Skip to main content
Erschienen in: HSS Journal ® 1/2018

17.10.2017 | Original Article

The Primary Stability of a Bioabsorbable Poly-L-Lactic Acid Suture Anchor for Rotator Cuff Repair Is Not Improved with Polymethylmethacrylate or Bioabsorbable Bone Cement Augmentation

verfasst von: Mehmet F. Güleçyüz, Dr. med., Michael Kraus-Petersen, Dipl.-Ing. (FH), Christian Schröder, Dr. rer. biol. hum. Dipl.-Ing. (FH), Andreas Ficklscherer, PD Dr. med., Markus U. Wagenhäuser, Dr. med., Christian Braun, Dr. med., Peter E. Müller, Prof. Dr. med., Matthias F. Pietschmann, Prof. Dr. med.

Erschienen in: HSS Journal ® | Ausgabe 1/2018

Einloggen, um Zugang zu erhalten

Abstract

Background

The incidence of osteoporosis and rotator cuff tears increases with age. Cement augmentation of bones is an established method in orthopedic and trauma surgery.

Questions/Purposes

This study analyses if polymethylmethacrylate or bioabsorbable cement can improve the primary stability of a bioabsorbable suture anchor in vitro in comparison to a non-augmented suture anchor in osteoporotic human humeri.

Methods

The trabecular bone mineral density was measured to ensure osteopenic human specimens. Then the poly-l-lactic acid Bio-Corkscrew® FT was implanted in the greater tuberosity footprint with polymethylmethacrylate Refobacin® cement augmentation (n = 8), with Cerament™ Bone Void Filler augmentation (n = 8) and without augmentation (n = 8). Using a cyclic testing protocol, the failure loads, system displacement, and failure modes were recorded.

Results

The Cerament™ augmented Bio-Corkscrew® FT yielded the highest failure loads (206.7 N), followed by polymethylmethacrylate Refobacin® augmentation (206.1 N) and without augmentation (160.0 N). The system displacement was lowest for Cerament™ augmentation (0.72 mm), followed by polymethylmethacrylate (0.82 mm) and without augmentation (1.50 mm). Statistical analysis showed no significant differences regarding the maximum failure loads (p = 0.1644) or system displacement (p = 0.4199). The main mode of failure for all three groups was suture slippage.

