The incidence of rotator cuff tears increases with age, thus the rotator cuff tear is often associated with osteoporotic or osteopenic bone in the proximal humerus, especially with female patients. For testing of fixation devices such as suture anchors used in rotator cuff repair often animal bones are used. They are easily to obtain, inexpensive and some have been found to be similar to human bone. But can we rely on the results drawn from these studies in our daily surgical practice?

The purpose of this study was to compare the trabecular bone mineral density, the trabecular bone volume fraction and the cortical layer thicknes in the greater tubercle in different species to evaluate their infiuence on primary stability of suture anchors under a cyclic loading protocol representing the physiologic forces placed on rotator cuff repairs in vivo. We hypothezised that maximum pullout forces as well as the modes of failure are different for a suture anchors in different humeri. The available three different types of anchor fixation design (screw: Spiralok 5mm, Super Revo 5mm, press-fit: Bioknotless RC, wedging: Ultrasorb) were tested. The bone mineral density (BMD) of the humeri was measured by a 64-slice-computed tomography system. Each anchor was tested individually until failure. The sutures were pulled at 135° to the axis of the humeral shaft, simulating the physiological pull of the supraspinatus tendon. Starting with 75 N the tensile load was gradually increased by 25 N after everey 50 cycles until failure of the anchor fixation system occurred. The ultimate failure load, the system displacement after the first pull with 75 N and the mode of failure were recorded.

The ultimate failure loads of each anchor were different in the human osteopenic, human healthy, ovine and bovine humeri. The statistical significancies for pull out forces between the anchors varied from species to species. The biomechanical testing of suture anchors for arthroscopic rotator cuff repair in ovine and bovine humeri does not give reliable data that can be transferred to the human situation. The significances between the suture anchors found in ovine and bovine humeri are different from the results in human humeri. When taking the impaired bone quality of older patients into account the results from ovine and bovine humeri are even less predictable. We found a positive correlation between maximum failure load and cortical layer thickness for the Super Revo and the Ultrasorb anchor. The ultimate failure load seems to depend mainly on the cortical thickness and on the subcortical trabecular bone quality.

Over the last 10 years ACI (Autologous Chondrocyte Implantation) has become an important surgical technique for treating large cartilage defects. The original method has been improved by using cell seeded scaffolds for implantation. The aim of our prospective study was to evaluate the efficiency of a matrix based ACI (MACI) with a collagen type I scaffold for repairing large cartilage defects of the knee. We present the clinical and radiological results of 22 pts. one year after collagen scaffold based ACI.

Out of 39 pts. treated with ACI for cartilage defects of the knee 22 had reached the one year follow up. We documented preoperatively and postoperatively (3, 6 and 12 months) the clinical situation with the IKDC Knee Examination Form. MRI scans were evaluated at all time points.

41% of the pts. were female, 59% male. The average age was 33 yrs. (min:15; max:49), the average BMI 25,4 (min:19; max:36). One third of the cartilage defects were localized retropatellar, the remaining on the medial or lateral femoral condyle. The average defect size was 5.7 cm2. In about 75% of the cases an additional surgical procedure was performed (ACL-reconstruction, lateral release, meniscal surgery). One major complication (a deep wound infection) occured. The IKDC score improved over time during follow up significantly. Patients with retropatellar defects have a poorer outcome compared to femoral defects. The MRI showed an improvement of the implanted scaffold over time as well.

The present study confirms the benefits of MACI in young patients with large cartilage defects of the knee. The matrix based ACI is a surgically less demanding technique then the traditional ACI. We expect a good long term outcome from MACI comparable to that of traditional ACI.