Bony Ingrowth of Coil-Type Open-Architecture Anchors Compared With Screw-Type PEEK Anchors for the Medial Row in Rotator Cuff Repair: A Randomized Controlled Trial

Published:December 03, 2019DOI:


      To evaluate outcomes of screw-type and coil-type open-architecture suture anchors with respect to bony ingrowth, release of biological markers, and patient-reported outcome measures when used in rotator cuff repair (RCR).


      Forty patients undergoing arthroscopic RCR for full-thickness rotator cuff tears were enrolled and prospectively randomized to receive a screw-type (19 patients) or coil-type (21 patients) suture anchor for the medial row during repair. All repairs used a transosseous-equivalent configuration with footprint anchors laterally. Marrow elements released during surgery were evaluated for 9 cytokine markers (insulin-like growth factor 1, fibroblast growth factor 2, bone morphogenetic proteins 7 and 2, platelet-derived growth factors AA and BB, epidermal growth factor, transforming growth factor beta1, and vascular endothelial growth factor). Postoperative computed tomography scans were performed at 6 months. Range of motion, strength, and validated patient-reported outcome measures (Simple Shoulder Test, Single Assessment Numeric Evaluation, visual analog scale, and American Shoulder and Elbow Surgeons scores) were gathered before the operation and at 6 months and 1 year postoperatively.


      Bone mineral density surrounding the coil-type anchor was significantly greater than that surrounding the screw-type anchor (P = .005). Bone mineral density values within the coil-type and screw-type anchors were comparable (P = .527); however, a larger amount of total bone mineral mass (in milligrams) was shown within the coil-type anchor owing to its larger volume (P < .01). Marrow elements released at the repair site were similar between groups (P > .05). Postoperatively, no statistically significant difference was found between groups for clinical outcome measures at 6 months or 1 year. Retear and complication rates were similar between groups (P > .05).


      Both the coil-type and screw-type anchors can be reliably used for RCR and produce similar clinical outcomes. The coil-type anchor resulted in superior bony growth surrounding the anchor and a larger total bone mineral mass within the anchor owing to its larger volume.

