title: Glenoid suture anchor fixation strength: Effect of insertion angle.
abstract: OBJECTIVE
  The purpose of this study was to determine the effect of varying insertion angles on the fixation strength of screw-in devices placed in the glenoid rim. Type of study Cadaveric biomechanical analysis.
  
  
  METHODS
  Eighteen cadaveric glenoids had 3.0-mm cannulated screws inserted for a depth of 10 mm in all 4 quadrants: anterior superior (AS), anterior inferior (AI), posterior superior (PS), posterior inferior (PI). Screws were inserted along the orthogonal to the glenoid rim at the point of insertion or at angles that deviated from this vector by 20 degrees and 40 degrees. Load to failure was performed at 10 mm/s along the orthogonal to the point of insertion.
  
  
  RESULTS
  For screws inserted orthogonal to the glenoid rim, the average load to failure was highest for the PS quadrant (733 +/- 369 N) and lowest for the AI quadrant (272 +/- 69 N). The AS and PI quadrants showed intermediate values (549 +/- 334 N and 484 +/- 141 N, respectively). Deviation from orthogonal correlated with decreased fixation strength. This decrease was statistically significant in the AS and PI quadrants, with deviation of 40 degrees, and in the AI quadrant, with deviation of 20 degrees, as well as 40 degrees. Conclusions Insertion angles for screw-in fixation devices should be orthogonal to the glenoid rim at the point of insertion to maximize strength. Deviation of 40 degrees from orthogonal compromises fixation in most quadrants and deviation as little as 20 degrees can compromise fixation in the AI quadrant.
  
  
  CONCLUSIONS
  To maximize strength of labral reattachment to the bony glenoid, screw-in type fixation devices should be inserted as orthogonal to the glenoid rim as possible. This is especially true for Bankart repairs, because device pullout occurs at significantly lower loads in the anteroinferior quadrant compared with the other 3 quadrants. Deviating as little as 20 degrees further decreases fixation strength significantly.
authors.affiliation: Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, USA. oilahi@mysurgeon.com
authors.forename: Omer A
authors.initials: OA
authors.lastname: Ilahi
authors.forename: Tarek
authors.initials: T
authors.lastname: Al-Fahl
authors.forename: Hasan
authors.initials: H
authors.lastname: Bahrani
authors.forename: Zong-Ping
authors.initials: ZP
authors.lastname: Luo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002102:Cadaver; D004868:Equipment Failure; D006801:Humans; D008875:Middle Aged; D019736:Prostheses and Implants; D012540:Scapula; D013314:Stress, Mechanical; D013536:Suture Techniques / Q000295:instrumentation*