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Feldman JJ, Ostrander B, Ithurburn MP, Fleisig GS, Tatum R, Ochsner MG, Ryan MK, Rothermich MA, Emblom BA, Dugas JR, Lyle Cain E. The Relationship Between All-Suture and Solid Medial-Row Anchors and Patient-Reported Outcomes for Double-Row Suture Bridge Rotator Cuff Repair. Orthop J Sports Med 2024; 12:23259671241262264. [PMID: 39131094 PMCID: PMC11307331 DOI: 10.1177/23259671241262264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/12/2024] [Indexed: 08/13/2024] Open
Abstract
Background The use of all-suture anchors for rotator cuff repair is increasing. Potential benefits include decreased bone loss and decreased damage to the chondral surface. Minimal evidence exists comparing outcomes among medial-row anchor fixation methods in double-row suture bridge rotator cuff repair. Purpose To compare the clinical outcomes between all-suture and solid medial-row anchors in double-row suture bridge rotator cuff repair. Study Design Case series; Level of evidence, 4. Methods A total of 352 patients (mean age at surgery, 60.3 years) underwent double-row suture bridge rotator cuff repair at our institution. Patients were separated into 2 groups based on whether they underwent all-suture (n = 280) or solid (n = 72) anchor fixation for the medial row. Outcomes data were collected via an ongoing longitudinal data repository or through telephone calls (minimum follow-up time, 2.0 years; mean follow-up time, 3.0 years). Outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) standardized shoulder assessment form and the visual analog scale (VAS). The same rehabilitation protocol was administered to all patients. The proportions of patients meeting previously published Patient Acceptable Symptom State (PASS) thresholds were calculated for the outcome measures, and outcome scores and the proportions of patients meeting PASS thresholds between groups were compared using linear and logistic regression, respectively. Results The groups did not differ in terms of age at surgery, sex distribution, rotator cuff tear size, or number of medial-row anchors used. The solid anchor group had a longer follow-up time compared with the all-suture anchor group (3.6 ± 0.7 vs 2.8 ± 0.8 years, respectively; P < .01). After controlling for follow-up time, the solid and all-suture anchor groups did not differ in ASES scores (89.6 ± 17.8 vs 88.8 ± 16.7, respectively; P = .44) or VAS scores (1.1 ± 2.1 vs 1.2 ± 2.1, respectively; P = .37). Similarly, after controlling for follow-up time, the solid and all-suture anchor groups did not differ in the proportions of patients meeting PASS cutoffs for the ASES (84.7% vs 80.7%, respectively; P = .44) or the VAS (80.6% vs 75.0%, respectively; P = .83). Conclusion Double-row suture bridge rotator cuff repair using all-suture anchors for medial-row fixation demonstrated similar excellent clinical outcomes to rotator cuff repair using solid medial-row anchors.
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Affiliation(s)
- John J. Feldman
- American Sports Medicine Institute, Birmingham, Alabama, USA
- South Palm Orthopedics, Delray Beach, Florida, USA
| | - Brook Ostrander
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Matthew P. Ithurburn
- American Sports Medicine Institute, Birmingham, Alabama, USA
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Robert Tatum
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Mims G. Ochsner
- American Sports Medicine Institute, Birmingham, Alabama, USA
- Chatham Orthopaedic Associates, Savannah, Georgia, USA
| | - Michael K. Ryan
- American Sports Medicine Institute, Birmingham, Alabama, USA
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | - Marcus A. Rothermich
- American Sports Medicine Institute, Birmingham, Alabama, USA
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | - Benton A. Emblom
- American Sports Medicine Institute, Birmingham, Alabama, USA
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | - Jeffrey R. Dugas
- American Sports Medicine Institute, Birmingham, Alabama, USA
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | - E. Lyle Cain
- American Sports Medicine Institute, Birmingham, Alabama, USA
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
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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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Wong SE, Julian KR, Carpio JG, Zhang AL. Proximal Hamstring Repair With All-Suture Anchors and an Accelerated Rehabilitation and Bracing Protocol Demonstrates Good Outcomes at 1-Year Follow-Up. Arthrosc Sports Med Rehabil 2024; 6:100891. [PMID: 38362482 PMCID: PMC10867423 DOI: 10.1016/j.asmr.2024.100891] [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: 09/11/2023] [Accepted: 01/10/2024] [Indexed: 02/17/2024] Open
Abstract
