The Use of Acrylic Bone Cement for Suture Anchoring

Abstract

Healing of tendon or ligament sutured to bone depends among other parameters on the mechanical stability of the suture fixation in or to the bone. The authors propose a method of anchoring suture material using bone cement as a substitute for conventional suture anchors. Conditions for secure fixation of suture material in bone cement were assessed and the technique of anchoring suture material with acrylic cement in bone was developed. Mechanical testing and microcomputed tomography of the suture-cement-bone compound were done. It was found that the suture always should be knotted before embedding it at least 2 mm deep in the bone cement. The holes drilled into the bone in which the sutures are secured with cement should be at least 3.5 mm in diameter and 10 mm deep; in cortical bone a tapped thread is required. Sutures can be secured safely using cement anchors which provide higher pull-out strength of a factor two to five than conventional metallic suture anchors of comparable size. They also adapt to anatomic situations where conventional anchors cannot be used and are more favorable in osteoporotic bone. Cement anchoring of sutures seems to be a cost-effective and valuable alternative when there is poor bone quality or extraordinarily high mechanical load.

Augmentation of Tendon-to-Bone Healing with a Magnesium-Based Bone Adhesive

“…While μCT has been used to assess bone formation in a rotator cuff model of tendon-to-bone healing, we believe this is the first to use it to determine the amount of bone formed in a tunnel. 15 We found the tibias of the 6-week animals that received the bone adhesive had significantly greater bone volume compared to controls. We did not find a significant difference between experimental and control femurs at this time point.…”

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

“…Within this scope of view, augmentation with TCP cement has an advantage as application of it by a Jamshidi needle could easily be adapted for arthroscopy. Penetration of the cement into the intertrabecular space reaches approximately 0.1 to 2 mm in a normal cancellous bone, but in a SOP bone, further and perhaps unexpected penetration might occur [ 7 ], so cemented anchor failure may cause larger defects than non-cemented anchor failure.…”

“…It was previously reported that augmentation of metal suture anchor fixation using bioabsorbable TCP cement and PMMA would increase the pullout strength of suture anchors from osteoporotic bones [ 3 , 6 , 7 ].…”

Bioabsorbable Tricalcium Phosphate Bone Cement Strengthens Fixation of Suture Anchors

“…These studies all showed increases in failure strength of constructs augmented with PMMA. PMMA alone also has been used to anchor suture to bone without use of a traditional suture anchor [14]. That study showed that PMMA alone can be used to anchor a suture directly into a hole in bone without the use of a suture anchor while providing fixation similar or superior to traditional suture anchor fixation.…”