All-Suture Anchors: Biomechanical Analysis of Pullout Strength, Displacement, and Failure Mode

Abstract Rotator cuff (RC) tears cause pain and functional disability of the shoulder. Despite advances in suture anchors, there are still reports about the incidence of surgical-related injuries to RC mainly associated with sutures. The purpose of this study was to design and evaluate the mechanical behavior of sutureless implants to repair RC tears. We hypothesized that the implants present mechanical characteristics suitable for the surgical treatment of RC tears as suture anchors. Three different implants (T1,T2,T3) were designed and fabricated with titanium: T1 has two rods and rectangular head; T2 has two rods with a small opening and enlarged rectangular head and T3 has three rods and a circular head. The implants were fixed in rigid polyurethane foam blocks by a series of blows, and the applied mechanical loads along with the number of blows were quantified. Pullout tests using tapes fixed between the implant head and testing machine grip were conducted until implant failure. The maximum pullout strength and displacement of the implant relative to the rigid foam block were computed. Statistical significance was set at p < 0.05. Owing to its geometric configuration, implant T2 presented the best characteristics related to stability, strength, and ease of insertion. Implant T2 confirms our hypothesis that its mechanical behavior is compatible with that of suture anchors which could lead to the reduction of RC repair failures and simplify the arthroscopic procedure.

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The Influence of Trabecular Microstructure on Mechanical Properties and the Pullout Strength of Suture Anchors

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19118 ◽

2010 ◽

Author(s):

Mariya Poukalova ◽

Christopher M. Yakacki ◽

Robert E. Guldberg ◽

Angela Lin ◽

Ken Gall

Keyword(s):

Mechanical Properties ◽

Bone Mineral Density ◽

Suture Anchor ◽

Common Type ◽

Tissue Fixation ◽

Suture Anchors ◽

Pullout Strength ◽

Mineral Density ◽

Trabecular Microstructure ◽

Type Of Surgery

Suture anchors provide soft-tissue fixation, often tendons and ligaments, to bone. The most common type of surgery in which suture anchors are used is in rotator cuff repairs, where the anchor is implanted into the humerus to create a point of fixation for the supraspinatus.[1–2] Pullout strength, or the force necessary to pull the anchor from the bone, has been previously used as a metric to compare suture anchor performance. In investigating suture anchor performance, it has been suggested that pullout strength is positively correlated to bone mineral density (BMD).[2]

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Pullout strength of suture anchors in comparison with transosseous sutures for rotator cuff repair

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-007-0460-3 ◽

2008 ◽

Vol 16 (5) ◽

pp. 504-510 ◽

Cited By ~ 26

Author(s):

Matthias F. Pietschmann ◽

Valerie Fröhlich ◽

Andreas Ficklscherer ◽

Jörg Hausdorf ◽

Sandra Utzschneider ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Suture Anchors ◽

Pullout Strength ◽

Cuff Repair

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Biomechanical analysis of bioabsorbable suture anchors for rotator cuff repair using osteoporotic and normal bone models

Journal of Orthopaedic Science ◽

10.1016/j.jos.2020.11.017 ◽

2021 ◽

Author(s):

Shohei Yamauchi ◽

Harehiko Tsukada ◽

Eiji Sasaki ◽

Shizuka Sasaki ◽

Yuka Kimura ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Biomechanical Analysis ◽

Suture Anchors ◽

Normal Bone ◽

Cuff Repair

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Cyclic Testing of Flexible All-Inside Meniscus Suture Anchors: Biomechanical Analysis

The American Journal of Sports Medicine ◽

10.1177/0363546504271204 ◽

2005 ◽

Vol 33 (3) ◽

pp. 388-394 ◽

Cited By ~ 51

Author(s):

Thore Zantop ◽

Ann K. Eggers ◽

Volker Musahl ◽

Andre Weimann ◽

Wolf Petersen

Keyword(s):