Purpose To evaluate patient-reported outcomes and risk for rerupture after surgical treatment of proximal hamstring tendon ruptures using all-suture anchors and a unique postoperative bracing strategy. Methods A retrospective review of a prospectively collected database was conducted of patients undergoing proximal hamstring repair or reconstruction from 2020 to 2022 at a tertiary, academic institution. Patients were included if they reached minimum 1-year follow-up and completed postoperative patient-reported outcomes. The surgical protocol for proximal hamstring repairs included all-suture anchors placed either in an open or endoscopic fashion in the ischial tuberosity. After surgery, all patients underwent an accelerated rehabilitation protocol, including 6 weeks touchdown weight-bearing in a hinged knee brace locked in extension for ambulation, allowing passive knee flexion to 90° while seated. Descriptive statistics were used to analyze the data. Results Twenty-one patients were included (mean age 50.4 ± 9.5 years, body mass index 24.4 ± 3.5, 66.7% female). Lower Extremity Functional Scale score achieved postoperatively was 74.2 ± 7.5 (out of 80). Patients had minimal pain (mean visual analog scale pain score of 0.9 ± 1.2). 61.9% of patients were able to return to the same level of activity after based on Tegner score by 1 year. Postoperative Single Assessment Numeric Evaluation activity of daily living was 94.3 ± 8.3, and Single Assessment Numeric Evaluation Sports was 82.3 ± 19.0. Mean Short Form Survey (SF-12) postoperative scores were 51.6 ± 6.8 for SF-12 Physical Component Score and 53.9 ± 9.7 for Mental Component Score. 95.2% (20 of 21) patients were satisfied with their outcome. There were no reruptures, infections, or reoperations. One patient of 21 (4.8%) incurred a postoperative deep venous thrombosis, which was treated with therapeutic anticoagulation for 3 months. Conclusions All-suture anchors for proximal hamstring repair with a unique accelerated postoperative rehabilitation and bracing protocol result in good outcomes and patient satisfaction with minimal risk of complications. Level of Evidence Level IV, case series, therapeutic.
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Affiliation(s)
- Stephanie E. Wong
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Kaitlyn R. Julian
- School of Medicine, University of California San Francisco, San Francisco, California, U.S.A
| | - Jocelyn G. Carpio
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Alan L. Zhang
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
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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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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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Rhee SM, Youn SM, Kim CH, Chang GW, Kim SY, Ham HJ, Rhee YG. Rotator cuff repairs with all-suture tape anchors: no difference in outcomes between with or without all-suture tape anchors. Knee Surg Sports Traumatol Arthrosc 2023; 31:4060-4067. [PMID: 37226010 DOI: 10.1007/s00167-023-07454-4] [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: 12/09/2022] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE This study aimed at comparing the outcomes of medium- to large-sized rotator cuff repairs performed using the suture bridge technique either with or without tape-like sutures, and single row techniques with conventional sutures. METHODS A total of 135 eligible patients with medium to large rotator cuff tears were identified and analyzed retrospectively, from 2017 to 2019. Only repairs using all-suture anchors were included in the study. Patients were divided into the following three groups: single-row (SR) repair (N = 50), standard double-row suture bridge (DRSB) repair with conventional sutures (N = 35), and DRSB with tape-like sutures (N = 50). The average postoperative follow-up period was 26.3 ± 9.8 months (range, 18-37). RESULTS DRSB with tapes had the highest re-tear rate of 16% (8/50), but there was no significant difference with the re-tear rates observed in SR (8%, 4/50) and DRSB with conventional sutures (11.4%, 4/35) (n.s.). DRSB with tapes demonstrated higher rate of type 2 re-tears (10%) compared to type 1 re-tears (6%), but the other two groups showed either similar or higher rates of type 1 re-tears compared to that of type 2. Post-operative functional scores of the three groups improved significantly (all p < 0.05), but the differences between the groups were not statistically significant. CONCLUSIONS No clinical difference in functional outcomes and re-tear rates were observed in DRSB with tapes when compared with SR and DRSB using the conventional sutures. Tape-like DRSB suture which was expected to be superior by its biomechanical advantage was clinically non-superior to conventional DRSB suture. There were no significant differences in VAS scores and UCLA scores. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sung-Min Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Seung-Min Youn
- The Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Butterfield St, Herston, QLD, Australia
| | - Cheol Hwan Kim
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-Dong, Deokyang-Gu, Goyang-Si, 10475, Gyeonggi-Do, Korea
| | - Geun-Wu Chang
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-Dong, Deokyang-Gu, Goyang-Si, 10475, Gyeonggi-Do, Korea
| | - Se Yeon Kim
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-Dong, Deokyang-Gu, Goyang-Si, 10475, Gyeonggi-Do, Korea
| | - Hyun Joo Ham
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-Dong, Deokyang-Gu, Goyang-Si, 10475, Gyeonggi-Do, Korea
| | - Yong Girl Rhee
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-Dong, Deokyang-Gu, Goyang-Si, 10475, Gyeonggi-Do, Korea.