Conclusion

The primary stability of the Bio-Corkscrew® FT is not influenced by bone cement augmentation with polymethylmethacrylate Refobacin® or with bioabsorbable Cerament™ in comparison to the non-cemented anchors. The cement augmentation of rotator cuff suture anchors in osteoporotic bones remains questionable since biomechanical tests show no significant advantage.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Abate M, Schiavone C, Di Carlo L et al. Prevalence of and risk factors for asymptomatic rotator cuff tears in postmenopausal women. Menopause. 2014;21:275–80.CrossRefPubMed Abate M, Schiavone C, Di Carlo L et al. Prevalence of and risk factors for asymptomatic rotator cuff tears in postmenopausal women. Menopause. 2014;21:275–80.CrossRefPubMed
3.
Zurück zum Zitat Braunstein V, Ockert B, Windolf M et al. Increasing pullout strength of suture anchors in osteoporotic bone using augmentation—a cadaver study. Clin Biomech. 2015;30:243–7.CrossRef Braunstein V, Ockert B, Windolf M et al. Increasing pullout strength of suture anchors in osteoporotic bone using augmentation—a cadaver study. Clin Biomech. 2015;30:243–7.CrossRef
5.
Zurück zum Zitat Clavert P, Bouchaib J, Sommaire C et al. Does bone density of the greater tuberosity change in patients over 70? Orthop Traumatol Surg Res. 2014;100:109–11.CrossRefPubMed Clavert P, Bouchaib J, Sommaire C et al. Does bone density of the greater tuberosity change in patients over 70? Orthop Traumatol Surg Res. 2014;100:109–11.CrossRefPubMed
6.
Zurück zum Zitat Cummins CA, Murrell GA. Mode of failure for rotator cuff repair with suture anchors identified at revision surgery. J Shoulder Elbow Surg. 2003;12:128–33.CrossRefPubMed Cummins CA, Murrell GA. Mode of failure for rotator cuff repair with suture anchors identified at revision surgery. J Shoulder Elbow Surg. 2003;12:128–33.CrossRefPubMed
7.
Zurück zum Zitat Er MS, Altinel L, Eroglu M et al. 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. J Orthop Surg Res. 2014;9:48.CrossRefPubMedPubMedCentral Er MS, Altinel L, Eroglu M et al. 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. J Orthop Surg Res. 2014;9:48.CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Giori NJ, Sohn DH, Mirza FM et al. Bone cement improves suture anchor fixation. Clin Orthop Relat Res. 2006;451:236–41.CrossRefPubMed Giori NJ, Sohn DH, Mirza FM et al. Bone cement improves suture anchor fixation. Clin Orthop Relat Res. 2006;451:236–41.CrossRefPubMed
9.
Zurück zum Zitat Haussler B, Gothe H, Gol D et al. Epidemiology, treatment and costs of osteoporosis in Germany—the BoneEVA Study. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2007;18:77–84.CrossRef Haussler B, Gothe H, Gol D et al. Epidemiology, treatment and costs of osteoporosis in Germany—the BoneEVA Study. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2007;18:77–84.CrossRef
10.
Zurück zum Zitat Kirchhoff C, Braunstein V, Milz S et al. Assessment of bone quality within the tuberosities of the osteoporotic humeral head: relevance for anchor positioning in rotator cuff repair. Am J Sports Med. 2010;38:564–9.CrossRefPubMed Kirchhoff C, Braunstein V, Milz S et al. Assessment of bone quality within the tuberosities of the osteoporotic humeral head: relevance for anchor positioning in rotator cuff repair. Am J Sports Med. 2010;38:564–9.CrossRefPubMed
11.
Zurück zum Zitat Kirchhoff C, Braunstein V, Milz S et al. Age and gender as determinants of the bone quality of the greater tuberosity: a HR-pQCT cadaver study. BMC Musculoskelet Disord. 2012;13:221.CrossRefPubMedPubMedCentral Kirchhoff C, Braunstein V, Milz S et al. Age and gender as determinants of the bone quality of the greater tuberosity: a HR-pQCT cadaver study. BMC Musculoskelet Disord. 2012;13:221.CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Kirchhoff C, Kirchhoff S, Sprecher CM et al. X-treme CT analysis of cancellous bone at the rotator cuff insertion in human individuals with osteoporosis: superficial versus deep quality. Arch Orthop Trauma Surg. 2013;133:381–7.CrossRefPubMed Kirchhoff C, Kirchhoff S, Sprecher CM et al. X-treme CT analysis of cancellous bone at the rotator cuff insertion in human individuals with osteoporosis: superficial versus deep quality. Arch Orthop Trauma Surg. 2013;133:381–7.CrossRefPubMed
13.
