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Cement augmentation of suture anchors in the proximal humerus during rotator cuff repair improves pullout strength: a systematic review
  1. Jeff S Kimball1,
  2. Anirudh K Gowd2,
  3. Brian R Waterman2,
  4. Seth L Sherman3,
  5. Jorge Chahla4,
  6. Nirav H Amin5,
  7. Joseph Liu1
  1. 1Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
  2. 2Orthopedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
  3. 3Orthopedic Surgery, Stanford University, Redwood City, California, USA
  4. 4Orthopedic Surgery, Midwest Orthopaedics at Rush LLC, Chicago, Illinois, USA
  5. 5Orthopedic Surgery, Veterans Health Administration, Loma Linda, California, USA
  1. Correspondence to Dr Jeff S Kimball, Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA; jkimball{at}llu.edu

Abstract

Importance Rotator cuff pathology is a growing concern in the ageing population. If cement augmentation of suture anchors improves pullout strength, its application can potentially be applied in cases of poor bone quality to prevent anchor failure.

Objective To evaluate the biomechanical benefits and fixation strength of cement-augmented versus non-augmented suture anchors in the proximal humerus during rotator cuff repair (RCR).

Evidence review A systematic review of PubMed, Embase and Cochrane Library was performed to identify all published articles reporting on biomechanical analysis of suture anchors in the shoulder in a cadaveric model. Inclusion criteria required fresh-frozen specimens, placement in the footprint of the proximal humerus, and comparative assessment of fixation constructs with or without polymethylmethacrylate (PMMA) or bioabsorbable composite cement augmentation. Biomechanical testing procedure, cement augmentation method and pullout force were assessed.

Findings After review of 105 abstracts, seven full manuscripts met inclusion criteria. Six of seven studies reported statistically significant differences in mean pullout force between augmented (three PMMAs, three composites, one PMMA vs composite) and non-augmented anchors. Of two studies evaluating cycles to failure, both found a significant increase in the augmented versus non-augmented anchors. Of two studies stratifying by anchor position, both investigations identified significant differences in mean pullout strength between augmented and non-augmented anchors at the posteromedial and anterolateral anchor positions.

Conclusions and relevance Cement augmentation of suture anchors in cadaveric humeri for RCR improves pullout strength regardless of cement type used or anchor position. Cement augmentation may provide a viable option for future clinical application.

Level of evidence IV, systematic review.

  • rotator cuff
  • shoulder
  • suture anchors

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors The primary and supervising authors performed review design and literature search. All contributing authors provided significant contribution to manuscript development, drafting and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Other others maintain the following competing interests: JL: paid presenter; JC and SLS: board membership and paid consultant; NHA: paid consultant, presenter and royalty/stock option; BRW: board membership, paid consultant and stock options.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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