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Pullout Strength of Suture Anchors Used in Rotator Cuff Repair
Markus J. Tingart, MD1; Maria Apreleva, P1; David Zurakowski, P2; Jon J.P. Warner, MD3
1 Orthopaedic Biomechanics Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN 115, Boston, MA 02215. E-mail address for M. Apreleva: maria.apreleva@gmx.net
2 Departments of Orthopaedic Surgery and Biostatistics, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115
3 Department of Orthopaedic Surgery, Massachusetts General Hospital, 275 Cambridge Street, Suite 403, Boston, MA 02114
View Disclosures and Other Information
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Deutsche Forschungsgemeinschaft, Orthopaedic Research Laboratories Alumni Council. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated. Mitek Products (Ethicon, Johnson and Johnson) donated the suture anchors.
Investigation performed at the Orthopaedic Biomechanics Laboratory, Beth Israel Deaconess Medical Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2003 Nov 01;85(11):2190-2198
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Abstract

Background: Surgical treatment of rotator cuff tears may be complicated by osteoporosis of the proximal part of the humerus. The purpose of this study was to determine whether pullout strength of suture anchors is affected by the location of the anchor placement and by bone mineral density. We hypothesized that higher bone mineral density is associated with higher pullout strength of suture anchors.

Methods: Peripheral quantitative computed tomography was used to measure total, trabecular, and cortical bone mineral density in different regions of the lesser and greater tuberosities in seventeen cadaveric humeri. Suture anchors were inserted into individual regions and subjected to cyclic loading. Repeated-measures analysis of variance was used to assess differences in bone mineral density and load to failure between regions of interest. Pearson correlation was used to determine the association between bone mineral density and pullout strength of suture anchors.

Results: Total, trabecular, and cortical bone mineral densities were an average of 50%, 50%, and 10% higher, respectively, in the proximal part of the tuberosities compared with the distal part (p < 0.01). Within the proximal part of the greater tuberosity, trabecular bone mineral density of the posterior region and cortical bone mineral density of the middle region were, on the average, 25% and 16% higher, respectively, than the densities in the other regions (p < 0.01). Load to failure in the proximal part of the tuberosities was an average of 53% higher than that in the distal part (p < 0.01). The lesser tuberosity showed, on the average, a 32% higher load to failure than did the greater tuberosity (p < 0.01). Within the proximal part of the greater tuberosity, loads to failure in the anterior and middle regions were, on the average, 62% higher than the load to failure in the posterior region (p < 0.01). Overall positive correlations were found between bone mineral density and load to failure (0.65 = r = 0.74, p < 0.01).

Conclusions: We found that pullout strength of suture anchors correlates well with bone mineral density of the tuberosities. Higher loads to failure were found in regions in the proximal part of the tuberosities. Placement of anchors in these regions may prevent anchor loosening, formation of a tendon-bone gap, and failure of the rotator cuff repair.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Sidney Goldman, M.D.
    Posted on December 01, 2003
    Pullout Strength of Suture Anchors in Rotator Cuff Repair
    Birmingham Orthopaedics & Sports Medicine

    To the Editor:

    Concerning the article “Pullout Strength of Suture Anchors Used In Rotator Cuff Repair” The title should more accurately state the single brand and design of anchor investigated. The conclusion that pullout strength correlates well with bone mineral density of the tuberosity should be restricted exclusively to the 5mm metal screw-like anchors that were tested. The conclusion cannot be extended to other types of anchors without further testing.

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