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

The objective of the paper is to investigate the mechanical and the handling properties of a novel injectable bone void filler based on calcium silicate. The orthopaedic cement based on calcium silicate was compared to a calcium phosphate cement, Norian SRS from Syntes Stratec, with regard to the working (ejection through 14 G needle) and setting time (Gillmore needles), Young’s modulus and the flexural (ASTM F-394) and compressive (ISO 9917) strength after storage in phosphate buffer saline at body temperature for time points from 1h up to 16 weeks. The calcium silicate cement is composed of a calcium silicate powder (grain size below 20 µm) that is mixed with a liquid (water and CaCl2) into a paste using a spatula and a mixing cup. The water to cement ratio used was about 0.5. The calcium silicate had a working time of 15 minutes and a setting time of 17 minutes compared to 5 and 10 minutes respectively for the calcium phosphate cement. The compressive strength was considerably higher for the calcium silicate cement (>100 MPa) compared to the calcium phosphate cement (>40 MPa). Regarding the flexural strength the calcium silicate cement had high values for up to 1 week (> 40 MPa) but it decreased to 25 MPa after 16 weeks. The phosphate cement had a constant flexural strength of about 25 MPa. The results show that calcium silicate cement has the mechanical and handling potential to be used as high strength bone void filler.

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Proximal Femoral Unicameral Cyst Resolved by Single Injection of a Calcium Phosphate Bone Void Filler without Instrumentation

International Journal of Biological Instrumentation ◽

10.35840/2631-5025/5101 ◽

2018 ◽

Vol 1 (1) ◽

Author(s):

EA Lindsay ◽

CE Abbaschian ◽

La Copley

Keyword(s):

Calcium Phosphate ◽

Single Injection ◽

Bone Void Filler ◽

Bone Void

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Novel Use of Calcium Phosphate Bone Void Filler in Rotator Cuff and Labral Repair

Techniques in Shoulder & Elbow Surgery ◽

10.1097/bte.0000000000000163 ◽

2019 ◽

Vol 20 (1) ◽

pp. 19-25 ◽

Cited By ~ 1

Author(s):

Eric A. Branch ◽

Ashley H. Ali ◽

Christopher E. Baker

Keyword(s):

Calcium Phosphate ◽

Rotator Cuff ◽

Labral Repair ◽

Bone Void Filler ◽

Bone Void

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Calcium Sulfate/Calcium Phosphate Bone Void Filler in the Treatment of Bilateral Adolescent Unicameral Calcaneal Bone Cysts: 36-Month Follow-Up

Journal of the American Podiatric Medical Association ◽

10.7547/17-020 ◽

2019 ◽

Vol 109 (5) ◽

pp. 379-388

Author(s):

Jeffrey C. Karr

Keyword(s):

Calcium Phosphate ◽

Calcium Sulfate ◽

Platelet Rich Plasma ◽

Open Approach ◽

Bone Cysts ◽

Allogenic Bone ◽

Bone Void Filler ◽

Calcaneal Cyst ◽

Bone Void

A 36-month follow-up of the management of bilateral adolescent unicameral bone cysts in a high school gymnast treated with a calcium sulfate/calcium phosphate (CSCP) bone void filler (BVF) is presented. The more developed left calcaneal cyst was managed with a traditional, open approach consisting of allogenic bone graft, CSCP BVF mixed with platelet-rich plasma. The less developed right calcaneal cyst was managed with a less used approach, a percutaneous bone cortex incision with only the CSCP BVF. The rationale for the selection between the open and percutaneous approaches, long-term BVF incorporation, and positive patient outcome allowing a quick return to athletics are presented.

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Self Hardening Macroporous Biphasic Calcium Phosphate Bone Void Filler for Bone Reconstruction; Animal Study and Human Data

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.493-494.709 ◽

2011 ◽

Vol 493-494 ◽

pp. 709-713 ◽

Cited By ~ 1

Author(s):

G. Daculsi ◽

Marlene Durand ◽

O. Hauger ◽

Seris Elodie ◽

Pascal Borget ◽

...

