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Suture anchors selected were an all\u2010suture anchor, PEEK (polyether ether ketone)\u2010threaded anchor, and a biocomposite\u2010threaded anchor. For each study arm, one half the samples were first filled with injectable CaP and the other half were not augmented with CaP. For the cadaveric portion, the PEEK\u2010 and biocomposite\u2010threaded anchors were assessed. Biomechanical testing consisted of a stepwise, increasing load protocol for a total of 40 cycles, followed by ramp to failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      For the foam block model, the average load to failure for anchors with CaP was significantly greater when compared with anchor fixation augmented without CaP; the all\u2010suture anchor was 135.2 \u00b1 20.2 N versus 83.3 \u00b1 10.3 N (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .0006); PEEK was 131 \u00b1 34.3 N versus 58.5 \u00b1 16.8 N (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .001); and biocomposite was 182.2 \u00b1 64.2 N versus 80.8 \u00b1 17.4 N (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .004). For the cadaveric model, the average load to failure for anchors augmented with CaP was again greater than anchor fixation without CaP; PEEK anchors went from 41.1 \u00b1 21.1 N to 193.6 \u00b1 63.9 N (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .0034) and biocomposite anchors went from 70.9 \u00b1 26.6 N to 143.2 \u00b1 28.9 N (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .004).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Augmenting various suture anchors with CaP has shown to significantly increase pull\u2010out strength and stiffness in an osteoporotic foam block and time zero cadaveric bone model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>Rotator cuff tears are common in the elderly patients, in whom poor bone quality jeopardizes treatment success. Exploring methods that increase the strength of fixation in osteoporotic bone to improve outcomes in this patient population is important.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.asmr.2023.01.010","type":"journal-article","created":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T09:38:27Z","timestamp":1676453907000},"update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":2,"title":["An Injectable Calcium Phosphate Bone Graft Substitute Improves the Pullout Strength of Various Suture Anchor Designs in an Osteoporotic Bone Model"],"prefix":"10.1002","volume":"5","author":[{"given":"Miguel A.","family":"Diaz","sequence":"first","affiliation":[{"name":"Foundation for Orthopaedic Research &amp; Education Tampa Florida U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Munassi","sequence":"additional","affiliation":[{"name":"Foundation for Orthopaedic Research &amp; Education Tampa Florida U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Teytelbaum","sequence":"additional","affiliation":[{"name":"Foundation for Orthopaedic Research &amp; Education Tampa Florida U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Pipitone","sequence":"additional","affiliation":[{"name":"Foundation for Orthopaedic Research &amp; Education Tampa Florida U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher E.","family":"Baker","sequence":"additional","affiliation":[{"name":"Florida Orthopaedic Institute Tampa Florida U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,2,15]]},"reference":[{"key":"e_1_2_2_2_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.91B2.21069"},{"key":"e_1_2_2_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546519834574"},{"key":"e_1_2_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2014.08.001"},{"key":"e_1_2_2_5_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.E.00835"},{"key":"e_1_2_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2015.05.031"},{"key":"e_1_2_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2021.08.019"},{"key":"e_1_2_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2022.01.116"},{"key":"e_1_2_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1058-2746(96)80028-0"},{"key":"e_1_2_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2018.11.008"},{"key":"e_1_2_2_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546511415659"},{"key":"e_1_2_2_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354657900700206"},{"key":"e_1_2_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2010.01.031"},{"key":"e_1_2_2_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-008-0689-4"},{"key":"e_1_2_2_15_2","doi-asserted-by":"publisher","DOI":"10.3109\/17453679808999054"},{"key":"e_1_2_2_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-012-1620-6"},{"key":"e_1_2_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2016.05.040"},{"key":"e_1_2_2_18_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200311000-00021"},{"key":"e_1_2_2_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546503262644"},{"key":"e_1_2_2_20_2","first-page":"71","article-title":"Large footprint bone cyst: Arthroscopic autologous cylinder press\u2010fit with buddy anchor interference\u2010fit for rotator cuff Repair","volume":"11","author":"Traverso A.","year":"2021","journal-title":"J\u00a0Orthop Case Rep"},{"key":"e_1_2_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2017.11.016"},{"key":"e_1_2_2_22_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.D.02035"},{"key":"e_1_2_2_23_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200402000-00002"},{"key":"e_1_2_2_24_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.00388"},{"key":"e_1_2_2_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546507313574"},{"key":"e_1_2_2_26_2","doi-asserted-by":"publisher","DOI":"10.1136\/jisakos-2020-000603"},{"key":"e_1_2_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcot.2021.05.016"},{"key":"e_1_2_2_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jses.2018.08.001"},{"key":"e_1_2_2_29_2","first-page":"92","article-title":"Bone grafting of humeral head cystic defects during rotator cuff repair","volume":"41","author":"Levy D.M.","year":"2012","journal-title":"Am J Orthop (Belle Mead NJ)"},{"key":"e_1_2_2_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2015.02.002"},{"key":"e_1_2_2_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2018.03.016"},{"key":"e_1_2_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2019.12.003"},{"key":"e_1_2_2_33_2","doi-asserted-by":"publisher","DOI":"10.1097\/BTE.0000000000000163"},{"key":"e_1_2_2_34_2","unstructured":"Tactoset Instructions for Use. 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