Suture Anchor Versus Transosseous Tunnel Repair for Inferior Pole Patellar Fractures Treated With Partial Patellectomy and Tendon Advancement: A Biomechanical Study

Background: Comminuted inferior pole patellar fractures can be treated in numerous ways. To date, there have been no studies comparing the biomechanical properties of transosseous tunnels versus suture anchor fixation for partial patellectomy and tendon advancement of inferior pole patellar fractures. Hypothesis: Suture anchor repair will result in less gapping at the repair site. We also hypothesize no difference in load to failure between the groups. Study Design: Controlled laboratory study. Methods: Ten cadaveric knee extensor mechanisms (5 matched pairs; patella and patellar tendon) were used to simulate a fracture of the extra-articular distal pole of the patella. The distal simulated fracture fragment was excised, and the patellar tendon was advanced and repaired with either transosseous bone tunnels through the patella or 2 single-loaded suture anchors preloaded with 1 suture per anchor. Load to failure and elongation from cycles 1 to 250 between 20 and 100 N of force were measured, and modes of failure were recorded. Statistical analysis was performed using a paired 2-tailed Student t test. Results: The suture anchor group had less gapping during cyclic loading as compared with the transosseous tunnel group (mean ± SD, 6.83 ± 2.23 vs 13.30 ± 5.74 mm; P = .047). There was no statistical difference in the load to failure between the groups. The most common mode of failure was at the suture-anchor interface in the suture anchor group (4 of 5) and at the knot proximally on the patella in the transosseous tunnel group (4 of 5). Conclusion: Suture anchors yielded similar strength profiles and less tendon gapping with cyclic loading when compared with transosseous tunnels in the treatment of comminuted distal pole of the patellar fractures managed with partial patellectomy and patellar tendon advancement. Clinical Relevance: Suture anchors may offer robust repair and earlier range of motion in the treatment of fractures of the distal pole of the patella. Clinical randomized controlled trials would help clinicians better understand the difference in repair techniques and confirm the translational efficacy in clinical practice.

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Biomechanical Analysis of Patellar Tendon Repair With Knotless Suture Anchor Tape Versus Transosseous Suture

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120954808 ◽

2020 ◽

Vol 8 (10) ◽

pp. 232596712095480

Author(s):

Patrick A. Massey ◽

Mitchell Myers ◽

Kaylan McClary ◽

Jimmy Brown ◽

R. Shane Barton ◽

...

Keyword(s):

Bone Density ◽

Patellar Tendon ◽

Tendon Repair ◽

Suture Repair ◽

Suture Anchors ◽

Gap Formation ◽

Inferior Pole ◽

Transosseous Suture ◽

Load To Failure ◽

Knotless Suture Anchor

Background: Patellar tendon ruptures have routinely been repaired with transosseous suture tunnels. The use of knotless suture anchors for repair has been suggested as an alternative. Purpose: To compare the load to failure and gap formation of patellar tendon repair at the inferior pole of the patella with knotless suture anchor tape versus transosseous sutures. A secondary objective was to investigate whether either technique shows an association between bone density and load to failure. Study Design: Controlled laboratory study. Methods: A total of 20 human tibias with attached patellar and quadriceps tendons were sharply incised at the bone-tendon junction at the inferior pole of the patella. A total of 10 tendons were repaired using 2 knotless suture anchors in the inferior pole of the patella and a single suture tape with 2 core sutures. The other 10 tendons were repaired using No. 2 suture passed through 3 transosseous tunnels. A distracting force was then applied through the suture in the quadriceps tendon. Gap distance through load cycling at the repair site and maximum load at repair failure were then measured. Bone density was measured using computed tomography scanning. Results: No difference was found in the mean load to failure of knotless patellar tendon repair versus transosseous suture repair (367.6 ± 112.2 vs 433.9 ± 99 N, respectively; P = .12). After 250 cycles, the mean repair site gap distance was 0.85 ± 0.45 mm for the knotless patellar tendon repair versus 2.94 ± 2.03 mm for the transosseous suture repair ( P = .03). A small correlation, although not statistically significant, was found between bone density and load to failure for the knotless tape repair ( R 2 = 0.228; P = .66). No correlation was found between bone density and load to failure for the transosseous repair ( R 2 = 0.086; P = .83). Conclusion: Suture tape repair with knotless anchors for repair of patellar tendon rupture has comparable load to failure with less gap formation than transosseous suture repair. There is a small correlation between bone density and failure load for knotless anchor repair, which may benefit from further investigation. Clinical Relevance: Using knotless suture anchors for patellar tendon rupture repair would allow for a smaller incision, less dissection, and likely shorter operating time.

