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Wallace AL, Calvo E, Ardèvol Cuesta J, Lanzetti R, Luengo-Alonso G, Rokito AS, Spencer EE, Spoliti M. Safety and efficacy of second-generation all-suture anchors in labral tear arthroscopic repairs: prospective, multicenter, 1-year follow-up study. JSES Int 2024; 8:763-768. [PMID: 39035662 PMCID: PMC11258834 DOI: 10.1016/j.jseint.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background This study's primary aim was to assess the safety and performance of second-generation all-soft suture anchors following arthroscopic labral tear repair. Methods This prospective, multicenter study was conducted by 6 surgeons at 6 sites in Europe and the United States between November 2018 and August 2020. Patients who required shoulder arthroscopic repair, for a range of labral injuries, were treated with a second-generation all-soft suture anchor. The primary outcome was clinical success rate (percentage of patients without signs of failure and/or reintervention) at 6 months. Secondary outcomes included clinical success rate at 12 months, intraoperative anchor deployment success rate, and patient-reported outcomes (PROs) at 6 and 12 months, including visual analog scale (VAS) pain assessment, VAS satisfaction assessment, EQ-5D-5L Index Score, EQ-5D-5L VAS Health Score, Rowe Shoulder Score for Instability, American Shoulder and Elbow Surgeons score, and Constant-Murley Shoulder Score. Serious adverse events and serious adverse device effects were collected throughout the study. Results Forty-one patients were enrolled (mean age, 28.2 years; 87.8% male, 12.2% female). Clinical success was achieved in 27/28 and 31/32 patients at 6 months and 12 months, respectively. Anchor deployment had a 100% success rate. Significant improvements over baseline were reported for all PROs except Constant-Murley Shoulder (6 months) and VAS Satisfaction Score (12 months). One patient experienced 1 serious adverse event and 1 patient experienced 1 serious adverse device effect. Conclusion Second-generation all-soft suture anchors used in this study demonstrated a high clinical success rate, a favorable safety profile, and patients exhibited significant improvement in PROs.
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Affiliation(s)
| | - Emilio Calvo
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | | | | | | | - Marco Spoliti
- Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
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Rodriguez Fontan F, Laynes R, Scott F. Non-absorbable Suture-Loaded Anchors for Finger Pulley Reconstruction. Cureus 2024; 16:e61250. [PMID: 38947663 PMCID: PMC11212109 DOI: 10.7759/cureus.61250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 07/02/2024] Open
Abstract
A 59-year-old woman, who previously underwent surgery on her left long finger A1 pulley and left small finger distal interphalangeal joint for triggering and mallet deformity at another medical facility in March 2021, sought evaluation at an Orthopedics Hand clinic. She presented with limited finger movement, a flexion contracture, and difficulty extending her left long finger. Examination revealed an A2 pulley injury with extensive scar tissue. Subsequently, she underwent surgery to remove the scar tissue and reconstruct the A2 pulley using suture tape anchors. This case highlights the negative outcome following A1 pulley release due to an unintended A2 injury, resulting in significant scarring and an intrinsic plus digit posture. Additionally, it underscores the potential effectiveness of using non-absorbable synthetic sutures to minimize scarring and promote an early range of motion in cases where healing leads to excessive scarring around the flexor tendon sheath.
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Affiliation(s)
- Francisco Rodriguez Fontan
- Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, ARG
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Renzo Laynes
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Frank Scott
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, USA
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Khaleel M, Oladeji LO, Smith CA, DeFroda SF, Nuelle CW. Two-Portal Arthroscopic Knotless All-Suture Anchor Posterior Labral Repair. Arthrosc Tech 2024; 13:102928. [PMID: 38835471 PMCID: PMC11144742 DOI: 10.1016/j.eats.2024.102928] [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: 11/14/2023] [Accepted: 12/23/2023] [Indexed: 06/06/2024] Open
Abstract
Isolated posterior shoulder instability accounts for approximately 10% of shoulder instability cases. Patients may present after an acute trauma or with insidious onset and associated posterior shoulder pain. Knotless and all-suture anchor devices have become increasing popular and are often used in arthroscopic shoulder instability cases to avoid knot stacks and allow for the ability to re-tension the fixation. This technical note describes our technique for 2-portal posterior labral repair using knotless all-suture anchors with the patient in the lateral decubitus position.
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Affiliation(s)
- Mubinah Khaleel
- Department of Orthopaedic Surgery, University of Missouri–Columbia, Columbia, Missouri, U.S.A
| | - Lasun O. Oladeji
- Department of Orthopaedic Surgery, University of Missouri–Columbia, Columbia, Missouri, U.S.A
| | - Conor A. Smith
- Department of Orthopaedic Surgery, University of Missouri–Columbia, Columbia, Missouri, U.S.A
| | - Steven F. DeFroda
- Department of Orthopaedic Surgery, University of Missouri–Columbia, Columbia, Missouri, U.S.A
| | - Clayton W. Nuelle
- Department of Orthopaedic Surgery, University of Missouri–Columbia, Columbia, Missouri, U.S.A
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Freeman DA, Hao KA, Hones KM, Olowofela BO, Parrish R, Damrow D, King JJ, Farmer KW, Pazik M, Roach RP. Pain scores and functional outcomes of patients with shoulder labral repair using all-suture anchors versus conventional anchors. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1509-1515. [PMID: 38265743 DOI: 10.1007/s00590-023-03820-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
HYPOTHESIS/PURPOSE The purpose of this study was to compare PROMs in patients undergoing anterior glenoid labral repair using all-suture versus conventional anchors. We hypothesized PROMs would be similar between groups. METHODS We performed a retrospective review of the Arthrex Global Surgical Outcomes System (SOS) database, querying patients who underwent arthroscopic glenoid labral repair between 01/01/2015 and 12/31/2020. Patients aged 18-100, who had isolated glenoid labrum repair with at least 12-month follow-up were included. The visual analog pain scale (VAS), Western Ontario Shoulder Instability Index, Veteran's RAND 12-items health survey, single assessment numeric evaluation and the American Shoulder and Elbow Surgeons score (ASES) were compared preoperatively, 3 months, 6 months, 1 year and 2 years postoperatively in patients who received all-suture anchors versus conventional anchors in the setting of anterior glenoid labrum repair. Our primary aim was comparison of PROMs between patients receiving all-suture versus conventional suture anchors. Secondarily, a sub-analysis was performed comparing outcomes based on anchor utilization for patients with noted anterior instability. RESULTS We evaluated 566 patients, 54 patients receiving all-suture anchors and 512 patients receiving conventional anchors. At two-year follow-up there was no significant difference between the two groups in PROMs. In a sub-analysis of isolated anterior labrum repair, there was an improvement in ASES (P = 0.034) and VAS (P = 0.039) with the all-suture anchor at two-year follow-up. CONCLUSIONS All-suture anchors provide similar or superior pain and functional outcome scores up to 2 years postoperatively compared to conventional anchors. CLINICAL RELEVANCE As all-suture anchors gain popularity among surgeons, this is the largest scale study to date validating their use in the setting of glenoid labrum repair. Institutional Review Board (IRB): IRB202102550.
