DESIGN GUIDE (—THIS SIDEBAR DOES NOT PRINT—) QUICK … · 2020-07-09 · RESEARCH POSTER...
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RESEARCH POSTER PRESENTATION DESIGN © 2015 www.PosterPresentations.com Arthroscopic shoulder stabilization using suture anchors are commonly used techniques. More recently developed all-suture systems employ smaller diameter anchors, which increase repair contact area and allow greater placement density on narrow surfaces such as the glenoid. Our goal is investigate the strength characteristics of various inter-anchor distances in a human glenoid model OBJECTIVES Twelve fresh-frozen human cadaveric glenoids were potted after the labrum was excised. The glenoids were then implanted with 1.4 mm all- suture anchors (JuggerKnot Soft Anchors, Zimmer Biomet, Warsaw, IN) at varying inter- anchor distances. Anchors were implanted adjacent to one another or at 2 mm, 3 mm, or 5 mm distances using a template with pre-drilled holes. The glenoids were then underwent single cycle pullout testing using a test frame (Instron 8521, Instron Inc., Norwood, MA). A 5N preload was applied to the construct and the actuator was driven away from the shoulder at a rate of 12.5 mm/s. Force and displacement were collected from the test frame actuator at a rate of 500 Hz. The primary outcomes were failure strength, stiffness, and ultimate strength. Stiffness was calculated from the initial linear region of the force displacement curve. Failure strength was defined as the first local maximum inflection point in the force displacement curve. Ultimate strength was taken to be the maximum overall load observed. METHODS During load to fail testing, all but three of the specimens had both anchors pull out of the glenoid. The other mode of failure included one or both of the sutures failing. Stiffness was 13.52 ± 3.8, 17.97 ± 5.02, 17.59 ± 4.65 and 18.95 ± 4.67 N/mm for the adjacent, 2 mm, 3 mm and 5 mm treatment groups. The adjacent group had a significantly lower stiffness compared to the other treatment groups. Failure strength was 48.68 ± 20.64, 76.16 ± 23.78, 73.19 ± 35.83 and 87.04 ± 34.67 N for the adjacent, 2 mm, 3 mm and 5 mm treatment groups. The adjacent group had a significantly lower failure strength compared to the other treatment groups. Ultimate strength was also measured to be 190.59 ± 140.93, 268.7 ± 115.1, 283.23 ± 118.43, and 291.28 ± 118.24 for the ADJ, 2mm, 3mm and 5mm treatment groups. The adjacently spaced anchors had a trend towards lower ultimate strength though there was no statistically significant difference. RESULTS CONCULSIONS These data provide biomechanical evidence that in the glenoid, small diameter all-suture anchors may be implanted as close as 2 mm to one another without significantly decreasing their strength characteristics REFERENCES 1.Diduch, D. R. et al. Tissue Anchor Use in Arthroscopic Glenohumeral Surgery: J. Am. Acad. Orthop. Surg. 20, 459–471 (2012). 2.Wolf, E. M., Wilk, R. M. & Richmond, J. C. Arthroscopic Bankart repair using suture anchors. Oper. Tech. Orthop. 1, 184–191 (1991). 3.Barber, F. A. & Deck, M. A. The in vivo histology of an absorbable suture anchor: a preliminary report. Arthrosc. J. Arthrosc. Relat. Surg. Off. Publ. Arthrosc. Assoc. N. Am. Int. Arthrosc. Assoc. 11, 77–81 (1995). 4.Park, M. C. et al. Part I: Footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J. Shoulder Elbow Surg. 16, 461–468 (2007). 5.Ahmad, C. S. et al. Evaluation of glenoid capsulolabral complex insertional anatomy and restoration with single- and double-row capsulolabral repairs. J. Shoulder Elbow Surg. 18, 948–954 (2009). 6.Kim, D.-S., Yoon, Y.-S. & Chung, H.-J. Single-Row Versus Double-Row Capsulolabral Repair: A Comparative Evaluation of Contact Pressure and Surface Area in the Capsulolabral Complex-Glenoid Bone Interface. Am. J. Sports Med. 39, 1500–1506 (2011). 7.Barber, F. A. & Herbert, M. A. Cyclic Loading Biomechanical Analysis of the Pullout Strengths of Rotator Cuff and Glenoid Anchors: 2013 Update. Arthrosc. J. Arthrosc. Relat. Surg. 29, 832–844 (2013). 8.Barber, F. A., Feder, S. M., Burkhart, S. S. & Ahrens, J. The relationship of suture anchor failure and bone density to proximal humerus location: a cadaveric study. Arthrosc. J. Arthrosc. Relat. Surg. Off. Publ. Arthrosc. Assoc. N. Am. Int. Arthrosc. Assoc. 13, 340–345 (1997). 9.Agrawal, V. & Pietrzak, W. Triple labrum tears repaired with the JuggerKnotTM soft anchor: Technique and results. Int. J. Shoulder Surg. 9, 81 (2015). 1 San Francisco Orthopedic Residency Program, San Francicso, CA, USA, 2 OrthoCarolina Sports Medicine Center, CharloKe, NC, USA, 3 Andrews Research and Educa/on Founda/on Program, Gulf Breeze, FL, USA, 4 The Taylor Labs, San Francisco, CA, USA Jonathan Kramer, MD 1 , Sean Robinson, MD 1 , Pascual DuKon, MD 1 , Ephraim Dickinson, MD 2 , John Paul Rodriguez, MD 3 , William Camisa 4 , Jeremi M. Leasure, MS 4 , William H. Montgomery, MD 1 . Analysis of Glenoid Inter-anchor Distance with an All-Suture Anchor System
Transcript of DESIGN GUIDE (—THIS SIDEBAR DOES NOT PRINT—) QUICK … · 2020-07-09 · RESEARCH POSTER...