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Biomechanical Evaluation of Proximal Hamstring Repair: All-Suture Anchor Versus Titanium Suture Anchor

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119892925 ◽

2020 ◽

Vol 8 (1) ◽

pp. 232596711989292 ◽

Cited By ~ 1

Author(s):

Alexander Otto ◽

Alyssa M. DiCosmo ◽

Joshua B. Baldino ◽

Julian Mehl ◽

Elifho Obopilwe ◽

...

Keyword(s):

Cyclic Loading ◽

Suture Anchor ◽

Testing Machine ◽

Optical Tracking ◽

Rank Test ◽

Suture Anchors ◽

Posterior Aspect ◽

Significant Difference ◽

Load To Failure ◽

Proximal Hamstring

Background: Proximal hamstring avulsions are severe tendon injuries and are commonly sports-related. Open and endoscopic techniques as well as different anchor configurations have already been described for proximal hamstring repair. Novel all-suture anchors have been developed to provide decreased bone loss during placement and reduced occupied bone volume when compared with titanium suture anchors. Hypothesis: Complete proximal hamstring avulsions repaired with all-suture anchors will demonstrate equal load to failure and comparable displacement under cyclic loading when compared with titanium suture anchors. Study Design: Controlled laboratory study. Methods: Complete proximal hamstring avulsions were created in 18 paired cadaveric specimens (mean ± SD age, 63.0 ± 10.4 years). Either all-suture anchors or titanium suture anchors were used for repair. Cyclic loading from 10 to 125 N at 1 Hz was performed for 1500 cycles with a material testing machine. Displacement was assessed along anterior and posterior aspects of the tendon repair with optical tracking. Specimens were loaded to failure at a rate of 120 mm/min. Displacement, load to failure, and repair construct stiffness were compared between matched pairs with the Wilcoxon signed-rank test. Correlations were determined by Spearman rho analysis. Results: The all-suture anchors showed significantly higher load-to-failure values when compared with the titanium anchor repairs (799.64 ± 257.1 vs 573.27 ± 89.9 N; P = .008). There was no significant difference in displacement between all-suture anchors and titanium suture anchors at the anterior aspect (6.60 ± 2.2 vs 5.49 ± 1.1 mm; P = .26) or posterior aspect (5.87 ± 2.08 vs 5.23 ± 1.37 mm; P = .678) of the repaired hamstring tendons. Conclusion: All-suture anchors demonstrated similar displacement and superior load to failure when compared with titanium suture anchors. Clinical Relevance: The results of this study suggest that all-suture anchors are an equivalent alternative to titanium suture anchors for proximal hamstring avulsion repair.

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Management of comminuted extraarticular inferior pole patella fractures with partial patellectomy and patellar tendon repair by transosseous sutures

International Journal of Medical Science and Public Health ◽

10.5455/ijmsph.2017.0925311092017 ◽

2017 ◽

pp. 1

Author(s):

Konchada Srikant ◽

Debasish Mishra ◽

Vijoy Sinha ◽

Sandeep Pradhan

Keyword(s):

Patellar Tendon ◽

Tendon Repair ◽

Inferior Pole ◽

Patella Fractures ◽

Partial Patellectomy

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Anatomic Suture Anchor Versus the Broström Technique for Anterior Talofibular Ligament Repair

The American Journal of Sports Medicine ◽

10.1177/0363546512458420 ◽

2012 ◽

Vol 40 (11) ◽

pp. 2590-2596 ◽

Cited By ~ 54

Author(s):

Norman E. Waldrop ◽

Coen A. Wijdicks ◽

Kyle S. Jansson ◽

Robert F. LaPrade ◽

Thomas O. Clanton

Keyword(s):