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Affiliation(s)
- David A Freeman
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Keegan M Hones
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | | | - Ryan Parrish
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Derek Damrow
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Kevin W Farmer
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Marissa Pazik
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Roach P Roach
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA.
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Yan H, Zhao L, Wang J, Lin L, Wang H, Wang C, Yu Y, Lu M, Xu T. An All-Suture Anchor Offers Equivalent Clinical Performance to an Established Solid Suture Anchor in the Arthroscopic Repair of Rotator Cuff Tears: A Prospective, Randomized, Multicenter Trial With 12-Month Follow-Up. Arthroscopy 2024; 40:265-276. [PMID: 37423469 DOI: 10.1016/j.arthro.2023.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of a next-generation, all-suture anchor in patients undergoing arthroscopic repair of rotator cuff tears, compared with that of an established solid suture anchor. METHODS Between April 2019 and January 2021, a prospective, comparative, randomized controlled noninferiority study conducted on people with Chinese ethnicity at 3 tertiary hospitals enrolled patients (18-75 years) requiring arthroscopic treatment for rotator cuff tears. Patients were randomized into 2 cohorts receiving either all-suture anchor or solid suture anchor and followed for 12 months. The primary outcome was the Constant-Murley score at the 12-month follow-up. Magnetic resonance imaging assessments determined the rate of retear of rotator cuff repair (defined as Sugaya classification 4 and 5). Safety evaluation was performed at all follow-up points to determine the adverse events (AEs). RESULTS In total, 120 patients with rotator cuff tears (mean age, 58.3 years; 62.5% female; 60 receiving all-suture anchor) underwent treatment. Five patients were lost to follow-up. Both cohorts showed significant improvement in Constant-Murley scores between baseline and 6 months (P < .001) and between 6 and 12 months (P < .001). There were no significant differences in Constant-Murley scores between the 2 cohorts at 12 months (P = .122) after operation. The retear rate at 12 months was 5.7% and 1.9% in the all-suture and solid suture anchor cohorts, respectively (P = .618). There were 2 cases of intraoperative anchor pullout, both of which were successfully resolved. No cases of postoperative reoperation or other anchor-related AEs were reported. CONCLUSIONS The all-suture anchor offered equivalent clinical performance to an established solid suture anchor at the 12-month follow-up in patients undergoing arthroscopic repair of rotator cuff tears. The retear rate was not statistically significantly different between the 2 cohorts. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Hui Yan
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, and Beijing Key Laboratory of Sports Injuries, Beijing, China.
| | - Lilian Zhao
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Jing Wang
- Department of Joint Surgery and Sports Medicine, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Lin Lin
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, and Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Hongtao Wang
- Department of Joint Surgery and Sports Medicine, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Changbing Wang
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Yongpei Yu
- Peking University Health Science Center, Beijing, China
| | - Mingfeng Lu
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Ting Xu
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
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Abedi A, Pourghazi F, Eslami M, Nabian MH, Ali Mohammadi AM, Zanjani LO, Farahmand F. An additively manufactured titanium tilting suture anchor: a biomechanical assessment on human and ovine bone specimens. Front Surg 2023; 10:1195728. [PMID: 38107406 PMCID: PMC10723827 DOI: 10.3389/fsurg.2023.1195728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction A novel titanium tilting suture anchor was designed and fabricated using additive manufacturing. The anchor enjoyed a nonsymmetrical structure to facilitate its insertion procedure through a weight-induced tilt, a saw-teeth penetrating edge to provide a strong initial fixation into cancellous bones of various densities, and an appropriate surface texture to enhance the longterm fixation strength through bone ingrowth. Methods Biomechanical tests were performed on 10 ovine and 10 human cadaveric humeri to examine the insertion procedure and assess the initial fixation strength of the anchor, in comparison with a standard screw-type anchor as control. Results This study indicated a simple yet reliable insertion procedure for the tilting anchor. All anchors survived after 400 cycles of cyclic loadings and failed in the load-to-failure step. There were no significant differences between the displacements and fixation stiffnesses of the anchors in either group. The ultimate failure load was significantly smaller (p<0.05) for tilting anchors in ovine group (273.7 ± 129.72 N vs. 375.6 ± 106.36 N), but not different in human group (311.8 ± 82.55 N vs. 281.9 ± 88.35). Also, a larger number of tilting anchors were pulled out in ovine group (6 vs. 3) but a smaller number in human group (4 vs. 6). Conclusion It was concluded that the biomechanical performance of the designed tilting anchor is comparable with that of the standard screw-type anchors.
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Affiliation(s)
- Ali Abedi
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Farzad Pourghazi
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
- Orthopedic Surgery Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maysa Eslami
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
- Orthopedic Surgery Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Nabian
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
- Orthopedic Surgery Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Leila Oryadi Zanjani
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
- Orthopedic Surgery Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzam Farahmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
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Yamakado K. UHMWPE suture induced pseudotumor following arthroscopic rotator cuff repair: A case report. Shoulder Elbow 2023; 15:87-91. [PMID: 37974602 PMCID: PMC10649478 DOI: 10.1177/17585732211067117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/15/2021] [Accepted: 11/24/2021] [Indexed: 11/19/2023]
Abstract
UHMWPE suture shows excellent biocompatibility and complication associated with suture debris had not been described before in shoulder surgery. In this study, a case of a 38-year-old man with a wear debris pseudotumor mimicking osteochondromatosis in the subacromial bursa five years after arthroscopic rotator cuff repair using a composite braid suture (a polydioxanone core with a sleeve of UHMWPE) was presented. Histological examination confirmed the presence of suture fragments surrounded with the osteochondral layer without inflammatory reactions. The present study implies the potential risk of free fragmented remnants from the UHMWPE suture. Because of the silent nature of the histological response, a high index of suspicion should be necessary to disclose the chanciness of its use.
