Soft‐Body Patellar Suture Anchors Show Greater Displacement but Similar Load to Failure Compared With Hard‐Body Anchors in a Cadaveric Medial Patellofemoral Ligament Reconstruction Model

PURPOSE: To compare biomechanical outcomes between soft-body (SB) knotless, hard-body (HB) knotless, and HB knotted anchors when simulating medial patellofemoral ligament reconstruction in a cadaveric model. METHODS: Forty-two anchors were placed in either a direct medial or a superior medial position during a medial patellofemoral ligament reconstruction cadaveric simulation. Each test assessed 1 of 3 anchor types: SB knotless, HB knotted, and HB knotless. Specimens were tested under cyclic loading (10-60 N, 100 cycles) and load-to-failure testing. Outcomes assessed included cyclic elongation, first-cycle excursion, elongation amplitude, maximum load to failure, stiffness, energy to failure, and failure mode. RESULTS: The SB knotless anchor exhibited significantly greater cyclic elongation compared with knotted and knotless HB anchors (P < .001, P = .007; respectively). Knotless HB anchors showed the highest maximum load to failure, significantly surpassing knotted HB anchors (P = .001). Stiffness was highest for knotless HB anchors, also significantly greater than knotted HB anchors (P = .002). Anchors placed superomedially had higher maximum load than direct medial placement (P = .017). Bone density was significantly higher in the superior medial position (P = .007), and univariate linear regression showed a significant positive correlation between bone density and maximum load (P < .001). CONCLUSIONS: Knotless HB anchors showed superior biomechanical performance, with greater maximum load and stiffness compared with knotted HB anchors, although there were slight design differences between the anchor bodies. Both HB anchors showed significantly lower cyclic elongation when compared with the SB anchor; however, no differences were found in cyclic creep. Superomedial anchor placement provided improved biomechanical strength relative to direct medial placement; however, this difference may be attributed to increased bone density in this region. CLINICAL RELEVANCE: Using knotless HB anchors during medial patellofemoral ligament reconstruction may improve fixation strength and potentially reduce complications associated with anchor failure. Likewise, use of the superomedial aspect of the patella may provide more robust anchor fixation.