Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Nov;41(11):4733-4739.
doi: 10.1016/j.arthro.2025.06.029. Epub 2025 Jul 1.

Interference Screw and Suture Anchor Fixation for Lateral Extra-articular Tenodesis Yield No Significant Differences in Load to Failure, While Staple Fixation Lags Behind: A Cadaveric Biomechanical Study

Ron Gilat  1 , Zeeshan A Khan  1 , Juan Bernardo Villareal-Espinosa  1 , Andrew S Bi  1 , Harkirat S Jawanda  1 , Garrett R Jackson  1 , Safa Gursoy  2 , Enzo S Mameri  1 , Elizabeth F Shewman  1 , Daniel J Kaplan  1 , Pablo E Gelber  3 , Jorge Chahla  4
Affiliations

Interference Screw and Suture Anchor Fixation for Lateral Extra-articular Tenodesis Yield No Significant Differences in Load to Failure, While Staple Fixation Lags Behind: A Cadaveric Biomechanical Study

Ron Gilat et al. Arthroscopy. 2025 Nov.

Abstract

Purpose: To evaluate the biomechanical properties and failure mechanisms of lateral extra-articular tenodesis (LET) performed using onlay staple, inlay interference screw, and onlay all-suture anchor fixation techniques.

Methods: Twenty-four nonmatched pairs of human cadaveric knees were randomized to receive a cortical staple (n = 8), an interference screw (n = 8), or an all-suture anchor (n = 8). A modified Lemaire LET technique was performed for all knees using their respective fixation technique. Biomechanical testing was performed using a tensile-testing apparatus (MTS Systems). All knees were subjected to an axially directed preload cycle and subsequently assessed for cyclic and load-to-failure outcomes. Results were analyzed via analysis of variance, Kruskal-Wallis, and post-hoc Tukey tests.

Results: Three staple-fixated LETs failed during the cyclic loading and were excluded from analysis. Average elongation after cyclic loading was 2.89 mm (staple), 2.06 mm (screw), and 3.51 mm (anchor) (P = .134). Average maximum load to failure was 174.1 N (staple), 250.8 N (screw), and 199.2 N (anchor), with a significant between-group difference on analysis of variance testing (P = .023). Post hoc analysis revealed staple fixation had a significantly lower maximum load than interference screw fixation (P = .026). Displacement at maximum load was significantly higher in the anchor group (22.2 mm) compared to the staple (11.3 mm) (P = .05).

Conclusions: While staple fixation resulted in early failure, both interference screw and anchor fixations are viable options for LET, with suture anchors offering less rigidity under high loads when compared with either fixation strategy. However, no differences were observed in elongation during cyclic loading.

Clinical relevance: Emerging literature has revealed a 70% tunnel convergence rate when utilizing an interference screw for femoral fixation of a LET. The results of the present time-zero cadaveric study explore the role of surface-based fixation methods, given that it may mitigate convergence risk.

PubMed Disclaimer

Conflict of interest statement

Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: R.G. is a member of the editorial or governing board of Arthroscopy, is a paid presenter or speaker for ENOVIS, and receives other financial or material support from Smith & Nephew. E.S.M. is a member of the editorial or governing board of BMC Musculoskeletal Disorders and BMC Sports Science, Medicine and Rehabilitation. P.E.G. is a paid consultant, presenter, or speaker for ConMed Linvatec and NewClip and received IP royalties from ConMed Linvatec. J.C. is a board or committee member of the American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; is a paid consultant for Arthrex, ConMed Linvatec, Ossur, and Smith & Nephew; and is a paid presenter or speaker for Smith & Nephew. All other authors(Z.A.K., J.B.V-E., A.S.B., H.S.J., G.R.J., S.G., E.F.S., D.J.K.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

LinkOut - more resources