Suture Anchor ◽

Suture Repair ◽

Anterior Talofibular Ligament ◽

Suture Anchors ◽

Premature Failure ◽

Repair Method ◽

Time Zero ◽

Load To Failure ◽

Strength And Stiffness ◽

Suture Anchor Repair

Background: Despite the popularity of the Broström procedure for secondary repair of chronic lateral ankle instability, there have been no biomechanical studies reporting on the strength of this secondary repair method, whether using suture fixation or suture anchors. Hypothesis: The purpose of our study was to perform a biomechanical comparison of the ultimate load to failure and stiffness of the traditional Broström technique using only a suture repair compared with a suture anchor repair of the anterior talofibular ligament (ATFL) at time zero. We believed that fixation strength of the suture anchor repair would be closer to the strength of the native ligament and allow more aggressive rehabilitation. Study Design: Controlled laboratory study. Methods: Twenty-four fresh-frozen cadaveric ankles were randomly divided into 4 groups of 6 specimens. One group was an intact control group, and the other groups consisted of the traditional Broström and 2 suture anchor modifications (suture anchors in talus or fibula) of the Broström procedure. The specimens were loaded to failure to determine the strength and stiffness of each construct. Results: In load-to-failure testing, ultimate failure loads of the Broström (68.2 ± 27.8 N; P = .013), suture anchor fibula (79.2 ± 34.3 N; P = .037), and suture anchor talus (75.3 ± 45.6 N; P = .027) repairs were significantly lower than that of the intact (160.9 ± 72.2 N) ATFL group. Stiffness of the Broström (6.0 ± 2.5 N/mm; P = .02), suture anchor fibula (6.8 N/mm ± 2.7; P = .05), and suture anchor talus (6.6 N/mm ± 4.0; P = .04) repairs were significantly lower than that of the intact (12.4 N/mm ± 4.1 N/mm) ATFL group. The 3 repair groups were not significantly different from each other, but all 3 were substantially lower in strength and stiffness when compared to the intact ATFL. Conclusion: The use of suture anchors to repair the ATFL produces a repair that can withstand loads to failure similar to the suture-only Broström repair. However, all 3 repair groups were much weaker than the intact, uninjured ATFL. Clinical Relevance: Biomechanically, the results show that both suture anchor and direct suture repair of the ATFL provide similar strength and stiffness. Unfortunately, these methods provide less than half the strength and stiffness of the native ATFL at time zero. As a result, regardless of the repair method, it is necessary to sufficiently protect the repair to avoid premature failure.

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Biomechanical Comparison of Flexor Digitorum Profundus Avulsion Repair

Journal of Wrist Surgery ◽

10.1055/s-0039-1685470 ◽

2019 ◽

Vol 08 (04) ◽

pp. 312-316 ◽

Cited By ~ 1

Author(s):

Jill G. Putnam ◽

Damon Adamany

Keyword(s):

Suture Anchor ◽

Tendon Repair ◽

Maximum Load ◽

Flexor Digitorum Profundus ◽

Anchor Group ◽

Load To Failure ◽

Group 3 ◽

Group 2 ◽

Flexor Digitorum ◽

Group 1

Purpose Multiple repair techniques have been investigated for flexor digitorum profundus (FDP) tendon avulsions. The purpose of this study is to compare the biomechanical characteristics of a new fully threaded titanium suture anchor with previously examined fixation techniques. Methods Repair of FDP tendon avulsions was performed in 18 fresh-frozen cadavers using one of three implants: Nano Corkscrew FT 1.7 mm suture anchor (Group 1; Arthrex, Inc., Naples, FL; n = 6), Mitek Micro 1.3 mm suture anchor (Group 2; Mitek Surgical Products, Westwood, MA; n = 6), or pullout suture button fixation (Group 3; n = 6). Constructs were preloaded before testing load to failure. For each trial, elongation at 20 N and maximum load, mean load to failure, stiffness, and failure mechanism were recorded. Results Load to failure occurred in all trials. Mean load to failure was significantly greater for Group 1 (61.6 ± 18.9 N) compared to Group 2 (42.5 ± 4.2 N; p < 0.05) and Group 3 (41.6 N ± 8.0 N; p < 0.05). Stiffness was significantly greater in Groups 1 and 2 compared to Group 3 (6.9 ± 2.2 N/mm vs. 6.1 ± 0.8 N/mm vs. 3.1 N/mm ± 0.5 N/mm, respectively, p < 0.01). Mechanism of failure differed between the groups: Group 1 broke at the anchor in two trials and tore through the tendon in three trials, Group 2's suture universally broke at the anchor, and Group 3's trials mainly failed at the button. Conclusions The Nano Corkscrew anchor (Group 1) has a significantly higher load to failure when compared with the other techniques. The higher load to failure of the corkscrew anchor provides a secure method for flexor tendon repair in zone I. Clinical Relevance A fully threaded titanium suture anchor used for FDP tendon avulsion injuries is likely to withstand early active range of motion protocols.

