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Abedi A, Farahmand F, Zanjani LO, Nabian MH. Effect of geometrical design variables on implantation configuration and fixation stiffness of titling bone anchors: A parametric finite element study. Med Eng Phys 2024; 129:104191. [PMID: 38906573 DOI: 10.1016/j.medengphy.2024.104191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/04/2024] [Accepted: 05/22/2024] [Indexed: 06/23/2024]
Abstract
The mechanical interaction of a tilting anchor and cancellous bones of various densities was simulated using finite element modeling. The model enjoyed a sophisticated representation of the bone, as an elasto-plastic material with large deformation capability. The anchor's tilting action during implantation phase, as well as its fixation stiffness during pull-out test, were predicted by the model and a parametric study was performed to investigate the effects of the anchor's distal width and corner fillet radius, on these measures. The model predictions were validated against the results of an experimental test on ovine humerus specimens. The model could reasonably reproduce the tilting action of the anchor during the implantation phase. Comparison of the model predictions with the experimental results revealed similar trends during both the implantation and the pull-out phases, but smaller displacement magnitudes (end points: 1.4 vs. 2.1 mm and 4.6 vs. 5.2 mm, respectively). The results of the parametric study indicated substantial increase in the fixation stiffness with increasing bone density. Reducing the distal width and increasing the fillet radius improved the anchor's implantation configuration and fixation stiffness in low-density bones. For high-density bone applications, however, a larger distal width was favored for improving the fixation stiffness.
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Affiliation(s)
- Ali Abedi
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Farzam Farahmand
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran.
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Wang C, Zhang X, Wang DM, Yung PSH, Tuan RS, Ker DFE. Optimized design of an enthesis-mimicking suture anchor-tendon hybrid graft for mechanically robust bone-tendon repair. Acta Biomater 2024; 176:277-292. [PMID: 38244656 DOI: 10.1016/j.actbio.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/22/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024]
Abstract
Repair of functionally graded biological interfaces requires joining dissimilar materials such as hard bone to soft tendon/ligament, with re-injuries/re-tears expected to be minimized by incorporating biomimicking, stress-reducing features within grafts. At bone-tendon interfaces (entheses), stress can be reduced via angled insertion, geometric flaring, mechanical gradation, and interdigitation of tissues. Here, we incorporated enthesis attributes into 3D in silico and physical models of a unique suture anchor-tendon hybrid graft (SATHG) and investigated their effects on stress reduction via finite element analyses (FEA) studies. Over 20 different simulations altering SATHG angulation, flaring, mechanical gradation, and interdigitation identified an optimal design, which included 90° angulation, 25° flaring, and a compliant (ascending then descending) mechanical gradient in SATHG's bone-to-tendon-like transitional region. This design reduced peak stress concentration factor (SCF) by 43.6 % relative to an ascending-only mechanical gradient typically used in hard-to-soft tissue engineering. To verify FEA results, SATHG models were fabricated using a photocrosslinkable bone-tendon-like polyurethane (QHM polymer) for ex vivo tensile assessment. Tensile testing showed that ultimate load (132.9 N), displacement-at-failure (1.78 mm), stiffness (135.4 N/mm), and total work-to-failure (422.1 × 10-3 J) were highest in the optimized design. Furthermore, to assess envisioned usage, SATHG pull-out testing and 6-week in vivo implantation into large, 0.5-cm segmental supraspinatus tendon defects was performed. SATHG pull-out testing showed secure bone attachment while histological assessment such as hematoxylin and eosin (H&E) together with Safranin-O staining showed biocompatibility including enthesis regeneration. This work demonstrates that engineering biomaterials with FEA-optimized, enthesis-like attributes shows potential for enhancing hard-to-soft tissue repair. STATEMENT OF SIGNIFICANCE: Successful repair of hard-to-soft tissue injuries is challenging due to high stress concentrations within bone-tendon/ligament grafts that mechanically compromise repair strength. While stress-reducing gradient biomaterials have been reported, little-to-no attention has focused on other bone-tendon/ligament interface (enthesis) features. To this end, a unique bone-tendon graft (SATHG) was developed by combining two common orthopaedic devices along with biomimetic incorporation of four enthesis-like features to reduce stress and encourage widespread clinician adoption. Notably, utilizing designs based on natural stress dissipation principles such as anchor insertion angle, geometric flaring, and mechanical gradation reduced stress by 43.6 % in silico, which was confirmed ex vivo, while in vivo studies showed SATHG's ability to support native enthesis regeneration. Thus, SATHG shows promise for hard-to-soft tissue repairs.
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Affiliation(s)
- Chenyang Wang
- Institute for Tissue Engineering and Regenerative Medicine, Lo Kwee-Seong Biomedical Sciences Building, Area 39, The Chinese University of Hong Kong, Hong Kong SAR; School of Biomedical Sciences, Lo Kwee-Seong Biomedical Sciences Building, Area 39, The Chinese University of Hong Kong, Hong Kong SAR
| | - Xu Zhang
- Institute for Tissue Engineering and Regenerative Medicine, Lo Kwee-Seong Biomedical Sciences Building, Area 39, The Chinese University of Hong Kong, Hong Kong SAR; School of Biomedical Sciences, Lo Kwee-Seong Biomedical Sciences Building, Area 39, The Chinese University of Hong Kong, Hong Kong SAR; Center for Neuromusculoskeletal Restorative Medicine, InnoHK, Hong Kong Science Park, Hong Kong SAR
| | - Dan Michelle Wang
- Institute for Tissue Engineering and Regenerative Medicine, Lo Kwee-Seong Biomedical Sciences Building, Area 39, The Chinese University of Hong Kong, Hong Kong SAR; School of Biomedical Sciences, Lo Kwee-Seong Biomedical Sciences Building, Area 39, The Chinese University of Hong Kong, Hong Kong SAR; Ministry of Education Key Laboratory for Regenerative Medicine, Lo Kwee-Seong Biomedical Sciences Building, Area 39, The Chinese University of Hong Kong, Hong Kong SAR; Center for Neuromusculoskeletal Restorative Medicine, InnoHK, Hong Kong Science Park, Hong Kong SAR; Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Hong Kong SAR
| | - Patrick S H Yung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Hong Kong SAR; Center for Neuromusculoskeletal Restorative Medicine, InnoHK, Hong Kong Science Park, Hong Kong SAR; Institute for Tissue Engineering and Regenerative Medicine, Lo Kwee-Seong Biomedical Sciences Building, Area 39, The Chinese University of Hong Kong, Hong Kong SAR
| | - Rocky S Tuan
- Institute for Tissue Engineering and Regenerative Medicine, Lo Kwee-Seong Biomedical Sciences Building, Area 39, The Chinese University of Hong Kong, Hong Kong SAR; School of Biomedical Sciences, Lo Kwee-Seong Biomedical Sciences Building, Area 39, The Chinese University of Hong Kong, Hong Kong SAR; Center for Neuromusculoskeletal Restorative Medicine, InnoHK, Hong Kong Science Park, Hong Kong SAR; Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Hong Kong SAR
| | - Dai Fei Elmer Ker
- Institute for Tissue Engineering and Regenerative Medicine, Lo Kwee-Seong Biomedical Sciences Building, Area 39, The Chinese University of Hong Kong, Hong Kong SAR; School of Biomedical Sciences, Lo Kwee-Seong Biomedical Sciences Building, Area 39, The Chinese University of Hong Kong, Hong Kong SAR; Ministry of Education Key Laboratory for Regenerative Medicine, Lo Kwee-Seong Biomedical Sciences Building, Area 39, The Chinese University of Hong Kong, Hong Kong SAR; Center for Neuromusculoskeletal Restorative Medicine, InnoHK, Hong Kong Science Park, Hong Kong SAR; Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, Hong Kong SAR.
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Matsuo A, Kaneda K, Michifuri K, Hayashi T, Morioka H. Utilizing Suture Anchors in Addition to Screws for Treatment of Tibial Tubercle Avulsion Fracture: A Case Report. Cureus 2024; 16:e56363. [PMID: 38633931 PMCID: PMC11022524 DOI: 10.7759/cureus.56363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Tibial tubercle avulsion fractures are relatively uncommon fractures commonly seen in adolescent males. The treatment goal is to restore the extensor mechanism and to repair the articular surface. Although previous surgical techniques have been mainly screws or tension band wiring, there is a certain consensus on this. However, the choice of these surgical techniques largely depends on the surgeon. In our case, we utilized a suture anchor distal to the cannulated screw. This enabled us to use a smaller screw and cover the screw head completely with the patellar tendon. Therefore, this can be an advantage in lowering the incidence of device irritation. Given the successful outcome of our technique, we may consider applying suture anchors more frequently in tibial tubercle avulsion fractures in the future.
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Affiliation(s)
- Anna Matsuo
- Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, JPN
| | - Kazuya Kaneda
- Orthopaedic Surgery, Keio University School of Medicine, Tokyo, JPN
| | - Kohei Michifuri
- Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, JPN
| | - Teppei Hayashi
- Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, JPN
| | - Hideo Morioka
- Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, JPN
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Jain V, Gupta H, Mehta N, Joshi D, Kataria H. Retrospective Comparative Analysis of Clinical and Functional Outcome After Arthroscopic Bankart Repair using All-Suture Anchor and Metal Anchor. Malays Orthop J 2024; 18:11-18. [PMID: 38638665 PMCID: PMC11023345 DOI: 10.5704/moj.2403.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/19/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction Both knotted all suture anchors and metal anchors are used for arthroscopic Bankart repair. We retrospectively evaluated and compared clinical and functional outcomes after arthroscopic Bankart repair using the knotted all-suture anchors and knotted metal anchors. Materials and methods In a retrospective cohort analysis, patients who underwent arthroscopic Bankart repair without any concomitant additional lesion repair using either all-suture anchors or metal anchors, between January 2015 and May 2018 were identified. Their pre- and post-operative functional and clinical outcomes were compared using Rowe and WOSI scores. The recurrence rate in the two groups was also compared. Results A total of 41 patients in all suture anchors group and 47 in the metal anchors group were identified as per inclusion and exclusion criteria. The demographic profile of both groups was comparable. There was no significant difference in clinical and functional outcome between the two suture anchor groups as per Rowe (pre-operative 40.13+6.51 vs 38.09+6.24 and post-operative 2 years 93.28+7.09 vs 92.55+9.2) and WOSI (pre-operative 943.05+216.64 vs 977.55+165.46 and post-operative 2 years 278.21+227.56 vs 270.94+186.25) scores. There was a significant improvement in both the groups between preoperative and post-operative ROWE and WOSI scores at 6 months and 2 years follow-up as compared to pre-operative scores (p<0.001). Re-dislocation rates were also comparable (4.8% vs 6.3%). Conclusion All-suture anchors showed comparable clinical and functional results as the metal anchors for arthroscopic Bankart repair at two-year follow-up.
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Affiliation(s)
- V Jain
- Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - H Gupta
- Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - N Mehta
- Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - D Joshi
- Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - H Kataria
- Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
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Abedi A, Pourghazi F, Eslami M, Nabian MH, Ali Mohammadi AM, Zanjani LO, Farahmand F. An additively manufactured titanium tilting suture anchor: a biomechanical assessment on human and ovine bone specimens. Front Surg 2023; 10:1195728. [PMID: 38107406 PMCID: PMC10723827 DOI: 10.3389/fsurg.2023.1195728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction A novel titanium tilting suture anchor was designed and fabricated using additive manufacturing. The anchor enjoyed a nonsymmetrical structure to facilitate its insertion procedure through a weight-induced tilt, a saw-teeth penetrating edge to provide a strong initial fixation into cancellous bones of various densities, and an appropriate surface texture to enhance the longterm fixation strength through bone ingrowth. Methods Biomechanical tests were performed on 10 ovine and 10 human cadaveric humeri to examine the insertion procedure and assess the initial fixation strength of the anchor, in comparison with a standard screw-type anchor as control. Results This study indicated a simple yet reliable insertion procedure for the tilting anchor. All anchors survived after 400 cycles of cyclic loadings and failed in the load-to-failure step. There were no significant differences between the displacements and fixation stiffnesses of the anchors in either group. The ultimate failure load was significantly smaller (p<0.05) for tilting anchors in ovine group (273.7 ± 129.72 N vs. 375.6 ± 106.36 N), but not different in human group (311.8 ± 82.55 N vs. 281.9 ± 88.35). Also, a larger number of tilting anchors were pulled out in ovine group (6 vs. 3) but a smaller number in human group (4 vs. 6). Conclusion It was concluded that the biomechanical performance of the designed tilting anchor is comparable with that of the standard screw-type anchors.
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Affiliation(s)
- Ali Abedi
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Farzad Pourghazi
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
- Orthopedic Surgery Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maysa Eslami
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
- Orthopedic Surgery Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Nabian
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
- Orthopedic Surgery Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Leila Oryadi Zanjani
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
- Orthopedic Surgery Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzam Farahmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
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Yamakado K. UHMWPE suture induced pseudotumor following arthroscopic rotator cuff repair: A case report. Shoulder Elbow 2023; 15:87-91. [PMID: 37974602 PMCID: PMC10649478 DOI: 10.1177/17585732211067117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/15/2021] [Accepted: 11/24/2021] [Indexed: 11/19/2023]
Abstract
UHMWPE suture shows excellent biocompatibility and complication associated with suture debris had not been described before in shoulder surgery. In this study, a case of a 38-year-old man with a wear debris pseudotumor mimicking osteochondromatosis in the subacromial bursa five years after arthroscopic rotator cuff repair using a composite braid suture (a polydioxanone core with a sleeve of UHMWPE) was presented. Histological examination confirmed the presence of suture fragments surrounded with the osteochondral layer without inflammatory reactions. The present study implies the potential risk of free fragmented remnants from the UHMWPE suture. Because of the silent nature of the histological response, a high index of suspicion should be necessary to disclose the chanciness of its use.
