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Use of a Novel Magnesium-Based Resorbable Bone Cement for Augmenting Anchor and Tendon Fixation

February 13, 2018 | Surgery
Brandon L. Roller, MD, PhD ; Keiichi Kuroki, DVM, PhD ; Chantelle C. Bozynski, DVM ; Ferris M. Pfeiffer, PhD ; James L. Cook, DVM, PhD
Author and Disclosure Information

Authors’ Disclosure Statement: Dr. Roller reports that he is a paid consultant for Bone Solutions Incorporated and a former Arthrex employee. Dr. Cook reports that he receives consulting fees, royalties, speaker honorarium, and grant support from Arthrex. The other authors report no actual or potential conflict of interest in relation to this article.

Acknowledgements: The authors would like to give special thanks to Stacy T. Cheavens, Certified Medical Illustrator, University of Missouri, for creating the illustrations for Figures 1 and 2; and to Vicki Kalsheur, Senior Research Specialist, University of Wisconsin-Madison, for processing the non-decal bone sections.

Dr. Roller is a Resident within the Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina. Dr. Kuroki is Associate Professor of Veterinary Pathology and Associated Director of the Thompson Laboratory for Regenerative Orthopaedics, Dr. Bozynski is a Veterinary Pathologist, Department of Orthopaedics, and Dr. Pfeiffer is Assistant Professor of Orthopaedics and Bioengineering, University of Missouri, Columbia, Missouri. Dr. Cook is the William & Kathryn Allen Distinguished Chair in Orthopaedic Surgery, Director of the Thompson Laboratory for Regenerative Orthopaedics and Mizzou BioJoint® Center, and Chief of Orthopaedic Research, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.

Address correspondence to: Brandon L. Roller, MD, PhD, Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (tel, 239-293-8256; email, Brandon.L.Roller@gmail.com).

Brandon L. Roller, MD, PhD Keiichi Kuroki, DVM, PhD Chantelle C. Bozynski, DVM Ferris M. Pfeiffer, PhD James L. Cook, DVM, PhD . Use of a Novel Magnesium-Based Resorbable Bone Cement for Augmenting Anchor and Tendon Fixation. Am J Orthop. February 13, 2018

TAKE-HOME POINTS

  • OsteoCrete, a magnesium-based resorbable bone cement, has potential to safely and effectively augment suture anchor fixation.
  • OsteoCrete increases anchor pull-out strength within 15 minutes of injection.
  • OsteoCrete has a more profound impact on anchors when used within bone of decreased density and quality.
  • OsteoCrete does not result in any untoward effect when placed near, or in contact with, rotator cuff or biceps tendons during fixation procedures.
  • OsteoCrete can potentially be used to replace the anchor within tenodesis procedures that utilize transcortical button fixation in addition to anchor fixation.

In this study, a short-term 12-week analysis revealed no significant differences in the nondestructive biomechanical testing and histologic analysis results between the use of OsteoCrete and the use of a tenodesis anchor. These results indicate the potential for using OsteoCrete as an anchor replacement. The biceps tendon did not react negatively to the OsteoCrete material, which indicated that OsteoCrete can be used adjacent to tendons without the concern of weakening the tendon due to an inflammatory reaction. This being said, tendon-to-bone integration was not evident at this early time point. It would be helpful to further explore the potential of this technique with a longer-term study investigating tendon-to-bone integration in more detail. Ideally, a long-term study would reveal an increased amount of new bone formation within the socket when compared to that with the anchor comparison, similar to the results reported by Gulotta and colleagues16 when using a tendon for ACL reconstruction with OsteoCrete.

We do note several limitations in this study. The dogs used in this study were healthy with normal bone and tendon morphology, the tendons were transected and repaired during the course of the same surgery, and only 1 early time point was evaluated. Additional investigations continuing the characterization of these clinical applications using an osteopenic or osteoporotic preclinical model with chronic tendon pathology and longer-term evaluation are now warranted based on the positive findings of this initial work.

CONCLUSION

OsteoCrete augmentation significantly improved initial rotator cuff anchor fixation (human in vitro) and was safe and effective for anchor and tendon fixation in rotator cuff tendon repair and biceps tenodesis procedures (canine in vivo), respectively, when compared with the current standard-of-care. Of note, the significant improvements associated with OsteoCrete were the greatest in poor-quality bone. Based on these results and considering the previously discussed limitations, it can be concluded that OsteoCrete has the potential for safely providing improved suture anchor and tissue fixation in patients with poor bone or tissue quality. Further in vivo study toward potential clinical applications is warranted.

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