Abstract
This study aimed to assess, using finite element analysis (FEA), the mechanical effects of cortical bone thickness and cancellous bone density on the pull-out strength of suture anchors. A PEEK anchor was modeled and embedded in synthetic bone blocks with cortical thicknesses ranging from 1 to 5 mm and cancellous densities of 10 PCF, 20 PCF, and 30 PCF. Axial tensile loading simulations were conducted for all combinations, and selected cases were validated through experimental pull-out tests using commercial synthetic bone, demonstrating agreement within ±6%. Both cortical thickness and cancellous density were found to enhance pull-out resistance, though the magnitude and pattern varied with density. At 10 PCF, pull-out strength increased linearly with cortical thickness. At 20 PCF, substantial gains were observed between 2 and 4 mm, followed by a plateau. At 30 PCF, most of the increase was confined between 2 and 3 mm, with minimal improvement thereafter. These findings suggest that fixation strategies should be adapted on the basis of bone quality and provide biomechanical insights to inform patient-specific implant design and surgical planning.