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The objective of this biomechanical study was to compare the performance of suture anchor and transosseous suture fixation in fractures of the inferior patellar pole in context of bone mineral density.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twelve fresh-frozen human cadaveric knees received a transverse osteotomy, simulating an AO\/OTA 34C1.3 inferior pole fracture of the patella. These fractures were fixated with either suture anchors (SA; Corkscrew<jats:sup>\u00ae<\/jats:sup>FT 4.5\u00a0mm) or transosseous suture (TS; #2 FiberWire<jats:sup>\u00ae<\/jats:sup>). Cyclic loading tests were performed by pulling the quadriceps tendon against gravity from 90\u00b0 flexion to almost full extension (5\u00b0) for 1000 cycles. Motion and fracture gap displacement were tracked until failure occurred. Subsequently, loading to failure tests followed. Differences between groups were compared using unpaired<jats:italic>t<\/jats:italic>-tests, and correlations were calculated with Pearson\u2019s correlation coefficient.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The suture anchor group showed significantly fewer cycles to failure than the transosseous suture group (SA: 539.0\u2009\u00b1\u2009465.6 cycles, TS: 1000\u2009\u00b1\u20090 cycles,<jats:italic>P<\/jats:italic>\u2009=\u20090.04). Bone mineral density correlated positively with cycles to failure in the suture anchor group (Pearson\u2019s<jats:italic>r<\/jats:italic>\u2009=\u20090.60,<jats:italic>P<\/jats:italic>\u2009=\u20090.02). No differences in fracture gap displacement could be proven after 100 cycles (SA: 4.1\u2009\u00b1\u20092.6\u00a0mm, TS: 6.5\u2009\u00b1\u20092.6\u00a0mm,<jats:italic>P<\/jats:italic>\u2009=\u20090.19); 500 cycles (SA: 6.4\u2009\u00b1\u20096.1\u00a0mm, TS: 9.6\u2009\u00b1\u20093.8\u00a0mm,<jats:italic>P<\/jats:italic>\u2009=\u20090.39); and 1000 cycles (SA: 4.0\u2009\u00b1\u20090.4\u00a0mm, TS: 11.0\u2009\u00b1\u20094.5\u00a0mm,<jats:italic>P<\/jats:italic>\u2009=\u20090.08). Furthermore, the mean destructive load to failure in the suture anchor group was also significantly lower than in the transosseous suture group (SA: 422.4\u2009\u00b1\u2009212.2\u00a0N, TS: 825.7\u2009\u00b1\u2009189.3\u00a0N,<jats:italic>P<\/jats:italic>\u2009=\u20090.04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Suture anchors may be a viable alternative to transosseous suture in younger patients for clinical advantages, but in osteoporotic bone, the more stable osteosynthesis with transosseous suture continues to prove superior. Therefore, trauma surgeons might consider the use of transosseous suture in elderly patients, especially in those presenting with low bone mineral density values.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s40001-022-00903-9","type":"journal-article","created":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T09:03:28Z","timestamp":1670058208000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Transosseous suture versus suture anchor fixation for inferior pole fractures of the patella in osteoporotic bone: a biomechanical study"],"prefix":"10.1186","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9808-9597","authenticated-orcid":false,"given":"Jana","family":"Seggewiss","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Fernando","family":"Nicolini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Lichte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Greven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marx","family":"Ribeiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Prescher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Michalik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Herren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Kobbe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Hildebrand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Pishnamaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,12,3]]},"reference":[{"key":"903_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3109\/ort.1972.43.suppl-143.01","volume":"143","author":"A Bostrom","year":"1972","unstructured":"Bostrom A. 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RWTH Publications. https:\/\/doi.org\/10.18154\/RWTH-2022-02362.","DOI":"10.18154\/RWTH-2022-02362"}],"container-title":["European Journal of Medical Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40001-022-00903-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40001-022-00903-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40001-022-00903-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,2]],"date-time":"2023-12-02T12:24:59Z","timestamp":1701519899000},"score":1,"resource":{"primary":{"URL":"https:\/\/eurjmedres.biomedcentral.com\/articles\/10.1186\/s40001-022-00903-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,3]]},"references-count":46,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["903"],"URL":"https:\/\/doi.org\/10.1186\/s40001-022-00903-9","relation":{},"ISSN":["2047-783X"],"issn-type":[{"value":"2047-783X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,3]]},"assertion":[{"value":"8 March 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 November 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 December 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The present study was approved by the Independent Ethics Committee (RWTH Aachen Faculty of Medicine, Universit\u00e4tsklinikum Aachen, Pauwelsstra\u00dfe 30, Aachen, Germany; reference number EK 237\/20).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"270"}}