Editorial Commentary: Biomechanics of All Suture Anchors: What We Know So Far

Fleischli, James E.

doi:10.1016/j.arthro.2018.07.010

Cited by 13 publications

(13 citation statements)

References 9 publications

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“…In this context, ASA are thought to be superior to conventional anchors because of their smaller footprint and through less bone removal during implantation. The results of this study provide evidence that, in the case of anchor pullout, ASA show a significantly smaller cortical defect compared to conventional anchor [3,10,11,19,21]. Moreover, this study confirms that the volume of the bone cavity induced by ASA pullout compared to conventional anchors is significantly smaller.…”

Section: Discussionsupporting

confidence: 75%

All-suture anchor pullout results in decreased bone damage and depends on cortical thickness

Ntalos

Huber

Sellenschloh

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the influence of cortical and cancellous bone structure on the biomechanical properties of all-suture and conventional anchors and compare the morphological bone damage after their failure. The hypothesis of the study is that all-suture anchor pullout is less invasive and that the pullout force is influenced by the cortical thickness. Methods Thirty human humeri were biomechanically tested as follows: starting with a load cycle from 20 to 50 N, a stepwise increase of the upper peak force by 0.05 N for each cycle at a rate of 1 Hz was performed. Analysis included maximum pullout strength for three different anchor implantation angles (45°, 90°, 110°) of the two anchor types. After anchor pullout, every sample underwent micro-CT analysis. Bone mineral density (BMD) and cortical thickness were determined at the anchor implantation site. Furthermore, the diameter of the cortical defect and the volume of the bone cavity were identified. Results The maximum pullout strength of all-suture anchors demonstrates a strong correlation to the adjacent cortical thickness (r = 0.82, p ≤ 0.05) with at least 0.4 mm needed to withstand 200 N. No correlation could be seen in conventional anchors. Moreover, no correlation could be detected for local BMD in both anchors. All-suture anchors show a significantly narrower cortical defect as well as a smaller bone cavity following pullout (4.3 ± 1.3 mm vs. 5.3 ± 0.9 mm, p = 0.037; 141 mm 3 vs. 212 mm 3 ; p = 0.009). The cortical defect is largest if the anchors are placed at a 45° angle. Conclusion In contrast to conventional anchors, the pullout force of all-suture anchors depends on the thickness of the humeral cortex. Furthermore, all-suture anchors show a significantly smaller cortical defect as well as decreased bone damage in the case of pullout. Therefore, the clinical implication of this study is that all-suture anchors are advantageous due to their bone preserving ability. Also, intraoperative decortication should not be performed and cortical thickness should be preoperatively evaluated to decrease the risk of anchor failure.

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Section: Discussionsupporting

confidence: 75%

All-suture anchor pullout results in decreased bone damage and depends on cortical thickness

Ntalos

Huber

Sellenschloh

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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“…evaluated eight different AC reconstruction techniques in a biomechanical study, observing the best restoration of anatomy with suture anchor fixation in the base of the coracoid process; (vi) When 3.5 mm suture anchors were used, both coracoid and clavicle tunnels were created by 2.0 mm drill bit or Kirschner wire, which needed smaller clavicle holes than those required for the tendon graft or endobutton procedure, thus minimizing the possibility of intraoperative and postoperative fractures; (v) Hardware removal was unnecessary, and implant‐related complication was avoided, indirectly reducing the cost for family members and the national healthcare system. Numerous studies have confirmed the feasibility and effectiveness of suture anchor fixation to repair ACJ separation 2, 21, 25, 46–48 . Nevertheless, all shoulders were immobilized in a sling for 6 weeks to ensure native CC ligament healing and prevent reduction loss.…”

Section: Discussionmentioning

confidence: 99%

“…This technology offers the following important features: (i) Regardless of whether 3.5 (295 N) or 5.0 mm (331N) was used, two suture anchors provided comparable biomechanical strength compared with the native CC ligament complex of 589 N and had sufficient strength to withstand physiological loads and restore stability 12,44 ; (ii) Suture anchor implantation in the base of the coracoid process was easier and less dangerous for the neurovascular structures than passing a loop underneath the coracoid process 25 ; (iii) Jerosch et al 45 evaluated eight different AC reconstruction techniques in a biomechanical study, observing the best restoration of anatomy with suture anchor fixation in the base of the coracoid process; (vi) When 3.5 mm suture anchors were used, both coracoid and clavicle tunnels were created by 2.0 mm drill bit or Kirschner wire, which needed smaller clavicle holes than those required for the tendon graft or endobutton procedure, thus minimizing the possibility of intraoperative and postoperative fractures; (v) Hardware removal was unnecessary, and implant-related complication was avoided, indirectly reducing the cost for family members and the national healthcare system. Numerous studies have confirmed the feasibility and effectiveness of suture anchor fixation to repair ACJ separation 2,21,25,[46][47][48] . Nevertheless, all shoulders were immobilized in a sling for 6 weeks to ensure native CC ligament healing and prevent reduction loss.…”