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Affiliation(s)
- Kotaro Yamakado
- Department of Orthopaedics, Fukui General Hospital, Fukui, Japan
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Barber FA. Editorial Commentary: Quadriceps Tendon Suture Anchor Repair Provides Better Patient-Reported Outcomes Than Transosseous Tunnel Repair: Defining the New Gold Standard. Arthroscopy 2023; 39:1490-1492. [PMID: 37147076 DOI: 10.1016/j.arthro.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 05/07/2023]
Abstract
Quadriceps tendon suture anchor repair provides biomechanically greater and more consistent failure loads than transosseous tunnel repair, including less cyclic displacement (gap formation). Although satisfactory clinical outcomes are found with both repair techniques, few studies provide a side-to-side comparison. However, recent research demonstrates better clinical outcomes in using suture anchors, with equal failure rates. Suture anchor repair is minimally invasive requiring smaller incisions, less patellar dissection, and eliminates patellar tunnel drilling that can breach the anterior cortex, create stress risers, result in osteolysis from nonabsorbable intraosseous sutures and longitudinal patellar fractures. Suture anchor quadriceps tendon repair should now be considered the gold standard.
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Yang YS, Shih CA, Fang CJ, Huang TT, Hsu KL, Kuan FC, Su WR, Hong CK. Biomechanical comparison of different suture anchors used in rotator cuff repair surgery-all-suture anchors are equivalent to other suture anchors: a systematic review and network meta-analysis. J Exp Orthop 2023; 10:45. [PMID: 37067646 PMCID: PMC10110812 DOI: 10.1186/s40634-023-00608-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/03/2023] [Indexed: 04/18/2023] Open
Abstract
PURPOSE Suture anchors are commonly used to repair rotator cuff tendons in arthroscopy surgery, and several anchor materials have been created to maximize pull-out strength and minimize iatrogenic damage. We hypothesized that all-suture anchors have biomechanical properties equivalent to those of conventional anchors. Our purpose is to compare the biomechanical properties of different anchors used for rotator cuff repair. METHODS The Embase, PubMed, Cochrane, and Scopus databases were searched for biomechanical studies on various suture anchors. The search keywords included rotator cuff tears and suture anchors, and two authors conducted study a selection, risk of bias assessment, and data extraction. The failure load, stiffness, and displacement were calculated using the mean differences with 95% confidence intervals (CIs). Failure modes were estimated using summary odds ratios with 95% CIs. The surface under the cumulative ranking curve was used for the relative ranking probabilities. A sensitivity analysis was performed by excluding studies using synthetic bones. RESULTS The polyetheretherketone (PEEK) (p < 0.001) and all-suture anchors (p < 0.001) had higher failure loads than the biocomposite anchors, whereas no significant difference was observed in stiffness among the anchors. The all-suture (p = 0.006) and biocomposite anchors (p < 0.001) had displacements higher than the metal anchors. The relative ranking of the included anchors in failure loads and displacement changed in sensitivity analysis. The meta-analysis did not find significant differences, but the relative ranking probabilities suggested that all-suture anchor had a higher rate of anchor pull-out and a lower rate of eyelet or suture breakage. In contrast, the metal anchors were associated with a higher number of eyelet breakage episodes. CONCLUSIONS All-suture anchors showed significantly higher failure loads than the biocomposite anchors and similar cyclic displacements to the biocomposite and PEEK anchors. There were no significant differences in stiffness between all-suture and conventional suture anchors. The relative ranking of biomechanical properties changed in sensitivity analysis, suggesting the potential effect of bone marrow density. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Yi-Shiuan Yang
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-An Shih
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Ju Fang
- Department of Secretariat, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Medical Library, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Teng Huang
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Duell B, Long MK, Divella M, Fogel J, Ruotolo C. Transosseous Repair With Nice Knot Augmentation Versus Knotless Suture Anchor Repair With Suture Tape for Quadriceps Tendon Rupture: A Cadaveric Study. Orthopedics 2022; 46:135-140. [PMID: 36508490 DOI: 10.3928/01477447-20221207-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Quadriceps tendon rupture is typically repaired using either transosseous tunnels or suture anchors. Recent literature has suggested that suture anchor repair is biomechanically superior to the use of transosseous tunnels. Augmentation of the transosseous technique with Nice knots may result in improved biomechanical properties as compared with a suture anchor construct. To compare biomechanical properties of a novel transosseous quadriceps tendon repair technique with Nice knot augmentation to those of knotless suture anchor repair, an artificial quadriceps tendon rupture was created in 10 matched pairs of cadaveric knees (n=20). Each cadaver was subjected to biomechanical testing to calculate the average ultimate load to failure, repair site gapping after early and late cyclic loading, and stiffness. Transosseous repair augmented with Nice knots as compared with knotless suture anchor repair had greater load to failure (mean±SD, 1489.5±297.6 N vs 717.7±191.4 N, P<.001), decreased gapping after early and late cyclic loading (cycles 1-20: mean±SD, 0.59±0.4 mm vs 2.1±1.2 mm, P=.008; cycles 21-250: mean±SD, 1.2±0.7 mm vs 3.9±1.7 mm, P=.002), and greater construct stiffness (mean±SD, 80.7±15.7 N/mm vs 44.4±13.4 N/mm, P=.001). The transosseous quadriceps tendon repair technique with Nice knot augmentation is biomechanically better than knotless suture anchor repair with regard to ultimate load to failure, gap formation after cyclic loading, and construct stiffness in cadaveric specimens. [Orthopedics. 202x;4x(x):xx-xx.].
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Alkaissy R, Richard M, Morris H, Snelling S, Pinchbeck H, Carr A, Mouthuy PA. Manufacture of Soft-Hard Implants from Electrospun Filaments Embedded in 3D Printed Structures. Macromol Biosci 2022; 22:e2200156. [PMID: 36048528 DOI: 10.1002/mabi.202200156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/14/2022] [Indexed: 01/15/2023]
Abstract
Rotator cuff tendon tears are common injuries of the musculoskeletal system that often require surgical repair. However, re-tearing following repair is a significant clinical problem, with a failure rate of up to 40%, notably at the transition from bone to tendon. The development of biphasic materials consisting of soft and hard components, which can mimic this interface, is therefore promising. Here, a simple manufacturing approach is proposed that combines electrospun filaments and 3D printing to achieve scaffolds made of a soft polydioxanone cuff embedded in a porous polycaprolactone block. The insertion area of the cuff is based on the supraspinatus tendon footprint and the size of the cuff is scaled up from 9 to 270 electrospun filaments to reach a clinically relevant strength of 227N on average. The biological evaluation shows that the biphasic scaffold components are noncytotoxic, and that tendon and bone cells can be grown on the cuff and block, respectively. Overall, these results indicate that combining electrospinning and 3D printing is a feasible and promising approach to create soft-to-hard biphasic scaffolds that can improve the outcomes of rotator cuff repair.
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Affiliation(s)
- Rand Alkaissy
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Michael Richard
- 3D LifePrints UK Ltd, Nuffield Orthopaedic Centre, Old Road, Oxford, OX3 7LD, United Kingdom
| | - Hayley Morris
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah Snelling
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Henry Pinchbeck
- 3D LifePrints UK Ltd, Nuffield Orthopaedic Centre, Old Road, Oxford, OX3 7LD, United Kingdom
| | - Andrew Carr
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Pierre-Alexis Mouthuy
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Single- and Double-Loaded All-Suture Anchor Repairs of Anteroinferior Labral Tears Are Biomechanically Similar in a Cadaveric Shoulder Model. Arthrosc Sports Med Rehabil 2022; 4:e1933-e1939. [PMID: 36579055 PMCID: PMC9791829 DOI: 10.1016/j.asmr.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/19/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose To compare the biomechanical strength of single- versus double-loaded all-suture constructs in an anteroinferior glenoid labral repair. Methods Anteroinferior labral lesions were created on 6 matched pairs of cadaveric shoulder specimens. Each shoulder in a matched pair was randomized to either receive capsulolabral repair with 3 single-loaded all-suture anchors or 3 double-loaded all-suture anchors. Immediately following capsulolabral repair, the specimens underwent mechanical testing, which included cyclic testing (5 N to 50 N for 500 cycles) and load-to-failure testing (rate of 15 mm/min). The gap formation between the repaired labrum and glenoid (measured at 1, 25, 100, and 500 cycles), the load at 2-mm gap formation, the maximum load at failure and the method of failure were recorded. Data were analyzed with paired Student t tests and Bonferroni correction factor. Results The single and double all-suture constructs did not differ significantly in gap formation at any number of cycles, load to 2-mm gap formation (P = .75), or maximum load to failure (P = .46) between the 2 groups. Conclusions In this study, single-loaded and double-loaded all-suture anchor constructs demonstrated comparable biomechanical performance and did not significantly differ in gap formation, load to 2-mm gap formation, or maximum load to failure when used in the capsulolabral repair of anteroinferior glenoid labral tears in human cadaveric specimens. Clinical Relevance Although studies have evaluated the biomechanical properties of various arthroscopic labral stabilization techniques, the biomechanical properties of all-suture anchors with regard to labral stabilization are not well understood.
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Day Hazra RO, Ernat JJ, Rakowski DR, Boykin RE, Millett PJ. The Evolution of Arthroscopic Rotator Cuff Repair. Orthop J Sports Med 2021; 9:23259671211050899. [PMID: 34901288 PMCID: PMC8652190 DOI: 10.1177/23259671211050899] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/19/2021] [Indexed: 01/08/2023] Open
Abstract
Over the past 30 years, arthroscopic rotator cuff repair (ARCR) has evolved to become the gold standard in treating rotator cuff pathology. As procedural concepts of ARCR continue to improve, it is also continually compared with the open rotator cuff repair as the historical standard of care. This review highlights the evolution of ARCR, including a historical perspective; the anatomic, clinical, and surgical implications of the development of an arthroscopic approach; how arthroscopy improved some of the problems of the open approach; adaptations in techniques and technologies associated with ARCR; future perspectives in orthobiologics as they pertain to ARCR; and lastly, the clinical improvements, or lack of improvements, with all of these adaptations.
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Affiliation(s)
- Rony-Orijit Day Hazra
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Justin J Ernat
- Steadman Philippon Research Institute, Vail, Colorado, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | | | - Robert E Boykin
- Steadman Philippon Research Institute, Vail, Colorado, USA.,EmergeOrtho, Asheville, North Carolina, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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13
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Lall AC, Ankem HK, Ryan MK, Beason DP, Diulus SC, Roach RP, Rosinsky PJ, Maldonado DR, Emblom BA, Domb BG. In-line Pullout Strength of 2 Acetabular Fixation Methods for Ligamentum Teres Reconstruction of the Hip: A Cadaveric Study. Orthop J Sports Med 2021; 9:23259671211052533. [PMID: 34881346 PMCID: PMC8646775 DOI: 10.1177/23259671211052533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/02/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Ligamentum teres (LT) reconstruction is an appropriate alternative in select cases of LT full-thickness tears, resulting in hip micro- or macroinstability. Graft fixation at the acetabular fossa is critical to achieving the best functional results. Purpose: The purpose of this study is to compare the pullout strength of 2 graft fixation methods used for LT reconstruction of the hip. Study Design: Controlled laboratory study. Methods: In 7 cadaveric specimens, the acetabular socket was prepared after the native LT was transected and the femoral head was removed. Seven separate tibialis anterior grafts were then prepared by suturing a running-locking No. 2 suture on each tail of the graft. Three specimens had fixation of the graft to the acetabulum using an adjustable cortical suspension suture button; the remaining 4 were fixed to the acetabulum using a knotless suture anchor. Specimens were then mounted onto a custom jig within a mechanical test frame to allow for the in-line pull of the graft fixation construct. After a preload of 5 N, each specimen was loaded to failure at 0.5 mm/s. Stiffness and load to failure were measured for each specimen construct. Results: Suture button fixation had a higher mean load to failure when compared with the knotless anchor fixation method (mean ± SD, 438.1 ± 114.3 vs 195.9 ± 50.0 N; P = .01). There was no significant difference in mean stiffness between the methods of fixation (24.5 ± 1.4 vs 26.5 ± 5.8 N/mm; P = .6). Conclusion: In this cadaveric study, the suture button fixation demonstrated greater load to failure than the knotless anchor fixation. Clinical Relevance: Results of this study can guide surgical decision making when selecting an acetabular fixation method for LT reconstruction.