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Proximal Adductor Avulsion: A Biomechanical Comparison of Suture Anchor Repair Techniques

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00426 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0042

Author(s):

Elan J. Golan ◽

Nicholas Yohe ◽

Ernest M. J. Schilders ◽

Srino Bharam

Keyword(s):

Suture Anchor ◽

Musculotendinous Junction ◽

Anchor Group ◽

Pull Out ◽

Acute Injuries ◽

Load To Failure ◽

Collection Data ◽

Fresh Frozen ◽

Biomechanical Comparison ◽

Repair Techniques

Objectives: Acute avulsion of the proximal fibrocartilaginous origin of the adductor longus (AL) is an injury mostly occurring in individuals that perform cutting and rapid lateral movements such as in hockey, soccer, and rugby. Especially in competitive athletes, recent trends have advocated for surgical repair of these acute injuries. However, while multiple repair configurations have been proposed, the current literature lacks biomechanical data to guide surgical technique. Therefore, the purpose of this study was to determine load-to-failure values for two proximal adductor repair techniques and to compare their strength to that of a native, uninjured proximal adductor tendon. Methods: Seventeen cadaveric fresh frozen pelvic specimens were dissected to preserve the proximal adductor tendon and the fibrocartilage attachment to the pubis. The specimens were then divided into three groups: an intact AL tendon(baseline control), and ‘torn’ tendons repaired with either a 2-suture anchor or 4-suture anchor technique. Once repaired, specimens were cyclically loaded on a custom jig to simulate a maximal effort soccer-style kick. Testing endpoints included suture anchor pull-out, loss of clamp fixation, or catastrophic tendon failure. To control for individual differences, values were reported both in terms of gross force and as load-to-displacement ratios. Following collection, data from each of the three groups were recorded and analyzed via Kruskal-Wallis and multiple comparison tests. Results: The mean load to failure for the 4-anchor group was 83.74±19.28 N, which was significantly greater than for either the intact (25.43±3.46 N, p <0.05) or 2-anchor repair (20.58±1.33 N, p <0.001) conditions. All intact and 4-anchor repair specimens failed via disruption distal to the adductor’s musculotendinous junction, with no failure at the bone-anchor interface noted in either of these groups. In contrast, 80% of 2-anchor repairs failed at the bone to anchor interface. In this group, following initial pullout, failure of a secondary anchor occurred with 41.4% less force than for the index failure (p < 0.001). Conclusion: This study provides biomechanical data which identifies a 4-anchor repair as being much more resistant to surgical-site failure than a 2-anchor construct. Further, the 4-anchor group failed at the same anatomic location as the intact adductor group, suggesting that a 4-anchor construct results in a repair that acts similar to an uninjured control. Based on this finding, a 4-anchor repair construct should be preferentially used in proximal adductor repair whenever clinically feasible. [Figure: see text][Figure: see text]

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Evaluation of Repair of the Hip Labrum under Simulated Full Weight-Bearing

Hip International ◽

10.5301/hipint.5000472 ◽

2017 ◽

Vol 27 (1) ◽

pp. 104-109 ◽

Cited By ~ 2

Author(s):

Jason L. Koh ◽

Kavish Gupta

Keyword(s):

Soft Tissues ◽

Suture Anchor ◽

Weight Bearing ◽

Labral Repair ◽

Full Weight Bearing ◽

Suture Anchors ◽

Gap Formation ◽

Labral Tears ◽

Axial Cyclic Loading ◽

Load To Failure

Introduction Repairs of labral tears are performed for unstable tears, hip instability, and after detachment concomitant to the treatment of femoroacetabular impingement (FAI), but limited data is known about the strength of repair. This study evaluated the effect of simulated axial weight-bearing on suture anchor based repair of the acetabular labrum. Methods 3 cadaveric pelvises underwent creation of a 1.5 cm anterior-superior labral tear in each hip. The tears were then repaired using 2 suture anchors per hip. Following repair, the hip joint underwent axial cyclic loading to 756 N, and were inspected for separation of the labrum from the acetabulum. The strength of the suture anchor repair was evaluated by testing load to failure, in-line with insertion. Results Upon visual examination, all 6 repairs remained fully intact following loading with no visible gap formation or damage at the repair site. In all cases an arthroscopic probe could not be inserted under the edge of the repair. The mean failure force of the 12 suture anchors, in-line with insertion, was 154 N ± 44 N. Conclusions Acetabular labral suture anchor repairs may be able to immediately withstand the physiological loads of axial weight-bearing. Labral repair may be able to tolerate axial weight-bearing immediately after repair, preserving the strength and integrity of muscles and soft tissues.

