title: Comparison of Suture-Based Anchors and Traditional Bioabsorbable Anchors in Foot and Ankle Surgery.
abstract: We compared the pullout strength of a suture-based anchor versus a bioabsorbable anchor in the distal fibula and calcaneus and evaluated the relationship between bone mineral density and peak load to failure. Eight paired cadaveric specimens underwent a modified Broström procedure and Achilles tendon reattachment. The fibula and calcaneus in the paired specimens received either a suture-based anchor or a bioabsorbable suture anchor. The fibular and calcaneal specimens were loaded to failure, defined as a substantial decrease in the applied load or pullout from the bone. In the fibula, the peak load to failure was significantly greater with the suture-based versus the bioabsorbable anchors (133.3 ± 41.8 N versus 76.8 ± 35.3 N; p = .002). No significant difference in load with 5 mm of displacement was found between the 2 groups. In the calcaneus, no difference in the peak load to failure was found between the 2 groups, and the peak load to failure with 5 mm of displacement was significantly lower with the suture-based than with the bioabsorbable anchors (52.2 ± 9.8 N versus 75.9 ± 12.4 N; p = .003). Bone mineral density and peak load to failure were significantly correlated in the fibula with the suture-based anchor. An innovative suture-based anchor had a greater peak load to failure compared with a bioabsorbable anchor in the fibula. In the calcaneus, the load at 5 mm of displacement was significantly lower in the suture-based than in the bioabsorbable group. The correlation findings might indicate the need for a cortical bone shelf with the suture-based anchor. Suture-based anchors could be a viable alternative to bioabsorbable anchors for certain foot and ankle procedures.
authors.affiliation: Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD.
authors.forename: W Chad
authors.initials: WC
authors.lastname: Hembree
authors.affiliation: Engineer, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Tsai
authors.affiliation: Engineer, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD.
authors.forename: Brent G
authors.initials: BG
authors.lastname: Parks
authors.affiliation: Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD. Electronic address: lyn.camire@medstar.net.
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Miller
mesh_terms: D020341:Absorbable Implants; D000125:Achilles Tendon / Q000601:surgery*; D000328:Adult; D000843:Ankle Joint / Q000601:surgery; D001696:Biomechanical Phenomena; D002102:Cadaver; D002111:Calcaneus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053441:Suture Anchors; D013536:Suture Techniques; D013718:Tensile Strength
keywords: Achilles tendinitis; Brostrm procedure; ankle instability; bone mineral density; calcaneus; fibula; load to failure