Keyword(s):

Calcium Phosphate ◽

Vertebral Body ◽

Biphasic Calcium Phosphate ◽

Bone Ingrowth ◽

Preclinical Study ◽

Bone Reconstruction ◽

Bone Void Filler ◽

The Matrix ◽

Bone Trabeculae ◽

Bone Void

Due to the lack of macroporosity in current available Calcium Phosphate cement used in osteoarticular surgery, Micro and Macroporous Biphasic CaP Cement (MCPC™) was developed. The MCPC™ concept was the association of a settable and a fast resorbable matrix and a sieved fraction of microporous biphasic calcium phosphate (BCP) granules, recognized for the high osteoconductive and osteogenic properties. During the resorption of the matrix, a porous structure is created and the osteoconductive effect of the granules promotes the bone ingrowth. A goat preclinical study was realized to evaluate the efficacy of MCPC™ for C3 and C4 vertebral body filling defects during 6 months. Bone remodelling was evidenced demonstrating bone ingrowth at the expense of the cement and surrounding the residual BCP granules. Bone trabeculae were observed coming from the spongious bone to the implant site. Human vertebral body filling cases demonstrated the biocompatibility and the safety of MCPC™ for bone reconstruction. Results of this study demonstrated the importance of special combination of calcium phosphate granules in the MCPC™ to provide macroporosity and scaffolding for newly formed bone.

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Silicate-substituted calcium phosphate as a bone void filler after kyphoplasty in a young patient with multiple compression fractures due to osteogenesis imperfecta variant

Neurosurgical FOCUS ◽

10.3171/foc.2006.21.6.11 ◽

2006 ◽

Vol 21 (6) ◽

pp. 1-5 ◽

Cited By ~ 13

Author(s):

Mitchell A. Hardenbrook ◽

Sergio R. Lombardo

Keyword(s):

Calcium Phosphate ◽

Pain Relief ◽

Osteogenesis Imperfecta ◽

Synthetic Bone ◽

Compression Fractures ◽

Synthetic Bone Graft ◽

Bone Void Filler ◽

Younger Patient ◽

Multiple Compression ◽

Bone Void

✓Kyphoplasty can be used to treat compression fractures resulting from a variety of causes. The use of polymethyl methacrylate (PMMA) in conjunction with kyphoplasty has many risks and potential complications, however, particularly in the younger patient population. Silicate-substituted calcium phosphate (Actifuse Synthetic Bone Graft; Apatech, Ltd.) is an alternative to PMMA that provides immediate pain relief and the ability to heal and incorporate within the vertebral body.

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Mapping of the Inferior Glenohumeral Ligament for Suture Pullout Strength: A Biomechanical Analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120969640 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712096964

Author(s):

Sumit Raniga ◽

Joseph Cadman ◽

Danè Dabirrahmani ◽

David Bui ◽

Richard Appleyard ◽

...

Keyword(s):

Range Of Motion ◽

Biomechanical Study ◽

Labral Repair ◽

Pullout Strength ◽

Recurrent Instability ◽

Glenohumeral Ligament ◽

Time Zero ◽

Capsular Plication ◽

Inferior Glenohumeral Ligament ◽

The Impact

Background: Suture pullout during rehabilitation may result in loss of tension in the inferior glenohumeral ligament (IGHL) and contribute to recurrent instability after capsular plication, performed with or without labral repair. To date, the suture pullout strength in the IGHL is not well-documented. This may contribute to recurrent instability. Purpose/Hypothesis: A cadaveric biomechanical study was designed to investigate the suture pullout strength of sutures in the IGHL. We hypothesized that there would be no significant variability of suture pullout strength between specimens and zones. Additionally, we sought to determine the impact of early mobilization on sutures in the IGHL at time zero. We hypothesized that capsular plication sutures would fail under low load. Study Design: Descriptive laboratory study. Methods: Seven fresh-frozen cadaveric shoulders were dissected to isolate the IGHL complex, which was then divided into 18 zones. Sutures in these zones were attached to a linear actuator, and the resistance to suture pullout was recorded. A suture pullout strength map of the IGHL was constructed. These loads were used to calculate the load applied at the hand that would initiate suture pullout in the IGHL. Results: Mean suture pullout strength for all specimens was 61.6 ± 26.1 N. The maximum load found to cause suture pullout through tissue was found to be low, regardless of zone of the IGHL. Calculations suggest that an external rotation force applied to the hand of only 9.6 N may be sufficient to tear capsular sutures at time zero. Conclusion: This study did not provide clear evidence of desirable locations for fixation in the IGHL. However, given the low magnitude of failure loads, the results suggest the timetable for initiation of range-of-motion exercises should be reconsidered to prevent suture pullout through the IGHL. Clinical Relevance: From this biomechanical study, the magnitude of force required to cause suture pullout through the IGHL is met or surpassed by normal postoperative early range-of-motion protocols.

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