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RESEARCH ARTICLE

Development of a Novel Hybrid Suture Anchor for

Osteoporosis by Integrating Titanium 3D Printing and

Traditional Machining

Chih-Hwa Chen 1,2,3 , Wen-Jen Chang , Yu-San Chen , Kuan Hao Chen , Shao-Fu Huang ,
2,7
6,8
4,5
6
Hsin-Ru Hsueh , Cun-Bin Li , Chun-Li Lin *
6 ,8
6
6
1 School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
2 Department of Orthopedics, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan
3 School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
4 Department of Information Management, Chang Gung University, Tao-Yuan, Taiwan
5 Department of Dentistry, Chang Gung Memorial Hospital, Taoyuan, Taiwan
6 Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
7 Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medial
University, Taipei, Taiwan
8 Innovation and Translation Center of Medical Device, National Yang Ming Chiao Tung University, Taipei, Taiwan

Abstract: The aim of this study is to develop a titanium three-dimensional (3D) printing novel hybrid suture anchor (HSA) with wing
structure mechanism which can be opened to provide better holding power for surrounding osteoporotic bone. A screw-type anchor
(5.5-mm diameter and 16-mm length) was designed with wing mechanism as well as micro dual-thread in the outer cortex bone contact
area and macro single-thread in the anchor body. Both side wings can be opened by an internal screw to provide better bone holding
power. The suture anchor and internal screw were manufactured using Ti6Al4V 3D printing and traditional machining, respectively.
Static pullout and after dynamic 300-cyclic load (150 N) pullout tests for HSA with or without the wing open and commercial solid
anchor (CSA) were performed (n = 5) in severely osteoporotic bone and osteoporotic bone to evaluate failure strengths. Comparison
of histomorphometrical evaluation was performed through in vivo pig implantation of HSAs with the wing open and CSAs. The
failure strengths of HSA with or without the wing open were 2.50/1.95- and 2.46/2.17-fold higher than those of CSA for static and
after dynamic load pullout tests in severely osteoporotic bone, respectively. Corresponding values for static and after dynamic load
pullout tests were 1.81/1.54- and 1.77/1.62-fold in osteoporotic bone, respectively. Histomorphometrical evaluation revealed that the
effects of new bone ingrowth along the anchor contour for CSA and HSA were both approximately 20% with no significant difference.
A novel HSA with wing mechanism was developed using 3D printing and the opened wing mechanism can be used to increase bone
holding power for osteoporosis when necessary. Better failure strength of HSA than CSA under static and after dynamic load pullout
tests and equivalence of bone ingrowth along the anchor contours confirmed the feasibility of the novel HSA.
Keywords: Suture anchor; Rotator cuff; 3D printing; Pullout; Failure strength

*Correspondence to: Chun-Li Lin, Department of Biomedical Engineering, Innovation and Translation Center of Medical Device, National Yang
Ming Chaio Tung University, Taipei, Taiwan; cllin2@nycu.edu.tw
Received: May 3, 2022; Accepted: June 12, 2022; Published Online: August 26, 2022

Citation: Chen CH, Chang WJ, Chen YS, et al., 2022. Development of a Novel Hybrid Suture Anchor for Osteoporosis by Integrating
Titanium 3D Printing and Traditional Machining. Int J Bioprint, 8(4):608. http://doi.org/10.18063/ijb.v8i4.608
1. Introduction decreases while an anchor is inserted into osteoporotic
or osteopenic bone in the proximal humerus, which
Arthroscopic rotator cuff repair using suture anchors to increases the failure rate of anchor treatment [3-5] . Several
reattach torn rotator cuff tissue to the bone is an important approaches, including buddy-system anchors, bone
surgical treatment [1,2] . However, bone holding power grafting, cement augmentation, and changing anchor
© 2022 Author(s). This is an Open-Access article distributed under the terms of the Creative Commons Attribution License, permitting distribution and
reproduction in any medium, provided the original work is properly cited.
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