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Chuang HC, Yen JZ, Hong CK, Hsu KL, Kuan FC, Chen Y, Chang HM, Su WR. Comparison of Biomechanical Failure Loads Between Tape-Type and Conventional Sutures in Internal Knotless Anchor–Based Constructs. Orthop J Sports Med 2022; 10:23259671211072523. [PMID: 35356310 PMCID: PMC8958676 DOI: 10.1177/23259671211072523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 10/28/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Despite the increasing prevalence of tape-type sutures, whether internal knotless anchors can consistently affix tape-type sutures has not been thoroughly investigated. Purpose: To evaluate whether substituting tape-type sutures for conventional sutures influences the suture-holding strength of internal knotless anchors. Study Design: Controlled laboratory study. Level of evidence, 5. Methods: A total of 3 internal knotless anchors were tested: a spiral core clamping anchor (Footprint Ultra PK), a winged clamping anchor (PopLok), and a spooling anchor (ReelX STT). Four constructs were compared for each type of anchor, with the anchor double or quadruple loaded with tape-type sutures or conventional sutures. The testing protocol comprised preloading suture tension to 10 N; cyclic loading, in which tension increased in increments of 10 N from 10 to 90 N; and a load-to-failure stage set at a speed of 0.5 mm/s. The clinical failure load (CFL) was defined as suture slippage of ≥3 mm. Also, 1-way analysis of variance and power analysis were used to compare the CFLs of the constructs. Results: For the quadruple-loaded spiral core clamping anchors, a significant reduction in CFLs was seen with conventional sutures over tape-type sutures (138.10 ± 4.73 vs 80.00 ± 12.25 N, respectively; P < .001). This reduction was not observed under the double-loaded condition (conventional vs tape type: 76.00 ± 5.48 vs 80.00 ± 10.00 N, respectively). Substitution of the suture materials did not significantly reduce the CFLs for the winged clamping anchors (conventional vs tape type: 40.00 ± 10.00 vs 30.00 ± 7.07 N for double loaded, respectively, and 64.00 ± 13.41 vs 50.00 ± 10.00 N for quadruple loaded, respectively) or the spooling anchors (conventional vs tape type: 62.00 ± 19.23 vs 56.32 ± 20.20N for double loaded, respectively, and 72.00 ± 21.68 vs 84.00 ± 13.42 N for quadruple loaded, respectively). Conclusion: Substituting tape-type sutures for conventional sutures increased the CFLs of some internal knotless anchors. With specific suture-anchor combinations, quadruple-loaded conventional suture anchors had CFLs higher than those of double-loaded conventional suture anchors. Clinical Relevance: When multiple tape-type sutures are used in conjunction with a clamping anchor, clinicians should note a possible reduction in CFLs and resultant early suture slippage.
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Affiliation(s)
- Hao-Chun Chuang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Joe-Zhi Yen
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Skeleton Materials and Bio-compatibility Core Laboratory, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Sin Lau Christian Hospital, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hao-Ming Chang
- Department of Orthopaedics, Tainan Municipal Hospital, Show Chwan Medical Care, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Skeleton Materials and Bio-compatibility Core Laboratory, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
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Kim H, Han SB, Song HS. Suture Slippage After Arthroscopic Cuff Repair: Medial Displacement of Suture Knots on Follow-up Ultrasonography. Orthop J Sports Med 2021; 9:23259671211021820. [PMID: 34409113 PMCID: PMC8366178 DOI: 10.1177/23259671211021820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/25/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Compared with the single-row technique, the double-row rotator cuff repair technique is known to have a higher load to failure and a lower frequency of gap formation, leading to a lower retear rate. There are some patients with poor clinical outcomes or poor muscle strength without radiologic retear. Purpose/Hypothesis: To assess the postoperative position of suture knots via serial ultrasonography in patients who had undergone arthroscopic rotator cuff repair with the suture-bridge technique. Our hypothesis was that the suture would pull out of the lateral anchor (suture slippage), changing the positions of the medial suture knots during healing. Study Design: Case series; Level of evidence, 4. Methods: This study included 53 patients (55 shoulders) who underwent arthroscopic suture-bridge repair and were evaluated for a minimum of 24 months. On serial ultrasonography, a straight line was drawn between the top of the greater tuberosity and the medial cortex of the anchor hole. The distances between the knots of the medial rows and the perpendicular line through the center of the anchor hole were measured in longitudinal plane images of the supraspinatus. Follow-up ultrasonography was performed at 2, 3, and 6 months postoperatively as well as at the final visit. The visual analog scale, the American Shoulder and Elbow Surgeons score, the Constant score, and the University of California, Los Angeles shoulder score were recorded preoperatively and on the final follow-up. Results: Of the 55 shoulders, 6 developed retears at repaired sites. The mean follow-up duration was 37.5 months (range, 24-65 months). Slippage distance increased significantly over time (P < .001). The slippage at the final visit did not differ between patients with retear and no retear (13.4 mm for retear group; 10.6 mm for no retear group [P = .096]). Conclusion: Suture knots of the medial row migrated medially via a suture pullout from the lateral row anchor of suture-bridge technique. Suture slippage distance did not differ significantly between retear and no retear groups.