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Affiliation(s)
- Kotaro Yamakado
- Department of Orthopaedics, Fukui General Hospital, Fukui, Japan
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8
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Ideler N, De Mesel A, Vercruysse L, Declercq G, van Riet R, Verborgt O. Clinical and radiological outcome of all-suture anchors in shoulder and elbow surgery. Shoulder Elbow 2023; 15:544-553. [PMID: 37811390 PMCID: PMC10557925 DOI: 10.1177/17585732221127433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 10/10/2023]
Abstract
Background All-suture anchors (ASAs) are noted to cause various bone reactions when used in upper limb surgery but clinical implications are unknown. Methods 88 shoulders and 151 elbows with a mean follow-up of 47.1 ± 17.7 months were invited for follow-up including clinical examination, questionnaires and radiographs. The anchor drill holes were radiographically assessed. Results At final follow up, mean DASH was 12.9 ± 13.8 and mean VAS 2.2 ± 2.4 in the shoulder population. In the elbow group mean MEPS was 91.8 ± 12.7 and mean VAS 1.5 ± 1.9. Implant-specific complications were seen in 10 elbow cases but none in the shoulder group. The mean diameter of the 1.4 mm all-suture anchor drill hole was enlarged to 2.5 ± 1.4 mm in the shoulder group and to 2.9 ± 1.0 mm in the elbow group. 50% of the 1.4 mm anchor drill holes showed abnormal morphology but these morphologic changes did not correlate with clinical outcome, complications or reoperation rate. Discussion Satisfying clinical outcomes are found in upper limb surgery using ASAs. Various bone changes are seen after implantation of an ASA, but these are not clinically relevant. Long-term consecutive follow-up data is required.
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Affiliation(s)
- Nick Ideler
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium
| | - Annelien De Mesel
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium
| | - Loïc Vercruysse
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium
| | - Geert Declercq
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium
| | - Roger van Riet
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium
- Department of Orthopedic Surgery and Traumatology, University Hospital Antwerp, Edegem, Belgium
| | - Olivier Verborgt
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium
- Department of Orthopedic Surgery and Traumatology, University Hospital Antwerp, Edegem, Belgium
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Saengpetch N, Noowan S, Boonrod A, Jaruwanneechai K, Sumanont S, Vijittrakarnrung C. Comparison of medial tibiofemoral joint mechanics between all-suture anchors and transtibial pullout technique for posterior medial meniscal root tears. J Orthop Surg Res 2023; 18:591. [PMID: 37559157 PMCID: PMC10413628 DOI: 10.1186/s13018-023-04071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The posterior medial meniscal root tear (PMMRT) seriously impacts the tibiofemoral joint biomechanics. Two available techniques for PMMRT repair include the transtibial pullout (TPO) repair and all-suture anchor (ASA) repair techniques. These techniques have not been compared biomechanically. METHODS A total of 20 fresh porcine cadaveric knee specimens were used. All 20 knees were randomly and evenly distributed into four groups (five specimens per group): (1) intact posterior meniscal root, (2) PMMRT, (3) TPO repair technique for PMMRT, and (4) ASA repair technique for PMMRT. The tibiofemoral contact mechanics were investigated using a pressure sensor. All knee specimens were tested by being loaded with 600 N axial compressive force at three different flexion angles (0°, 45°, and 90°). The contact surface area, contact pressure, peak pressure, and time-zero displacement were recorded. RESULTS The PMMRT caused a significant decrease in contact surface area, an increase in contact pressure, and peak pressure from the reference values observed in the intact meniscus group (P = 0.05, 0.016, and 0.008, respectively). After fixation, no significant difference was observed between the ASA and intact group. Meanwhile, significant differences were found between the TPO and intact group in terms of contact surface area, contact pressure, and peak pressure. In the comparison between the two techniques, the ASA group demonstrated higher contact surface area than the TPO group at the average knee flexion angle (p = 0.05). CONCLUSION For most testing conditions, the ASA technique demonstrated superior biomechanical property in terms of contact surface area compared with the TPO technique under compressive loading conditions. The ASA technique could also restore the tibiofemoral contact mechanics to be comparable with those of the native intact knee. Meanwhile, a significant difference in tibiofemoral mechanics, compared with the intact knee, could be observed in the TPO technique.
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Affiliation(s)
- Nadhaporn Saengpetch
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Sutip Noowan
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Artit Boonrod
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon kaen, 40002, Thailand
| | - Khananut Jaruwanneechai
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon kaen, 40002, Thailand
| | - Sermsak Sumanont
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon kaen, 40002, Thailand
| | - Chaiyanun Vijittrakarnrung
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand.
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10
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Joshi A, Basukala B, Sharma R, Singh N, Bista R, Pradhan I. "Make and Use" All Suture Anchor-A Cost-Effective Method of Making an All-Suture Anchor. Arthrosc Tech 2023; 12:e1311-e1318. [PMID: 37654876 PMCID: PMC10466185 DOI: 10.1016/j.eats.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/29/2023] [Indexed: 09/02/2023] Open
Abstract
All-suture anchors (ASA) are newer anchors that anchor soft tissues to the bone. It has several biomechanical and clinical advantages; however, the high cost of this anchor limits its use in low socioeconomic countries. The cost of the anchor dramatically increases the cost of surgery; hence, acceptance of surgery is also affected if patients have to pay their expenditure from their pocket. We have designed a simple, cost-effective method of making an ASA, which can be made instantly and used during surgery; hence, the name "make-and-use anchor." To make this anchor, few high-strength sutures are required. Over the suture, a sleeve of suture was created using an Ethibond. This sleeve will create a "ball" after deployment under the cortical bone, which provides anchorage to the sutures serving as an anchor. This anchor can be deployed both in the pull-in and push-in methods. This technical note aims to share the technique of making this cost-effective anchor, which is made instantly using locally available suture materials and can be used in various surgeries requiring anchors.
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Affiliation(s)
- Amit Joshi
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B&B Hospital, Gwarko, Lalitpur, Nepal
| | - Bibek Basukala
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B&B Hospital, Gwarko, Lalitpur, Nepal
| | - Rajiv Sharma
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B&B Hospital, Gwarko, Lalitpur, Nepal
| | - Nagmani Singh
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B&B Hospital, Gwarko, Lalitpur, Nepal
| | - Rohit Bista
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B&B Hospital, Gwarko, Lalitpur, Nepal
| | - Ishor Pradhan
- AKB Center for Arthroscopy, Sports Injuries and Regenerative Medicine, B&B Hospital, Gwarko, Lalitpur, Nepal
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11
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Hassebrock JD, Sylvia SM, McCarthy TP, Stokes DJ, Shinsako KK, Frank RM. Posterior Labral Repair Using Knotless "All-Suture" Suture Anchors. Arthrosc Tech 2023; 12:e1219-e1224. [PMID: 37533896 PMCID: PMC10391341 DOI: 10.1016/j.eats.2023.03.011] [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: 02/06/2023] [Accepted: 03/17/2023] [Indexed: 08/04/2023] Open
Abstract
Isolated posterior instability is well described but relatively uncommon, accounting for less than 10% of all shoulder instability cases. When nonoperative management fails, surgical outcomes demonstrate improved patient-reported outcomes with a high level of return to sport. Knotless suture anchor and "all-suture" suture anchor technology are now available and used for instability procedures in the shoulder. This technical description describes knotless "all-suture" suture anchor fixation for isolated posterior labral tears.
