Sutures, pull out strength, anchors

BACKGROUND: While posterior medial meniscus root (PMMR) techniques have evolved, there remains a need to both optimize repair strength and improve resistance to cyclic loading. HYPOTHESIS: Adjustable tensioning would lead to higher initial repair strength and reduce displacement with cyclic loading compared with previously described transtibial pull-out repair (TPOR) fixation techniques. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 56 porcine medial menisci were used...

Repair of functionally graded biological interfaces requires joining dissimilar materials such as hard bone to soft tendon/ligament, with re-injuries/re-tears expected to be minimized by incorporating biomimicking, stress-reducing features within grafts. At bone-tendon interfaces (entheses), stress can be reduced via angled insertion, geometric flaring, mechanical gradation, and interdigitation of tissues. Here, we incorporated enthesis attributes into 3D in silico and physical models of a unique suture anchor-tendon hybrid graft (SATHG) and investigated their effects on stress reduction via finite element analyses (FEA) studies...

Fixation with suture anchors and metallic hardware for osteosynthesis are common in orthopedic surgeries. Most metallic commercial bone anchors achieve their fixation to bone through shear of the bone located between the threads. They have several deficiencies, including stress-shielding due to mechanical properties mismatch, generation of acidic by-products, poor osteointegration, low mechanical strength and catastrophic failure often associated with large bone defects that may be difficult to repair. To overcome these deficiencies, a swelling porous co-polymeric material, to be used as bone anchors with osteointegration potential, was introduced...

INTRODUCTION: A novel titanium tilting suture anchor was designed and fabricated using additive manufacturing. The anchor enjoyed a nonsymmetrical structure to facilitate its insertion procedure through a weight-induced tilt, a saw-teeth penetrating edge to provide a strong initial fixation into cancellous bones of various densities, and an appropriate surface texture to enhance the longterm fixation strength through bone ingrowth. METHODS: Biomechanical tests were performed on 10 ovine and 10 human cadaveric humeri to examine the insertion procedure and assess the initial fixation strength of the anchor, in comparison with a standard screw-type anchor as control...

Conventional suture anchors (CAs) and all-suture anchors (ASAs) are used for rotator cuff repair. Pull-out strength (POS) is an important factor that affects surgical outcomes. While the fixation mechanism differs between the anchor types and relies on the quality, few studies have compared biomechanical properties of anchors based on bone quality. This study aimed to compare the biomechanical properties of anchors using osteoporotic bone (OB) and non-osteoporotic bone (NOB) simulators. Humerus simulators were fabricated using fused deposition modeling of 3D printing and acrylonitrile butadiene styrene adjusting the thickness of cortical bone and density of cancellous bone based on CT images...

BACKGROUND: Biceps tenodesis is an effective treatment for symptomatic long head of biceps tendon pathology. Recently the arthroscopic "double lasso-loop" suture anchor (DLSA) technique was described, advantaged by reduced cost, complexity, and operative time. We aimed to compare the in vitro strength of DLSA with conventional interference screws (IS). METHODS: A biomechanical analysis was conducted on 14 sheep shoulders (8 DLSA, 6 IS), consisting of a 500-cycle cyclic loading experiment of 5-70 N and ultimate failure load (UFL) test where each specimen was pulled until failure...

Background: Treatment of muscle belly lacerations remains a problem for surgeons. Inadequate repair of lacerations can cause functional disability. To date, there is no consensus on the method of repair for these injuries. We have previously described a technique of repairing mid-substance muscle belly lacerations. The aim of this study was to determine the ultimate strength of an intact muscle belly and to compare the anchor suture (AS) technique with the modified Kessler (MK) technique. Methods: Fifteen fresh frozen hind-legs from adolescent pigs were divided into three groups and used for the testing...

OBJECTIVE: To study the mechanical properties related to the typical functional failure modes of non-absorbable suture anchor in clinical use, and to support product design, development and verification. METHODS: By retrieving the database of relevant adverse events, the typical functional failure modes of non-absorbable suture anchor were summarized, and the influencing factors of functional failure were further analyzed by studying the mechanical properties related to functional failure...

PURPOSE: To compare various suture anchor designs with and without calcium phosphate (CaP) augmentation in an osteoporotic foam block model and decorticated proximal humerus cadaveric model. METHODS: This was a controlled biomechanical study, consisting of 2 parts: (1) an osteoporotic foam block model (0.12 g/cc; n = 42) and (2) a matched pair cadaveric humeral model (n = 24). Suture anchors selected were an all-suture anchor, PEEK (polyether ether ketone)-threaded anchor, and a biocomposite-threaded anchor...

