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Suture slippage in knotless suture anchors as a potential failure mechanism in rotator cuff repair


Wieser, Karl; Farshad, Mazda; Vlachopoulos, Lazaros; Ruffieux, Kurt; Gerber, Christian; Meyer, Dominik C (2012). Suture slippage in knotless suture anchors as a potential failure mechanism in rotator cuff repair. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 28(11):1622-1627.

Abstract

PURPOSE: To quantify the strength of suture fixation of knotless suture anchors in relation to the anchors' pullout strength and to compare these results with the static friction between different sutures and anchor materials. METHODS: Suture slippage within the anchor and pullout strength of 4 different knotless suture anchor models were assessed in a bovine bone model. Furthermore, the peak force before onset of slippage of different sutures trapped between increasingly loaded 4-mm rods made of commonly used anchor material (polyetheretherketone, poly-L-lactide acid, metal) was assessed. RESULTS: In all but 1 of the tested anchors, there was a relevantly lower load needed for slippage of the sutures than to pull out the anchor from bone. The mean load to anchor pullout ranged between 156 and 269 N. The load to suture slippage ranged between 66 and 109 N. All sutures were better held between the metal rods (mean, 21; 95% confidence interval [CI], 19.2 to 23.3) than with polyetheretherketone rods (mean, 17; 95% CI, 15.7 to 18.1) or poly-L-lactide acid rods (mean, 18; 95% CI, 17.6 to 18.4). CONCLUSIONS: In the case of suture anchors that hold the sutures by clamping, the hold of the suture in the anchor may be far lower than the pullout strength of the anchor from bone, because the sutures just slip out from the anchor through the clamping mechanism. This is well explained by the low static friction achieved between the tested sutures and the test rods made of anchor materials. CLINICAL RELEVANCE: The use of knotless suture anchors appears quick and easy to perform; however, most of the anchor systems could not even reach half of the anchor pullout strength from bone before suture slippage occurred.

PURPOSE: To quantify the strength of suture fixation of knotless suture anchors in relation to the anchors' pullout strength and to compare these results with the static friction between different sutures and anchor materials. METHODS: Suture slippage within the anchor and pullout strength of 4 different knotless suture anchor models were assessed in a bovine bone model. Furthermore, the peak force before onset of slippage of different sutures trapped between increasingly loaded 4-mm rods made of commonly used anchor material (polyetheretherketone, poly-L-lactide acid, metal) was assessed. RESULTS: In all but 1 of the tested anchors, there was a relevantly lower load needed for slippage of the sutures than to pull out the anchor from bone. The mean load to anchor pullout ranged between 156 and 269 N. The load to suture slippage ranged between 66 and 109 N. All sutures were better held between the metal rods (mean, 21; 95% confidence interval [CI], 19.2 to 23.3) than with polyetheretherketone rods (mean, 17; 95% CI, 15.7 to 18.1) or poly-L-lactide acid rods (mean, 18; 95% CI, 17.6 to 18.4). CONCLUSIONS: In the case of suture anchors that hold the sutures by clamping, the hold of the suture in the anchor may be far lower than the pullout strength of the anchor from bone, because the sutures just slip out from the anchor through the clamping mechanism. This is well explained by the low static friction achieved between the tested sutures and the test rods made of anchor materials. CLINICAL RELEVANCE: The use of knotless suture anchors appears quick and easy to perform; however, most of the anchor systems could not even reach half of the anchor pullout strength from bone before suture slippage occurred.

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3 citations in Web of Science®
4 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:November 2012
Deposited On:31 Jan 2013 09:57
Last Modified:05 Apr 2016 16:24
Publisher:Elsevier
ISSN:0749-8063
Publisher DOI:https://doi.org/10.1016/j.arthro.2012.04.150
PubMed ID:22981366

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