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Affiliation(s)
- Jeffrey D. Hassebrock
- University of Colorado Medical Center, Department of Orthopedic Surgery, Boulder, Colorado, U.S.A
| | - Stephen M. Sylvia
- University of Colorado Medical Center, Department of Orthopedic Surgery, Boulder, Colorado, U.S.A
| | - Timothy P. McCarthy
- University of Colorado Medical Center, Department of Orthopedic Surgery, Boulder, Colorado, U.S.A
| | - Daniel J. Stokes
- University of Colorado School of Medicine, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
| | - Kevin K. Shinsako
- University of Colorado School of Medicine, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
| | - Rachel M. Frank
- University of Colorado School of Medicine, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
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12
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Grade D, Cip J, Lengnick H. Chronic Lateral Ankle Instability with Os Subfibulare in a Child Treated with Modified Broström/Gould Surgical Technique - A Case Report. J Orthop Case Rep 2023; 13:87-91. [PMID: 37255648 PMCID: PMC10226637 DOI: 10.13107/jocr.2023.v13.i05.3658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/10/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Patients with lateral instability of the ankle have a much higher prevalence of an os subfibulare compared with the general population. In children and adolescents with known os subfibulare and chronic instability of the ankle, surgical resection of the os subfibulare and the Broström/Gould procedure to reattach the ATFL to the fibula has been described if conservative therapy fails. Case Report Our case is about a 10-year-old girl with chronic instability of the ankle and a symptomatic os subfibulare, with additional cystic and edematous changes in the distal fibula in the MRI. Due to the reduced bone density, we assumed a higher risk of anchor pullout with the normal refixation at the distal fibula. Therefore, the surgical technique according to Broström/Gould was modified and the ATFL was refixed on the talar side. Conclusion In cases of symptomatic os subfibulare with clinical instability of the ankle, a Broström/Gould operation and resection of the os subfibulare is recommended after failure of conservative therapy. Our case showed that a very satisfying post-operative result can be achieved with a modification of the Broström/Gould operation, with reattachment of the ATFL to the talus instead of the fibula.
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Affiliation(s)
- Dorothea Grade
- Department of Paediatric Orthopaedics, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Johannes Cip
- Department of Paediatric Orthopaedics, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Harald Lengnick
- Department of Paediatric Orthopaedics, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
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Anastasia M, Pramantha B, Kholinne E, Anestessia IJ. Tibialis anterior tendon transfer using suture anchor provides excellent alternative treatment for relapse clubfoot: A case report. Int J Surg Case Rep 2023; 106:108270. [PMID: 37156200 DOI: 10.1016/j.ijscr.2023.108270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Relapsed clubfoot is defined as the recurrence of any component of deformity after a complete correction. While the Ponseti method has been known to have excellent outcomes, several relapse cases have been reported. Thus, further surgical intervention is needed to achieve a good and reliable long-term outcome. PRESENTATION OF THE CASE We report a presentation of a 5-year-old boy who came to the clinic with a relapsed bilateral clubfoot after serial Ponseti casting. Plantar fascia release, Achilles tendon lengthening, and tibialis anterior tendon transfer (TATT) were performed respectively followed by an above-knee cast. The patient gained acceptable walking balance and ability to perform high impact sports at one year follow-up. CLINICAL DISCUSSION There are several factors contributing to the relapse clubfoot including adherence to post op foot abduction brace (FAB) protocol, muscle imbalance or inadequate correction of initial deformities. The current case report described a relapse clubfoot following serial Ponseti casting caused by non-compliance of the use of foot abduction brace. Further surgical interventions must be performed in the presence of relapse case of clubfoot. CONCLUSION Relapse clubfoot is the presence of any recurring deformity following correction. Surgical intervention, especially TATT procedure provides a favorable outcome in treating patients with relapse clubfoot.
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Affiliation(s)
- Maria Anastasia
- Faculty of Medicine, Universitas Katolik Indonesia Atma Jaya, Jakarta, Indonesia
| | - Bagus Pramantha
- Carolus Bone & Joint Center, St. Carolus Hospital, Jakarta, Indonesia; Adhyaksa General Hospital, Indonesia
| | - Erica Kholinne
- Carolus Bone & Joint Center, St. Carolus Hospital, Jakarta, Indonesia; Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia.
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Yang YS, Shih CA, Fang CJ, Huang TT, Hsu KL, Kuan FC, Su WR, Hong CK. Biomechanical comparison of different suture anchors used in rotator cuff repair surgery-all-suture anchors are equivalent to other suture anchors: a systematic review and network meta-analysis. J Exp Orthop 2023; 10:45. [PMID: 37067646 PMCID: PMC10110812 DOI: 10.1186/s40634-023-00608-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/03/2023] [Indexed: 04/18/2023] Open
Abstract
PURPOSE Suture anchors are commonly used to repair rotator cuff tendons in arthroscopy surgery, and several anchor materials have been created to maximize pull-out strength and minimize iatrogenic damage. We hypothesized that all-suture anchors have biomechanical properties equivalent to those of conventional anchors. Our purpose is to compare the biomechanical properties of different anchors used for rotator cuff repair. METHODS The Embase, PubMed, Cochrane, and Scopus databases were searched for biomechanical studies on various suture anchors. The search keywords included rotator cuff tears and suture anchors, and two authors conducted study a selection, risk of bias assessment, and data extraction. The failure load, stiffness, and displacement were calculated using the mean differences with 95% confidence intervals (CIs). Failure modes were estimated using summary odds ratios with 95% CIs. The surface under the cumulative ranking curve was used for the relative ranking probabilities. A sensitivity analysis was performed by excluding studies using synthetic bones. RESULTS The polyetheretherketone (PEEK) (p < 0.001) and all-suture anchors (p < 0.001) had higher failure loads than the biocomposite anchors, whereas no significant difference was observed in stiffness among the anchors. The all-suture (p = 0.006) and biocomposite anchors (p < 0.001) had displacements higher than the metal anchors. The relative ranking of the included anchors in failure loads and displacement changed in sensitivity analysis. The meta-analysis did not find significant differences, but the relative ranking probabilities suggested that all-suture anchor had a higher rate of anchor pull-out and a lower rate of eyelet or suture breakage. In contrast, the metal anchors were associated with a higher number of eyelet breakage episodes. CONCLUSIONS All-suture anchors showed significantly higher failure loads than the biocomposite anchors and similar cyclic displacements to the biocomposite and PEEK anchors. There were no significant differences in stiffness between all-suture and conventional suture anchors. The relative ranking of biomechanical properties changed in sensitivity analysis, suggesting the potential effect of bone marrow density. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Yi-Shiuan Yang
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-An Shih
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Ju Fang
- Department of Secretariat, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Medical Library, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Teng Huang
- Department of Medicine, 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
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, 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
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 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 Lab, 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.
