Mehmet F Güleçyüz1, Michael Kraus-Petersen2, Christian Schröder2, Andreas Ficklscherer3, Markus U Wagenhäuser4, Christian Braun5, Peter E Müller1, Matthias F Pietschmann1. 1. Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany. 2. 2Laboratory for Biomechanics and Experimental Orthopedics, University of Munich (Ludwig-Maximilian-University), Feodor-Lynen-Strasse 19, 81377 Munich, Germany. 3. Orthopädie Oberland, Alpenstraße 7, 82362 Weilheim in Oberbayern, Germany. 4. 4Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany. 5. 5Institute of Forensic Medicine, University of Munich (Ludwig-Maximilian-University), Nußbaumstraße 26, 80336 Munich, Germany.
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.
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.
Entities:
Keywords:
augmentation; biomechanics; bone cement; bone mineral density; osteoporosis; poly-l-lactic acid suture anchor; rotator cuff
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