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Loeb AE, Ostrander B, Ithurburn MP, Fleisig GS, Arceo C, Brockington D, Tatum R, Feldman JJ, Ryan MK, Rothermich MA, Emblom BA, Dugas JR, Cain EL. Outcomes of Double-Row Rotator Cuff Repair Using a Novel All-Suture Soft Anchor Medial Row. Orthop J Sports Med 2023; 11:23259671231192134. [PMID: 37576454 PMCID: PMC10422908 DOI: 10.1177/23259671231192134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/27/2023] [Indexed: 08/15/2023] Open
Abstract
Background Few studies have examined the short-term clinical outcomes of rotator cuff repair (RCR) with all-suture anchors for medial row anchor fixation. Purpose To evaluate clinical outcomes of double-row suture bridge RCR using a novel all-suture medial row anchor. Study Design Case series; Level of evidence, 4. Methods We enrolled 179 patients before double-row suture bridge RCR (mean age at surgery, 60.0 years; 63% male patients) at a single institution. All patients underwent RCR with all-suture anchor fixation for the medial row and solid anchor fixation for the lateral row. Preoperative (baseline) and follow-up (minimum follow-up time of 2 years; mean, 2.5 years) clinical outcomes were compared using the American Shoulder and Elbow Surgeons (ASES) score and a 10-point numeric pain rating scale (NPRS). We calculated the proportions of patients meeting previously published Patient Acceptable Symptom State (PASS) thresholds for the ASES (≥78.0) and NPRS (≤1.7). We further compared baseline and follow-up outcome scores and the proportions of patients meeting PASS thresholds using paired t tests and McNemar tests, respectively, and calculated effect size to quantify the magnitude of change from baseline to follow-up. Results Values significantly improved from baseline to follow-up for ASES (from 45.3 ± 19.8 to 87.3 ± 17.1) and NPRS (from 5.2 ± 2.5 to 1.4 ± 2.1). The proportion of patients meeting PASS thresholds also significantly improved for the ASES (from 6% to 77%) and the NPRS (from 7% to 72%). The magnitude of baseline to follow-up change for all measures was large (all effect sizes ≥1.5). Conclusion Our study demonstrated excellent short-term clinical outcomes and substantial improvements for patients undergoing double-row suture bridge RCR with all-suture anchors for medial row fixation.
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Affiliation(s)
| | - Brook Ostrander
- American Sports Medicine Institute, Birmingham, Alabama, USA.MD
| | - Matthew P. Ithurburn
- American Sports Medicine Institute, Birmingham, Alabama, USA.MD
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Cristian Arceo
- American Sports Medicine Institute, Birmingham, Alabama, USA.MD
| | | | - Robert Tatum
- American Sports Medicine Institute, Birmingham, Alabama, USA.MD
| | - John J. Feldman
- American Sports Medicine Institute, Birmingham, Alabama, USA.MD
- South Palm Orthopedics, Delray Beach, Florida, USA
| | - Michael K. Ryan
- American Sports Medicine Institute, Birmingham, Alabama, USA.MD
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | - Marcus A. Rothermich
- American Sports Medicine Institute, Birmingham, Alabama, USA.MD
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | - Benton A. Emblom
- American Sports Medicine Institute, Birmingham, Alabama, USA.MD
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | - Jeffrey R. Dugas
- American Sports Medicine Institute, Birmingham, Alabama, USA.MD
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | - E. Lyle Cain
- American Sports Medicine Institute, Birmingham, Alabama, USA.MD
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
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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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Alkaissy R, Richard M, Morris H, Snelling S, Pinchbeck H, Carr A, Mouthuy PA. Manufacture of Soft-Hard Implants from Electrospun Filaments Embedded in 3D Printed Structures. Macromol Biosci 2022; 22:e2200156. [PMID: 36048528 DOI: 10.1002/mabi.202200156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/14/2022] [Indexed: 01/15/2023]
Abstract
Rotator cuff tendon tears are common injuries of the musculoskeletal system that often require surgical repair. However, re-tearing following repair is a significant clinical problem, with a failure rate of up to 40%, notably at the transition from bone to tendon. The development of biphasic materials consisting of soft and hard components, which can mimic this interface, is therefore promising. Here, a simple manufacturing approach is proposed that combines electrospun filaments and 3D printing to achieve scaffolds made of a soft polydioxanone cuff embedded in a porous polycaprolactone block. The insertion area of the cuff is based on the supraspinatus tendon footprint and the size of the cuff is scaled up from 9 to 270 electrospun filaments to reach a clinically relevant strength of 227N on average. The biological evaluation shows that the biphasic scaffold components are noncytotoxic, and that tendon and bone cells can be grown on the cuff and block, respectively. Overall, these results indicate that combining electrospinning and 3D printing is a feasible and promising approach to create soft-to-hard biphasic scaffolds that can improve the outcomes of rotator cuff repair.
