears to 91% in massive tears, leading to a failure of healing, particularly in patients with osteoporosis or acute bone loss. Calcitonin used for acute bone loss has currently become a consensus. This study aims to assess the efficacy of salmon calcitonin nasal spray (SCNS) in patients with RCTs after arthroscopic repair. Methods It was a retrospective study which involved patients affected by RCTs from January 2018 to December 2019. All of the patients accepted arthroscopic surgery and were divided into two groups, with or without use of SCNS after the surgery. Patients were evaluated with clinical examination, pain scores based on visual analog scale (VAS) and functional outcomes based on the Constant-Murley shoulder score (CMS) and simple shoulder test (SST) before surgery, at 3, 6, and 24 months after surgery. Results Groups 1 (control group) and 2 (study group) comprised 26 and 29 patients, respectively, who showed no significant differences in demographic characteristics (p>0.05). In general, the mean ± sd of patient age was 52.27 ± 8.53 years (range, 39–75 years). Among the patients, 28 (50.9%) were male, and 27 (49.1%) were female. Shoulder function (CMS, SST) improved over time in both groups (p<0.05). At 3 months, VAS, CMS and SST values in study group were superior to those in control group (p<0.05). However, this trend was not persisted at 6 and 24 months. Tendon re-tear was seen in two of the patients in control group, but there was no significant difference in re-tear rates in the two groups (p=0.219). No other post-surgical complication was found in either group. Conclusions Use of SCNS could significantly reduce postoperative pain level and improve shoulder function in the early stage after arthroscopic repair, but it could not decrease the rotator cuff re-tear rate. Prospective studies involving large samples are required to observe the long term effects further more.

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Calcium Phosphate Bone Void Filler Increases Threaded Suture Anchor Pullout Strength: A Biomechanical Study

Cited by 7 publications

References 27 publications

Biomechanical properties of a suture anchor system from human allogenic mineralized cortical bone matrix for rotator cuff repair

Biomechanical properties of a suture anchor system from human allogenic mineralized cortical bone matrix for rotator cuff repair

Interference Screw versus Cement Fixation in Anterior Cruciate Ligament Soft Tissue Grafts: A Biomechanical Study

Preliminary evaluation of the clinical efficacy of salmon calcitonin nasal spray in patients with rotator cuff tears after arthroscopic repair: a retrospective study

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