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Affiliation(s)
- Ajay C Lall
- American Hip Institute, Des Plaines, Illinois, USA.,American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Hari K Ankem
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Michael K Ryan
- Andrews Sport Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | - David P Beason
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Samantha C Diulus
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Ryan P Roach
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Philip J Rosinsky
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - David R Maldonado
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Benton A Emblom
- Andrews Sport Medicine and Orthopaedic Center, Birmingham, Alabama, USA.,American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Benjamin G Domb
- American Hip Institute, Des Plaines, Illinois, USA.,American Hip Institute Research Foundation, Des Plaines, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
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14
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Sasaki R, Nagashima M, Otani T, Okada Y, Aida S, Takeshima K, Ishii K. Suture Anchor Repair With Fully Threaded Knotless Anchors for Quadriceps Tendon Rupture Resulted in Favorable Outcomes After 2 Years. Arthrosc Sports Med Rehabil 2021; 3:e1931-e1936. [PMID: 34977650 PMCID: PMC8689259 DOI: 10.1016/j.asmr.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate clinical outcomes over 2 years in cases of quadriceps tendon rupture (QTR) that were surgically treated using fully threaded knotless anchors. Methods A total of four knees in four male patients with QTR repaired with fully threaded knotless anchors at our hospital from November 2017 to January 2019 were enrolled. Mean patient age at surgery was 65.3 years (range: 61-70 years). Intraoperatively, stability of the sutured site was confirmed by knee flexion to 90°. Full weight walking with the orthosis in extension was commenced on the seventh postoperative day. Surgical findings, pathologies of the ruptured quadriceps tendons, and postoperative clinical outcomes were evaluated in all patients. Results The QTR was complete in three cases and partial in one. Average surgical duration was 58.5 (range: 49–74) minutes. Pathological evaluation revealed hyaline degeneration with granulation of the quadriceps tendon in two cases. No complications, such as infection and rerupture, occurred. Magnetic resonance imaging performed 1 year postoperatively confirmed complete healing of the repaired tendon. The mean follow-up period was 35.5 months (range: 24–46 months). None of the patients had extension lag of the knee, and mean Lysholm score and range of flexion were 95.3 (range: 85–100) and 141.3° (range: 140–145°), respectively, at the final follow-up. Conclusions Clinical outcomes were favorable in all cases, including two cases with pathological degenerative changes. Suture anchor repair with fully threaded knotless anchors can be considered a minimally invasive and effective method for QTR, with sufficient strength to allow early rehabilitation.
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Affiliation(s)
- Ryo Sasaki
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita City, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, Narita Hospital, Narita City, Japan
| | - Masaki Nagashima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita City, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, Narita Hospital, Narita City, Japan
- Address correspondence to Masaki Nagashima, M.D., Ph.D., Department of Orthopaedic Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan.
| | - Toshiro Otani
- Department of Orthopaedic Surgery, International University of Health and Welfare, Ichikawa Hospital, Ichikawa City, Chiba, Japan
| | - Yoshifumi Okada
- Department of Orthopaedic Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Shinsuke Aida
- Department of Pathological Diagnosis, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Kenichiro Takeshima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita City, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, Narita Hospital, Narita City, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita City, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, Narita Hospital, Narita City, Japan
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15
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Cho CH, Bae KC, Kim DH. Biomaterials Used for Suture Anchors in Orthopedic Surgery. Clin Orthop Surg 2021; 13:287-292. [PMID: 34484619 PMCID: PMC8380519 DOI: 10.4055/cios20317] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 11/09/2022] Open
Abstract
Suture anchors are broadly used for attaching soft tissue (e.g., tendons, ligaments, and meniscus) to the bone and have become essential devices in sports medicine and during arthroscopic surgery. As the usage of suture anchors has increased, various material-specific advantages and challenges have been reported. As a result, suture anchors are continually changing to become safer and more efficient. In this ever-changing environment, it is clinically essential for the surgeon to understand the key characteristics of existing anchors sufficiently. This paper aims to summarize the current concepts on the characteristics of available suture anchors.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Ki-Cheor Bae
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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16
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Ayoub M, EL-Anwar M, Negm MI. Arthroscopic Suture Anchor Design Finite Element Study. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: This in-vitro study investigated arthroscopic suture anchors’ main design parameters effect on surrounding bone.
METHODS: Thirty-dimensional arthroscopic suture anchor designs’ models were created on engineering CAD software by changing thread profile, pitch, and anchor tip profile as design parameters. These models were imported into ANSYS Workbench for finite element analysis. Bone was simplified and modeled as two coaxial cylinders. Tensile vertical load of 300 N, and oblique at 45º to the vertical axis, were applied to each model as two loading conditions while the simplified bone base was fixed in place as a boundary condition.
RESULTS: The finite element analyses on all models under both loading conditions showed stresses within physiological limits on bone. Trapezoidal teeth and inclined cut teeth designs showed the lowest values of stresses and deformations respectively on the bone under oblique loads, while curved tooth and square tooth designs showed the lowest values of stresses and deformations respectively on the bone under vertical loads. General ascending or descending trend was recorded by increasing pitch from 1.2 to 1.5 to 1.8 mm on the total deformation and maximum Von Mises stress on bone and anchor body. Tapered tip slightly increased bone and anchor stresses.
CONCLUSION: Arthroscopic anchors thread profile has minor affect on cortical bone behavior. Trapezoidal teeth, square tooth, and inclined cut teeth profiles showed the lowest values of stresses and deformations on cortical bone. Increasing thread pitch of arthroscopic suture anchors increases or decreases stress on the bone, and anchor body according to thread profile edges. Anchor tip profile negligibly affects both deformations and stresses on bone and anchor body.
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17
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Godry H, Jettkant B, Seybold D, Venjakob AJ, Bockmann B. Pullout strength and failure mode of industrially manufactured and self-made all-suture anchors: a biomechanical analysis. J Shoulder Elbow Surg 2020; 29:1479-1483. [PMID: 32197807 DOI: 10.1016/j.jse.2019.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study presents a new technique for assembling an all-suture anchor from existing medical products. The biomechanical characteristics of this self-made anchor (SMA) are compared with those of an industrially manufactured all-suture anchor. METHODS The SMAs were made from established medical products (FiberWire #2 and 2-mm FiberTape; Arthrex, Naples, FL, USA). Pretesting was performed in biphasic polyurethane foam blocks. In the next step, 10 SMAs and 10 industrially made anchors (IMAs; 1.8-mm double-loaded Y-Knot Flex all-suture anchor; ConMed Linvatec, Largo, FL, USA) were applied with an insertion tool and tested in fresh porcine femora using a servohydraulic testing system, with a preload of 10 N and a displacement rate of 12.5 mm/s. Pullout strength and failure mode were recorded. RESULTS The mean load at failure in the foam blocks was 459 ± 124 N in the SMA group and 538 ± 83 N in the IMA group. In porcine bone, failure occurred at 461 ± 102 N in the SMA group and 431 ± 135 N in the IMA group. The differences in pullout strength between the 2 types of anchor were not statistically significant, either in the foam blocks (P = .17) or in porcine bone (P = .62). CONCLUSION A handmade all-suture anchor using 2 high-strength sutures woven into a 2-mm strip of high-strength tape did not show statistically different failure loads in polyurethane foam or in porcine metaphyseal bone in comparison with a commercially produced double-loaded all-suture anchor. The principal mode of failure in porcine bone in both groups was anchor pullout.
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Affiliation(s)
- Holger Godry
- Department of Rheumatology and Arthroscopy, Marienkrankenhaus Düsseldorf-Kaiserswerth, Düsseldorf, Germany
| | - Birger Jettkant
- Institution for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr University Bochum, Bochum, Germany
| | - Dominik Seybold
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Arne Johannes Venjakob
- Department of Rheumatology and Arthroscopy, Marienkrankenhaus Düsseldorf-Kaiserswerth, Düsseldorf, Germany
| | - Benjamin Bockmann
- Department of Orthopaedics and Trauma Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.
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18
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Berthold DP, Mazzocca AD. Editorial Commentary: A New Star Is Born-The Knotless All-Suture Anchor. Arthroscopy 2020; 36:1533-1534. [PMID: 32503769 DOI: 10.1016/j.arthro.2020.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 02/02/2023]
Abstract
The development of all-suture anchors has revolutionized the field of orthopaedic surgery. Biomechanically, these anchors have similar or better strength when compared with conventional solid anchors. All-suture anchors allow the suture to be placed in cortical bone tunnels, with a smaller diameter, thus limiting potential iatrogenic damage. To avoid the inconsistencies of knot tying and eliminate knot stacks, knotless all-suture anchors have been increasingly used in arthroscopic surgery. This may reduce the potential risk of knot abrasion, which can lead to soft-tissue or cartilage damage. Depending on the intraoperative situation and surgeon preference, surgeons must decide whether knotted or knotless anchor systems are indicated.
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19
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Biomechanical Evaluation of Knotless and Knotted All-Suture Anchor Repair Constructs in 4 Bankart Repair Configurations. Arthroscopy 2020; 36:1523-1532. [PMID: 32057982 DOI: 10.1016/j.arthro.2020.01.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the biomechanical performance of Bankart repair using 1.8-mm knotless all-suture anchors in comparison to 1.8-mm knotted all-suture anchors with both simple and horizontal mattress stitch configurations. METHODS Thirty fresh-frozen human cadaveric shoulders were dissected to the capsule, leaving the glenoid and humeral capsular insertions intact. A standardized anteroinferior labral tear was created and repaired using 3 anchors. A 2 × 2 factorial design was implemented, with 6 matched pairs randomized between knotless and knotted anchor repairs and 6 matched pairs randomized into simple and horizontal mattress stitch configurations. In addition, 6 unpaired shoulders were used to evaluate the native capsulolabral state. First failure load, ultimate load, and stiffness were assessed. Linear mixed-effects modeling was used to compare endpoints. Digital image correlation was used to evaluate capsular strain throughout testing. Failure modes were reported qualitatively. RESULTS The knotless all-suture anchor repair showed similar biomechanical strength to the knotted all-suture anchors for first failure load (coefficient, 142 N; 95% confidence interval [CI], -30 to 314 N; P = .12), ultimate load (coefficient, 11.1 N; 95% CI, -104.9 to 127.2 N; P = .847), and stiffness (coefficient, 3.4 N/mm2; 95% CI, -14.1 to 20.9 N/mm2; P = .697) when stitch configuration was held constant. No statistically significant differences were found on comparison of simple and mattress stitch configurations for first failure load (coefficient, -31 N; 95% CI, -205 to 143 N; P = .720), ultimate load (coefficient, 112 N; 95% CI, -321 to 97 N; P = .291), and stiffness (coefficient, -9.6 N/mm2; 95% CI, -27.3 to 8.1 N/mm2; P = .284) when anchor type was held constant. Specimens with knotless anchors and simple stitch techniques resulted in lower stiffness compared with the native state (P = .030). The knotless-mattress configuration resulted in significantly lower strain than the knotted-mattress (P = .037) and knotless-simple (P = .019) configurations and was the only configuration that did not result in a significant increase in strain compared with the intact specimens (P = .216). Fewer instances of suture slippage (loss of loop security) were observed with knotless anchors versus knotted anchors (11% vs 30%), and less soft-tissue failure was observed with the mattress stitch configuration versus the simple stitch configuration (36% vs 47%). CONCLUSIONS Knotless and knotted all-suture anchor repairs with simple and mattress stitch configurations showed similar values of ultimate load, first failure load, and stiffness. However, the horizontal mattress stitch configuration proved to decrease capsular strain more similarly to the native state compared with the simple stitch configuration. Ultimate load and first failure load for all repairs were similar to those of the native state. CLINICAL RELEVANCE Knotless all-suture anchors have a smaller diameter than solid anchors, can be inserted through curved guides, and preserve glenoid bone stock. This study presents knotless, tensionable all-suture anchor repair for labral tears that displays high biomechanical fixation strength, similar to the native capsulolabral state.
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20
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Kim JH, Kim YS, Park I, Lee HJ, Han SY, Jung S, Shin SJ. A Comparison of Open-Construct PEEK Suture Anchor and Non-Vented Biocomposite Suture Anchor in Arthroscopic Rotator Cuff Repair: A Prospective Randomized Clinical Trial. Arthroscopy 2020; 36:389-396. [PMID: 31864818 DOI: 10.1016/j.arthro.2019.08.049] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare radiologic bone ingrowth and the clinical outcomes of an open-construct (PEEK) (polyether ether ketone) suture anchor with those of a non-vented biocomposite suture anchor in patients with arthroscopic rotator cuff repair. METHODS Sixty-nine patients were randomly allocated into 2 groups based on type of suture anchors used for rotator cuff repair; group 1: open-construct PEEK anchor (36 patients), group 2: non-vented biocomposite anchor (33 patients). The status of bone ingrowth into the anchor and the presence of cyst formation were evaluated at 6 months postoperatively by computed tomography scan using the Modified Barber's ossification scale. The American Shoulder and Elbow Surgeons score, Constant score, and visual analog scale score for pain and range of motion were evaluated. Magnetic resonance imaging or ultrasonography was performed at 12 months postoperatively to examine the integrity of the repaired rotator cuff tendon. RESULTS Significant improvements in shoulder function and pain relief were observed regardless of the anchor used (both Group 1 and 2; P < .001). No differences were found in functional scores and range of motion between the 2 groups. Group 1 showed better bone ingrowth grades than group 2 (poor 2.8 vs 24.2%, fair 27.8 vs 39.4%, good 38.9 vs 33.3%, and excellent 30.6 vs 3.0%; P < .001). The rate of cyst formation around the anchor on the 6 months' postoperative computed tomography (group 1: 14% and group 2: 12%) and re-tear rate at 12 months (5% each) showed no difference between the 2 groups. CONCLUSIONS Shoulder function was improved after complete rotator cuff repair and similar clinical outcomes were achieved regardless of suture anchor material and shape. However, the open-construct PEEK anchor provided better bone ingrowth into the anchor than the non-vented biocomposite anchor at 6 months after arthroscopic rotator cuff repair. LEVEL OF EVIDENCE Level I; Prospective Randomized Trial.