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Affiliation(s)
- Hyungsuk Kim
- Department of Orthopedic Surgery, Eunpyeong Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Bin Han
- Department of Orthopedic Surgery, Eunpyeong Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Seok Song
- Department of Orthopedic Surgery, Eunpyeong Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Hyun Seok Song, MD, Department of Orthopedic Surgery, Eunpyeong Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, Republic of Korea ()
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Martinel V, Bonnevialle N. Contribution of postoperative ultrasound to early detection of anchor pullout after rotator cuff tendon repair: Report of 3 cases. Orthop Traumatol Surg Res 2020; 106:229-234. [PMID: 32192933 DOI: 10.1016/j.otsr.2019.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/10/2019] [Accepted: 12/02/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Rotator cuff repair by suture bridge is now widely used. Few studies reported secondary pullout of radiotransparent anchors. The aim of the present prospective study was to demonstrate the contribution of in-office ultrasonography to detect pullout, and to describe the examination procedure. MATERIAL AND METHOD A total of 102 patients underwent arthroscopic rotator cuff repair by suture bridge, with impacted second-row anchors. Ultrasonography was performed by the surgeon in postoperative consultations. RESULTS At 6 weeks' follow-up, 3 patients showed mean 2nd-row implant pullout of 8.3mm. All underwent arthroscopic revision to extract the implant, which was mobile within its tunnel in all cases. Clinical progression was good, with mean Constant score 72 and no aggravation of the lesion on ultrasound at 3 months' follow-up. DISCUSSION The present series would seem to be the first to report: early radiotransparent in-vivo pullout 6 weeks after suture bridge cuff repair; ultrasound detection of pullout in consultation by the orthopedic surgeon; a description of the ultrasound technique for screening this rare and specific problem. CONCLUSION Ultrasound now enables radiotransparent anchor positioning to be monitored following rotator cuff repair as of the first postoperative days, without compromising tendon healing. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Vincent Martinel
- Polyclinique de l'Ormeau, 28, boulevard du 8-mai-1945, 65000 Tarbes, France.
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Barber FA, Spenciner DB, Zani BG, Melidone R. Suture-Based Debris Behavior in the Draining Lymph Nodes of a Porcine Knee: A Study of Silicone, Polyethylene and Carbon. Arthrosc Sports Med Rehabil 2019; 1:e131-e136. [PMID: 32266350 PMCID: PMC7120811 DOI: 10.1016/j.asmr.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/17/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To determine whether debris from a silicone core suture has an observable intra-articular or extra-articular impact or can be shown to migrate into the lymphatic system. Methods Using a porcine stifle joint model, 2 study groups were created: 1 group used silicone-suture particles created by rupturing hand-tied knots of a nonabsorbable suture with an outer sheath of ultrahigh molecular-weight polyethylene, an inner polyester sheath and a medical-grade silicone/sodium chloride-filled core. The second group used a mixture of 3 vitreous carbon particles sizes. Twelve Yorkshire pigs were randomly assigned to each group. Only 1 type of study particle was used in a single animal to avoid cross-contamination. Half of the study materials were placed by arthrotomy into the joint and, after capsular closure, the remaining half were placed on the joint capsule before skin closure. Six weeks postimplantation, the stifle joints and regional lymph nodes were examined macroscopically and microscopically. The extracapsular and intra-articular tissue and the lymph nodes were examined. Results Macroscopically, none of the 12 silicone-suture particle group limbs had abnormal macroscopic observations. Of the 12 limbs in the carbon particle group, 8 demonstrated discoloration in the extracapsular, intra-articular and lymph node tissues; 6 limbs demonstrated joint discoloration (extracapsular and intra-articular). The silicone-suture particle group showed lymph node inflammation in 25% of the iliac lymph nodes and 42% of the inguinal lymph nodes but none in the popliteal lymph nodes. In the carbon particle group, 100% of the iliac lymph nodes, 75% of the inguinal lymph nodes and 8% of the popliteal nodes showed inflammation. No silicone-suture debris migration was observed microscopically. Visible carbon particle migration was present in 100% of the iliac lymph nodes and in 50% of the inguinal lymph nodes but in none (0) of the popliteal lymph nodes. The carbon particle group also showed inflammation in these areas. Conclusions Carbon particles in the porcine knee migrated into the lymph nodes (iliac 100%; inguinal 50%, popliteal 0); gross discoloration was observed in 8 of 12 specimens. Silicone-suture particles could not be found in the lymph nodes, and no macroscopic joint damage was observed. Clinical Relevance The clinical use of a suture containing a silicone/salt central core is common, and the porcine lymphatic model suggests that this type of suture material does not result in clinically significant silicone particulates.