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Pak T, Menendez ME, Hwang S, Ardebol J, Ghayyad K, Denard PJ. Soft Anchors for Rotator Cuff Repair: A Review. JBJS Rev 2023; 11:01874474-202302000-00004. [PMID: 36763758 DOI: 10.2106/jbjs.rvw.22.00207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
» All-suture anchors or so-called "soft" anchors, initially adapted for labral repairs, have increased in popularity for use in rotator cuff repair because of their smaller size, decreased occupation of the footprint, improved points of fixation, ease of use, and ease of revision. » In limited series, soft anchors have demonstrated equivalent biomechanical and clinical performance compared with hard body anchors for rotator cuff repair. » Perianchor cyst formation can occur with both hard body and soft anchors. » Biomechanical and clinical data support aiming for vertical angles of insertion for soft anchors.
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Ernat JJ, Comfort SM, Jildeh TR, Ruzbarsky JJ, Philippon MJ. Effect of Anchor Density on Functional Outcomes After Arthroscopic Hip Labral Repair. Am J Sports Med 2022; 50:3210-3217. [PMID: 36122359 DOI: 10.1177/03635465221121577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While labral repair has been widely adopted as the first line treatment for labral injury during hip arthroscopy, there is no widespread consensus on the procedural technique, including the number of anchors that should be used to avoid recurrent instability and revision surgery. PURPOSE To determine if anchor density can predict patient-reported outcomes after arthroscopic labral repair in the hip. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients aged 18 to 50 years who underwent primary hip arthroscopic surgery with labral repair between January 2011 and December 2016 were identified from a prospectively collected database. Exclusion criteria consisted of previous ipsilateral surgery, osteoarthritis (Tönnis grade >1), and severe cartilage defects (Outerbridge grade III/IV) or concomitant labral reconstruction, capsular reconstruction, or microfracture. Minimum 2-year patient-reported outcomes (modified Harris Hip Score [mHHS], Hip Outcome Score [HOS]-Activities of Daily Living [ADL], HOS-Sport Specific Subscale [SSS], 12-Item Short Form Health Survey [SF-12]), rates of achieving the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) for each score, revision surgery rate, and rate of conversion to total hip arthroplasty (THA) were compared based on anchor density (number of anchors per millimeter of labral tear). RESULTS A total of 634 hips (575 patients) with a mean age of 30.4 ± 9.5 years (range, 18.0-49.9 years) met inclusion criteria. The mean labral tear size was 31 ± 11 mm (range, 2-70 mm) with a median number of anchors used for labral repair of 3 (range, 1-7) and mean anchor density of 0.11 ± 0.08 anchors (range, 0.03-1.33) per millimeter of labral tear. Hips with a minimum 2-year follow-up (451/634 [71.1%]) had significant improvements on the mHHS, HOS-ADL, HOS-SSS, and SF-12 Physical Component Summary (P < .001 for all). There was no significant correlation detected between anchor density or number of anchors used and postoperative scores (correlation coefficient range, -0.05 to 0.17; P > .05 for all). The rate of revision surgery was 6.4% (28 patients), with 8 hips found to have labral tears and/or deficiency on revision. Additionally, 6 hips (1.3%) had to undergo THA at a mean of 3.6 ± 2.1 years (range, 2.0-5.5 years). CONCLUSION Anchor density did not have a correlation with postoperative outcomes, achieving the MCID or PASS, revision hip arthroscopic surgery, complications, or conversion to THA.
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Affiliation(s)
- Justin J Ernat
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | | | - Marc J Philippon
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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Hoffman TR, Lamplot JD, McClish SJ, Payne C, Denard PJ. Three Medial All Suture Anchors Improves Contact Force Compared to Two Hard Body Anchors in a Biomechanical Two-Tendon Rotator Cuff Tear Model. Arthrosc Sports Med Rehabil 2022; 4:e1601-e1607. [PMID: 36312697 PMCID: PMC9596862 DOI: 10.1016/j.asmr.2022.05.012] [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: 01/19/2022] [Accepted: 05/26/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose To biomechanically compare a knotless double-row construct with 3 medial all-suture (3AS) anchors with a standard 2 medial hard body (2HB) anchor construct. Methods Twelve matched cadaveric shoulder specimens with a mean age of 57 years (range: 54-61 years) were randomized to receive a knotless double-row repair with either a 3AS or 2HB construct. In the 3AS construct, three 2.6-mm all-suture anchors were placed adjacent to the articular margin and secured laterally with two 4.75-mm knotless hard body anchors. In the 2HB construct, two 4.75-mm medial hard body anchors were placed medially, lateral fixation was identical to the 3AS construct. Creep, displacement, stiffness, and ultimate load were recorded for each sample. In addition, a SynDaver model was used to compare contact pressure between the 2 repair constructs. Results There were no differences in cyclic displacement at 1, 30, and 100 cycles (P = .616, .497, .190, respectively), cyclic stiffness (.928), ultimate load (.445), or load to failure (P = .445) between the 2 constructs. The 3AS repair construct had improved contact pressure between tendon and bone when compared with the 2HB construct at loads of 20 N, 30 N, and 40 N (P = .01, .02, and .04, respectively). Conclusions Displacement and load to failure properties are similar between knotless constructs using either 2HB or 3AS for the medial row. However, contact force may improve with the use of 3 medial all-suture anchors. Clinical Relevance As all-suture anchors are smaller in size when compared with hard body anchors. For this reason, there is potential to place an additional all-suture medial anchor to improve contact force and potentially improve rotator cuff healing when compared with the use of hard body anchors.