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Affiliation(s)
- Jong-Ho Kim
- Department of Orthopedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University of School of Medicine, Gunpo, Gyeonggi-do, Korea
| | - Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - In Park
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University, Seoul, Korea
| | - Hyo-Jin Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sang-Yup Han
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sehoon Jung
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University, Seoul, Korea.
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El-Anwar M, Osman W. Finite Element Study On Arthroscopic Anchor Design Aspects. Open Access Maced J Med Sci 2019; 7:628-631. [PMID: 30894926 PMCID: PMC6420950 DOI: 10.3889/oamjms.2019.164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 12/01/2022] Open
Abstract
AIM: This research aims to study arthroscopic anchors design parameters. Prototypes were manufactured by new parameters values. The the performance of the prototypes was also tested. METHODS: Five 3D arthroscopic anchor models were created to evaluate the role of some design aspects. Thread type, pitch and tip angle were tested as variable parameters. These models were produced on engineering CAD software then imported into ANSYS for finite element analysis. A tensile load of 300 N was applied to each model while the simplified bone base was fixed-in-place as a boundary condition. The finite element results were compared with prototypes tensile testing. RESULTS: The finite element analyses showed stresses within physiological limits on the bone with all tested models. Thread type and pitch affected stresses on bone and anchor body. From stress point of view, two critical zones appeared on anchor body, anchor cortical bone connection and eyelet zone, while thread geometry (depth) affect the cortical bone response only. Laboratory tests matched finite element results and literature. CONCLUSION: Increasing thread pitch of arthroscopic anchors decreases stress on the bone, while increases stress on anchor body. Arthroscopic anchors thread type has a negligible effect on bone, while it reduces stresses on anchor body if it placed more material around eyelet in internal drive mechanism and suture eyelet type of anchors. Anchor tip angle has a negligible effect on bone and anchor body.
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Affiliation(s)
- Mohamed El-Anwar
- Mechanical Engineering Department, National Research Centre, Cairo, Egypt
| | - Walid Osman
- Orthopedic Department, Helwan University, Helwan, Egypt
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22
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Safran MR, Behn AW, Botser IB, Mardones R. Knotless Anchors in Acetabular Labral Repair: A Biomechanical Comparison. Arthroscopy 2019; 35:70-76.e1. [PMID: 30473457 DOI: 10.1016/j.arthro.2018.07.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 07/20/2018] [Accepted: 07/20/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the failure mechanism, stiffness, and pullout strength of acetabular knotless suture anchors. METHODS Seven suture anchors were tested in high-density (0.48 g/cc) synthetic blocks. The anchors were implanted perpendicular to the bone block. The anchor's suture(s) were tied around a loop of 8 high-strength nonabsorbable sutures and pulled in line with the anchor at a rate of 1 mm/s until failure. The following knotless anchors were tested: Stryker Knotilus 3.5, Arthrex Pushlock 2.9, Linvatec PopLok 2.8, Linvatec PopLok 3.3, ArthroCare SpeedLock HIP (3.4-mm), and Smith & Nephew Bioraptor Knotless 2.9. The standard knot tying Smith & Nephew Bioraptor 2.9 mm served as a baseline for comparison. RESULTS Stiffness was highest in the Pushlock, the SpeedLock HIP, and Knotilus. At 1 mm displacement, the SpeedLock HIP exhibited significantly higher load than all other anchors, excluding the Pushlock and PopLok 3.3 (P ≤ .012 for all comparisons). Excluding the SpeedLock HIP and Knotilus, the Pushlock displayed significantly higher load than all other anchors at 2-mm displacement (P ≤ .015 for all comparisons). Maximum load was the highest for the Knotilus and Bioraptor knotted anchor (P < .001 compared with all other anchors). CONCLUSIONS All knotless suture anchors used in hip arthroscopy, except for the Knotilus 3.5, failed by suture pullout from the anchor. The 2 anchors with the highest maximum load, the Knotilus 3.5 and knotted Bioraptor 2.9, failed by suture failure; however, these anchors displayed the lowest stiffness and load at 1 mm displacement among all anchors tested. Stiffness and loads at clinically relevant displacements, not maximum load alone, may be most important in predicting anchor clinical performance during the early phases of labral healing. CLINICAL RELEVANCE Knotless suture anchors tend to fail by suture pullout from the anchor, yet the stiffness of these constructs suggests that minimal displacement of the repair will occur under physiologic loads.
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Affiliation(s)
- Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, U.S.A..
| | - Anthony W Behn
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, U.S.A
| | | | - Rodrigo Mardones
- Department of Orthopedic Surgery, Clinica Las Condes, Santiago, Chile; Hip Surgery Unit, Hospital Militar, Santiago, Chile
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23
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The history of suture anchors in orthopaedic surgery. Clin Biomech (Bristol, Avon) 2019; 61:70-78. [PMID: 30502638 DOI: 10.1016/j.clinbiomech.2018.11.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 11/12/2018] [Accepted: 11/20/2018] [Indexed: 02/07/2023]
Abstract
The suture anchor allows secure fixation of soft tissue to bone and has become an invaluable tool for the orthopaedic surgeon. The original suture anchor was developed over 3 decades ago when a suture was bonded to a headless screw. Since then anchors have undergone a wide variety of design modifications to increase strength and allow for new applications based on biomechanical and clinical evidence. The suture anchor chain consists of the anchor to bone fixation, anchor suture interface, suture itself and suture to soft tissue interface. The early suture anchors failed most commonly from anchor pull out or breakage, with the strongest early design being a bone-screw-suture complex. Early concerns of metalwork complications saw the introduction of biodegradable suture anchors, originally lactic acid polymers and then osteoconductive bio-composites. Improvements in anchor design saw the suture become the main link of failure until the advent of novel suture materials made of ultrahigh molecular weight polyethylene. A form failure of suture at the anchor eyelet via cut-out led to redesign of the anchor suture interface with novel eyelet designs. Further innovations in the anchor suture interface have seen the advent of knotless anchors, especially useful in arthroscopic surgery. The newest products are all-suture anchors which show impressive strength whilst reducing the iatrogenic damage caused by insertion. The further biomechanical development of suture anchors is likely to produce new designs that continue to increase strength whilst managing size requirements for tailored clinical applications.
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Christensen J, Fischer B, Nute M, Rizza R. Fixation Strength of Polyetheretherketone Sheath-and-Bullet Device for Soft Tissue Repair in the Foot and Ankle. J Foot Ankle Surg 2018; 57:60-64. [PMID: 29268903 DOI: 10.1053/j.jfas.2017.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Indexed: 02/03/2023]
Abstract
Tendon transfers are often performed in the foot and ankle. Recently, interference screws have been a popular choice owing to their ease of use and fixation strength. Considering the benefits, one disadvantage of such devices is laceration of the soft tissues by the implant threads during placement that potentially weaken the structural integrity of the grafts. A shape memory polyetheretherketone bullet-in-sheath tenodesis device uses circumferential compression, eliminating potential damage from thread rotation and maintaining the soft tissue orientation of the graft. The aim of this study was to determine the pullout strength and failure mode for this device in both a synthetic bone analogue and porcine bone models. Thirteen mature bovine extensor tendons were secured into ten 4.0 × 4.0 × 4.0-cm cubes of 15-pound per cubic foot solid rigid polyurethane foam bone analogue models or 3 porcine femoral condyles using the 5 × 20-mm polyetheretherketone soft tissue anchor. The bullet-in-sheath device demonstrated a mean pullout of 280.84 N in the bone analog models and 419.47 N in the porcine bone models. (p = .001). The bullet-in-sheath design preserved the integrity of the tendon graft, and none of the implants dislodged from their original position.
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Affiliation(s)
- Jay Christensen
- Second-Year Resident, Podiatric Medicine and Surgery Program, Wheaton Franciscan Healthcare, Milwaukee, WI.
| | - Brian Fischer
- First-Year Resident, Podiatric Medicine and Surgery Program, Wheaton Franciscan Healthcare, Milwaukee, WI
| | - Michael Nute
- Attending Physician, Podiatric Medicine and Surgery Program, Wheaton Franciscan Healthcare, Milwaukee, WI
| | - Robert Rizza
- Associate Professor, Milwaukee School of Engineering, Milwaukee, WI
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Noyes MP, Lederman E, Adams CR, Denard PJ. Triple-Loaded Suture Anchors Versus a Knotless Rip Stop Construct in a Single-Row Rotator Cuff Repair Model. Arthroscopy 2018; 34:1414-1420. [PMID: 29456064 DOI: 10.1016/j.arthro.2017.12.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/07/2017] [Accepted: 12/04/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical properties of single-row repair with triple-loaded (TL) anchor repair versus a knotless rip stop (KRS) repair in a rotator cuff repair model. METHODS Rotator cuff tears were created in 8 cadaveric matched-pair specimens and repaired with a TL anchor or KRS construct. In the TL construct, anchors were placed in the greater tuberosity and then all suture limbs were passed through the rotator cuff as simple sutures and tied. In the KRS construct, a 2-mm suture tape was passed through the tendon in an inverted mattress fashion, and a free suture was passed medial to the suture tape to create a rip-stop. Then, the suture tape and free suture were secured with knotless anchors. Displacement was observed with video tracking after cyclic loading, and specimens were loaded to failure. RESULTS The mean load to failure was 438 ± 59 N in TL anchor repairs compared with 457 ± 110 N in KRS repairs (P = .582). The mean displacement with cyclic loading was 3.8 ± 1.6 mm in TL anchor repairs versus 4.3 ± 1.8 mm in the KRS group (P = .297). Mode of failure was consistent in both groups, with 6 of 8 failures in the TL anchor group and 7 of 8 failures in KRS group occurring from anchor pullout. CONCLUSIONS There is no statistical difference in load to failure and cyclic loading between TL anchor and KRS single-row repair techniques. CLINICAL RELEVANCE KRS repair technique may be an alternative method of repairing full-thickness supraspinatus tendon tears with a single-row construct.
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Affiliation(s)
- Matthew P Noyes
- Department of Orthopaedic Surgery, Western Reserve Hospital, Cuyahoga Falls, Ohio, U.S.A
| | - Evan Lederman
- The Orthopedic Clinic Association, Phoenix, Arizona, U.S.A.; Department of Orthopedic Surgery, Banner University Medical Center, Phoenix, Arizona, U.S.A
| | | | - Patrick J Denard
- Southern Oregon Orthopedics, Medford, Oregon, U.S.A.; Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon, U.S.A..
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Brown M, Wallace A, Lachlan A, Alexander S. Arthroscopic Soft Tissue Procedures for Anterior Shoulder Instability. Open Orthop J 2017; 11:979-988. [PMID: 29114337 PMCID: PMC5646175 DOI: 10.2174/1874325001711010979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 10/26/2016] [Accepted: 10/28/2016] [Indexed: 12/24/2022] Open
Abstract
Background: Arthroscopy has rapidly transformed the treatment of anterior shoulder instability over the past 30 years. Development of arthroscopic equipment has permitted the investigation and diagnosis of the unstable shoulder, and fixation methods have evolved to promote arthroscopy from an experimental procedure to one of first-line mainstream treatment. Methods: Key research papers were reviewed to identify the fundamental principles in patient diagnosis and appropriate selection for arthroscopic treatment. The evolution of arthroscopy is described in this article to facilitate the understanding of current treatment. Results: Accurate diagnosis of the shoulder instability subtype is essential prior to selection for surgery. Different surgical techniques are described to address different pathology within the glenohumeral joint related to instability and the appropriate method should be selected accordingly to optimise outcome. Conclusion: Anterior shoulder instability can be treated successfully using arthroscopic surgery, but the surgeon must treat each patient as an individual case and recognise the different subtypes of instability, the associated pathological lesions and the limitations of arthroscopy. The article concludes with a suggested algorithm for the treatment of anterior shoulder instability.