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Affiliation(s)
- Rand Alkaissy
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Michael Richard
- 3D LifePrints UK Ltd, Nuffield Orthopaedic Centre, Old Road, Oxford, OX3 7LD, United Kingdom
| | - Hayley Morris
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah Snelling
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Henry Pinchbeck
- 3D LifePrints UK Ltd, Nuffield Orthopaedic Centre, Old Road, Oxford, OX3 7LD, United Kingdom
| | - Andrew Carr
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Pierre-Alexis Mouthuy
- Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Lappen S, Geyer S, Kadantsev P, Hinz M, Kleim B, Degenhardt H, Imhoff AB, Siebenlist S. All-suture anchors for distal biceps tendon repair: a preliminary outcome study. Arch Orthop Trauma Surg 2022; 143:3271-3278. [PMID: 36416943 DOI: 10.1007/s00402-022-04690-0] [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] [Received: 01/27/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of this study was to retrospectively evaluate the clinical outcome of double intramedullary all-suture anchors' fixation for distal biceps tendon ruptures. MATERIALS AND METHODS A retrospective case series of patients who underwent primary distal biceps tendon repair with all-suture anchors was conducted. Functional outcome was assessed at a minimum follow-up of at 12 months based on the assessments of the Mayo Elbow Performance Score (MEPS), Andrews-Carson Score (ACS), Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), and the Visual Analog Scale (VAS) for pain. Maximum isometric strength test for flexion and supination as well as postoperative range of motion (ROM) were determined for both arms. RESULTS 23 patients treated with all-suture anchors were assessed at follow-up survey (mean age 56.5 ± 11.4 years, 96% male). The follow-up time was 20 months (range Q0.25-Q0.75, 15-23 months). The following outcome results were obtained: MEPS 100 (range Q0.25-Q0.75, 100-100); ACS 200 (range Q0.25-Q0.75, 195-200); QuickDASH 31 (range Q0.25-Q0.75, 30-31); VAS 0 (range Q0.25-Q0.75, 0-0). The mean strength compared to the uninjured side was 95.6% (range Q0.25-Q0.75, 80.9-104%) for flexion and 91.8 ± 11.6% for supination. There was no significant difference in ROM or strength compared to the uninjured side and no complications were observed in any patient. CONCLUSION Distal biceps tendon refixation using all-suture anchors provides good-to-excellent results in terms of patient-reported and functional outcome. This repair technique appears to be a viable surgical option, although further long-term results are needed. LEVEL OF EVIDENCE Level IV (case series).