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Sequeira SB, Imbergamo C, Gould HP. Interference Screws Are Biomechanically Superior to Suture Anchors for Medial Patellofemoral Ligament Reconstruction: A Systematic Review and Meta-Analysis. Arthrosc Sports Med Rehabil 2022; 4:e1581-e1588. [PMID: 36033175 PMCID: PMC9402472 DOI: 10.1016/j.asmr.2022.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To systematically review the literature to evaluate the biomechanical properties of the interference screw (IS) versus suture anchor (SA) techniques for patellar and femoral fixation of medial patellofemoral ligament (MPFL) reconstruction. Methods A systematic review was performed by searching PubMed, the Cochrane library, and Embase using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies that analyzed the biomechanical properties of IS and SA techniques for MPFL reconstruction. The search phrase implemented was “medial patellofemoral ligament reconstruction biomechanics.” Evaluated outcomes included ultimate load to failure (N), stiffness (N/mm), and mode of failure. Forest plots were created for statistical analysis and heterogeneity was assessed via I2 statistic. Results Six studies met inclusion criteria, including a total of 108 cadaveric specimens, for MPFL patellar fixation, and 3 studies met inclusion criteria, including a total of 50 cadaveric specimens, for MPFL femoral fixation. Pooled analysis from 5 studies reporting on stiffness for MPFL patellar fixation revealed a statistically significant difference in favor of IS compared with SA (P = .007). Pooled analysis from 3 studies reporting on ultimate load to failure of femoral fixation revealed a statistically significant difference in favor of IS compared with SA (P = .043). Conclusions The use of IS was associated with a greater stiffness compared with the use of SA in MPFL patellar fixation, but there was no difference in load to failure between IS and SA. The use of IS was associated with a greater load to failure compared with the use of SA in MPFL femoral fixation, but there was no difference in stiffness between IS and SA. Clinical Relevance There have been multiple individual biomechanical studies conducted comparing IS and SA fixation for MPFL patellar and femoral fixation; however, they have yielded conflicting results, with small sample sizes. Pooling the data from these studies in a meta-analysis may allow for more meaningful biomechanical data to coincide with the existing, albeit scarce, clinical data, this may help to inform clinical decision making for surgeons managing these injuries.
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Affiliation(s)
- Sean B. Sequeira
- Address correspondence to Sean B. Sequeira, M.D., Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert St., Suite 400, Baltimore, MD 21218.
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Zhu C, Wang J, Cheng W, Wang D, Pan H, Zhang W. Case Report: Bilateral Biportal Endoscopic Open-Door Laminoplasty With the Use of Suture Anchors: A Technical Report and Literature Review. Front Surg 2022; 9:913456. [PMID: 35747435 PMCID: PMC9209651 DOI: 10.3389/fsurg.2022.913456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundUnilateral biportal endoscopy (UBE) is a newly developed technique for spine surgery. Owing to the convenience of nerve decompression and compatibility with open surgical instruments under endoscopic guidance, this technique has seen widespread global use. In this study, we first used modified UBE with suture anchor fixation for cervical laminoplasty in a 65-year-old female patient with good clinical outcomes.MethodsWe used bilateral biportal endoscopy (BBE) for cervical laminoplasty with suture anchor fixation in a patient with cervical stenosis. Under endoscopic guidance, a bilateral approach was used to make the gutter and lift the lamina door. After the lamina doors were opened, sutures were tied tightly using facia cannula and knot pusher. After confirming the solidarity of the open-door status, the drainage tube was inserted and the incisions were closed. The patient’s pre- and postoperative radiological and clinical results were evaluated.ResultsPostoperative Japanese Orthopaedic Association (JOA) and Neck Disability Index (NDI) scores were improved clinically, and cervical canal was decompressed radiologically.ConclusionsBBE laminoplasty combined with suture anchor fixation showed a favorable clinical and radiological result and appears to be a safe and effective technique for cervical stenosis.
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Affiliation(s)
- Chengyue Zhu
- Department of Orthopaedics, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Jing Wang
- Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, China
| | - Wei Cheng
- Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, China
| | - Dong Wang
- Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, China
| | - Hao Pan
- Department of Orthopaedics, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Wei Zhang
- Department of Orthopaedics, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
- Correspondence: Wei Zhang;
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Cole EW, Werner BC, Denard PJ. Perianchor Cyst Formation Is Similar Between All-Suture and Conventional Suture Anchors Used for Arthroscopic Rotator Cuff Repair in the Same Shoulder. Arthrosc Sports Med Rehabil 2022; 4:e949-e955. [PMID: 35747662 PMCID: PMC9210368 DOI: 10.1016/j.asmr.2022.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/14/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose The purpose of this study was to compare perianchor cyst formation between soft and hard suture anchors placed in the same patient 1 year after arthroscopic rotator cuff repair (ARCR). Methods This study reviewed patients who underwent primary ARCR using a “hybrid” technique using at least one soft anchor (FiberTak, Arthrex, Naples, FL) and one hard anchor (SwiveLock) placed in the same shoulder between January 1, 2018 and December 31, 2018. Magnetic resonance imaging was obtained at minimum 1-year postoperative to assess cyst formation (perianchor fluid signal) and rotator cuff healing. Range of motion (ROM) and patient-reported outcome measures (PROMs) were evaluated at baseline and 1-year follow up. PROMs included visual analog scale pain score, Simple Shoulder Test score, American Shoulder and Elbow Surgeon (ASES) score. Results Nineteen patients with a combined 45 hard and 26 soft suture anchors were available for follow-up at a mean of 20 months postoperatively. There was a higher proportion of grade 1 fluid signal changes in the hard anchor group compared to the soft group (62.2% to 7.7; P < .001); however, there was no difference in the incidence of cyst formation (grade 2 or 3 changes) between groups (13.3% vs 3.8%; P = .251). There was also no difference in the rate of cyst formation between biocomposite and polyether-ether-ketone-type hard anchors (18.2% vs 0%; P = .113) or between anchors placed at the greater and lesser tuberosities (10.2% vs 5.3%, P = .519). Conclusion Hard suture anchors showed increased fluid signal compared to soft suture anchors at short-term follow-up after ARCR, but there was no difference in cyst formation between anchor types.
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Affiliation(s)
- Elliott W. Cole
- Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, U.S.A
| | - Patrick J. Denard
- Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, Oregon, U.S.A
- Oregon Shoulder Institute, Medford, Oregon, U.S.A
- Address correspondence to Patrick J. Denard, M.D., Southern Oregon Orthopedics, 2780 E. Barnett Rd., Suite 200, Medford, OR, 97530, U.S.A.