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Affiliation(s)
- Mathew Brown
- Fortius Clinic Central 17 Fitzhardinge Street London W1H 6EQ UK
| | - Andrew Wallace
- Fortius Clinic Central 17 Fitzhardinge Street London W1H 6EQ UK
| | - Andrew Lachlan
- Fortius Clinic Central 17 Fitzhardinge Street London W1H 6EQ UK
| | - Susan Alexander
- Fortius Clinic Central 17 Fitzhardinge Street London W1H 6EQ UK
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Erickson J, Chiarappa F, Haskel J, Rice J, Hyatt A, Monica J, Dhawan A. Biomechanical Comparison of a First- and a Second-Generation All-Soft Suture Glenoid Anchor. Orthop J Sports Med 2017; 5:2325967117717010. [PMID: 28795073 PMCID: PMC5524240 DOI: 10.1177/2325967117717010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background: All–soft tissue suture anchors provide advantages of decreased removal of bone and decreased glenoid volume occupied compared with traditional tap or screw-in suture anchors. Previous published data have led to biomechanical concerns with the use of first-generation all-soft suture anchors. Purpose/Hypothesis: The purpose of this study was to evaluate the load to 2-mm displacement and ultimate load to failure of a second-generation all-soft suture anchor, compared with a first-generation anchor and a traditional PEEK (polyether ether ketone) anchor. The null hypothesis was that the newer second-generation anchor will demonstrate no difference in loads to 2-mm displacement after cycling compared with first-generation all-soft suture anchors. Study Design: Controlled laboratory study. Methods: Twenty human cadaveric glenoids were utilized to create 97 total suture anchor sites, and 1 of 3 anchors were randomized and placed into each site: (1) first-generation all-soft suture anchor (Juggerknot; Biomet), (2) second-generation all-soft suture anchor (Suturefix; Smith & Nephew), and (3) a control PEEK anchor (Bioraptor; Smith & Nephew). After initial cyclic loading, load to 2 mm of displacement and ultimate load to failure were measured for each anchor. Results: After cyclic loading, the load to 2-mm displacement was significantly less in first-generation anchors compared with controls (P < .01). However, the load to 2-mm displacement was significantly greater in second-generation anchors compared with controls (P < .01). There was no difference in ultimate load to failure between the first- and second-generation all-soft suture anchors (P > .05). Conclusion: The newer generation all-soft suture anchors with a theoretically more rigid construct and deployment configuration demonstrate biomechanical characteristics (specifically, with load to 2-mm displacement after cyclic loading) that are improved over first-generation all-soft suture anchors and similar to a traditional solid tap-in anchor. The configuration of these newer generation all-soft suture anchors appears to mitigate the biomechanical concerns of decreased load to failure with first-generation all–soft tissue suture anchors. Clinical Relevance: The theoretical advantages of all-soft anchors may be particularly valuable in revision surgery or in cases where multiple anchors are being placed into a small anatomic area.
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Affiliation(s)
- John Erickson
- Department of Orthopaedics, Rutgers-Robert Wood Johnson Medical School (UMDNJ Legacy), New Brunswick, New Jersey, USA
| | - Frank Chiarappa
- Department of Orthopaedics, Rutgers-Robert Wood Johnson Medical School (UMDNJ Legacy), New Brunswick, New Jersey, USA
| | - Jonathan Haskel
- Department of Orthopaedics, Rutgers-Robert Wood Johnson Medical School (UMDNJ Legacy), New Brunswick, New Jersey, USA
| | - Justin Rice
- Department of Orthopaedics, Rutgers-Robert Wood Johnson Medical School (UMDNJ Legacy), New Brunswick, New Jersey, USA
| | - Adam Hyatt
- Department of Orthopaedics, Rutgers-Robert Wood Johnson Medical School (UMDNJ Legacy), New Brunswick, New Jersey, USA
| | - James Monica
- Department of Orthopaedics, Rutgers-Robert Wood Johnson Medical School (UMDNJ Legacy), New Brunswick, New Jersey, USA
| | - Aman Dhawan
- Penn State Hershey Bone and Joint Institute, Hershey, Pennsylvania, USA
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Douglass NP, Behn AW, Safran MR. Cyclic and Load to Failure Properties of All-Suture Anchors in Synthetic Acetabular and Glenoid Cancellous Bone. Arthroscopy 2017; 33:977-985.e5. [PMID: 28132809 DOI: 10.1016/j.arthro.2016.11.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 11/11/2016] [Accepted: 11/28/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the cyclic displacement, maximum load to failure, and failure mode of multiple all-suture anchors (ASAs) in 2 different densities of sawbones cancellous bone substitute. METHODS Anchors tested included the Suturefix Ultra 1.7 mm, JuggerKnot 1.45 mm (No. 1 and No. 2 MaxBraid) and 2.9 mm, Y-Knot Flex 1.3 mm and 1.8 mm, Iconix 1, 2, 25, and 3, Q-Fix 1.8 mm, and Bioraptor 2.3 PK. The Bioraptor served as a non-all-suture-based control. Seven to eleven anchors were tested in both 20 and 30 pounds per cubic foot (pcf) test blocks that were chosen to simulate glenoid and acetabular cancellous bone, respectively. After a 40 N deployment force, anchors were cyclically loaded at 0.5 Hz from 10 to 50 N and then 10 to 100 N for 200 cycles each. Surviving specimens were pulled to failure at 10 mm/s. Displacement, stiffness, maximum load, and failure mode were recorded. Welch t-tests and Welch analysis of variance with Games-Howell post hoc tests were used for statistical analysis. RESULTS In higher density blocks, 11 of 12 anchors had significantly (P < .05) higher maximum loads to failure, and 8 anchors showed significantly lower post-cyclic displacement. The Q-Fix 1.8 displayed the lowest post-cyclic displacement in both densities (0.1 ± 0.2 mm, mean ± standard deviation, in both densities). All other groups exhibited at least 2.8 mm and 0.6 mm post-cyclic displacement in 20 and 30 pcf, respectively. The Bioraptor did not survive cyclic testing in 20 pcf and had 0.6 ± 0.3 mm post-cyclic displacement in 30 pcf. CONCLUSIONS ASAs show better fixation in higher density synthetic bone. The cyclic displacement and maximum load of ASAs vary widely depending on anchor design and bone density. Most anchors fail by suture anchor pullout. In general, the Bioraptor 2.3 PK outperformed ASAs in higher density test blocks with mixed results in lower density test blocks. CLINICAL RELEVANCE ASAs show mixed results compared with a traditional suture anchor. They perform better in higher density bone substitute.
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Affiliation(s)
- Nathan P Douglass
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, U.S.A
| | - Anthony W Behn
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, U.S.A
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, U.S.A..
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Zumstein MA, Raniga S, Labrinidis A, Eng K, Bain GI, Moor BK. Optimal Lateral Row Anchor Positioning in Posterior-Superior Transosseous Equivalent Rotator Cuff Repair: A Micro-Computed Tomography Study. Orthop J Sports Med 2016; 4:2325967116671305. [PMID: 27900336 PMCID: PMC5122170 DOI: 10.1177/2325967116671305] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: The optimal placement of suture anchors in transosseous-equivalent (TOE) double-row rotator cuff repair remains controversial. Purpose: A 3-dimensional (3D) high-resolution micro–computed tomography (micro-CT) histomorphometric analysis of cadaveric proximal humeral greater tuberosities (GTs) was performed to guide optimal positioning of lateral row anchors in posterior-superior (infraspinatus and supraspinatus) TOE rotator cuff repair. Study Design: Descriptive laboratory study. Methods: Thirteen fresh-frozen human cadaveric proximal humeri underwent micro-CT analysis. The histomorphometric parameters analyzed in the standardized volumes of interest included cortical thickness, bone volume, and trabecular properties. Results: Analysis of the cortical thickness of the lateral rows demonstrated that the entire inferior-most lateral row, 15 to 21 mm from the summit of the GT, had the thickest cortical bone (mean, 0.79 mm; P = .0001), with the anterior-most part of the GT, 15 to 21 mm below its summit, having the greatest cortical thickness of 1.02 mm (P = .008). There was a significantly greater bone volume (BV; posterior, 74.5 ± 27.4 mm3; middle, 55.8 ± 24.9 mm3; anterior, 56.9 ± 20.7 mm3; P = .001) and BV as a percentage of total tissue volume (BV/TV; posterior, 7.3% ± 2.7%, middle, 5.5% ± 2.4%; anterior, 5.6% ± 2.0%; P = .001) in the posterior third of the GT than in intermediate or anterior thirds. In terms of both BV and BV/TV, the juxta-articular medial row had the greatest value (BV, 87.3 ± 25.1 mm3; BV/TV, 8.6% ± 2.5%; P = .0001 for both) followed by the inferior-most lateral row 15 to 21 mm from the summit of the GT (BV, 62.0 ± 22.7 mm3; BV/TV, 6.1% ± 2.2%; P = .0001 for both). The juxta-articular medial row had the greatest value for both trabecular number (0.3 ± 0.06 mm–1; P = .0001) and thickness (0.3 ± 0.08 μm; P = .0001) with the lowest degree of trabecular separation (1.3 ± 0.4 μm; P = .0001). The structure model index (SMI) has been shown to strongly correlate with bone strength, and this was greatest at the inferior-most lateral row 15 to 21 mm from the summit of the GT (2.9 ± 0.9; P = .0001). Conclusion: The inferior-most lateral row, 15 to 21 mm from the tip of the GT, has good bone stock, the greatest cortical thickness, and the best SMI for lateral row anchor placement. The anterior-most part of the GT 15 to 21 mm below its summit had the greatest cortical thickness of all zones. The posterior third of the GT also has good bone stock parameters, second only to the medial row. The best site for lateral row cortical anchor placement is 15 to 21 mm below the summit of the GT. Clinical Relevance: Optimal lateral anchor positioning is 15 to 21 mm below the summit of the greater tuberosity in TOE.
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Affiliation(s)
- Matthias A Zumstein
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Department of Orthopedics and Traumatology, University of Adelaide, South Australia, Australia
| | - Sumit Raniga
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Agatha Labrinidis
- Department of Orthopedics and Traumatology, University of Adelaide, South Australia, Australia.; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, South Australia, Australia.; Department of Orthopaedics and Trauma, Modbury Public Hospital, South Australia, Australia
| | - Kevin Eng
- Department of Orthopedics and Traumatology, University of Adelaide, South Australia, Australia.; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, South Australia, Australia.; Department of Orthopaedics and Trauma, Modbury Public Hospital, South Australia, Australia
| | - Gregory I Bain
- Department of Orthopedics and Traumatology, University of Adelaide, South Australia, Australia.; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, South Australia, Australia.; Department of Orthopaedics and Trauma, Modbury Public Hospital, South Australia, Australia
| | - Beat K Moor
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Yang I, Kim S, Kang H, Lee H, Kwon J, Kim S. A Study on Evaluation of Bioabsorbable Anchor (PLGA + β-TCP) Through Mechanical Test Under Moisture Difference1. J Med Device 2016. [DOI: 10.1115/1.4033848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Inchul Yang
- Department of Medical Biotechnology, Dongguk University, Seoul 04620, South Korea
- Research Institute, Solmedix Co., Ltd., Seoul 04196, South Korea
| | - Suryeon Kim
- Department of Medical Device Industry, Dongguk University, Seoul 04620, South Korea
| | - Hochul Kang
- Department of Medical Biotechnology, Dongguk University, Seoul 04620, South Korea
- Research Institute, Solmedix Co., Ltd., Seoul 04196, South Korea
| | - Hyegyeong Lee
- Department of Medical Device Industry, Dongguk University, Seoul 04620, South Korea
| | - Jiyean Kwon
- Department of Medical Device Industry, Dongguk University, Seoul 04620, South Korea
| | - Sungmin Kim
- Department of Medical Biotechnology, Dongguk University, Seoul 04620, South Korea
- Department of Medical Device Industry, Dongguk University, Seoul 04620, South Korea
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31
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Chen JS, Novikov D, Kaplan DJ, Meislin RJ. Effect of Additional Sutures per Suture Anchor in Arthroscopic Bankart Repair: A Review of Single-loaded Versus Double-loaded Suture Anchors. Arthroscopy 2016; 32:1415-20. [PMID: 27157660 DOI: 10.1016/j.arthro.2016.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 01/27/2016] [Accepted: 02/01/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To directly compare single-loaded suture anchors (SSA) with double-loaded suture anchors (DSA) to help surgeons optimize the operative technique, time, and cost of Bankart repairs. METHODS A literature review was performed using the PubMed and SCOPUS databases. Studies that directly compared SSA and DSA for Bankart repairs, or indirectly compared them by collecting relevant data despite a different objective, were included. RESULTS A total of two studies were included, both of which were cadaveric laboratory studies. A total of 28 shoulders were tested. Tests conducted include loading to failure and cyclic loading. One study found SSA to be biomechanically equivalent to DSA, and one found DSA to be superior. CONCLUSIONS Based on limited cadaveric study, DSA are at least equivalent biomechanically to SSA, and may be superior. By using DSA, surgeons create repair constructs that are as strong as, or stronger than, those made with SSA, but with fewer anchors. This reduces the amount of holes drilled and implants placed in the glenoid, while also minimizing cost. CLINICAL RELEVANCE Quantifying the benefit of additional sutures in a suture anchor can help optimize the quality of repair, time, and cost in arthroscopic shoulder repair.
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Affiliation(s)
- Jeffrey S Chen
- Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - David Novikov
- Stony Brook University School of Medicine, Stony Brook, New York, U.S.A
| | - Daniel J Kaplan
- NYU Hospital for Joint Diseases, New York, New York, U.S.A..
