SLR - August 2012 - Matthew J. Hentges(2)
Reference: Giza E, Nathe R, Nathe T, et al (2012). Strength of bone tunnel versus suture anchor and push-lock construct in Brostrum repair. Am J Sports Med 40(6), 1419-1423.
Scientific Literature Review
Reviewed by: Matthew J. Hentges, DPM
Residency Program: The Western Pennsylvania Hospital, Pittsburgh, PA
Podiatric Relevance:
Ankle sprains are one of the most common traumatic injuries seen by foot and ankle surgeons, and there are approximately 23,000 ankle injuries per day in the United States. Anatomic reconstruction of chronic lateral ankle instability is considered the “gold standard” yet there are many different techniques utilized by surgeons. This article compares the strength of two commonly utilized techniques, the bone tunnel construct versus suture anchor and push-lock construct.
Methods:
Seven pairs of lower limbs from human cadavers were obtained consisting of the distal half of the leg. The specimen for the bone tunnel construct was chosen at random, and the matched pair was the used for the suture anchor construct. The respective constructs were tested cyclically for 20 cycles and then to failure. The protocol used had been previously described in the literature.
Results:
Four of the seven suture anchor constructs failed at the anchor, and seven of seven bone tunnel constructs failed at the bone tunnel. Only three out of 14 specimens failed by suture pullout. Statistical analysis revealed no significant difference in strength, stiffness, torque to failure, or initial stiffness between the two constructs. A majority of the constructs failed at the bone interface. Two major weaknesses of this study include: (1) the varying quality of bone in the cadaver specimens; and (2) the limitation of mechanical testing.
Conclusions:
This report demonstrates that a suture anchor construct can safely be used and is equal in strength and stiffness to the bone tunnel construct. Both of the techniques tested in this study have demonstrated excellent clinical results in published reports. It is of the author’s opinion that a suture anchor construct allows for a smaller incision, less dissection, improved efficiency, and early protected mobilization.