      Level of Evidence

      Level II, randomized prospective comparative study.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Tashjian R.Z.
        Epidemiology, natural history, and indications for treatment of rotator cuff tears.
        Clin Sports Med. 2012; 31: 589-604
        • Huang A.L.
        • Thavorn K.
        • van Katwyk S.
        • MacDonald P.
        • Lapner P.
        Double-row arthroscopic rotator cuff repair is more cost-effective than single-row repair.
        J Bone Joint Surg Am. 2017; 99: 1730-1736
        • Piper C.C.
        • Hughes A.J.
        • Ma Y.
        • Wang H.
        • Neviaser A.S.
        Operative versus nonoperative treatment for the management of full-thickness rotator cuff tears: A systematic review and meta-analysis.
        J Shoulder Elbow Surg. 2018; 27: 572-576
        • Shen C.
        • Tang Z.H.
        • Hu J.Z.
        • Zou G.Y.
        • Xiao R.C.
        Incidence of retear with double-row versus single-row rotator cuff repair.
        Orthopedics. 2014; 37: e1006-e1013
        • Millett P.J.
        • Espinoza C.
        • Horan M.P.
        • et al.
        Predictors of outcomes after arthroscopic transosseous equivalent rotator cuff repair in 155 cases: A propensity score weighted analysis of knotted and knotless self-reinforcing repair techniques at a minimum of 2 years.
        Arch Orthop Trauma Surg. 2017; 137: 1399-1408
        • Guo Q.
        • Li C.
        • Qi W.
        • et al.
        A novel suture anchor constructed of cortical bone for rotator cuff repair: A biomechanical study on sheep humerus specimens.
        Int Orthop. 2016; 40: 1913-1918
        • Pietschmann M.F.
        • Gulecyuz M.F.
        • Fieseler S.
        • et al.
        Biomechanical stability of knotless suture anchors used in rotator cuff repair in healthy and osteopenic bone.
        Arthroscopy. 2010; 26: 1035-1044
        • Barber F.A.
        • Herbert M.A.
        • Hapa O.
        • et al.
        Biomechanical analysis of pullout strengths of rotator cuff and glenoid anchors: 2011 Update.
        Arthroscopy. 2011; 27: 895-905
        • Efird C.
        • Traub S.
        • Baldini T.
        • et al.
        Knotless single-row rotator cuff repair: A comparative biomechanical study of 2 knotless suture anchors.
        Orthopedics. 2013; 36: e1033-e1037
        • Barber F.A.
        • Dockery W.D.
        • Cowden III, C.H.
        The degradation outcome of biocomposite suture anchors made from poly L-lactide-co-glycolide and beta-tricalcium phosphate.
        Arthroscopy. 2013; 29: 1834-1839
        • Cobaleda Aristizabal A.F.
        • Sanders E.J.
        • Barber F.A.
        Adverse events associated with biodegradable lactide-containing suture anchors.
        Arthroscopy. 2014; 30: 555-560
        • Sano H.
        • Tokunaga M.
        • Noguchi M.
        • et al.
        Comparison of fixation properties between coil-type and screw-type anchors for rotator cuff repair: A virtual pullout testing using 3-dimensional finite element method.
        J Orthop Sci. 2016; 21: 452-457
        • Jeong J.Y.
        • Chung P.K.
        • Yoo J.C.
        Effect of sodium hyaluronate/carboxymethyl cellulose (Guardix-sol) on retear rate and postoperative stiffness in arthroscopic rotator cuff repair patients: A prospective cohort study.
        J Orthop Surg (Hong Kong). 2017; 25 (2309499017718908)
        • Rodeo S.A.
        • Delos D.
        • Williams R.J.
        • Adler R.S.
        • Pearle A.
        • Warren R.F.
        The effect of platelet-rich fibrin matrix on rotator cuff tendon healing: A prospective, randomized clinical study.
        Am J Sports Med. 2012; 40: 1234-1241
        • Hernigou P.
        • Flouzat Lachaniette C.H.
        • Delambre J.
        • et al.
        Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: A case-controlled study.
        Int Orthop. 2014; 38: 1811-1818
        • Ebert J.R.
        • Wang A.
        • Smith A.
        • et al.
        A midterm evaluation of postoperative platelet-rich plasma injections on arthroscopic supraspinatus repair: A randomized controlled trial.
        Am J Sports Med. 2017; 45: 2965-2974
        • Charles M.D.
        • Christian D.R.
        • Cole B.J.
        The role of biologic therapy in rotator cuff tears and repairs.
        Curr Rev Musculoskelet Med. 2018; 11: 150-161
        • Greenspoon J.A.
        • Moulton S.G.
        • Millett P.J.
        • Petri M.
        The role of platelet rich plasma (PRP) and other biologics for rotator cuff repair.
        Open Orthop J. 2016; 10: 309-314
        • Simon P.
        • Gupta A.
        • Pappou I.
        • et al.
        Glenoid subchondral bone density distribution in male total shoulder arthroplasty subjects with eccentric and concentric wear.
        J Shoulder Elbow Surg. 2015; 24: 416-424
        • Rho J.Y.
        • Hobatho M.C.
        • Ashman R.B.
        Relations of mechanical properties to density and CT numbers in human bone.
        Med Eng Phys. 1995; 17: 347-355
        • Cvetanovich G.L.
        • Gowd A.K.
        • Liu J.N.
        • et al.
        Establishing clinically significant outcome after arthroscopic rotator cuff repair.
        J Shoulder Elbow Surg. 2019; 28: 939-948
        • Zuke W.A.
        • Leroux T.S.
        • Gregory B.P.
        • et al.
        Establishing maximal medical improvement after arthroscopic rotator cuff repair.
        Am J Sports Med. 2018; 46: 1000-1007
        • Tiaka E.K.
        • Papanas N.
        • Manolakis A.C.
        • Georgiadis G.S.
        Epidermal growth factor in the treatment of diabetic foot ulcers: An update.
        Perspect Vasc Surg Endovasc Ther. 2012; 24: 37-44
        • Tokunaga T.
        • Shukunami C.
        • Okamoto N.
        • et al.
        FGF-2 stimulates the growth of tenogenic progenitor cells to facilitate the generation of tenomodulin-positive tenocytes in a rat rotator cuff healing model.
        Am J Sports Med. 2015; 43: 2411-2422
        • Wang L.L.
        • Yin X.F.
        • Chu X.C.
        • Zhang Y.B.
        • Gong X.N.
        Platelet-derived growth factor subunit B is required for tendon-bone healing using bone marrow-derived mesenchymal stem cells after rotator cuff repair in rats.
        J Cell Biochem. 2018; 119: 8897-8908
        • Liu X.N.
        • Yang C.J.
        • Kim J.E.
        • et al.
        Enhanced tendon-to-bone healing of chronic rotator cuff tears by bone marrow aspirate concentrate in a rabbit model.
        Clin Orthop Surg. 2018; 10: 99-110
        • Foster T.E.
        • Puskas B.L.
        • Mandelbaum B.R.
        • Gerhardt M.B.
        • Rodeo S.A.
        Platelet-rich plasma: From basic science to clinical applications.
        Am J Sports Med. 2009; 37: 2259-2272
        • Holtby R.
        • Christakis M.
        • Maman E.
        • et al.
        Impact of platelet-rich plasma on arthroscopic repair of small- to medium-sized rotator cuff tears: A randomized controlled trial.
        Orthop J Sports Med. 2016; 4 (2325967116665595)
        • Pandey V.
        • Bandi A.
        • Madi S.
        • et al.
        Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial.
        J Shoulder Elbow Surg. 2016; 25: 1312-1322
        • Chung S.W.
        • Oh J.H.
        • Gong H.S.
        • Kim J.Y.
        • Kim S.H.
        Factors affecting rotator cuff healing after arthroscopic repair: Osteoporosis as one of the independent risk factors.
        Am J Sports Med. 2011; 39: 2099-2107