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Arthroscopy. 2017 Jan;33(1):68-74. doi: 10.1016/j.arthro.2016.05.040. Epub 2016 Jul 29.

Suture Anchor Fixation in Osteoporotic Bone: A Biomechanical Study in an Ovine Model.

Author information

1
Department of Orthopedic Surgery, Dokuz Eylül University, Izmir, Turkey.
2
Department of Orthopedic Surgery, Dokuz Eylül University, Izmir, Turkey. Electronic address: onurhapa@gmail.com.
3
Plano Orthopedic and Sports Medicine Center, Plano, Texas, U.S.A.
4
Department of Biomechanics, Dokuz Eylül University, Izmir, Turkey.

Abstract

PURPOSE:

To evaluate the load to failure strength of anchor techniques suitable for osteoporotic bone.

METHODS:

Using an osteoporotic ovine model in 72 humeri, 6 fixation techniques were tested. Group 1: two interlocking 5-mm anchors with fewer, wider threads; group 2: one 5-mm anchor; group 3: one 5-mm anchor reinforced laterally by a 6.5-mm cancellous screw; group 4: one 5-mm anchor in an area reinforced with a cancellous plug; group 5: two interlocking 5-mm anchors with smaller threads; group 6: one 5-mm smaller threaded anchor. After a 10-N preload, the specimens were cyclically loaded between 10 N and 30 N for 50 cycles and then destructively tested. Peak-to-peak displacement, cyclic elongation, ultimate load, stiffness, and failure mode were recorded.

RESULTS:

Group 1 had lower peak-to-peak displacement than group 3 (P = .001), group 5 (P = .001), and group 6 (P = .033). In addition, group 1 showed lower cyclic elongation than group 3 (P = .001), group 5 (P = .035), and group 6 (P = .001). Group 1 had a higher ultimate load than group 2 (P = .002), group 3 (P = .019), and group 6 (P = .006). Group 1 also showed higher stiffness than group 2 (P = .007) and group 3 (P = .022). Mode of failure was predominantly caused by anchor pullout for all of the groups except group 3, which mainly failed by suture rupture.

CONCLUSIONS:

Two interlocking suture anchors are stronger than a single anchor in osteoporotic bone. The anchor with fewer, wider threads and a smaller core diameter showed greater strength and less elongation than the other constructs. Reinforcement by cancellous autografting increased suture anchor strength.

CLINICAL RELEVANCE:

Considering concerns about suture anchor pullout from osteoporotic bone, interlocking a second suture anchor with the first increases load to failure resistance. Anchors with small core diameters and fewer but wider threads are more efficient in osteoporotic bone.

PMID:
27476640
DOI:
10.1016/j.arthro.2016.05.040
[Indexed for MEDLINE]

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