Section: Technical Characteristics and Key Technologies Of This Studymentioning

confidence: 99%

Acromioclavicular Joint Separation: Repair Through Suture Anchors for Coracoclavicular Ligament and Nonabsorbable Suture Fixation for Acromioclavicular Joint

Liu

Bao

Jiang

et al. 2020

Orthopaedic Surgery

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Objective: To evaluate the clinical and radiographic outcomes of patients undergoing coracoclavicular (CC) ligament repair by two suture anchors and acromioclavicular (AC) joint (ACJ) fixation using heavy nonabsorbable sutures for the treatment of types III-V ACJ injuries with a minimum of 1-year follow-up. Methods: The clinical and radiographic outcomes of 36 consecutive patients (26 men and 10 women) who underwent anatomic reduction for acute ACJ dislocation using two suture anchors for CC ligament reconstruction and two strands of non-absorbable stitches for ACJ fixation between December 2013 and December 2018 were reviewed. Two 3.5 mm suture anchors with double-loaded sutures were separately inserted into the anterolateral and posteromedial portions of the coracoid process. The suture strands were passed through the hole created in the clavicle using 2.0 mm drill and tied over the clavicle. Additional ACJ augmentation using two strands of non-absorbable heavy sutures was performed in all patients. At 3, 6, and 12 months and last follow-up visit, the scores on the visual analog scale (VAS), the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and simple shoulder test (SST) questionnaires were used to provide a final evaluation of shoulder function. Comparison between baseline and treatment results was performed. Radiographic analysis included vertical displacement and horizontal shift. Results: A total of 29 patients (20 men and nine women) were included in the study. A total of seven, six, and 16 patients had Rockwood type III, type IV, and type V ACJ dislocations, respectively. The mean patient age was 42.8 AE 13.5 years, with a mean follow-up of 28 months (range, 12-56 months). At the 12-month follow-up, the mean ASES score was 92.1 AE 3.5, with a mean pain score of 0.5 AE 0.7 on the VAS and mean Constant-Murley score of 93.0 AE 2.4. The new number of positive answers on the SST was 11.5 AE 0.6. Compared with the baseline, the clinical results improved significantly (P < 0.05). No significant difference could be found between the 6-and 12-month follow-up evaluations (P > 0.05). Radiographs showed two partial loss of reduction, whereas no horizontal displacement was found in all patients. One patient developed a superficial wound infection 3 weeks postoperation. The wound healed after routine wound care. No neurovascular complications were recorded. Conclusions: CC ligament reconstruction using two suture anchors and ACJ augmentation using two strands of nonabsorbable heavy sutures on high-grade AC dislocation is a reliable technique for restoring stability to the ACJ and can obtain good to excellent clinical results.

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“…The diameter of the ASA increases when tension is applied through pulling, allowing the anchor to lock beneath the inner cortex of the bone. [3][4][5][6] These implants are believed to be less invasive than traditional implants, and could therefore minimize anchor related complications such as secondary joint damage in case of implant loosening and migration. [7][8][9][10][11][12][13][14][15] Additionally, these implants are radiolucent, reducing artifacts in postoperative imaging.…”

Section: Introductionmentioning

confidence: 99%

Clinical and radiological outcome of all-suture anchors in shoulder and elbow surgery

Ideler¹,

Mesel²,

Vercruysse³

et al. 2022

Shoulder & Elbow

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Background All-suture anchors (ASAs) are noted to cause various bone reactions when used in upper limb surgery but clinical implications are unknown. Methods 88 shoulders and 151 elbows with a mean follow-up of 47.1 ± 17.7 months were invited for follow-up including clinical examination, questionnaires and radiographs. The anchor drill holes were radiographically assessed. Results At final follow up, mean DASH was 12.9 ± 13.8 and mean VAS 2.2 ± 2.4 in the shoulder population. In the elbow group mean MEPS was 91.8 ± 12.7 and mean VAS 1.5 ± 1.9. Implant-specific complications were seen in 10 elbow cases but none in the shoulder group. The mean diameter of the 1.4 mm all-suture anchor drill hole was enlarged to 2.5 ± 1.4 mm in the shoulder group and to 2.9 ± 1.0 mm in the elbow group. 50% of the 1.4 mm anchor drill holes showed abnormal morphology but these morphologic changes did not correlate with clinical outcome, complications or reoperation rate. Discussion Satisfying clinical outcomes are found in upper limb surgery using ASAs. Various bone changes are seen after implantation of an ASA, but these are not clinically relevant. Long-term consecutive follow-up data is required.

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Editorial Commentary: Biomechanics of All Suture Anchors: What We Know So Far

Cited by 13 publications

References 9 publications

All-suture anchor pullout results in decreased bone damage and depends on cortical thickness

All-suture anchor pullout results in decreased bone damage and depends on cortical thickness

Acromioclavicular Joint Separation: Repair Through Suture Anchors for Coracoclavicular Ligament and Nonabsorbable Suture Fixation for Acromioclavicular Joint

Clinical and radiological outcome of all-suture anchors in shoulder and elbow surgery

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