Zurück zum Zitat Milgrom C, Schaffler M, Gilbert S et al. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Joint Surg. 1995;77:296–8. Milgrom C, Schaffler M, Gilbert S et al. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Joint Surg. 1995;77:296–8.
14.
Zurück zum Zitat Oshtory R, Lindsey DP, Giori NJ et al. Bioabsorbable tricalcium phosphate bone cement strengthens fixation of suture anchors. Clin Orthop Relat Res. 2010;468:3406–12.CrossRefPubMedPubMedCentral Oshtory R, Lindsey DP, Giori NJ et al. Bioabsorbable tricalcium phosphate bone cement strengthens fixation of suture anchors. Clin Orthop Relat Res. 2010;468:3406–12.CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Pietschmann MF, Froehlich V, Ficklscherer A et al. Biomechanical testing of a new knotless suture anchor compared with established anchors for rotator cuff repair. J Shoulder Elbow Surg. 2008;17:642–646.CrossRefPubMed Pietschmann MF, Froehlich V, Ficklscherer A et al. Biomechanical testing of a new knotless suture anchor compared with established anchors for rotator cuff repair. J Shoulder Elbow Surg. 2008;17:642–646.CrossRefPubMed
16.
Zurück zum Zitat Pietschmann MF, Frohlich V, Ficklscherer A et al. Suture anchor fixation strength in osteopenic versus non-osteopenic bone for rotator cuff repair. Arch Orthop Trauma Surg. 2009;129:373–9.CrossRefPubMed Pietschmann MF, Frohlich V, Ficklscherer A et al. Suture anchor fixation strength in osteopenic versus non-osteopenic bone for rotator cuff repair. Arch Orthop Trauma Surg. 2009;129:373–9.CrossRefPubMed
17.
Zurück zum Zitat Pietschmann MF, Gulecyuz MF, Fieseler S et al. Biomechanical stability of knotless suture anchors used in rotator cuff repair in healthy and osteopenic bone. Arthroscopy: the journal of arthroscopic & related surgery: official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2010;26:1035–44.CrossRef Pietschmann MF, Gulecyuz MF, Fieseler S et al. Biomechanical stability of knotless suture anchors used in rotator cuff repair in healthy and osteopenic bone. Arthroscopy: the journal of arthroscopic & related surgery: official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2010;26:1035–44.CrossRef
18.
Zurück zum Zitat Postl LK, Braunstein V, Von Eisenhart-Rothe R et al. Footprint reconstruction in a rotator cuff tear associated cyst of the greater tuberosity: augmented anchorage. Arch Orthop Trauma Surg. 2013;133:81–5.CrossRefPubMed Postl LK, Braunstein V, Von Eisenhart-Rothe R et al. Footprint reconstruction in a rotator cuff tear associated cyst of the greater tuberosity: augmented anchorage. Arch Orthop Trauma Surg. 2013;133:81–5.CrossRefPubMed
19.
Zurück zum Zitat Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999;8:296–9.CrossRefPubMed Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999;8:296–9.CrossRefPubMed
20.
Zurück zum Zitat Tingart MJ, Apreleva M, Lehtinen J et al. 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? Am J Sports Med. 2004;32:1466–73.CrossRefPubMed Tingart MJ, Apreleva M, Lehtinen J et al. 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? Am J Sports Med. 2004;32:1466–73.CrossRefPubMed
21.
Zurück zum Zitat Waldorff EI, Lindner J, Kijek TG et al. Bone density of the greater tuberosity is decreased in rotator cuff disease with and without full-thickness tears. J Shoulder Elbow Surg. 2011;20:904–8.CrossRefPubMed Waldorff EI, Lindner J, Kijek TG et al. Bone density of the greater tuberosity is decreased in rotator cuff disease with and without full-thickness tears. J Shoulder Elbow Surg. 2011;20:904–8.CrossRefPubMed
Metadaten
Titel
The Primary Stability of a Bioabsorbable Poly-L-Lactic Acid Suture Anchor for Rotator Cuff Repair Is Not Improved with Polymethylmethacrylate or Bioabsorbable Bone Cement Augmentation
verfasst von
Mehmet F. Güleçyüz, Dr. med.
Michael Kraus-Petersen, Dipl.-Ing. (FH)
Christian Schröder, Dr. rer. biol. hum. Dipl.-Ing. (FH)
Andreas Ficklscherer, PD Dr. med.
Markus U. Wagenhäuser, Dr. med.
Christian Braun, Dr. med.
Peter E. Müller, Prof. Dr. med.
Matthias F. Pietschmann, Prof. Dr. med.
Publikationsdatum
17.10.2017
Verlag
Springer US
Erschienen in
HSS Journal ® / Ausgabe 1/2018
Print ISSN: 1556-3316
Elektronische ISSN: 1556-3324
DOI
https://doi.org/10.1007/s11420-017-9574-4

Weitere Artikel der Ausgabe 1/2018

HSS Journal ® 1/2018 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.