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Sano H, Tokunaga M, Noguchi M, Inawashiro T, Irie T, Abe H, Abrassart S, Itoi E. Comparison of fixation properties between coil-type and screw-type anchors for rotator cuff repair: A virtual pullout testing using 3-dimensional finite element method. J Orthop Sci 2016; 21:452-457. [PMID: 27188930 DOI: 10.1016/j.jos.2016.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 11/15/2015] [Accepted: 03/16/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND Pullout of inserted anchor constitutes one of the pathomechanisms of re-tearing after rotator cuff repair. The purpose of the present study was to investigate the fixation properties of suture anchors using 3-dimensional finite element method. METHODS The computer models of three types of anchors (TwinFix Ti, HEALICOIL PK and HEALICOIL RG) were inserted into the isotropic cube model that simulated cancellous bone. In the virtual pullout testing, a tensile load (500 N) along the long axis of the inserted anchor was applied to the site of suture thread attachment to simulate a traction force. The distribution of von Mises equivalent stress, the failure patterns of elements inside the cube and the anchor displacement were compared among the three anchors. RESULTS In TwinFix Ti, the highest stress concentration was seen around the anchor threads close to the surface of the cube, which caused element failure at this site. On the other hand, both HEALICOIL PK and HEALICOIL RG demonstrated a high stress concentration as well as element failure around the anchor tip. Comparing the anchor displacement, HEALICOIL RG showed the smallest displacement among the three anchors. The tensile loads that required a 0.1-mm displacement for TwinFix Ti, HEALICOIL PK and HEALICOIL RG were 400 N, 370 N, and greater than 500 N, respectively. CONCLUSIONS The bony structures close to the footprint surface may be damaged during surgery due to preparation for the bony bed as well as the insertion of anchors. Thus, we assumed that HEALICOIL RG represented the best initial fixation properties among the three anchors tested. Virtual pullout testing using 3-dimensional finite element method could reveal the detailed biomechanical characteristics of each suture anchor, which would be important for shoulder surgeons to improve the clinical outcomes of rotator cuff repair.
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Affiliation(s)
- Hirotaka Sano
- Division of Orthopedics, Sendai City Hospital, Sendai, Japan(1).
| | - Masako Tokunaga
- Division of Orthopedics, Sendai City Hospital, Sendai, Japan(1)
| | | | | | - Taichi Irie
- Division of Orthopedics, Sendai City Hospital, Sendai, Japan(1)
| | - Hiroo Abe
- Division of Orthopedics, Sendai City Hospital, Sendai, Japan(1)
| | | | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
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33
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Sellei RM, Bauer E, Hofman M, Kobbe P, Lichte P, Garrison RL, Pape HC, Horst K. Reconstruction of a quadriceps tendon tear using Polyvinylidene fluoride sutures and patellar screw fixation: A biomechanical study. Knee 2015; 22:535-41. [PMID: 26004197 DOI: 10.1016/j.knee.2015.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/19/2015] [Accepted: 04/15/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acute quadriceps tendon tears are infrequent injuries requiring surgical treatment. Improved stability after surgical repair may allow for earlier weight-bearing and range of motion. Therefore, a new implant was tested and compared with the "gold standard", using transosseous sutures. METHODS Quadriceps tendon tears were constructed using a cadaveric model of 12 fresh matched-pair specimens (aged 61-97; mean age: 82 years). The biomechanical testing compared non-absorbable suture anchors (Polyvinylidene fluoride) versus transosseous absorbable sutures (Polydioxanon). Following anatomic reconstruction, the repaired specimens were loaded until they failed (testing machine: Hounsfield H10KM, Redhill, United Kingdom; maximum force: 1000 N; load speed: 25 mm/min; maximum test length: 150 mm; pre-load: 5 N). Values for load until tear displacement, maximum load until complete failure of the construct (pullout or breakage of the sutures or anchors) and stiffness of the reconstruction were recorded. RESULTS The stiffness found in the Polyvinylidene fluoride reconstruction (mean 9.83 N/mm) (standard deviation (SD) 7.75) showed a significant increase compared to the Polydioxanon reconstruction (mean 6.66 N/mm (SD 3.32); P=0.045). Transosseous fixation showed comparable results to the suture anchor system. There was no significant difference found in the maximum load to tear displacement (PVDF: 290.88 N (SD 106.01) vs. PDS: 266.75 N (SD 82.61); P=0.358). CONCLUSIONS Using the Polyvinylidene fluoride thread showed comparable results to the established method in reconstruction of ruptured quadriceps tendon. Stiffness of the Polyvinylidene fluoride thread reconstruction was even greater than Polydioxanon thread. CLINICAL RELEVANCE Improved stiffness may facilitate healing and is suggested as clinical relevance in reconstruction.
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Affiliation(s)
- R M Sellei
- Department of Orthopaedic Trauma, Sana Klinikum Offenbach, Germany.
| | - E Bauer
- Department of Orthopaedic Trauma, RWTH Aachen University Hospital, Germany
| | - M Hofman
- Department of Orthopaedic Trauma, RWTH Aachen University Hospital, Germany
| | - P Kobbe
- Department of Orthopaedic Trauma, RWTH Aachen University Hospital, Germany
| | - P Lichte
- Department of Orthopaedic Trauma, RWTH Aachen University Hospital, Germany
| | | | - H C Pape
- Department of Orthopaedic Trauma, RWTH Aachen University Hospital, Germany
| | - K Horst
- Department of Orthopaedic Trauma, RWTH Aachen University Hospital, Germany
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34
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Sano H, Imagawa K, Yamamoto N, Ozawa H, Yokobori AT, Itoi E. Predicting failures of suture anchors used for rotator cuff repair: a CT-based 3-dimensional finite element analysis. Biomed Mater Eng 2015; 25:371-80. [PMID: 26407199 DOI: 10.3233/bme-151535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Failure of inserted anchors has been recognized as one of the major pathomechanisms of re-tearing after rotator cuff repair. OBJECTIVE To predict the inserted anchor failure using CT-based 3-dimensional finite element method (CT/3D-FEM). METHODS Among twenty patients who underwent rotator cuff repair, 5 had anchor failure (failed anchor group) and 15 had no anchor failure (stable anchor group). A 3D model of proximal humerus was developed for each patient based on the CT data. A virtual pullout testing of TWINFIX™ anchors inserted into bone at 6 different sites was performed using FEM. Then, mean failure load of 6 anchors for each patient was compared between two groups. Moreover, an optimal cut-off value of the mean failure load was determined for predicting anchor failure. RESULTS The mean failure load in the failed anchor group (70.3 N) was significantly lower than that in the stable anchor group (119.0 N; p<0.0001). In our method, the optimum cut-off value of the mean failure load was 75.4 N. CONCLUSIONS Failure of the inserted TWINFIX™ anchor could be predicted using CT/3D-FEM. In this method, there seemed to be a high risk of anchor failure in shoulders with a mean failure load of <75.4 N.
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Affiliation(s)
- Hirotaka Sano
- Division of Orthopedics, Sendai City Hospital, Sendai, Japan
| | - Kei Imagawa
- Division of Orthopedics, Saiseikai Matsuyama Hospital, Ehime, Japan
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Hiroshi Ozawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - A Toshimitsu Yokobori
- Department of Nano Mechanics, Graduate School of Engineering, Tohoku University, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
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Rodríguez C, García TE, Montes S, Rodríguez L, Maestro A. In vitro comparison between cortical and cortico-cancellous femoral suspension devices for anterior cruciate ligament reconstruction: implications for mobilization. Knee Surg Sports Traumatol Arthrosc 2015; 23:2324-2329. [PMID: 24839039 DOI: 10.1007/s00167-014-3055-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 05/02/2014] [Indexed: 01/10/2023]
Abstract
PURPOSE To analyse the capability of cortical and cortical-cancellous suspension devices to provide a strong fixation in order to follow an aggressive early mobilization protocol. METHODS Anterior cruciate ligament (ACL) reconstruction was performed in vitro on 40 porcine femurs employing a high-strength braided cord as a graft. Four femoral suspension devices were analysed: the cortical suspension devices Endobutton and XO Button and the cortical-cancellous suspension devices Biosteon Cross-pin and Cross-pin ACL. Two kinds of biomechanical testing were carried out: static and post-fatigue failure strength tests. Stiffness, failure load, elongation at failure load, elongation after 20 cycles and elongation after 1,000 cycles were assessed. The bones were cut after testing to analyse the failure pattern. RESULTS All of the devices exceed 50 % of total elongation in the first 20 cycles of fatigue. In the static failure tests, there were significant differences (p < 0.05) in elongation to failure between the cortical-cancellous suspension devices Biosteon Cross-pin and Cross-pin ACL and the cortical suspension device Endobutton. No significant differences were found in the failure tests after 1,000 cycles of loading. The failure mode of the cortical devices comprised breakage of the cortical bone, accompanied by introduction of the device into the tunnel. The failure mode of the cortical-cancellous devices was pin breakage accompanied by tunnel enlargement. CONCLUSION The first cycles of mobilization are critical for elongation. This mobilization process does not significantly diminish the mechanical characteristics of the reconstructions. All the fixations support an intensive early mobilization protocol, with loads of over 500 N.
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Affiliation(s)
- Cristina Rodríguez
- University Institute of Industrial Technology of Asturias (IUTA), University of Oviedo, Edificio Departamental Oeste. 7.1.17. Campus Universitario de Gijón, 33203, Gijón, Spain
| | - Tomás Eduardo García
- University Institute of Industrial Technology of Asturias (IUTA), University of Oviedo, Edificio Departamental Oeste. 7.1.17. Campus Universitario de Gijón, 33203, Gijón, Spain.
| | - Susana Montes
- University Institute of Industrial Technology of Asturias (IUTA), University of Oviedo, Edificio Departamental Oeste. 7.1.17. Campus Universitario de Gijón, 33203, Gijón, Spain
| | - Luis Rodríguez
- Orthopaedic Surgery and Sport Medicine, FREMAP, Juan Carlos I, 1, 33212, Gijón, Spain
| | - Antonio Maestro
- Orthopaedic Surgery and Sport Medicine, FREMAP, Juan Carlos I, 1, 33212, Gijón, Spain
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Braunstein V, Ockert B, Windolf M, Sprecher CM, Mutschler W, Imhoff A, Postl LKL, Biberthaler P, Kirchhoff C. Increasing pullout strength of suture anchors in osteoporotic bone using augmentation--a cadaver study. Clin Biomech (Bristol, Avon) 2015; 30:243-7. [PMID: 25686676 DOI: 10.1016/j.clinbiomech.2015.02.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 02/01/2015] [Accepted: 02/02/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rotator cuff tears are of increasing clinical impact in the physically active elderly patients. Recent research revealed, that a high percentage of these patients present with significant loss of bone mineral density at the insertion site of the rotator cuff, thereby compromising suture anchorage for operative repair. We therefore hypothesized that augmentation of suture anchors improves biomechanical properties in low bone quality. METHODS 28 osteoporotic humeral heads were included in this biomechanical study. Bone quality at the anchor insertion sites (group 1: posterior-medial; group 2: anterior-lateral) within the greater tuberosity was analyzed using HR-pQCT (voxel size: 82μm). Anchor positions of identical quality were then randomized to either conventional screw anchorage or polymethylmethacrylat augmented screw anchorage. All anchors were cyclically ramp-loaded until pullout. FINDINGS Pullout strength accounted for 226N in group I for conventional anchorage and for 332N in augmented technique. In group 2 (anterior-lateral) the pullout strength was 209N (conventional) and 304N (augmented). Pull-out strength of augmented screw anchors was significantly higher in both groups (p<0.05). INTERPRETATION Compared to conventional insertion techniques, the cement augmentation technique increases the pullout strength of suture anchors in low bone quality significantly. Cement augmentation could therefore be a helpful tool for improved suture anchor stability, especially in locations of low bone quality.
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Affiliation(s)
- Volker Braunstein
- OrthoPlus-Muenchen, Germany; Department of Orthopedic Surgery and Traumatology, Ludwig-Maximilians-Universitaet, Muenchen, Germany
| | - Ben Ockert
- Department of Orthopedic Surgery and Traumatology, Ludwig-Maximilians-Universitaet, Muenchen, Germany
| | - Markus Windolf
- AO Research Institute, AO Foundation, Davos, Switzerland
| | | | - Wolf Mutschler
- Department of Orthopedic Surgery and Traumatology, Ludwig-Maximilians-Universitaet, Muenchen, Germany
| | - Andreas Imhoff
- Department of Sports Orthopedics, Technische Universitaet, Muenchen, Germany
| | | | - Peter Biberthaler
- Department of Trauma Surgery, Technische Universitaet, Muenchen, Germany
| | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Technische Universitaet, Muenchen, Germany.
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Skaliczki G, Paladini P, Merolla G, Campi F, Porcellini G. Early anchor displacement after arthroscopic rotator cuff repair. INTERNATIONAL ORTHOPAEDICS 2015; 39:915-20. [DOI: 10.1007/s00264-015-2690-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/22/2015] [Indexed: 01/14/2023]
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Abstract
PURPOSE Rotator cuff surgery is a rapidly evolving branch in orthopaedics, which has raised from a minor niche to a fully recognized subspecialty. This article summarizes its history, examining the development of its key principles and the technical advancements. METHODS Literature was thoroughly searched, and few senior surgeons were interviewed in order to identify the significant steps in the evolution of rotator cuff surgery. RESULTS A wide variety of surgical options is available to reduce pain and restore function after rotator cuff tears. Rotator cuff repair surgical techniques evolved from open to arthroscopic and are still in development, with new fixation techniques and biological solutions to enhance tendon healing being proposed, tested in laboratory and in clinical trials. Although good or excellent results are often obtained, there is little evidence that the results of rotator cuff repair are improving with the decades. An overall high re-tear rate remains, but patients with failed rotator cuff repairs can experience outcomes comparable with those after successful repairs. CONCLUSIONS Rotator cuff repair techniques evolve at a fast pace, with new solutions often being used without solid clinical evidence of superiority. It is necessary to conduct high-level clinical studies, in which data relating to anatomical integrity, patient self-assessed comfort and function, together with precise description of patient's condition and surgical technique, are collected. LEVEL OF EVIDENCE IV.
