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Chen, et al.
Table 1. Numbers of HSA/CSA for static/dynamic pullout test and in vivo animal experiment
Anchor type In vitro biomechanical test (number) In vivo animal
experiment (number)
20 pcf 7.5 pcf Pig shoulder
HSA (n=44) With the wing open (HSAWW)
Static pull out 5 5
Dynamic pull out 5 5
Animal experiment 4
Without the wing open (HSAWOW)
Static pull out 5 5
Dynamic pull out 5 5
CSA
CSA (Arthex) (n=24) Static pull out 5 5
Dynamic pull out 5 5
Animal experiment 4
HSA, Hybrid suture anchor; CSA, Commercial solid anchor

A B C

D

Figure 3. (A) Schematic diagram of the pullout test. (B) Local view of the test and anchor inserted in 20 pcf Sawbone. (C) Top view of
hybrid suture anchor. (D) Top view of commercial solid anchor.

Kruskal–Wallis test was used to perform the statistical anatomy, and size with human humerus. Moreover, cost
analysis to understand the difference of failure strength and variability are lower in this model than others .
[11]
between HSAWW, HSAWOW, and CSA because sample Bone mineral density was not calculated in this study
sizes were relatively small and cannot determine if the because all pig shoulders were young and of the same
data were normally distributed. age (4 months ± 1 week).
The pigs were fasted for 12 h before surgery. For
2.4. In vivo anchor implantation and sedation and anesthesia, zoletil-50 5 mg/kg, xylazine
histomorphometrical evaluation 2 mg/kg, atropine 0.03 mg/kg, and ketoprofen 2 mg/kg

The study was reviewed and approved by the ethics were given by intramuscular injection. Anesthesia was
review committee of the Institutional Animal Care maintained with 3% isoflurane through endotracheal
and Use Committee of Chi-Mei Medical Center inhalation, with oxygen 2 L/min. The pig was placed
(No.: 110011201). Two female, skeletally mature, in the lateral position and the skin was disinfected with
Yorkshire pigs, weighing around 20 kg (mean ± SD: povidone-iodine. A 5–6-cm long skin incision was made
20.25 ± 0.695 kg), with an average age of 4 months, were at the upper shoulder area. Deltoid and other superficial
used for the in vivo implantation study. The pig model muscles were separated with bleeding control. The
was chosen due to its similarity in bone quality, density, infraspinatus muscle was identified by anatomical

International Journal of Bioprinting (2022)–Volume 8, Issue 4 165