Why prefer all-suture anchor? A new comprehensive evaluation method.

All-suture anchor (ASA) is an emerging suture anchor used to fix soft tissue to bone. Composed entirely of textile material, ASA has the advantage of a small size and less damage to the bone. The purpose of this study was to analyze the mechanism of the pullout process of ASA from bone tissue and to quantitatively compare the extent of damage to cancellous bone by ASA and conventional suture anchors. First, pullout experiments were conducted on ASA in two different synthetic bone blocks to verify the effect of bone density on ASA performance, and the extraction process of ASA in the bone was simulated. In addition, a model of the proximal humerus was created, and different suture anchors were implanted. The damage to cancellous bone caused by the suture anchors was calculated and compared under the same force of 0-150 N and cyclic force of 0-100 N. The results showed that when the force was 150 N, the volume of plastic strain after implantation of conventional suture anchors was 26% larger than that after ASA implantation. The maximum plastic strain after implantation of conventional suture anchors was 1.5 times greater than that after implantation of ASA. Finally, a comprehensive evaluation method of suture anchor performance based on overall stiffness was proposed. According to this evaluation method, the performance of ASA is superior to that of conventional suture anchors.