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Piraino JA, Busch EL, Sansosti LE, Pettineo SJ, Creech C. Use of an all-suture anchor for re-creation of the anterior talofibular ligament: a case report. J Foot Ankle Surg 2014; 54:126-9. [PMID: 25441274 DOI: 10.1053/j.jfas.2014.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Indexed: 02/03/2023]
Abstract
The lateral ankle ligament complex is typically injured during athletic activity caused by an inversion force on a plantar flexed foot. Numerous open surgical procedures to reconstruct the lateral ankle complex have been described. In contrast, we present a case report in which an all-suture anchor was used arthroscopically to re-create the anterior talofibular ligament in conjunction with ankle arthroscopy. A retrospective analysis of a 55-year-old male with a work-related inversion ankle sprain was performed with 14 months of follow-up. Objective and subjective assessments were obtained using range of motion measures, a strength assessment, and the Foot Function Index. An all-suture anchor was deployed through the anterolateral portal and secured in both the fibula and talus, re-creating the anterior talofibular ligament at its origin and insertion. Active range of motion physical therapy began at 2 weeks postoperatively. The patient started a neuromuscular re-education program at 5 weeks with minimal pain or discomfort. A return to full duty was achieved at 3 months postoperatively. To our knowledge, the use of an all-suture anchor has not been previously reported for lateral ankle complex re-creation. It is hoped that this approach to anterior talofibular ligament repair will decrease the incidence of complications and improve outcomes.
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Affiliation(s)
- Jason A Piraino
- Associate Professor, Chief, Foot and Ankle Surgery, and Director, Podiatric Medicine and Surgery Residency, Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine at Jacksonville, Jacksonville, FL
| | - Elliot L Busch
- Resident, St. Lukes University Health Network, Allentown, PA.
| | | | - Steven J Pettineo
- Assistant Professor, Temple University School of Podiatric Medicine, Philadelphia, PA
| | - Corine Creech
- Resident, Temple University Hospital, Philadelphia, PA
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Hanypsiak BT, DeLong JM, Simmons L, Lowe W, Burkhart S. Knot Strength Varies Widely Among Expert Arthroscopists. Am J Sports Med 2014; 42:1978-84. [PMID: 24925142 DOI: 10.1177/0363546514535554] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While most surgeons can tie visually appealing knots under an arthroscope, few surgeons have undergone an objective evaluation of their ability to consistently tie knots with maximum loop and knot security. PURPOSE/HYPOTHESES The purpose of this study was to evaluate and compare variations in ultimate load to failure, 3-mm displacement (clinical failure), and knot stack height of arthroscopic suture knots tied by 73 independent expert orthopaedic arthroscopists. The hypotheses were (1) that skilled arthroscopic surgeons would be able to routinely tie arthroscopic knots of similar strength, (2) that surgeons with <10 years of clinical practice would tie stronger and more consistent knots, and (3) that surgeons who performed >200 arthroscopic shoulder cases per year would produce stronger and more consistent knots than would surgeons who performed fewer cases. STUDY DESIGN Controlled laboratory study. METHODS Each surgeon tied 5 of the same type of their preferred arthroscopic knot and half-hitch locking mechanism. Each knot was mechanically tested for ultimate load to failure and clinical failure. RESULTS For the 365 individual knots tested, the mean ultimate load across each knot was 231 N (range, 29-360 N). The mean clinical failure load was 139 N (range, 16-328 N). The average knot stack height among the 365 knots was 5.61 mm (range, 2.89-10.32 mm). For an individual surgeon, the standard deviations of the 5 consecutive knots tied ranged from 6 to 133 N. The ultimate load and clinical failure load for surgeons with <10 years of practice (n = 39) were 248 ± 93 N and 142 ± 56 N, respectively. The mean ± SD ultimate and clinical failure loads for surgeons with >10 years of practice (n = 34) were 211 ± 111 N and 136 ± 69 N, respectively. When knot strength was used to measure performance, significant differences existed in ultimate load (P = .001); however, there were no differences in clinical failure load (P = .329). Surgeons with <10 years of practice were able to tie knots more consistently than were surgeons in practice for >10 years, for both ultimate load (P = .018) and clinical failure load (P = .005). There was no significant difference based on number of cases performed with respect to ultimate load or clinical failure load (P = .292 and .479, respectively). There was no difference in consistency, as both groups had similar standard deviations (P = .814 for ultimate load, P = .545 for clinical failure). CONCLUSION Considerable variations in knot strength exist between arthroscopic knots tied by surgeons. Study findings revealed that surgeons were unable to tie 5 consecutive knots of the same type consistently; that for both ultimate load and clinical failure load, surgeons with <10 years in practice were able to tie knots more consistently than surgeons with >10 years; and that surgeons performing >200 arthroscopic shoulder cases annually failed to tie stronger or more consistent knots than their counterparts performing fewer cases. CLINICAL RELEVANCE This variation in knot tying has the potential to affect the integrity of arthroscopic repairs. Independent objective testing of the ability to tie secure knots as part of a surgeons' training may be necessary.
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Affiliation(s)
- Bryan T Hanypsiak
- Mt Sinai Hospital, New York, New York, USA Arthrex Incorporated, Naples, Florida, USA
| | - Jeffrey M DeLong
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lillian Simmons
- Arthrex Incorporated, Naples, Florida, USA NOVA Southeastern University, Fort Lauderdale, Florida, USA
| | - Walt Lowe
- University of Texas Medical Center at Houston, Houston, Texas, USA
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Feerick EM, Wilson J, Jarman-Smith M, Ó’Brádaigh CM, McGarry JP. Self-tapping ability of carbon fibre reinforced polyetheretherketone suture anchors. J Biomater Appl 2014; 29:502-13. [DOI: 10.1177/0885328214535274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An experimental and computational investigation of the self-tapping ability of carbon fibre reinforced polyetheretherketone (CFR-PEEK) has been conducted. Six CFR-PEEK suture anchor designs were investigated using PEEK-OPTIMA® Reinforced, a medical grade of CFR-PEEK. Experimental tests were conducted to investigate the maximum axial force and torque required for self-taping insertion of each anchor design. Additional experimental tests were conducted for some anchor designs using pilot holes. Computational simulations were conducted to determine the maximum stress in each anchor design at various stages of insertion. Simulations also were performed to investigate the effect of wall thickness in the anchor head. The maximum axial force required to insert a self-tapping CFR-PEEK suture anchor did not exceed 150 N for any anchor design. The maximum torque required to insert a self-tapping CFR-PEEK suture anchor did not exceed 0.8 Nm. Computational simulations reveal significant stress concentrations in the region of the anchor tip, demonstrating that a re-design of the tip geometry should be performed to avoid fracture during self-tapping, as observed in the experimental component of this study. This study demonstrates the ability of PEEK-OPTIMA Reinforced suture anchors to self-tap polyurethane foam bone analogue. This provides motivation to further investigate the self-tapping ability of CFR-PEEK suture anchors in animal/cadaveric bone. An optimised design for CFR-PEEK suture anchors offers the advantages of radiolucency, and mechanical properties similar to bone with the ability to self-tap. This may have positive implications for reducing surgery times and the associated costs with the procedure.
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Affiliation(s)
- Emer M Feerick
- Department of Mechanical and Biomedical Engineering, National University of Ireland Galway, Ireland
| | - Joanne Wilson
- Invibio Biomaterials Solutions, Technology Centre-Hillhouse International, Thornton Cleveleys, Lancashire, United Kingdom
| | - Marcus Jarman-Smith
- Invibio Biomaterials Solutions, Technology Centre-Hillhouse International, Thornton Cleveleys, Lancashire, United Kingdom
| | - Conchur M Ó’Brádaigh
- Department of Mechanical and Biomedical Engineering, National University of Ireland Galway, Ireland
| | - J Patrick McGarry
- Department of Mechanical and Biomedical Engineering, National University of Ireland Galway, Ireland
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Abstract
Several studies have noted that increasing age is a significant factor for diminished rotator cuff healing, while biomechanical studies have suggested the reason for this may be an inferior healing environment in older patients. Larger tears and fatty infiltration or atrophy negatively affect rotator cuff healing. Arthroscopic rotator cuff repair, double-row repairs, performing a concomitant acromioplasty, and the use of platelet-rich plasma (PRP) do not demonstrate an improvement in structural healing over mini-open rotator cuff repairs, single-row repairs, not performing an acromioplasty, or not using PRP. There is conflicting evidence to support postoperative rehabilitation protocols using early motion over immobilization following rotator cuff repair.
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Affiliation(s)
- Nathan A Mall
- Regeneration Orthopedics, 6 McBride and Son Center Drive, Suite 204, St. Louis, MO 63005. E-mail address for N.A. Mall: . E-mail address for L.S. Choi: . E-mail address for G.A. Paletta Jr.:
| | - Miho J Tanaka
- Regeneration Orthopedics, 6 McBride and Son Center Drive, Suite 204, St. Louis, MO 63005. E-mail address for N.A. Mall: . E-mail address for L.S. Choi: . E-mail address for G.A. Paletta Jr.:
| | - Luke S Choi
- Regeneration Orthopedics, 6 McBride and Son Center Drive, Suite 204, St. Louis, MO 63005. E-mail address for N.A. Mall: . E-mail address for L.S. Choi: . E-mail address for G.A. Paletta Jr.:
| | - George A Paletta
- Regeneration Orthopedics, 6 McBride and Son Center Drive, Suite 204, St. Louis, MO 63005. E-mail address for N.A. Mall: . E-mail address for L.S. Choi: . E-mail address for G.A. Paletta Jr.:
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Long-term degradation of poly-lactic co-glycolide/β-tricalcium phosphate biocomposite anchors in arthroscopic bankart repair: a prospective study. Arthroscopy 2014; 30:165-71. [PMID: 24360347 DOI: 10.1016/j.arthro.2013.09.082] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 09/22/2013] [Accepted: 09/23/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate, using magnetic resonance (MR), the biological efficacy of anchors made of 30% β-tricalcium phosphate and 70% poly-lactic co-glycolide (PLGA) used for the repair of Bankart lesions after shoulder instability. METHODS Twenty consecutive patients who were candidates for surgical treatment for unidirectional, post-traumatic shoulder instability were treated arthroscopically with anchors made of 70% PLGA plus 30% β-tricalcium phosphate preloaded with OrthoCord suture (DePuy Mitek, Raynham, MA). Fifteen of them were evaluated by MR at least 16 months after the intervention. A second evaluation was performed at least 12 months after the first evaluation in the patients in whom implanted anchors were still visible at the first evaluation (n = 5) with a low-intensity signal in all sequences. Two radiologists, with different amounts of experience (15 and 3 years), separately evaluated the MR patterns of the trabecular glenoid bone, the walls of the bone tunnel, and the signal from the anchors. The following parameters were considered in the MR evaluation: integrity of the tunnel edge (grade 0 to 2), intensity of the signal from the anchor site (grade 1 to 3), and presence of cystic lesions. The normal signal from the glenoid trabecular bone has been used as the reference parameter. The anchors were considered independent variables, and thus each one was analyzed individually, even in the same patient. At the final clinical follow-up, a Rowe questionnaire was filled out for each patient. RESULTS Overall, 44 anchors were evaluated (33 anchors at the first follow-up and 11 anchors at the second follow-up). The mean follow-up period was 28.6 months. With the exception of 2 patients (10%), none of the patients had any episodes of dislocation, having satisfactory postoperative results. No cystic lesions were detected by MR imaging. The interobserver concordance between the 2 radiologists calculated with the Cohen κ was substantial (κ = 0.780 and κ = 0.791 for integrity of tunnel edge and for intensity of signal from anchor site, respectively). Both the integrity of the tunnel border and the intensity of the signal at the site of the anchors that had been implanted more than 24 months before the evaluation were significantly different from those of anchors implanted less than 24 months before the evaluation (tunnel border grade of 0 in 41%, 1 in 50%, and 2 in 9% v 0 in 4.5%, 1 in 50%, and 2 in 45.5% [P = .003]; anchor signal grade of 1 in 41%, 2 in 45.5%, and 3 in 13.5% v 1 in 13.5%, 2 in 41%, and 3 in 45.5% [P = .03]). Analysis of the linear contrasts (analysis of variance) showed a linear increase in the mean values for time to increased tunnel border grade (grade 0, 22 ± 4 months; grade 1, 27 ± 8 months; and grade 2, 29 ± 5 months [P = .02]) and grade of intensity of the signal in the anchor site (grade 1, 24 ± 6 months; grade 2, 26 ± 7 months; and grade 3, 29 ± 7 months [P = .05]). CONCLUSIONS Anchors made of 30% β-tricalcium phosphate and 70% PLGA showed excellent biological efficacy, without causing significant cystic lesions, producing gradual changes in the MR signal that seems to become equivalent to that of the glenoid trabecular bone at a mean of 29 months after implantation. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Efird C, Traub S, Baldini T, Rioux-Forker D, Spalazzi JP, Davisson T, Hawkins M, McCarty E. Knotless single-row rotator cuff repair: a comparative biomechanical study of 2 knotless suture anchors. Orthopedics 2013; 36:e1033-7. [PMID: 23937749 DOI: 10.3928/01477447-20130724-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to compare the gap formation during cyclic loading, maximum repair strength, and failure mode of single-row full-thickness supraspinatus repairs performed using 2 knotless suture anchors with differing internal suture-retention mechanisms in a human cadaver model. Nine matched pairs of cadaver shoulders were used. Full-thickness tears were induced by detaching the supraspinatus tendon from the greater tuberosity. Single-row repairs were performed with either type I (Opus Magnum PI; ArthroCare, Austin, Texas) or type II (ReelX STT; Stryker, Mahwah, New Jersey) knotless suture anchors. The repaired tendon was cycled from 10 to 90 N for 500 cycles, followed by load to failure. Gap formation was measured at 5, 100, 200, 300, 400, and 500 cycles with a video digitizing system. Anchor type or location (anterior or posterior) had no effect on gap formation during cyclic loading regardless of position (anterior, P=.385; posterior, P=.389). Maximum load to failure was significantly greater (P=.018) for repairs performed with type II anchors (288±62 N) compared with type I anchors (179±39 N). Primary failure modes were anchor pullout and tendon tearing for type II anchors and suture slippage through the anchor for type I anchors. The internal ratcheting suture-retention mechanism of type II anchors may have helped this anchor outperform the suture-cinching mechanism of type I anchors by supporting significantly higher loads before failure and minimizing suture slippage, potentially leading to stronger repairs clinically.