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Affiliation(s)
- Sebastian Lappen
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephanie Geyer
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Pavel Kadantsev
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Maximilian Hinz
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Benjamin Kleim
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Hannes Degenhardt
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Kim MS, Rhee SM, Cho NS. Perianchor cyst formation in all-suture anchor after rotator cuff repair: an evaluation of anchor insertion angle. J Shoulder Elbow Surg 2022; 31:1831-1839. [PMID: 35367621 DOI: 10.1016/j.jse.2022.02.028] [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: 11/23/2021] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies reported that micromotion after all-suture anchor implantation can lead to perianchor cyst formation (PCF), leading to risk of retear. Modifying anchor insertion angle (AIA) is known to be one of the various ways to increase anchor stability. However, there currently are few studies that assess the correlation between PCF, AIA, and retear. PURPOSE To find the correlation of PCF and the repaired rotator cuff integrity with AIA after arthroscopic double-row suture-bridge rotator cuff repair (RCR) using an all-suture anchor in the medial row. METHODS A total of 218 patients who underwent arthroscopic double-row suture-bridge RCR were retrospectively reviewed. All patients underwent RCR using all-suture anchors and polyether ketone anchors in the medial and lateral rows, respectively. Magnetic resonance imaging was conducted 6 months after the surgery to evaluate PCF, AIA, and integrity of the repaired cuff. The all-suture anchor insertion angle in the medial row was measured with reference to the greater tuberosity to assess the relationship between the AIA and PCF. The correlations between PCF, AIA, and post-RCR integrity were evaluated including various demographic and radiologic factors. RESULTS Perianchor cysts were formed in 93 patients (42.7%). Mediolateral tear size (2.1 ± 1.2 cm vs. 1.7 ± 0.9 cm, P = .034) and AIA (61.9° ± 15.2° vs. 68.4° ± 13.0°, P = .001) were significantly different between patient groups with and without perianchor cysts. Multivariate logistic regression analysis showed that mediolateral tear size (odds ratio [OR] 1.318, 95% confidence interval [CI] 1.008-1.724; P = .043) and AIA (OR 0.967, 95% CI 0.947-0.988; P = .002) were independent risk factors for PCF. In addition, PCF was observed more frequently (69.6% vs. 32.1%, P < .001) and the AIA was lower (59.4° ± 13.7° vs. 67.8° ± 13.8°, P < .001) in the retear group than in the healed group. CONCLUSIONS Perianchor cysts were formed in approximately 40% of patients who underwent arthroscopic double-row suture-bridge RCR using all-suture anchors. Low AIA and large mediolateral tear size were risk factors for PCF. Moreover, perianchor cyst and AIA were correlated with post-RCR integrity. Therefore, a high AIA must be carefully considered when all-suture anchors are inserted into the medial row when performing RCR.
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Affiliation(s)
- Myung Seo Kim
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea; College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sung Min Rhee
- College of Medicine, Kyung Hee University, Seoul, Republic of Korea; Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Nam Su Cho
- Department of Orthopedic Surgery, Cheil Orthopedic Hospital, Seoul, Republic of Korea.
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Scanaliato JP, Childs BR, Dunn JC, Czajkowski H, Parnes N. Arthroscopic Posterior Labral Repair in Active-Duty Military Patients: A Reliable Solution for an At-Risk Population, Regardless of Anchor Type. Am J Sports Med 2022; 50:3036-3044. [PMID: 35983962 DOI: 10.1177/03635465221111568] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Active-duty servicemembers are a population at risk for the development of posterior shoulder instability. While short-term outcomes after arthroscopic posterior labral repair for posterior shoulder instability are promising, there is a paucity of longer term follow-up data for this procedure. PURPOSES The primary purpose was to report midterm outcomes after arthroscopic posterior labral repair in active-duty military patients for posterior shoulder instability without bone loss. The secondary purpose was to determine if outcomes varied between anchor types used. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Preoperative and postoperative outcomes, with a minimum 3-year follow-up, for a visual analog scale for pain, the Single Assessment Numeric Evaluation (SANE), the American Shoulder and Elbow Surgeons (ASES) score, and the Rowe score were collected and analyzed. A separate subgroup analysis was performed comparing the outcomes of patients who underwent repair with biocomposite anchors versus those who underwent repair with all-suture anchors. RESULTS A total of 73 patients with a mean follow-up of 82.55 ± 24.20 months met the inclusion criteria and were available for analysis. As a whole, the cohort demonstrated statistically and clinically significant improvements in outcome scores at final follow-up. Preoperative and postoperative range of motion did not vary significantly. While the difference in final outcome scores between the 2 anchor types did not reach statistical significance, a statistically significantly larger proportion of patients who underwent repair with all-suture anchors versus those who underwent repair with biocomposite anchors met the Patient Acceptable Symptom State for the SANE (97.14% vs 78.95%, respectively; P = .0180) and the ASES score (88.57% vs 68.42%, respectively; P = .0171). The proportion of patients who achieved the substantial clinical benefit or surpassed the minimal clinically important difference, however, did not vary by anchor type. Overall, 70 patients (95.89%) remained on active duty and were able to return to preinjury work and recreational activity levels. There were 3 patients (4.11%) who had recurrent posterior instability. CONCLUSION This population of active-duty servicemembers undergoing posterior labral repair for posterior labral instability without bone loss demonstrated a statistically and clinically significant improvement in midterm outcomes, a low recurrence rate, and a rate of return to active duty of 95.89%, regardless of the anchor type used.