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Does Greater Trochanter Decortication Affect Suture Anchor Pullout Strength in Abductor Tendon Repairs? A Biomechanical Study

The American Journal of Sports Medicine ◽

10.1177/0363546518759033 ◽

2018 ◽

Vol 46 (7) ◽

pp. 1668-1673 ◽

Cited By ~ 11

Author(s):

Jill G. Putnam ◽

Anikar Chhabra ◽

Paulo Castañeda ◽

J. Brock Walker ◽

Collin C. Barber ◽

...

Keyword(s):

Bone Mineral Density ◽

Bone Density ◽

Suture Anchor ◽

Tendon Repair ◽

Suture Anchors ◽

Pullout Strength ◽

Mineral Density ◽

Greater Trochanter ◽

Load To Failure ◽

Lateral Facet

Background: Greater trochanter decortication is frequently performed at the time of abductor tendon repair to theoretically increase healing potential. No previous studies have determined the effect that greater trochanter decortication has on the pullout strength of suture anchors. Hypothesis/Purpose: The purpose of this study is to determine whether greater trochanter decortication and bone mineral density affect suture anchor pullout strength in abductor tendon repair. The authors hypothesize that both will have a significant detrimental effect on suture anchor pullout strength. Study Design: Controlled laboratory study. Methods: Nineteen cadaveric proximal femurs with accompanying demographic data and computed tomography scans were skeletonized to expose the greater trochanter. Bone density measurements were acquired by converting Hounsfield units to T-score, based on a standardized volumetric sample in the intertrochanteric region of the femur. The gluteus medius insertion site on the lateral facet of the greater trochanter was evenly divided into 2 regions, anterior-distal and posterior-proximal, and each region was randomly assigned to receive either no decortication or 2 mm of bone decortication. A single biocomposite anchor was implanted in each region and initially tested with cyclic loading for 10 cycles at 0-50 N, 0-100 N, 0-150 N, and 0-200 N, followed by load to failure (LTF) tested at 1 mm/s. For each trial, the number of cycles endured, LTF, mechanism of failure, and stiffness were recorded. Results: Greater trochanters with no decortication and 2 mm of decortication survived a mean ± SD 35.1 ± 6.4 and 28.5 ± 10.6 cycles, respectively ( P < .01). Load to failure for nondecorticated specimens was 206.7 ± 75.0 N versus 152.3 ± 60.2 N for decorticated specimens ( P < .001). In a multivariate analysis, decortication and bone density were determinants in LTF ( P < .05). Conclusion: Decortication and decreased bone mineral density significantly decreased the pullout strength of suture anchors in the lateral facet of the greater trochanter. Clinical Relevance: Bone density should be considered when determining whether to perform greater trochanter decortication in abductor tendon repairs.

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The 2.5 mm PushLock suture anchor system versus a traditional suture anchor for ulnar collateral ligament injuries of the thumb: a biomechanical study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193409349152 ◽

2009 ◽

Vol 35 (2) ◽

pp. 139-143 ◽

Cited By ~ 13

Author(s):

C. D. Jarrett ◽

G. R. Mcgillivary ◽

W. C. Hutton

Keyword(s):

Cyclic Loading ◽

Suture Anchor ◽

Ulnar Collateral Ligament ◽

Suture Anchors ◽

Gap Formation ◽

Ligament Injuries ◽

Collateral Ligament ◽

Average Force ◽

Anchor System ◽

Load To Failure

We compared the biomechanical strength of the 2.5 mm PushLock suture anchor with a traditional Bio-SutureTak suture anchor in repair of ulnar collateral ligament injuries. Iatrogenic ulnar collateral ligament injuries in 18 cadaveric thumbs were repaired and used to test for load to failure and cyclic loading. The average force required to generate a 2 mm gap was 7.7 N for the 2.5 mm PushLock and 6.3 N for the Bio-SutureTak ( p = 0.04). The ultimate load to failure was 28.0 N for the 2.5 mm PushLock and 18.8 N for the Bio-SutureTak ( p = 0.16). There were no statistical differences between the two suture anchors under cyclic loading. The 2.5 mm PushLock suture anchor provides significantly stronger resistance to 2 mm gap formation at the repair site and is less likely to fail at the suture–ligament interface. However, there was no difference in the load to failure between the two suture anchors.

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