Cyclic Loading ◽

Biomechanical Properties ◽

Meniscus Repair ◽

Biomechanical Analysis ◽

Suture Techniques ◽

Suture Anchors ◽

Pull Out ◽

Meniscus Suture ◽

Significant Difference ◽

Pull Out Strength

Background Flexible meniscus repair devices are designed to combine the benefits of rigid all-inside meniscus anchors with the biomechanical properties of sutures. Hypothesis Stiffness and pull-out strength of flexible all-inside suture anchors and conventional sutures under cyclic loading conditions will be comparable. Study Design Controlled laboratory study Methods In 50 fresh frozen bovine menisci, artificial meniscus lesions were repaired with different meniscus fixation techniques: horizontal and vertical FasT-Fix, RapidLoc, and horizontal and vertical 2-0 Ethibond sutures. The specimens were cycled 1000 times between 5 and 20 N and then loaded to failure. Results All devices survived the cyclic loading protocol. There was no significant difference in the displacement between all repair techniques tested (horizontal FasT-Fix, 6.23 mm; vertical FasT-Fix, 5.34 mm; RapidLoc, 6.84 mm; horizontal 2-0 Ethibond, 6.03 mm; vertical 2-0 Ethibond, 5.61 mm (P >. 05). Vertical and horizontal FasT-Fix suture anchors had a significantly higher stiffness and pull-out strength (94.1 N and 80.8 N, respectively) than did horizontal sutures (50.2 N) and RapidLoc devices (30.3 N) (P >. 05). Conclusions In this study, flexible all-inside meniscus anchors (FasT-Fix) had higher pull-out strength than did conventional vertical suture techniques. Biomechanical characteristics of the flexible RapidLoc are comparable to those of horizontal sutures. Clinical Relevance Flexible all-inside meniscus repair devices are an alternative to conventional suture techniques.

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Biomechanical Analysis of a Double-Loaded Glenoid Anchor Configuration

The American Journal of Sports Medicine ◽

10.1177/0363546512469090 ◽

2012 ◽

Vol 41 (1) ◽

pp. 163-168 ◽

Cited By ~ 22

Author(s):

Ganesh V. Kamath ◽

Stephen Hoover ◽

R. Alexander Creighton ◽

Paul Weinhold ◽

Aaron Barrow ◽

...

Keyword(s):

Tensile Load ◽

The Other ◽

Biomechanical Analysis ◽

Bankart Repair ◽

Matched Pair ◽

Materials Testing ◽

Testing Device ◽

Suture Anchors ◽

Variable Reluctance ◽

Biomechanical Strength

Background: Bankart repair with multiple anchor holes concentrated in the anterior-inferior glenoid may contribute to glenoid weakening and potentially may induce glenoid failure. Purpose: To compare the biomechanical strength of a Bankart repair construct that used 3 single-loaded suture anchors versus a repair construct that used 2 double-loaded suture anchors. Study Design: Comparative laboratory study. Methods: A standard Bankart lesion was created in 18 human cadaveric shoulders (9 matched pairs). Within each matched pair, 1 repair construct used 3 single-loaded anchors, whereas the other used 2 double-loaded suture anchors. Measured outcomes (load, stiffness, and energy absorbed) were recorded at failure and at 2 mm of labral displacement. Constructs were loaded to failure with a materials testing device that had differential variable reluctance transducers for displacement measurements. Results: The double-loaded anchor construct had a significantly higher ultimate tensile load (944 ± 231 vs 784 ± 287 N; P = .03). For the other measures (load at 2 mm of displacement, energy absorbed at failure and at 2 mm of displacement and stiffness), there were no significant differences between tested constructs. Conclusion: A Bankart repair construct that used 2 double-loaded anchors was either superior to or equal to a repair construct that used 3 single-loaded anchors in all measured outcomes. Clinical Relevance: Using 2 double-loaded suture anchors for a Bankart repair may limit anchor holes in the glenoid and reduce the risk of postsurgical glenoid fracture while providing a stable repair construct.

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