JSES - 2026-05-19 - Journal Article
Bone Marrow Stimulation and Decortication Compromise the Biomechanical Strength of All Suture Anchor in Rotator Cuff Repair.
Shih CA, Hsu KL, Chen Y, Lin FH, Su WR, Kuan FC
Topics
Key Takeaway
Remnant-preserving footprint preparation yields 209.6 N ultimate failure load for 2.8-mm all-suture anchors, significantly exceeding decortication (137.2 N) and bone marrow stimulation (151.6 N) by approximately 35–38%.
Summary Depth
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Summary
This study compared biomechanical performance of 2.8-mm all-suture anchors across three footprint preparation techniques—remnant-preserving, decortication, and bone marrow stimulation—using cyclic loading in 18 fresh-frozen cadaveric shoulders. Remnant-preserving technique produced the highest load to failure (209.6 ± 61.6 N), greatest cycles to failure, and smallest cortical defect size compared to both decortication (137.2 ± 51.2 N, p=.002) and bone marrow stimulation (151.6 ± 56.5 N, p=.002). Suture anchor pullout was the dominant failure mode across all groups, implicating cortical bone integrity as the primary determinant of fixation strength.
Key Limitation
Cadaveric testing eliminates the biological healing response, meaning the study cannot determine whether the enhanced vascularity from bone marrow stimulation or decortication ultimately compensates for acute biomechanical weakness during the critical early postoperative healing window.
Original Abstract
BACKGROUND
Footprint preparation is considered an important factor influencing tendon-bone healing and fixation strength in arthroscopic rotator cuff repair. This study aimed to compare the biomechanical characteristics of all-suture anchors following three different footprint preparation techniques.
METHODS
Eighteen fresh-frozen human cadaveric shoulders were used. The anterior, middle, and posterior regions of the greater tuberosity were randomly and equally assigned to three footprint preparation techniques: remnant-preserving, decortication, and bone marrow stimulation. A 2.8-mm all-suture anchor was inserted at each designated site. Cyclic loading tests were performed to simulate the traction forces by the rotator cuff. The cyclic displacement, ultimate failure load, number of cycles, failure mode, and cortical defect size were recorded for comparison among groups.
RESULTS
The remnant-preserving group demonstrated the highest load to failure (209.6 ± 61.6 N), which was significantly greater than both the decortication (137.2 ± 51.2 N) and bone marrow stimulation (151.6 ± 56.5 N) groups (p = .002). Similarly, the remnant-preserving group withstood significantly more cycles to failure compared with the other two groups (p = .003). Suture anchor pullout was the predominant mode of failure in all specimens. The remnant-preserving group also exhibited the smallest cortical defect size (p = .019).
CONCLUSIONS
Both decortication and bone marrow stimulation techniques resulted in a significant reduction in the biomechanical performance of the suture anchors compared with the remnant-preserving technique.
LEVEL OF EVIDENCE
Basic Science Study; Biomechanics.