PURPOSE: Suture anchors are commonly used to repair rotator cuff tendons in arthroscopy surgery, and several anchor materials have been created to maximize pull-out strength and minimize iatrogenic damage. We hypothesized that all-suture anchors have biomechanical properties equivalent to those of conventional anchors. Our purpose is to compare the biomechanical properties of different anchors used for rotator cuff repair. METHODS: The Embase, PubMed, Cochrane, and Scopus databases were searched for biomechanical studies on various suture anchors...

PURPOSE: This study evaluated 1.0-mm mini suture anchors for repairing the central slip of the extensor mechanism at the proximal interphalangeal joint. Studies have reported a requirement for central slip fixation to withstand 15 N during postoperative rehabilitation exercises and 59 N during forceful contraction. METHODS: Index and middle fingers from 10 matched pairs of cadaveric hands were prepared with 1.0-mm mini suture anchors with 2-0 sutures or threaded with 2-0 sutures through a bone tunnel (BTP)...

BACKGROUND: To determine the ideal fixation technique for an ACL reconstruction with a hamstring graft, multiple studies have been undertaken to define the initial biomechanical properties of tibial fixation. PURPOSE: The aim of this study was to compare the biomechanical properties of tibial fixation methods by creating single or hybrid systems. METHODS: Bovine tibias and forefoot digital extensor tendons were prepared with four different tibial anterior cruciate ligament fixation methods and compared biomechanically...

Background Shoulder instability and recurrent dislocations are common problems encountered by orthopedic surgeons and are frequently associated with a Bankart lesion. These are classically treated with either open or arthroscopic repair utilizing traditional suture anchors, though anchorless fixation techniques have recently been developed as an alternate fixation method that reduces native bone loss and has comparable pull-out strength. Methods A retrospective review was performed at a single institution for patients who underwent Bankart repair from January 2008 through February 2014...

Objective: Suture pull-out remains a significant mechanism of long-term neochordal repair failure, as demonstrated by clinical reports on recurrent mitral valve regurgitation and need for reoperation. The objective of this study was to provide a quantitative comparison of suture pull-out forces for various neochordal implantation locations. Methods: Posterior leaflets were excised from fresh porcine mitral valves (n = 54) and fixed between two 3-dimensional-printed plates...

Introduction: Rotator cuff tendons are typically reattached to the proximal humerus using transosseous sutures or suture anchors. Their primary mode of failure is at the tendon-bone interface. Methods: We investigated the addition of an adhesive, gelatin-resorcin-formalin (GRF) glue, to a single-row rotator cuff repair (RCR) on ex vivo sheep models. We hypothesised the addition of GRF glue would increase the repair construct strength. The study consisted of three groups of six sheep infraspinatus tendons with an inverted-mattress stitch, tension-band configuration...

BACKGROUND: Primary device fixation and the resistance against gap formation during repetitive loading influence the quality of meniscal repair. There are limited biomechanical data comparing primary tensioning and cyclic behavior of all-inside versus inside-out repair. HYPOTHESIS: All-inside devices provide higher initial load on the meniscal repair than inside-out fixation, and stiffer constructs show higher resistance against gap formation during cyclic loading...

BACKGROUND: The buddy anchor technique is useful to reinforce loose anchors in the osteoporotic humeral head during arthroscopic rotator cuff repair. However, theoretical parallel insertion of the buddy anchor to index a loose anchor is challenging in arthroscopy and can widen the entry site and decrease structural integrity. PURPOSE: To investigate and compare the biomechanical stability between 2 buddy anchor insertion techniques (parallel insertion vs divergent insertion) in the osteoporotic humeral head...

Percutaneous Achilles tendon repairs can be performed with 2 distal fixation techniques: knotless suture anchor repair (KL) or percutaneous end-to-end repair (ETE). There is a paucity of literature comparing the biomechanical strength of these 2 distal fixation techniques. The aim of this study was to compare the strength of KL and ETE repairs using flat-braided suture for mid-substance Achilles tendon rupture during simulated progressive rehabilitation. Nine matched pairs of fresh-frozen below-knee cadaveric extremities were randomly assigned into these 2 repair groups...

BACKGROUND: Multiple techniques for the repair of flexor tendon injuries in zone 1 have been proposed over time. While pull-out suture techniques and bone anchor seem to be stronger than internal suture techniques, they are associated with a higher complication rate. We therefore developed an alternative internal suture repair with similar biomechanical stability to those of pull-out sutures and bone anchors. METHODS: Twenty porcine distal phalanges and deep flexor tendons were randomized to 2 groups of 10 each...

Background: Compared with the single-row technique, the double-row rotator cuff repair technique is known to have a higher load to failure and a lower frequency of gap formation, leading to a lower retear rate. There are some patients with poor clinical outcomes or poor muscle strength without radiologic retear. Purpose/Hypothesis: To assess the postoperative position of suture knots via serial ultrasonography in patients who had undergone arthroscopic rotator cuff repair with the suture-bridge technique...