Isolating Suture Slippage During Cadaveric Testing of Knotless Anchors

We evaluated a testing method designed to isolate and analyze the effectiveness of different suture-retention mechanisms in knotless suture anchors used for rotator cuff repairs. Six knotless PushLock implants (Arthrex) with a suture-retention mechanism dependent on a press-fit of suture between the anchor's outer diameter and surrounding bone were compared with 6 ReelX STT devices (Stryker) reliant on an intrinsic suture-locking mechanism. Suture slippage beyond minimal clinical failure thresholds, as well as ultimate failure load, were determined with a novel testing fixture that isolated suture slippage. Suture slippage was isolated from anchor-bone disengagement. Each PushLock exhibited suture slippage of more than 3 mm, and each ReelX exhibited slippage of less than 3 mm. The PushLock implants also exhibited significantly (P < .05) more interval and maximum slippage; 5 of these 6 implants failed via complete suture slippage before dynamic testing could be completed. All ReelX devices survived dynamic testing and ultimately failed via suture breakage. This novel axial load biomechanical testing technique isolated suture slippage in 2 uniquely designed knotless anchors. The press-fit PushLock implant was prone to slippage failure, whereas the ReelX device with its internal suture-locking mechanism exhibited minimal slippage.