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Affiliation(s)
| | | | - John C Dunn
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | | | - Nata Parnes
- Carthage Area Hospital, Carthage, New York, USA.,Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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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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15
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Memon KA, Dimock R, Bernasconi A, Sobti A, Consigliere P, Imam MA, Narvani AA. Clinical and Radiological Outcomes of Rotator Cuff Repairs Using All-Suture Anchors as Medial Row Anchors. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:527-535. [PMID: 34692935 DOI: 10.22038/abjs.2021.52827.2654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/08/2021] [Indexed: 11/06/2022]
Abstract
Background The aim of our study is to report the clinical and radiological outcomes of a series of prospectively enrolled patients who have had double-row transosseous equivalent rotator cuff repairs, where all-suture anchors were used as medial-row anchors, with a minimum follow-up of 1 year. Methods Twenty-two consecutive patients underwent arthroscopic transosseous equivalent double-row rotator cuff repair using all-suture anchors as medial-row anchors. Oxford Shoulder Score, Constant Score and Visual Analogue Scale pain score, together with shoulder range of motion, were used preoperatively and at 3 months, 6 months and final follow-up. Radiological evaluation was performed with magnetic resonance imaging at one-year post surgery to assess the structural integrity of the repair and the rate of cyst formation in greater tuberosity. Results The patient mean age was 61 years (range 46-75). Minimum follow-up was 1 year, and the mean final follow-up was 15 months (range 12-24). Healing failure in our patients was less than 5% (1/22 patients). There were significant improvements in shoulder function outcome scores at final follow-up. The Constant and Oxford scores were 78 and 44 at final follow-up respectively. There were similar magnitudes of improvement in range of motion (combined abduction and rotation), pain score and supraspinatus strength at final follow up. The improvements in outcome scores were already statistically significant at 3 months (P<.001). Using Kim's classification for cyst formation on T2-weighted MRI images, we observed no fluid or minimal fluid collection in 85% of the patients (17/22 patients). There were no correlations between the grade of bone changes and the clinical outcomes. Conclusion It is safe to use all-suture anchors as medial-row anchors when performing double-row anchor transosseous equivalent rotator cuff repairs. The purported advantages of all-suture anchors may outweigh their perceived disadvantages in rotator cuff repair surgery.
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Affiliation(s)
- Kashif A Memon
- Rowley Bristow Unit, Ashford and St Peter's NHS Trust, Chertsey, United Kingdom
| | - Richard Dimock
- Rowley Bristow Unit, Ashford and St Peter's NHS Trust, Chertsey, United Kingdom
| | - Alessio Bernasconi
- Orthopaedic and Traumatology Unit, University "Federico II" of Naples, Naples, Italy
| | - Anshul Sobti
- The Reading Shoulder Unit, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, England
| | - Paolo Consigliere
- The Reading Shoulder Unit, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, England
| | - Mohamed A Imam
- Rowley Bristow Unit, Ashford and St Peter's NHS Trust, Chertsey, United Kingdom.,Smart Health Academic Unit, University of East London, UK
| | - A Ali Narvani
- Rowley Bristow Unit, Ashford and St Peter's NHS Trust, Chertsey, United Kingdom.,Fortius Clinic, London, England
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All-Suture Anchors in Orthopaedic Surgery: Design, Rationale, Biomechanical Data, and Clinical Outcomes. J Am Acad Orthop Surg 2021; 29:e950-e960. [PMID: 34550098 DOI: 10.5435/jaaos-d-20-01224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 05/11/2021] [Indexed: 02/01/2023] Open
Abstract
All-suture anchors (ASAs) are a relatively new alternative to traditional suture anchors, comprised of sutures, suture tapes, or ribbons woven through a soft sleeve. These novel anchors are typically smaller than traditional anchors, allowing for more anchors to be used in the same amount of space or for use when bone stock is limited, for example, in revision settings. They can be inserted through curved guides to reach more challenging locations, and they have thus far had similar loads to failure during biomechanical testing as traditional anchors. However, these benefits must be weighed against new challenges. When using ASAs, care must be taken to fully deploy and seat the anchor against cortical bone for optimal fixation and to prevent gap formation. Furthermore, decortication, often performed to enhance the biologic environment for soft-tissue healing, may weaken the cortical bone on which ASA fixation depends on. The purpose of this article is to provide insight on the designs, advantages, and potential disadvantages associated with ASAs, as well as review the available biomechanical and clinical data.
