# A Low-Cost All-Suture Anchor: A Novel Technique With Mechanical Test Validation in Osteoporotic Bone Models

## TL;DR

Researchers created a low-cost suture anchor using common surgical materials and tested it in a model of osteoporotic bone, finding it as effective as commercial options.

## Contribution

A novel, low-cost all-suture anchor design using standard operating room materials with mechanical validation in an osteoporotic bone model.

## Key findings

- The low-cost all-suture anchor achieved maximum pullout force comparable to commercial anchors.
- The anchor performed similarly under 90-degree and 45-degree loading angles in an osteoporotic bone model.
- The design is a viable alternative for under-resourced settings but requires further testing before clinical use.

## Abstract

Achieving higher-quality health care while reducing costs is an ideal goal for health care systems throughout the globe. Commercially available suture anchor costs can be prohibitive in some under-resourced settings. This disparity highlights the need for innovative solutions that maintain high clinical efficacy while being economically accessible.

In the present study, we developed a novel all-suture anchor (ASA) design using the same general placement procedure, but utilizing materials that are available in standard operating rooms. A 2.0 braided polyblend suture was woven through a 2.5 cm-long piece of 5 mm-wide Mersilene tape, leaving two loose ends of suture on either end of the tape. We deployed this ASA into a 10-pound/cubic foot (PCF) Sawbones® block (Pacific Research Laboratories, Inc., Vashon, WA, USA), representing osteoporotic bone, using a custom-made, autoclavable deployment tool. Anchors were tested at 90-degree and 45-degree angles in a custom fixture under uniaxial biomechanical tension. Test samples were first preloaded to 1 N, preconditioned via cyclic loading, and then loaded to failure to assess the maximum pullout force required for failure of each ASA. A continuous outcome non-inferiority statistical analysis was used to compare test outcomes to historical data published on commercially available ASAs, tested using similar-density material and the same insertion and loading angles. We were able to achieve our aim of creating a low-cost ASA from existing operating room materials. These anchors were not statistically different from the maximum pullout force values of commercial ASA products previously tested. This alternate soft anchor may be a viable option for those in need of a low-cost solution, but further material options, deployment techniques, and loading angles must be explored before cadaveric testing is done.