Biomechanical Effects of Partial Decortication on All-Suture and Conventional Suture Anchors in Different Bone Densities

While biomechanical testing has shown a correlation between decortication and anchor failure load, the effects of partial decortication on the biomechanical properties of all-suture anchors remain unclear. We aimed to evaluate the biomechanical effects of partial decortication on all-suture anchors and conventional suture anchors in Sawbones of varying densities. Suture anchors were tested in nondecorticated, partially decorticated, and completely decorticated Sawbones. Two types of all-suture anchors and one type of conventional anchor were evaluated. Two types of biphasic polyurethane foam were used to mimic normal bone: 0.32 g/cm³ density (20 pounds per cubic foot, pcf 20) and osteoporotic bone: 0.16 g/cm³ density (10 pounds per cubic foot, pcf 10). Cyclic loadings were applied, and peak displacement was recorded. After cyclic loading tests, surviving anchors were subjected to pull-to-failure tests. The number of cycles, peak displacement, ultimate failure loads, and failure modes were determined. First, peak displacement was significantly influenced by bone density and anchor type: normal bone models exhibited lower peak displacement than osteoporotic models, and conventional screw-type anchors consistently demonstrated reduced peak displacement compared to all-suture anchors. In contrast, the extent of bone decortication-whether non-decorticated, partially decorticated, or completely decorticated-showed no significant effect on peak displacement. Second, in osteoporotic bone models (10 pounds per cubic foot), no significant difference in failure load was observed between the partially and non-decorticated groups, but both exhibited significantly higher values than the completely decorticated group.