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Gorica Z, McFarland K, Lewis JS, Schweitzer KM, Vap AR. Surgical Repair of Posttraumatic Hallux Valgus Deformity in a Collegiate Football Player: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00012. [PMID: 36099514 DOI: 10.2106/jbjs.cc.22.00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE We report a rare case of posttraumatic hallux valgus in a collegiate football player after an acute medial collateral ligament tear of the first metatarsophalangeal joint. The patient was treated with a modification of the modified McBride technique, using an all-suture anchor for the medial ligamentous complex repair. There was return to sport at 5 months and a Foot and Ankle Outcome Score of 95% at 10 months. CONCLUSION A modified McBride procedure further modified with the utilization of an all-suture anchor for the medial ligamentous complex repair can result in correction of deformity, pain-free movement and return to sport.
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Affiliation(s)
- Zylyftar Gorica
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | | | - John S Lewis
- Louisville Orthopedic Clinic, Louisville, Kentucky
| | - Karl M Schweitzer
- Department of Orthopaedic Surgery, Duke University, Raleigh, North Carolina
| | - Alexander R Vap
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia
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22
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Gorica Z, McFarland K, Lewis JS, Schweitzer KM, Vap AR. Post-Traumatic Hallux Valgus: A Modified Surgical Technique. Arthrosc Tech 2022; 11:e37-e42. [PMID: 35127427 PMCID: PMC8807717 DOI: 10.1016/j.eats.2021.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/29/2021] [Indexed: 02/03/2023] Open
Abstract
Post-traumatic hallux valgus, a turf toe variant, is a rare, yet limiting injury. According to the literature, the deformity has been associated with acute medial collateral ligament tears, turf toe variant injuries, Lisfranc injury patterns, and first metatarsal fractures. There have been few documented cases of post-traumatic hallux valgus secondary to medial collateral ligament tears, and the treatment has been variable. Some authors have described direct end-to-end repair of the ligament to address the deformity, while others have described a modified McBride bunionectomy involving a Silver bunionectomy, lateral soft tissue release, and medial capsular and ligamentous repair. We propose a modified technique similar to the modified McBride bunionectomy, however, with the use of an all-suture anchor in the medial capsular and ligamentous repair. Our belief is that the all-suture anchor will allow for a stronger repair that will meet the physical demands of everyday ambulation and athletic participation. We used this technique in an individual who had evidence of a medial ligamentous complex injury of the hallux on MRI and failed conservative management. Postoperatively, the patient is immobilized until they can begin working on range of motion, strengthening, and finally to achieve return to full activity and sports.
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Affiliation(s)
- Zylyftar Gorica
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
- Address correspondence to Zylyftar Gorica, M.D., Department of Orthopaedic Surgery, Virginia Commonwealth University, 1200 East Broad St., 9th Fl., Box 980153, Richmond, VA 23298, U.S.A.
| | - Kimberly McFarland
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - John S. Lewis
- Louisville Orthopedic Clinic, Louisville, Kentucky, U.S.A
| | - Karl M. Schweitzer
- Department of Orthopaedic Surgery, Duke University, Raleigh, North Carolina, U.S.A
| | - Alexander R. Vap
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
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Nezu S, Saito T, Yoshida A, Narazaki S, Shimamura Y, Furumatsu T, Ozaki T. Effect of difference in fixation methods of tendon graft and the microfracture procedure on tendon-bone junction healing. JSES Int 2021; 6:155-166. [PMID: 35141691 PMCID: PMC8811408 DOI: 10.1016/j.jseint.2021.10.001] [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] [Indexed: 12/02/2022] Open
Abstract
Background There are generally two methods of fixation for tendon grafts used in ligament reconstruction: bone tunnel fixation and anchor fixation. The microfracture (Mf) procedure is a technique to induce bleeding from the bone marrow, and the bleeding may contain cells with differentiation potential. However, few studies have compared the effects of the Mf procedure with those of the fixation methods. This study aimed to evaluate the effectiveness of the Mf procedure on two tendon graft fixation methods: histological, gene expression, tendon graft thickness, and mechanical. We especially focused our investigation on junction healing of tendon grafts and bone in the two fixation methods. Methods We used 20 rabbits to evaluate tendon and bone healing in a peroneal tendon graft model. The rabbit models were divided into five groups according to the combination of peroneal tendon graft fixation method and Mf technique as follows: control group (C, n = 4), bone tunnel fixation without Mf procedure group (BT − Mf, n = 4), bone tunnel fixation with Mf procedure group (BT + Mf, n = 4), anchor fixation without Mf procedure group (A − Mf, n = 4), and anchor fixation with Mf procedure group (A + Mf, n = 4). All animals were sacrificed at 4 weeks postoperatively. The specimens underwent histological evaluation, mRNA analysis, tendon graft thickness at the tendon-bone junction, and biomechanical testing. Results Histological evaluation of the BT + Mf and A + Mf groups showed healing with fibrocartilage formation at the tendon graft-bone junction. The mRNA expression showed significant increase in type 2 collagen, Scleraxis, and SRY-box9 in the BT + Mf and A + Mf groups. In biomechanical tests, the BT + Mf and A + Mf groups showed significantly increased tensile strength compared with the BT − Mf and A − Mf groups (BT + Mf group, 21.6 ± 1.7 N; A + Mf group, 22.5 ± 2.3 N vs. BT − Mf group, 12.3 ± 2.4 N; A − Mf group, 11 ± 2.3 N). Conclusion The Mf procedure resulted in fibrocartilage formation at the tendon-bone junction in the BT and anchor fixation and improved the fixation strength at 4 weeks.
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Affiliation(s)
- Satoshi Nezu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Taichi Saito
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Corresponding author: Taichi Saito, MD, PhD, Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry, and Pharmaceutical Sciences, Okayama, Japan, 2-5-1, Shikatacho, Kitaku, Okayama City, 700-8558.
