Biomechanical Evaluation of Proximal Hamstring Repair: All-Suture Anchor Versus Titanium Suture Anchor

Alexander Otto, Alyssa M. DiCosmo, Joshua B. Baldino, Julian Mehl, Elifho Obopilwe, Mark P. Cote, Andreas B. Imhoff, Knut Beitzel, Augustus D. Mazzocca, Katherine Coyner

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: Proximal hamstring avulsions are severe tendon injuries and are commonly sports-related. Open and endoscopic techniques as well as different anchor configurations have already been described for proximal hamstring repair. Novel all-suture anchors have been developed to provide decreased bone loss during placement and reduced occupied bone volume when compared with titanium suture anchors. Hypothesis: Complete proximal hamstring avulsions repaired with all-suture anchors will demonstrate equal load to failure and comparable displacement under cyclic loading when compared with titanium suture anchors. Study Design: Controlled laboratory study. Methods: Complete proximal hamstring avulsions were created in 18 paired cadaveric specimens (mean ± SD age, 63.0 ± 10.4 years). Either all-suture anchors or titanium suture anchors were used for repair. Cyclic loading from 10 to 125 N at 1 Hz was performed for 1500 cycles with a material testing machine. Displacement was assessed along anterior and posterior aspects of the tendon repair with optical tracking. Specimens were loaded to failure at a rate of 120 mm/min. Displacement, load to failure, and repair construct stiffness were compared between matched pairs with the Wilcoxon signed-rank test. Correlations were determined by Spearman rho analysis. Results: The all-suture anchors showed significantly higher load-to-failure values when compared with the titanium anchor repairs (799.64 ± 257.1 vs 573.27 ± 89.9 N; P =.008). There was no significant difference in displacement between all-suture anchors and titanium suture anchors at the anterior aspect (6.60 ± 2.2 vs 5.49 ± 1.1 mm; P =.26) or posterior aspect (5.87 ± 2.08 vs 5.23 ± 1.37 mm; P =.678) of the repaired hamstring tendons. Conclusion: All-suture anchors demonstrated similar displacement and superior load to failure when compared with titanium suture anchors. Clinical Relevance: The results of this study suggest that all-suture anchors are an equivalent alternative to titanium suture anchors for proximal hamstring avulsion repair.

Original languageEnglish (US)
JournalOrthopaedic Journal of Sports Medicine
Issue number1
StatePublished - Jan 1 2020
Externally publishedYes


  • all-suture anchor
  • biomechanics
  • hip
  • proximal hamstring avulsion
  • proximal hamstring repair
  • titanium suture anchor

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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