Cyclic and Load-to-Failure Properties of All-Suture Anchors in Human Cadaveric Shoulder Glenoid Bone

Ruder, John A.; Dickinson, Ephraim Y.; Peindl, Richard D.; Habet, Nahir A.; Trofa, David P.; Fleischli, James E.

doi:10.1016/j.arthro.2019.01.022

Cited by 14 publications

(11 citation statements)

References 24 publications

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“…10 Although 5 mm of displacement is considered clinically significant, for a labral or Bankart repair, 3 mm of gap formation or even less may be a concern. Ruder et al 19 have shown that 3 of 4 all-suture anchors tested exceeded the 5-mm limit during cyclic loading. When 3 mm was considered the cutoff, the number of failed allsuture anchors was even greater.…”

Section: Discussionmentioning

confidence: 95%

The Effect of Torque Differences for All-Suture Anchor Fixation Strength: A Biomechanical Analysis

Lacheta

Miles

Douglass

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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To investigate the biomechanical influence of differential loading of suture strands (torque) on the fixation strength of knotted and knotless all-suture anchors. Methods: The biomechanical strength of 48 all-suture anchors was evaluated for 4 conditions in polyurethane foam blocks: (1) 12 knotted all-suture anchors loaded proportionately, (2) 12 knotted all-suture anchors with 1 suture strand bearing 50% of total force (partial torque), (3) 12 knotted all-suture anchors with 1 strand fixated and the other loaded (full torque), and (4) 12 knotless all-suture anchors with the loop kept open via a fixed rod. Force for 1 mm and 2 mm of displacement and ultimate failure load were assessed. Results: For 1 mm of displacement, groups 2, 3, and 4 showed significantly lower forces than group 1 (all P < .001), with no statistically significant difference between groups 2 and 3 (P ¼ .516); for 2 mm of displacement, all groups showed significantly lower forces than group 1 (P < .001), which positively correlated with applied torque. No differences in the mean ultimate loads observed between testing groups 1, 2, and 4 were noted, with 93.3 AE 3.8 N, 91.4 AE 4.7 N, and 92.6 AE 5.6 N, respectively; however, group 3 exhibited a significantly lower mean ultimate load (62.3 AE 1.7 N) than all other groups (P < .001). Conclusions: The ultimate failure load of knotted and knotless all-suture anchor fixation was partially affected by loading differentials between strands in this validated foam block model. Differential loading of knotted all-suture anchor fixation presented greater initial displacement when compared with symmetrically loaded knotted all-suture anchors. Despite an initial increase in displacement, knotless all-suture anchors showed similar ultimate failure loads to knotted all-suture anchors with strands loaded equally. Clinical Relevance: The role of suture strand loading imbalance on anchor fixation is variable and should be considered during placement and fixation of the repair constructs in a clinical setting.

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Section: Discussionmentioning

confidence: 95%

The Effect of Torque Differences for All-Suture Anchor Fixation Strength: A Biomechanical Analysis

Lacheta

Miles

Douglass

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…The superior performance of the Q-Fix is attributed to mechanical rather than manual tensioning during anchor deployment. Other authors in addition to Ruder et al 1 have reported that all-suture anchor displacement is significantly reduced by mechanical tensioning. 15…”

Section: Anchor Displacementmentioning

confidence: 92%

“…I n "Cyclic and Load to Failure Properties of All-Suture Anchors in Human Cadaveric Shoulder Glenoid Bone," 1 Ruder, Dickinson, Peindl, Habet, and Fleischli performed biomechanical testing and evaluated cyclic displacement and failure loads of all-suture glenoid anchors. The authors are to be congratulated for their contribution.…”

Section: See Related Article On Page 1954mentioning

confidence: 99%

Editorial Commentary: All-Suture Shoulder Glenoid Anchors: Can We Adequately Tension Them or Knot?