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Affiliation(s)
- F. Alan Barber
- Plano Orthopedic Sports Medicine and Spine Center, Plano, Texas, U.S.A
- Address correspondence to F. Alan Barber, M.D., F.A.C.S., Plano Orthopedic Sports Medicine and Spine Center, 800 Broadmoor Lane, Propser, TX 75078, U.S.A.
| | | | - Brett G. Zani
- Concord Biomedical Sciences and Emerging Technologies, Lexington, Massachusetts, U.S.A
| | - Raffaele Melidone
- Concord Biomedical Sciences and Emerging Technologies, Lexington, Massachusetts, U.S.A
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Feng P, Wu P, Gao C, Yang Y, Guo W, Yang W, Shuai C. A Multimaterial Scaffold With Tunable Properties: Toward Bone Tissue Repair. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2018; 5:1700817. [PMID: 29984132 PMCID: PMC6033191 DOI: 10.1002/advs.201700817] [Citation(s) in RCA: 155] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/23/2018] [Indexed: 05/25/2023]
Abstract
Polyetheretherketone (PEEK)/β-tricalcium phosphate (β-TCP) scaffolds are expected to be able to combine the excellent mechanical strength of PEEK and the good bioactivity and biodegradability of β-TCP. While PEEK acts as a closed membrane in which β-TCP is completely wrapped after the melting/solidifying processing, the PEEK membrane degrades very little, hence the scaffolds cannot display bioactivity and biodegradability. The strategy reported here is to blend a biodegradable polymer with PEEK and β-TCP to fabricate multi-material scaffolds via selective laser sintering (SLS). The biodegradable polymer first degrades and leaves caverns on the closed membrane, and then the wrapped β-TCP is exposed to body fluid. In this study, poly(l-lactide) (PLLA) is adopted as the biodegradable polymer. The results show that large numbers of caverns form on the membrane with the degradation of PLLA, enabling direct contact between β-TCP and body fluid, and allowing for their ion-exchange. As a consequence, the scaffolds display the bioactivity, biodegradability and cytocompatibility. Moreover, bone defect repair studies reveal that new bone tissues grow from the margin towards the center of the scaffolds from the histological analysis. The bone defect region is completely connected to the host bone end after 8 weeks of implantation.
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Affiliation(s)
- Pei Feng
- State Key Laboratory of High Performance Complex ManufacturingCollege of Mechanical and Electrical EngineeringCentral South UniversityChangsha410083China
| | - Ping Wu
- College of ChemistryXiangtan UniversityXiangtan411105China
| | - Chengde Gao
- State Key Laboratory of High Performance Complex ManufacturingCollege of Mechanical and Electrical EngineeringCentral South UniversityChangsha410083China
| | - Youwen Yang
- State Key Laboratory of High Performance Complex ManufacturingCollege of Mechanical and Electrical EngineeringCentral South UniversityChangsha410083China
| | - Wang Guo
- State Key Laboratory of High Performance Complex ManufacturingCollege of Mechanical and Electrical EngineeringCentral South UniversityChangsha410083China
| | - Wenjing Yang
- State Key Laboratory of High Performance Complex ManufacturingCollege of Mechanical and Electrical EngineeringCentral South UniversityChangsha410083China
| | - Cijun Shuai
- State Key Laboratory of High Performance Complex ManufacturingCollege of Mechanical and Electrical EngineeringCentral South UniversityChangsha410083China
- School of Energy and Machinery EngineeringJiangxi University of Science and TechnologyGanzhou341000China
- State Key Laboratory of High Performance Complex ManufacturingCentral South UniversityChangsha410083China
- Key Laboratory of Organ InjuryAging and Regenerative Medicine of Hunan ProvinceChangsha410008China
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