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Publisher DOI: 10.1007/s00167-020-06004-6
Title: All-suture anchor pullout results in decreased bone damage and depends on cortical thickness
Language: English
Authors: Ntalos, Dimitris 
Huber, Gerd 
Sellenschloh, Kay 
Saito, Hiroaki 
Püschel, Klaus 
Morlock, Michael 
Frosch, Karl-Heinz 
Klatte, Till Orla 
Keywords: All suture; Arthroscopy; Bone mass density; Cortical thickness; Micro-CT; Pullout; Rotator cuff; Shoulder surgery; Suture anchor
Issue Date: Jul-2021
Publisher: Springer
Source: Knee Surgery, Sports Traumatology, Arthroscopy 29 (7): 2212-2219 (2021-07)
Abstract (english): 
Purpose: To evaluate the influence of cortical and cancellous bone structure on the biomechanical properties of all-suture and conventional anchors and compare the morphological bone damage after their failure. The hypothesis of the study is that all-suture anchor pullout is less invasive and that the pullout force is influenced by the cortical thickness.

Methods: Thirty human humeri were biomechanically tested as follows: starting with a load cycle from 20 to 50 N, a stepwise increase of the upper peak force by 0.05 N for each cycle at a rate of 1 Hz was performed. Analysis included maximum pullout strength for three different anchor implantation angles (45°, 90°, 110°) of the two anchor types. After anchor pullout, every sample underwent micro-CT analysis. Bone mineral density (BMD) and cortical thickness were determined at the anchor implantation site. Furthermore, the diameter of the cortical defect and the volume of the bone cavity were identified.

Results: The maximum pullout strength of all-suture anchors demonstrates a strong correlation to the adjacent cortical thickness (r = 0.82, p ≤ 0.05) with at least 0.4 mm needed to withstand 200 N. No correlation could be seen in conventional anchors. Moreover, no correlation could be detected for local BMD in both anchors. All-suture anchors show a significantly narrower cortical defect as well as a smaller bone cavity following pullout (4.3 ± 1.3 mm vs. 5.3 ± 0.9 mm, p = 0.037; 141 mm3 vs. 212 mm3; p = 0.009). The cortical defect is largest if the anchors are placed at a 45° angle.

Conclusion: In contrast to conventional anchors, the pullout force of all-suture anchors depends on the thickness of the humeral cortex. Furthermore, all-suture anchors show a significantly smaller cortical defect as well as decreased bone damage in the case of pullout. Therefore, the clinical implication of this study is that all-suture anchors are advantageous due to their bone preserving ability. Also, intraoperative decortication should not be performed and cortical thickness should be preoperatively evaluated to decrease the risk of anchor failure.
DOI: 10.15480/882.3642
ISSN: 0942-2056
Journal: Knee surgery, sports traumatology, arthroscopy 
Institute: Biomechanik M-3 
Document Type: Article
License: CC BY 4.0 (Attribution) CC BY 4.0 (Attribution)
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