Editorial Commentary: All-Suture Anchors, Foam Blocks, and Biomechanical Testing

Brand, Jefferson C.

doi:10.1016/j.arthro.2017.01.012

Cited by 4 publications

(6 citation statements)

References 12 publications

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“…Differing results could also be explained by the discrepancy between the varying all-suture anchor systems. Even though the basic principle includes an expansion of the anchor and its locking underneath the cortex, significant differences have recently been reported [7–9,32]. Still, comparing the pullout strength of similar all-suture systems, the results of this study were superior to the ones reported by Nagra et al (247.2 ± 78 N vs. 145.8 ± 23.1 N).…”

Section: Discussioncontrasting

confidence: 65%

Conventional rotator cuff versus all-suture anchors—A biomechanical study focusing on the insertion angle in an unlimited cyclic model

et al. 2019

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PurposeThe purpose of this study was to compare the biomechanical properties of an all-suture anchor to a conventional anchor used commonly in rotator cuff repairs. Furthermore, the biomechanical influence of various implantation angles was evaluated in both anchor types in a human cadaveric model.Methods30 humeri were allocated into three groups with a similar bone density. The two different anchor types were inserted at a predefined angle of 45°, 90° or 110°. Biomechanical testing included an initial preload of 20N followed by a cyclic protocol with a stepwise increasing force of 0,05N for each cycle at a rate of 1Hz until system failure. Number of cycles, maximum load to failure, stiffness, displacement and failure mode were determined.Results27 anchors failed by pullout. There was no significant difference between the conventional and the all-suture anchor regarding mean pullout strength. No considerable discrepancy in stiffness or displacement could be perceived. Comparing the three implantation angles no significant difference could be observed for the all-suture or the conventional anchor.ConclusionAll-suture anchors show similar biomechanical properties to conventional screw shaped anchors in an unlimited cyclic model. The exact insertion angle is not a significant predictor of failure.

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Section: Discussioncontrasting

confidence: 65%

Conventional rotator cuff versus all-suture anchors—A biomechanical study focusing on the insertion angle in an unlimited cyclic model

et al. 2019

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“…Both he and Brand 3 point out that all-suture anchors allow for smaller drill holes in the target bone. Brand also reminded us that all-suture anchors can cause bone reactions leading to cyst formation, 3 which is based upon the work by Pfeiffer et al, 4 who evaluated in vivo the 1.4-mm JuggerKnot. At 8 weeks, the JuggerKnot anchor tunnels were transformed into 6.3-mm cystic cavities, and the all-suture anchors showed significantly greater displacement than the control conventional anchor.…”

Section: See Related Article On Page 1954mentioning

confidence: 99%

Editorial Commentary: All-Suture Shoulder Glenoid Anchors: Can We Adequately Tension Them or Knot?

Barber¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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All-suture anchors require smaller drill holes (often under 2.0 mm) than comparable solid glenoid anchors (e.g., Gryphon: 2.5-mm drill). A smaller drill allows closer anchor approximation, but there is no indication that this improves repair biomechanics. In fact closely associated multiple fixation points are associated with glenoid fractures, and the same multiple fixation points can be achieved with double-or triple-loaded conventional anchors. All-suture anchors require deployment immediately adjacent to intact cortical bone. Without this, slack and pistoning of the suture ball anchor occur during cyclic loading and have been associated with bone cavitation, repair loosening, and gap formation. A mechanical tensioning mechanism more effectively removes the slack than hand tensioning by the surgeon. Drill length is another concern. All-suture anchor drills measure between 20 and 24 mm long. This length is commonly associated with far cortex penetration and places the suprascapular nerve and axillary nerve at increased risk of contact damage. Maximizing all-suture anchor performance is associated with mechanical deployment systems rather than hand traction applied by the surgeon. Finally, no current all-suture anchor is biodegradable, osteoconductive, or replaced by bone.

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“…In a recent editorial entitled "All Suture Anchors, Foam Blocks and Biomechanical Testing," Brand eloquently concluded that "biomechanical trials do not predict clinical feasibility." 5 So what impact will this information have on my practice? Does this study suggest that I should be using more anchors to repair my rotator cuffs, especially in osteoporotic bone?…”

Section: See Related Article On Page 377mentioning

confidence: 99%

Editorial Commentary: Anchors Away! Reflections on Anchor Placement and Number in Rotator Cuff Repair

Curtis

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The ideal construct for a rotator cuff repair continues to be a hot topic for debate and biomechanical investigation. A recent study shows that anchors could be placed as close as 1 mm apart without impact on pullout strength. However, further overlap (the buddy anchor construct) led to earlier failure. This conclusion differs from other studies that have recommended the "buddy anchor" construct as a bail-out option in osteoporotic bone. Biomechanical studies are an important source of information for surgical decision making, but often do not directly predict the in vivo environment. The final determination of anchor number and placement in a rotator cuff repair should be based on 4 factors: minimizing cost, avoiding complications, using appropriate technique, and proper restoration of anatomy.

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Editorial Commentary: All-Suture Anchors, Foam Blocks, and Biomechanical Testing

Cited by 4 publications

References 12 publications

Conventional rotator cuff versus all-suture anchors—A biomechanical study focusing on the insertion angle in an unlimited cyclic model

Conventional rotator cuff versus all-suture anchors—A biomechanical study focusing on the insertion angle in an unlimited cyclic model

Editorial Commentary: All-Suture Shoulder Glenoid Anchors: Can We Adequately Tension Them or Knot?

Editorial Commentary: Anchors Away! Reflections on Anchor Placement and Number in Rotator Cuff Repair

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