The effect of the trabecular microstructure on the pullout strength of suture anchors

Yakacki, Christopher M.; Poukalova, Mariya; Guldberg, Robert E.; Lin, Angela; Saing, Minn; Gillogly, Scott D.; Gall, Ken

doi:10.1016/j.jbiomech.2010.03.013

Cited by 56 publications

(42 citation statements)

References 28 publications

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“…Gabet et al [] demonstrated that trabecular bone volume density (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), and connectivity density were all increased in peri‐implant bone by intermittent PTH administration, and that a highly significant correlation existed between biomechanical and morphometric parameters, especially trabecular volume density (r 2 = 0.72) and thickness (r 2 = 0.60). A multi‐variant model of suture anchor pullout strength that was based on trabecular morphometric parameters was also highly correlated (r 2 = 0.86) with actual pullout strength [Yakacki et al, ]. The results of these studies [Gabet et al, ; Yakacki et al, ] closely mirror some of the results of the current study.…”

Section: Discussionsupporting

confidence: 77%

Heat and radiofrequency plasma glow discharge pretreatment of a titanium alloy promote bone formation and osseointegration

et al. 2013

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Orthopedic and dental implants manifest increased failure rates when inserted into low density bone. We determined whether chemical pretreatments of a titanium alloy implant material stimulated new bone formation to increase osseointegration in vivo in trabecular bone using a rat model. Titanium alloy rods were untreated or pretreated with heat (600°C) or radiofrequency plasma glow discharge (RFGD). The rods were then coated with the extracellular matrix protein fibronectin (1 nM) or left uncoated and surgically implanted into the rat femoral medullary cavity. Animals were euthanized 3 or 6 weeks later, and femurs were removed for analysis. The number of trabeculae in contact with the implant surface, surface contact between trabeculae and the implant, and the length and area of bone attached to the implant were measured by histomorphometry. Implant shear strength was measured by a pull-out test. Both pretreatments and fibronectin enhanced the number of trabeculae bonding with the implant and trabeculae-to-implant surface contact, with greater effects of fibronectin observed with pretreated compared to untreated implants. RFGD pretreatment modestly increased implant shear strength, which was highly correlated (r2 = 0.87 – 0.99) with measures of trabecular bonding for untreated and RFGD-pretreated implants. In contrast, heat pretreatment increased shear strength 3 to 5-fold for both uncoated and fibronectin-coated implants at 3 and 6 weeks, suggesting a more rapid increase in implant-femur bonding compared to the other groups. In summary, our findings suggest that the heat and RFGD pretreatments can promote the osseointegration of a titanium alloy implant material.

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Section: Discussionsupporting

confidence: 77%

Heat and radiofrequency plasma glow discharge pretreatment of a titanium alloy promote bone formation and osseointegration

et al. 2013

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“…Average values for microstructural properties in cadaver bone specimens used for pullout testing have been shown in a concurrent study ( See Appendix). (Yakacki, Poukalova et al)…”

Section: Resultsmentioning

confidence: 99%

“…(Yakacki, Poukalova et al) It was found that three of six microstructural properties analyzed show a statistical correlation to pullout strength: BMD, structural model index (SMI), and TbTh. A model was developed using these three properties to explain the variances in the individual correlations.…”

Section: Introductionmentioning

confidence: 99%

Pullout strength of suture anchors: Effect of mechanical properties of trabecular bone

Poukalova

Yakacki

Guldberg

et al. 2010

Journal of Biomechanics

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This study investigated the relationships between trabecular microstructure and elastic modulus, compressive strength, and suture anchor pullout strength. Twelve fresh-frozen humeri underwent mechanical testing followed by micro-computed tomography (μCT). Either compression testing of cylindrical bone samples or pullout testing using an Arthrex 5 mm Corkscrew was performed in synthetic sawbone or at specific locations in the humerus such as the greater tuberosity, lesser tuberosity, and humeral head. Synthetic sawbone underwent identical mechanical testing and μCT analysis. Bone volume fraction (BVF), structural model index (SMI), trabecular thickness (TbTh), trabecular spacing (TbSp), trabecular number (TbN), and connectivity density were compared against modulus, compressive strength, and pullout strength in both materials. In cadaveric bone, modulus showed correlations to all of the microstructural properties, while compressive and pullout strength were only correlated to BVF, SMI, and TbSp. The microstructure of synthetic bone differed from cadaveric bone as SMI and TbTh showed little variation across the densities tested. Therefore, SMI and TbTh were the only microstructural properties that did not show correlations to the mechanical properties tested in synthetic bone. This study helps identify key microstructure-property relationships in cadaveric and synthetic bone as well as illustrate the similarities and differences between cadaveric and synthetic bone as biomechanical test materials.

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“…They conclude that if a suture is placed so that the head of the anchor is significantly below the surface of the cortical bone-then pullout failure is likely to be a problem, whereas shallower placement is likely to lead to suture failure. Yakacki et al [6] focused on the characteristics of the underlying bone, and investigated the effect of trabecular microstructure on suture anchor pullout. The study was based on pullout tests in human cadaver bone, and found the greatest correlation of pullout force was with trabecular structure [7], measured via the Structural Materials Index (SMI).…”

Section: Introductionmentioning

confidence: 99%

Bone Anchors—A Preliminary Finite Element Study of Some Factors Affecting Pullout

Hughes

Bordush

Robioneck

et al. 2014

Journal of Medical Devices

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Bone anchors (or suture anchors) are used to provide attachment points for sutures to connect tissue such as tendons or ligaments to bone, and work by engaging a threaded portion-sometimes tapered-to the cancellous and/or cortical bone. Such repair is often needed after trauma, or as part of reconstructive surgery. This paper uses the finite element method to compare the pullout characteristics of one common type of bone anchor in different cancellous bone structures. Finite element models are created by using computed tomography (CT) scans of cancellous bone and building computer-aided design (CAD) models to define the cancellous bone geometry. Orthopedic surgeons will sometimes remove parts of the cortical shell and this paper also examines the mechanical effects of decortication. Furthermore, the importance of the connection between anchor and cortical layer is examined. One of the key outcomes from the model is that the coefficient of friction between bone and anchor determines potential mechanisms of pullout. The stiffness of anchors and the effect of the cortical layer are presented for different pullout angles to obtain the theoretical response. The results show the detailed modeling that includes the micro-architecture of the cancellous bone is necessary to capture the large variations that can exist.

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The effect of the trabecular microstructure on the pullout strength of suture anchors

Cited by 56 publications

References 28 publications

Heat and radiofrequency plasma glow discharge pretreatment of a titanium alloy promote bone formation and osseointegration

Heat and radiofrequency plasma glow discharge pretreatment of a titanium alloy promote bone formation and osseointegration

Pullout strength of suture anchors: Effect of mechanical properties of trabecular bone

Bone Anchors—A Preliminary Finite Element Study of Some Factors Affecting Pullout

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