| | - Aki Yoshida
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shinji Narazaki
- Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital, Okayama, Okayama, Japan
| | - Yasunori Shimamura
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Increased Load to Failure in Biceps Tenodesis With All-Suture Suture Anchor Compared With Interference Screw: A Cadaveric Biomechanical Study. Arthroscopy 2021; 37:3016-3021. [PMID: 33895306 DOI: 10.1016/j.arthro.2021.03.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/01/2021] [Accepted: 03/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical characteristics of a single radially expanding all-suture anchor with an interference screw for open subpectoral long head of biceps tendon (LHBT) tenodesis. METHODS Eighteen fresh-frozen matched-pair human cadaveric humeri were used for this biomechanical study. The matched pair humeri were randomly assigned into 2 experimental biceps tenodesis groups: conventional interference screw (CIS) or all-suture suture anchor (ASSA). Open subpectoral LHBT tenodesis was then performed and biomechanical testing was performed using a servohydraulic test frame. A preload of 5 N was applied for 2 minutes before cyclic loading. Displacement was recorded at cycle 300 (D300) and cycle 500 (D500) and at ultimate failure. Data recorded included displacement, load to failure, displacement at failure. Paired t test was used for analysis. RESULTS Decreased displacement was observed for the CIS group at D300 (1.67 ± 0.57 mm vs 3.35 ± 2.24 mm; P = .04), D500 (2.00 ± 0.76 mm vs 3.87 ± 2.20 mm; P = .04), and at failure (5.17 ± 3.05 mm vs 10.76 ± 2.66 mm; P < .001). Load to failure was lower in CIS specimens (170 ± 24.5 N vs 217.8 ± 51.54 N; P = .02). Failure in each case was tendon pullout for all CIS specimens; in ASSA 6 specimens failed as the suture pulled through the tendon, 2 specimens failed by suture breakage. No difference in stiffness was observed between the 2 groups (CIS = 98.33 ± 22.98 N/m vs ASSA = 75.94 ± 44.83 N/m; P = .20). CONCLUSIONS Our study found that open subpectoral biceps tenodesis performed with an ASSA construct results in increased load to failure as compared with CIS. However, the CIS did demonstrate decreased displacement as compared to ASSA in this cadaveric biomechanical study. CLINICAL RELEVANCE ASSA and CIS at time zero provide fixation as indicated by the provider intraoperatively for LHBT tenodesis. ASSA, however, does remove less cortical bone than does CIS and therefore produces a smaller stress riser in the proximal humerus. Further testing as to the integrity of ASSA is warranted to determine the integrity of the tenodesis with cyclical loading.
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Ritsch M. Bizeps- und Trizepssehnenrupturen im Kraftsport. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00486-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Paik RS. Editorial Commentary: All-Suture Anchors Are Small, Easier to Revise, and Biomechanically Equivalent to Conventional Implants: They Are the Way of the Future. Arthroscopy 2021; 37:2807-2808. [PMID: 34481621 DOI: 10.1016/j.arthro.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 02/02/2023]
Abstract
All-suture anchors (ASAs) show biomechanical equivalence to conventional implants. The smaller size and easier ability to revise are important advantages of ASAs. A more vertical insertion angle increases ASA pullout strength. Proper depth of insertion is required to optimally seat ASAs on cortical bone. ASA pullout strength also results from compression of cancellous bone between the anchor and the cortex, and appropriately pretensioning the suture before loading is critical. A larger anchor (and a higher the number of sutures loaded per anchor) leads to a higher pullout strength of the anchor. Understanding the correct implantation technique is important to optimize the strength of ASAs.
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Thangarajah T, Lo IK, Sabo MT. Rotator cuff repair techniques: Current concepts. J Clin Orthop Trauma 2021; 17:149-156. [PMID: 33854942 PMCID: PMC8022250 DOI: 10.1016/j.jcot.2021.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 01/04/2023] Open
Abstract
Arthroscopic rotator cuff repair is being performed by an ever-increasing number of surgeons. With an ageing population and growing patient expectations it is crucial that clinical outcomes are optimised. Anatomical reduction of the tendon back to its footprint with minimal tension contributes to this, but this can only be achieved if key biomechanical factors are taken into consideration. In this review of the technical aspects of a rotator cuff repair, we focus on: (1) patient positioning, (2) biomechanical principles, (3) optimal visualisation, and (4) repair techniques for both anterior and postero-superior tears.
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Affiliation(s)
- Tanujan Thangarajah
- University of Calgary, Department of Trauma and Orthopaedic Surgery, 2500 University Drive NW, Calgary, Alberta, 2N 1N4, Canada
| | - Ian K. Lo
- University of Calgary, Department of Trauma and Orthopaedic Surgery, 2500 University Drive NW, Calgary, Alberta, 2N 1N4, Canada
| | - Marlis T. Sabo
- SCRUBS Research Unit, Cumming School of Medicine, University of Calgary, Canada
- Corresponding author. 4448 Front St SE, Calgary, AB, T3M 1M4, Canada.
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Lacheta L, Miles J, Douglass B, Millett P. The Effect of Torque Differences for All-Suture Anchor Fixation Strength: A Biomechanical Analysis. Arthrosc Sports Med Rehabil 2021; 3:e549-e554. [PMID: 34027468 PMCID: PMC8129443 DOI: 10.1016/j.asmr.2020.12.008] [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: 07/09/2020] [Accepted: 12/24/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the biomechanical influence of differential loading of suture strands (torque) on the fixation strength of knotted and knotless all-suture anchors. Methods The biomechanical strength of 48 all-suture anchors was evaluated for 4 conditions in polyurethane foam blocks: (1) 12 knotted all-suture anchors loaded proportionately, (2) 12 knotted all-suture anchors with 1 suture strand bearing 50% of total force (partial torque), (3) 12 knotted all-suture anchors with 1 strand fixated and the other loaded (full torque), and (4) 12 knotless all-suture anchors with the loop kept open via a fixed rod. Force for 1 mm and 2 mm of displacement and ultimate failure load were assessed. Results For 1 mm of displacement, groups 2, 3, and 4 showed significantly lower forces than group 1 (all P < .001), with no statistically significant difference between groups 2 and 3 (P = .516); for 2 mm of displacement, all groups showed significantly lower forces than group 1 (P < .001), which positively correlated with applied torque. No differences in the mean ultimate loads observed between testing groups 1, 2, and 4 were noted, with 93.3 ± 3.8 N, 91.4 ± 4.7 N, and 92.6 ± 5.6 N, respectively; however, group 3 exhibited a significantly lower mean ultimate load (62.3 ± 1.7 N) than all other groups (P < .001). Conclusions The ultimate failure load of knotted and knotless all-suture anchor fixation was partially affected by loading differentials between strands in this validated foam block model. Differential loading of knotted all-suture anchor fixation presented greater initial displacement when compared with symmetrically loaded knotted all-suture anchors. Despite an initial increase in displacement, knotless all-suture anchors showed similar ultimate failure loads to knotted all-suture anchors with strands loaded equally. Clinical Relevance The role of suture strand loading imbalance on anchor fixation is variable and should be considered during placement and fixation of the repair constructs in a clinical setting.
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Affiliation(s)
- Lucca Lacheta
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- Center for Musculoskeletal Surgery, Charitè Universitaetsmedizin Berlin, Berlin, Germany
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Jon Miles
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Peter Millett
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- The Steadman Clinic, Vail, Colorado, U.S.A
- Address correspondence to Peter Millett, M.D., M.Sc., Steadman Philippon Research Institute, The Steadman Clinic, 181 W Meadow Dr, Ste 400, Vail, CO 81657, U.S.A.
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