Barber¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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All-suture anchors require smaller drill holes (often under 2.0 mm) than comparable solid glenoid anchors (e.g., Gryphon: 2.5-mm drill). A smaller drill allows closer anchor approximation, but there is no indication that this improves repair biomechanics. In fact closely associated multiple fixation points are associated with glenoid fractures, and the same multiple fixation points can be achieved with double-or triple-loaded conventional anchors. All-suture anchors require deployment immediately adjacent to intact cortical bone. Without this, slack and pistoning of the suture ball anchor occur during cyclic loading and have been associated with bone cavitation, repair loosening, and gap formation. A mechanical tensioning mechanism more effectively removes the slack than hand tensioning by the surgeon. Drill length is another concern. All-suture anchor drills measure between 20 and 24 mm long. This length is commonly associated with far cortex penetration and places the suprascapular nerve and axillary nerve at increased risk of contact damage. Maximizing all-suture anchor performance is associated with mechanical deployment systems rather than hand traction applied by the surgeon. Finally, no current all-suture anchor is biodegradable, osteoconductive, or replaced by bone.

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“…It is possible that different manufacturers and anchor types could vary. 1,37 However, by only comparing anchors from 1 company (Arthrex), there may be more consistency in anchor materials and properties for comparison purposes. The study is further limited by the number of specimens tested.…”

Section: Limitationsmentioning

confidence: 99%

Biomechanical Analysis of Anteroinferior Bankart Repair Anchor Types

Yanke,

Allahabadi,

Wang

et al. 2023

Am J Sports Med

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Background: All-suture anchors and knotless anchors are increasingly used in the repair of anteroinferior labral tears in patients with shoulder instability. Optimal repair constructs may limit recurrent instability. Purpose: To perform a quantitative biomechanical comparison of 3 labral fixation devices for soft tissue Bankart lesions: knotless soft-body tensionable anchor (SB knotless), knotted soft-body anchor (SB knotted), and knotless hard-body PEEK (polyether ether ketone) interference anchor (HB knotless). Study Design: Controlled laboratory study. Methods: A total of 21 glenoid specimens were randomized into 3 groups: SB knotless, SB knotted, and HB knotless. Artificial Bankart lesions were created at the anteroinferior labrum. Anchors were placed at the 3:30, 4:30, and 5:30 clockface positions, and sutures were passed through 1 cm of tissue. Anchors were tested simultaneously as one construct by pulling capsular tissue connected to the anteroinferior quadrant. Cyclic loading (5-25 N, 100 cycles) was followed by load-to-failure testing (15 mm/min). Biomechanical testing variables were collected, and failure mechanisms were recorded per individual anchor. Results: There were no differences in baseline specimen characteristics. There was no difference in elongation during cyclic loading ( P = .40). The ultimate load to failure between SB knotless (309.7 ± 125.6 N), SB knotted (226.4 ± 34.8 N), and HB knotless (256.5 ± 90.5 N) did not significantly differ ( P = .25). Failure mechanisms differed among groups ( P = .008); mechanisms included anchor pullout (SB knotless: 33.3%; SB knotted: 23.8%; HB knotless: 28.6%), suture pull-through (SB knotless: 66.7%; SB knotted: 38.1%; HB knotless: 33.3%), and anchor fixation method failure, defined as knot failure for knotted anchors or locking mechanism failure for knotless anchors (SB knotless: 0.0%; SB knotted: 38.1%; HB knotless: 38.1%).) Conclusion: The SB knotless, SB knotted, and HB knotless labral fixation anchors studied exhibited comparable elongation during cyclic loading, stiffness, and ultimate loads to failure in a cadaveric model. However, the failure mechanisms significantly differed, as SB knotless anchors failed primarily from suture pull-through, while SB knotted and HB knotless anchors were subject to knot failure and locking mechanism failure, respectively. Clinical Relevance: These data support the benefit of SB knotless anchors for anteroinferior labral repair in limiting knot failure typically seen with knotted anchors, perhaps demonstrating that all-suture anchors may have better locking mechanism quality than their PEEK counterparts.

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Cyclic and Load-to-Failure Properties of All-Suture Anchors in Human Cadaveric Shoulder Glenoid Bone

Cited by 14 publications

References 24 publications

The Effect of Torque Differences for All-Suture Anchor Fixation Strength: A Biomechanical Analysis

The Effect of Torque Differences for All-Suture Anchor Fixation Strength: A Biomechanical Analysis

Editorial Commentary: All-Suture Shoulder Glenoid Anchors: Can We Adequately Tension Them or Knot?

Biomechanical Analysis of Anteroinferior Bankart Repair Anchor Types

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