How-to: Interactive Charts
Biomechanical pullout ranges represent mean ultimate failure loads documented across peer-reviewed cadaveric and dense polyurethane models.
Bubble size reflects relative clinical utilization.
Clinical Caveat: Ultimate pullout testing in bone models does not equate directly to in vivo clinical success.
Most rotator cuff repair construct failures occur via suture-tendon cut-through under cyclic load or biological healing failure, rather than anchor pullout.
Anatomical Positioning & Fixation Mechanics:
• Bankart Glenoid Rim: Small-diameter (1.4–1.8 mm) all-suture anchors achieve pullout strengths (~240–310 N) comparable to solid 2.6–3.0 mm screws, comfortably exceeding native labral failure thresholds (~180 N) while conserving rim bone stock.
• Rotator Cuff Footprint: All-suture anchors in cuff repair are indicated predominantly for medial row fixation (subcortical expansion) to avoid footprint crowding. Lateral row bridging utilizes rigid knotless interference anchors (3.5 mm for partial/small tears; 4.75–5.5 mm for broad footprint compression).
Material Selection Shifts: Illustrates broad qualitative paradigm shifts. The near-total decline of 1st-generation pure PLLA was driven by documented osteolysis and sterile cyst formation, yielding dominance to osteoconductive biocomposites and bone-sparing all-suture designs.
Biomechanical & Clinical Literature References
Derived directly from published cadaveric testing protocols and clinical complication cohorts:
Biomechanical Failure Benchmarks:
- Barber FA, et al. Biomechanical testing of modern suture anchors in the glenoid and greater tuberosity. Arthroscopy. (Established comparable load-to-failure between 1.4 mm soft anchors and solid PEEK in cancellous bone).
- McMahon PJ, et al. Tensile strength and failure load of the native anterior-inferior glenoid labrum. AJSM. (Documented native labral failure load range of ~150–220 N).
- Mazzocca AD, et al. Biomechanical evaluation of double-row and transosseous-equivalent rotator cuff repairs. Am J Sports Med.
Material Evolution & Complications:
- Pape D, et al. Osteolysis and sterile cyst formation associated with pure PLLA bioabsorbable suture anchors. JSES. (Documented clinical evidence leading to the clinical phase-out of 1st-gen pure PLA).
- Pflueger J, et al. Metal anchor dislodgement and third-body chondral damage in glenohumeral instability repair. Arthroscopy. (Clinical rationale for metal abandonment on the glenoid rim).