Suture anchor fixation strength with or without augmentation in osteopenic and severely osteoporotic bones in rotator cuff repair: a biomechanical study on polyurethane foam model

Er, Mehmet Serhan; Altınel, Levent; Eroglu, Mehmet; Verim, Ozgur; Demir, Teyfik; Atmaca, Halil

doi:10.1186/1749-799x-9-48

Cited by 29 publications

(15 citation statements)

References 20 publications

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“…According to in vitro tests, all sutures were failed at around 280N. That matches previous studies by Aktay et al, and Er et al, [5], [22], that find it of order 300 N. A common area of failure with metallic anchors is at the suture–anchor interface where the suture is serially abraded by the anchor’s eyelet [19]. The eyelet design along with surface roughness and the arc of contact between the eyelet and suture all contribute to the frictional resistance created.…”

Section: Discussionsupporting

confidence: 89%

Finite Element Study On Arthroscopic Anchor Design Aspects

El-Anwar¹,

Osman²

2019

Open Access Maced J Med Sci

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AIM: This research aims to study arthroscopic anchors design parameters. Prototypes were manufactured by new parameters values. The the performance of the prototypes was also tested. METHODS: Five 3D arthroscopic anchor models were created to evaluate the role of some design aspects. Thread type, pitch and tip angle were tested as variable parameters. These models were produced on engineering CAD software then imported into ANSYS for finite element analysis. A tensile load of 300 N was applied to each model while the simplified bone base was fixed-in-place as a boundary condition. The finite element results were compared with prototypes tensile testing. RESULTS: The finite element analyses showed stresses within physiological limits on the bone with all tested models. Thread type and pitch affected stresses on bone and anchor body. From stress point of view, two critical zones appeared on anchor body, anchor cortical bone connection and eyelet zone, while thread geometry (depth) affect the cortical bone response only. Laboratory tests matched finite element results and literature. CONCLUSION: Increasing thread pitch of arthroscopic anchors decreases stress on the bone, while increases stress on anchor body. Arthroscopic anchors thread type has a negligible effect on bone, while it reduces stresses on anchor body if it placed more material around eyelet in internal drive mechanism and suture eyelet type of anchors. Anchor tip angle has a negligible effect on bone and anchor body.

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Section: Discussionsupporting

confidence: 89%

Finite Element Study On Arthroscopic Anchor Design Aspects

El-Anwar¹,

Osman²

2019

Open Access Maced J Med Sci

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“…7) In a biomechanical test, the cementing technique showed the highest pull-out strength. 5,10) However, there maybe a few concerns related to healing or washout before fully curing of the cement. There is an exothermic curing in PMMA cement, and it could violate the surrounding tissues and nerves.…”

Section: Discussionmentioning

confidence: 99%

Cement Augmentation for Lateral Row Fixation in Rotator Cuff Repair: A Case Report

Kim¹,

Koh

2017

Clinics in Shoulder and Elbow

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One of the most important factors leading to a successful healing of rotator cuff tear is good bone quality to secure the suture anchor in the bone for a stable fixation. However, rotator cuff tear are commonly found in elderly patients, and their proximal humerus often shows osteoporosis or cystic lesions. Especially when the transosseous repair prevails for a torn rotator cuff, a weak metaphyseal cancellous bone is often the case, which associated with difficulty in stable fixation of the lateral row suture anchor. In this situation, we were able to augment the lateral row fixation with polymethylmethacrylate bone cement. Although there is a concern of disturbance in the blood flow and healing potential, our case showed good clinical results with respect to healing. If we suspect a weak fixation of the lateral row suture anchor, bone cement seems to be a good option for augmentation. Rotator cuff tear is one of the most common causes of shoulder pain. When conservative treatments are non-responsive, surgical repair is usually recommended for active patients. Arthroscopic repair using a suture anchor is the mainstay of its surgical treatment, and a recent trend for repair of torn cuff tendon shifted the attention away from the traditional single row repair with open technique to arthroscopic double row or transosseous equivalent repair. 1)The healing or retear of repaired cuff tendon depends on several factors, including the biological condition surrounding the repaired tendon, biomechanical properties of repair construct, design of suture anchor, and bone quality. In fact, most degenerative rotator cuff tears are found in elderly patients, and considering the age distribution, these tears are commonly overlapped with osteoporosis.2,3) Since the poor local bone density in elderly patients might lead to the loosening of the suture anchor and may compromise the healing of repaired tendon; 3) thus, the enhancement of fixation quality can be more important in these patients than other factors. 2,3)Several techniques have been introduced to improve the fixation strength of the suture anchor in the osteoporotic bone. 4-7)However, in previous studies, the augmentation of suture anchor strength were conducted only on cadavers, and thus, clinical cases regarding augmentation techniques have rarely been reported.The present report is a case of rotator cuff repair in which failed lateral row anchor was augmented by polymethylmethacrylate (PMMA) bone cement. Case ReportA 59-year-old female patient visited our outpatient clinic due to an unresponsive conservative treatment of more than three months for pain in the right shoulder. Her shoulder pain began more than a year ago, which had gotten worse and aggravated four months prior to this visit. Conservative treatment consisted of pain medication, physiotherapy, and steroid injection. There was no prior history of trauma, surgery, or other inflammatory

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“…One common application of PUR foam is the development and testing of medical devices [ 10 , 11 ]. For this purpose, certified PUR foam (Sawbones, Vashon, WA, USA) with standardized structure and density are used.…”

Section: Introductionmentioning

confidence: 99%

Application of an Arbitrary Lagrangian–Eulerian Method to Modelling the Machining of Rigid Polyurethane Foam

et al. 2021

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Rigid polyurethane (PUR) foam, which has an extensive range of construction, engineering, and healthcare applications, is commonly used in technical practice. PUR foam is a brittle material, and its mechanical material properties are strongly dependent on temperature and strain rate. Our work aimed to create a robust FE model enabling the simulation of PUR foam machining and verify the results of FE simulations using the experiments’ results. We created a complex FE model using the Arbitrary Lagrangian–Eulerian (ALE) method. In the developed FE model, a constitutive material model was used in which the dependence of the strain rate, damage initiation, damage propagation, and plastic deformation on temperature was implemented. To verify the FE analyses’ results with experimentally measured data, we measured the maximum temperature during PUR foam drilling with different densities (10, 25, and 40 PCF) and at various cutting speeds. The FE models with a constant cutting speed of 500 mm/s and various PUR foam densities led to slightly higher Tmax values, where the differences were 13.1% (10 PCF), 7.0% (25 PCF), and 10.0% (40 PCF). The same situation was observed for the simulation results related to various cutting speeds at a constant PUR foam density of 40 PCF, where the differences were 25.3% (133 mm/s), 10.1% (500 mm/s), and 15.5% (833 mm/s). The presented results show that the ALE method provides a good match with the experimental data and can be used for accurate simulation of rigid PUR foam machining.

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Suture anchor fixation strength with or without augmentation in osteopenic and severely osteoporotic bones in rotator cuff repair: a biomechanical study on polyurethane foam model

Cited by 29 publications

References 20 publications

Finite Element Study On Arthroscopic Anchor Design Aspects

Finite Element Study On Arthroscopic Anchor Design Aspects

Cement Augmentation for Lateral Row Fixation in Rotator Cuff Repair: A Case Report

Application of an Arbitrary Lagrangian–Eulerian Method to Modelling the Machining of Rigid Polyurethane Foam

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