Biomechanical analysis of conventional anchor revision after all-suture anchor pullout: a human cadaveric shoulder model

J Shoulder Elbow Surg. 2019 Dec;28(12):2433-2437. doi: 10.1016/j.jse.2019.04.053. Epub 2019 Jul 13.


Hypothesis and background: The possibility of implanting a conventional anchor at the pullout site following all-suture anchor failure was evaluated in a biomechanical cadaveric model. The hypothesis of the study was that anchor revision would yield equal biomechanical properties.

Methods: Ten human humeri were obtained, and bone density was determined via computed tomography. After all-suture anchor (n = 5) and conventional 4.5-mm anchor (n = 5) insertion, biomechanical testing was conducted. Following all-suture anchor pullout, a conventional 5.5-mm anchor was inserted at the exact site of pullout (n = 5) and biomechanical testing was reinitiated. Testing was conducted using an initial preload of 20 N, followed by an unlimited cyclic protocol, with a stepwise increasing force of 0.05 N for each cycle at a rate of 1 Hz until system failure. The number of cycles, maximum load to failure, stiffness, displacement, and failure mode, as well as macroscopic observation at the failure site including diameter, shape, and cortical destruction, were registered.

Results: The defect following all-suture pullout showed a mean diameter of 4 mm, and conventional revision was possible in each sample. There was no significant difference between the initial all-suture anchor implantation and the conventional anchor implantation or the conventional revision following all-suture failure regarding mean pullout strength, stiffness, displacement, or total number of cycles until failure.

Conclusion: Conventional anchor revision at the exact same site where all-suture anchor pullout occurred is possible and exhibits similar biomechanical properties.

Keywords: Shoulder surgery; all suture; arthroscopy; pullout; rotator cuff; suture anchor.

MeSH terms

  • Aged
  • Biomechanical Phenomena
  • Cadaver
  • Humans
  • Humerus / surgery*
  • Middle Aged
  • Prosthesis Failure*
  • Reoperation
  • Shoulder Joint / surgery*
  • Suture Anchors / adverse effects*