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Sano H, Takahashi A, Chiba D, Hatta T, Yamamoto N, Itoi E. Stress distribution inside bone after suture anchor insertion: simulation using a three-dimensional finite element method. Knee Surg Sports Traumatol Arthrosc 2013; 21:1777-82. [PMID: 22622782 DOI: 10.1007/s00167-012-2060-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 05/11/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE To define stress distribution patterns inside a bone around suture anchors inserted at different angles using a three-dimensional finite element (FE) method. METHODS An isotropic cube model (Young's modulus, 1,380 MPa; Poisson's ratio, 0.3) was designed on a computer to standardize analysis conditions. A virtual Twinfix anchor was inserted into the cube at two different angles (45° and 90°) against the top surface. A traction force (100 N) was applied to the anchor at six different angles (15°, 30°, 45°, 60°, 75° and 90°) against the top surface. Elastic analysis was performed, and the distribution of the von Mises equivalent stress inside the cube was calculated. The highest value of the equivalent stress at each traction angle was compared between the 45° and 90° anchor insertion settings. RESULTS Stress concentration was most evident around proximal anchor threads, particularly on the traction side. Interestingly, stress gradually declined with an increase in traction angle only for the 90° insertion setting. At 15° and 90° traction angles, the equivalent stress was lower for the 45° insertion setting than for the 90° insertion setting. In contrast, the 90° insertion setting exhibited lower equivalent stress than the 45° insertion setting at 30°, 45° and 60° traction angles. CONCLUSIONS Insertion of an anchor at 90° might reduce the stress concentration around the proximal anchor threads on the traction side and provide lower equivalent stress in the middle range of traction angles (30°-60°) than insertion at 45°. This could avoid early postoperative anchor failure.
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Affiliation(s)
- Hirotaka Sano
- Department of Orthopaedic Surgery, School of Medicine, Tohoku University, 1-1, Seiryo-machi, Aobaku, Sendai, 980-8574, Japan.
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Galland A, Airaudi S, Gravier R, Le Cann S, Chabrand P, Argenson JN. Pullout strength of all suture anchors in the repair of rotator cuff tears: a biomechanical study. INTERNATIONAL ORTHOPAEDICS 2013; 37:2017-23. [PMID: 23835556 DOI: 10.1007/s00264-013-1984-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 06/13/2013] [Indexed: 01/08/2023]
Abstract
PURPOSE We evaluated the biomechanical strength of two all suture anchors (ASA) of reduced diameter (1.4 mm) and compared them with the standard screw anchor (SA) with larger diameter (5.5 mm) used in rotator cuff tears. METHODS We conducted 30 uniaxial vertical pullout tests using Material Testing System Instron 5566A until failure of the anchorage defined as rupture of the threads or anchor or detachment of the anchor. Anchor fixation was on tuberosities of fresh bovine humerus bone. ASAs were spaced four millimetres apart and were compared with a control SA implanted on the same greater tubercle at two centimetres. The tests were all performed at room temperature in a dry environment. Tensile loads (10 mm/min) were applied parallel to the axis of insertion. A preloading of 10 N was used to overcome loading artifacts of the test sample at the beginning of the test. RESULTS Student's t test showed no statistically significant difference between anchors in terms of load to failure (ASA: force 265.06 ± 87.25 N versus SA : 325.35 ± 113.46 N; p = 0.09) and mean elongation at rupture (ASA : 23 ± 7 mm versus SA : 21 ± 6 mm; p = 0.46). CONCLUSIONS In vitro, this experimental study showed no statistically significant difference in pullout strength and displacement between ASA and SA at a chosen level of significance (p < 0.05).
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Affiliation(s)
- Alexandre Galland
- Institut du Mouvement et de l'appareil Locomoteur, 270 Bd Sainte Marguerite, 13009, Marseille, France,
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Haneveld H, Hug K, Diederichs G, Scheibel M, Gerhardt C. Arthroscopic double-row repair of the rotator cuff: a comparison of bio-absorbable and non-resorbable anchors regarding osseous reaction. Knee Surg Sports Traumatol Arthrosc 2013; 21:1647-54. [PMID: 23604175 DOI: 10.1007/s00167-013-2510-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 04/15/2013] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study was to analyse the osseous reaction after arthroscopic double-row rotator cuff repair using bio-absorbable poly-L-lactic acid (PLLA) and non-absorbable polyetheretherketone (PEEK) suture anchors. Focus of interest was the appearance of peri-implant fluid and anchor tunnel widening. METHODS Thirty-six patients were evaluated at final follow-up (16 PLLA and 20 PEEK). Clinical results were acquired by use of the subjective shoulder value, the Constant score and the Western Ontario Rotator Cuff Index. Radiological results were analysed by supraspinatus tendon integrity, footprint coverage, muscular atrophy and fatty infiltration. Furthermore, anchor tunnel expansion was measured, anchor structure and peri-implant fluids graduated. RESULTS At 28.4 ± 8.9-month follow-up, clinical outcome was similar (n.s.). MRI investigation revealed osseous reaction in both groups; tunnel widening was 0.9 ± 0.7 mm in PLLA and 0.8 ± 0.6 mm in PEEK anchors (n.s.). Peri-implant fluid was pronounced in PLLA anchors (p < 0.05). Tunnel widening was significantly higher in lateral anchors irrespectively of the material used. Tendon integrity, muscular atrophy, fatty infiltration and footprint coverage were not significantly different (n.s.). CONCLUSION Both materials lead to osseous reaction in this study, whereas consequences of pronounced fluid in PLLA patients remain unclear. Pronounced tunnel widening in lateral anchors leads to the assumption that other causes such as mechanical stress potentially have to be considered when analysing osseous reaction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hendrik Haneveld
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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Barber FA, Herbert MA, Crates JM. A comparison of lateral ankle ligament suture anchor strength. Foot Ankle Surg 2013; 19:108-11. [PMID: 23548452 DOI: 10.1016/j.fas.2012.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 11/26/2012] [Accepted: 12/11/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lateral ankle ligament repairs increasingly use suture anchors instead of bone tunnels. Our purpose was to compare the biomechanical properties of a knotted and knotless suture anchor appropriate for a lateral ankle ligament reconstruction. METHODS In porcine distal fibulae, 10 samples of 2 different PEEK anchors were inserted. The attached sutures were cyclically loaded between 10N and 60N for 200 cycles. A destructive pull was performed and failure loads, cyclic displacement, stiffness, and failure mode recorded. RESULTS PushLock 2.5 anchors failed before 200 cycles. PushLock 100 cycle displacement was less than Morphix 2.5 displacement (p<0.001). Ultimate failure load for anchors completing 200 cycles was 86.5N (PushLock) and 252.1N (Morphix) (p<0.05). The failure mode was suture breaking for all PushLocks while the Morphix failed equally by anchor breaking and suture breakage. CONCLUSIONS The knotted Morphix demonstrated more displacement and greater failure strength than the knotless PushLock. The PushLock failed consistently with suture breaking. The Morphix anchor failed both by anchor breaking and by suture breaking.
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Affiliation(s)
- F Alan Barber
- Plano Orthopedic Sports Medicine and Spine Center, 5228 West Plano Parkway, Plano, TX 75093, USA
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Cyclic biomechanical testing of biocomposite lateral row knotless anchors in a human cadaveric model. Arthroscopy 2013; 29:1012-8. [PMID: 23578366 DOI: 10.1016/j.arthro.2013.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 01/25/2013] [Accepted: 02/04/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to assess the mechanical performance of biocomposite knotless lateral row anchors based on both anchor design and the direction of pull. METHODS Two lateral row greater tuberosity insertion sites (anterior and posterior) were identified in matched pairs of fresh-frozen human cadaveric shoulders DEXA (dual energy X-ray absorptiometry) scanned to verify comparability. The humeri were stripped of all soft tissue and 3 different biocomposite knotless lateral row anchors: HEALIX Knotless BR (DePuy Mitek, Raynham MA), BioComposite PushLock (Arthrex, Naples, FL), and Bio-SwiveLock (Arthrex). Fifty-two anchors were distributed among the insertion locations and tested them with either an anatomic or axial pull. A fixed-gauge loop (15 mm) of 2 high-strength sutures from each anchor was created. After a 10-Nm preload, anchors were cycled from 10 to 45 Nm at 0.5 Hz for 200 cycles and tested to failure at 4.23 mm/second. The load to reach 3 mm and 5 mm displacement, ultimate failure load, displacement at ultimate failure, and failure mode were recorded. RESULTS Threaded anchors (Bio-SwiveLock, P = .03; HEALIX Knotless, P = .014) showed less displacement with anatomic testing than did the nonthreaded anchor (BioComposite PushLock), and the HEALIX Knotless showed less overall displacement than did the other 2 anchors. The Bio-SwiveLock exhibited greater failure loads than did the other 2 anchors (P < .05). Comparison of axial and anatomic loading showed no maximum load differences for all anchors as a whole (P = .1084). Yet, anatomic pulling produced higher failure loads than did axial pulling for the Bio-SwiveLock but not for the BioComposite PushLock or the HEALIX Knotless. The nonthreaded anchor (BioComposite PushLock) displayed lower failure loads than did both threaded anchors with axial pulling. CONCLUSIONS Threaded biocomposite anchors (HEALIX Knotless BR and Bio-SwiveLock) show less anatomic loading displacement and higher axial failure loads than do the nonthreaded (BioComposite PushLock) anchor. The HEALIX Knotless BR anchor showed less displacement than did the BioComposite PushLock and Bio-SwiveLock anchors. Neither axial nor anatomic loading had an effect on overall anchor displacement. CLINICAL RELEVANCE Because of the strength profiles exhibited, this study supports the use of biocomposite anchors, which have definite advantages over polyetheretherketone (PEEK) and metal products. However, the nonthreaded BioComposite PushLock anchor cannot be recommended.
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Bisbinas I, Magnissalis E, Gigis I, Beslikas T, Hatzokos I, Christoforidis I. Rotator cuff repair: a biomechanical ex vivo ovine study. Proc Inst Mech Eng H 2013; 227:560-70. [PMID: 23637266 DOI: 10.1177/0954411912474781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to assess load to failure of sutures, suturing techniques, and suture anchors used in rotator cuff surgery in order to explore their weaknesses. Ten types of sutures (absorbable and nonabsorbable), four types of suturing techniques, and eight types of suture anchors (bioabsorbable and metallic) were tested. Material Testing Machine and attached load cell were used to test the biomaterials in ex vivo ovine tissues. The results show that the mean load to failure and stiffness were higher in nonabsorbable sutures. Massive cuff tear and modified Mason-Allen suturing techniques had higher failure strength and stiffness when compared to simple and mattress techniques, but there was no substantial difference between them. Metallic suture anchors had higher failure strength when compared to bioabsorbable ones. Often either in metallic or in bioabsorbable anchors, the eyelet fails first. The failure sequence in ovine tissues is found to be in the following order: simple and mattress suturing techniques, nonabsorbable sutures, massive cuff tear and modified Mason-Allen suturing techniques, bioabsorbable anchors, and metallic anchors. Thus, it is concluded that metallic anchors mounted with modern nonabsorbable sutures will fail last. If we use simple and mattress techniques, the tendon-suture level will fail first, but it will improve substantially using more sophisticated suturing techniques (massive cuff tear or modified Mason-Allen).
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Affiliation(s)
- Ilias Bisbinas
- A' Department in Orthopaedics and Trauma Surgery, 424 Military General Hospital, Thessaloniki, Greece.
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