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Anchor Design and Bone Mineral Density Affect the Pull-out Strength of Suture Anchors in Rotator Cuff Repair

Which Anchors Are Best to Use in Patients With Low Bone Quality?

Markus J. Tingart, MD^*,, Maria Apreleva, PhD, Janne Lehtinen, MD, David Zurakowski, PhD^ll and Jon J. P. Warner, MD

From the Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany, the Orthopaedic Biomechanics Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, and the ^ll Departments of Orthopaedic Surgery and Biostatistics, Children’s Hospital, Boston, Massachusetts

^* Address correspondence to Markus J. Tingart, Department of Orthopaedic Surgery, University of Regensburg, Silbernagelgasse 9, Regensburg, Germany 93047 (e-mail: markus.tingart{at}gmx.de).

Background: Different metal and biodegradable suture anchors are available for rotator cuff repair. Poor bone quality may result in anchor loosening and tendon rerupture.

Hypotheses: Higher bone mineral density is associated with higher pull-out strength of suture anchors. Depending on anchor placement, pull-out strengths of anchors are different within the greater tuberosity.

Study Design: Cadaveric biomechanical study.

Methods: Trabecular and cortical bone mineral densities were determined for different regions within the greater tuberosity. Metal screw-type and biodegradable hook-type anchors were cyclically loaded.

Results: Mean failure load of metal and biodegradable anchors was 273 N and 162 N, respectively, for the proximal part (P < .01) and 184 N and 112 N, respectively, for the distal part (P < .01). Both types of anchors showed higher failure loads in the proximal-anterior and -middle parts of the greater tuberosity than in the distal part (P < .01). A significant positive correlation was found between cortical bone mineral density and failure load of metal anchors (P < .01).

Conclusion: Bone quality, anchor type, and anchor placement have a significant impact on anchor failure loads.

Clinical Relevance: Suture anchors should be placed in the proximal-anterior and -middle parts of the greater tuberosity. In the distal parts, biodegradable hook-like anchors should be used with caution.

Key Words: rotator cuff repair • bone mineral density • suture anchor • anchor design • pull-out strength

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