RESEARCH POSTER PRESENTATION DESIGN © 2015
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(—THIS SIDEBAR DOES NOT PRINT—) DES I G N G U I DE
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Arthroscopic shoulder stabilization using suture anchors are commonly used techniques. More recently developed all-suture systems employ smaller diameter anchors, which increase repair contact area and allow greater placement density on narrow surfaces such as the glenoid. Our goal is investigate the strength characteristics of various inter-anchor distances in a human glenoid model
OBJECTIVES
Twelve fresh-frozen human cadaveric glenoids were potted after the labrum was excised. The glenoids were then implanted with 1.4 mm all-suture anchors (JuggerKnot Soft Anchors, Zimmer Biomet, Warsaw, IN) at varying inter-anchor distances. Anchors were implanted adjacent to one another or at 2 mm, 3 mm, or 5 mm distances using a template with pre-drilled holes. The glenoids were then underwent single cycle pullout testing using a test frame (Instron 8521, Instron Inc., Norwood, MA). A 5N preload was applied to the construct and the actuator was driven away from the shoulder at a rate of 12.5 mm/s. Force and displacement were collected from the test frame actuator at a rate of 500 Hz. The primary outcomes were failure strength, stiffness, and ultimate strength. Stiffness was calculated from the initial linear region of the force displacement curve. Failure strength was defined as the first local maximum inflection point in the force displacement curve. Ultimate strength was taken to be the maximum overall load observed.
METHODS
During load to fail testing, all but three of the specimens had both anchors pull out of the glenoid. The other mode of failure included one or both of the sutures failing. Stiffness was 13.52 ± 3.8, 17.97 ± 5.02, 17.59 ± 4.65 and 18.95 ± 4.67 N/mm for the adjacent, 2 mm, 3 mm and 5 mm treatment groups. The adjacent group had a significantly lower stiffness compared to the other treatment groups. Failure strength was 48.68 ± 20.64, 76.16 ± 23.78, 73.19 ± 35.83 and 87.04 ± 34.67 N for the adjacent, 2 mm, 3 mm and 5 mm treatment groups. The adjacent group had a significantly lower failure strength compared to the other treatment groups. Ultimate strength was also measured to be 190.59 ± 140.93, 268.7 ± 115.1, 283.23 ± 118.43, and 291.28 ± 118.24 for the ADJ, 2mm, 3mm and 5mm treatment groups. The adjacently spaced anchors had a trend towards lower ultimate strength though there was no statistically significant difference.
RESULTS CONCULSIONSThese data provide biomechanical evidence
that in the glenoid, small diameter all-suture anchors may be implanted as close as 2 mm to one another without significantly decreasing their strength characteristics
REFERENCES
1.Diduch, D. R. et al. Tissue Anchor Use in Arthroscopic Glenohumeral Surgery: J. Am. Acad. Orthop. Surg. 20, 459–471 (2012). 2.Wolf, E. M., Wilk, R. M. & Richmond, J. C. Arthroscopic Bankart repair using suture anchors. Oper. Tech. Orthop. 1, 184–191 (1991). 3.Barber, F. A. & Deck, M. A. The in vivo histology of an absorbable suture anchor: a preliminary report. Arthrosc. J. Arthrosc. Relat. Surg. Off. Publ. Arthrosc. Assoc. N. Am. Int. Arthrosc. Assoc. 11, 77–81 (1995). 4.Park, M. C. et al. Part I: Footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J. Shoulder Elbow Surg. 16, 461–468 (2007). 5.Ahmad, C. S. et al. Evaluation of glenoid capsulolabral complex insertional anatomy and restoration with single- and double-row capsulolabral repairs. J. Shoulder Elbow Surg. 18, 948–954 (2009). 6.Kim, D.-S., Yoon, Y.-S. & Chung, H.-J. Single-Row Versus Double-Row Capsulolabral Repair: A Comparative Evaluation of Contact Pressure and Surface Area in the Capsulolabral Complex-Glenoid Bone Interface. Am. J. Sports Med. 39, 1500–1506 (2011). 7.Barber, F. A. & Herbert, M. A. Cyclic Loading Biomechanical Analysis of the Pullout Strengths of Rotator Cuff and Glenoid Anchors: 2013 Update. Arthrosc. J. Arthrosc. Relat. Surg. 29, 832–844 (2013). 8.Barber, F. A., Feder, S. M., Burkhart, S. S. & Ahrens, J. The relationship of suture anchor failure and bone density to proximal humerus location: a cadaveric study. Arthrosc. J. Arthrosc. Relat. Surg. Off. Publ. Arthrosc. Assoc. N. Am. Int. Arthrosc. Assoc. 13, 340–345 (1997). 9.Agrawal, V. & Pietrzak, W. Triple labrum tears repaired with the JuggerKnotTM soft anchor: Technique and results. Int. J. Shoulder Surg. 9, 81 (2015).
1SanFranciscoOrthopedicResidencyProgram,SanFrancicso,CA,USA,2OrthoCarolinaSportsMedicineCenter,CharloKe,NC,USA,3AndrewsResearchandEduca/onFounda/onProgram,GulfBreeze,FL,USA,4TheTaylorLabs,SanFrancisco,CA,USA
JonathanKramer,MD1,SeanRobinson,MD1,PascualDuKon,MD1,EphraimDickinson,MD2,JohnPaulRodriguez,MD3,WilliamCamisa4,JeremiM.Leasure,MS4,WilliamH.Montgomery,MD1.
AnalysisofGlenoidInter-anchorDistancewithanAll-SutureAnchorSystem