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17
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SPSS Analysis of Pain Factors in Rotator Cuff Repair. J CHEM-NY 2021. [DOI: 10.1155/2021/8491846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In this study, the matched case-control study was used. Nineteen cases of severe pain in the early postoperative period among 55 patients were set as the observation group, and 57 cases of simultaneous rotator cuff repair without severe pain were matched in a 1 : 3 ratio as the control group. Patients’ general information, disease characteristics, anesthesia and analgesia scheme, and operation information were collected. Frequency statistics, Wilcoxon signed rank sum test, regulatory effect analysis, and Poisson regression analysis were performed on these data. Some findings are included in the analysis. (1) There was a markable difference of 0.01 between the preoperative 48 h maximum pain value and the postoperative 48 h maximum pain value in the observation group. (2) There was a markable difference of 0.01 between the size and shape of the wound tear and the maximum pain value at 48 h after operation in the observation group. (3) When the number of opioid use affected the maximum pain value at 48 h after operation, the regulatory variables (type, quantity, and number of days of postoperative analgesics) were at different levels, and the impact amplitude had markable differences. (4) Age has a markable negative impact on the postoperative hospital stay. (5) The operation duration has a markable positive relationship with the postoperative hospital stay. (6) The analgesic pump had a markable positive impact on the postoperative hospital stay. (7) The location of injury did not affect the postoperative hospital stay.
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Matijakovich D, Solomon D, Benitez CL, Huang HH, Poeran J, Berger N, Lebaschi A, Seneviratne A. Long-term follow-up of perianchor cyst formation after rotator cuff repair. JSES Int 2021; 5:863-868. [PMID: 34505097 PMCID: PMC8411048 DOI: 10.1016/j.jseint.2021.05.010] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Perianchor cyst formation (PCF) can occur after arthroscopic rotator cuff repair with poly-L-lactic acid (PLLA) anchors; however, little is known about PCF after all-suture anchor (ASA) use. Methods We reviewed patients who underwent double-row arthroscopic rotator cuff repair from 2012 to 2017 with ASAs implanted in the medial row and PLLA anchors in the lateral row. We evaluated PCF (graded on magnetic resonance imaging) and compared physical examination and functional surveys between patients with PCF (WC) and without PCF (WoC) at long-term follow-up. Results Among twenty-two patients (23 shoulders), 93% of PLLA anchors (vs. 79% ASA) displayed a grade 0 PCF, P = .100. No PLLA anchors had a grade 3 or 4 PCF, compared to 11% of ASAs, P = .158. At a mean postoperative follow-up time of 113 weeks, there was no significant difference between WC and WoC cohorts with regard to range of motion, rotator cuff strength, American Shoulder and Elbow Surgeons survey scores, or retear rates. However, the WoC cohort had a significantly higher University of California at Los Angeles shoulder survey score at final follow-up (34.3 WoC vs. 30.9 WC, P = .024). Conclusion No difference was found in PCF between ASAs and PLLA anchors. At long-term follow-up, WoC patients had significantly improved functional outcome scores, based on the University of California at Los Angeles survey, but equivalent range of motion and rotator cuff strength examinations compared with WC patients.
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Affiliation(s)
| | - David Solomon
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | | | - Hsin-Hui Huang
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jashvant Poeran
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Natalie Berger
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amir Lebaschi
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Aruna Seneviratne
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
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Ruiz Ibán MA, Vega Rodriguez R, Ruiz Díaz R, Pérez Expósito R, Zarcos Paredes I, Diaz Heredia J. Arthroscopic remplissage with all-suture anchors causes cystic lesions in the humerus: a volumetric CT study of 55 anchors. Knee Surg Sports Traumatol Arthrosc 2021; 29:2342-2347. [PMID: 33030611 DOI: 10.1007/s00167-020-06314-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/28/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate with computed tomography (CT) the incidence of implant-related osteolysis after implantation of two types of all-suture anchors during remplissage for the management of Hill-Sachs lesions in shoulder instability. METHODS Single-cohort, observational study with a minimum of 12 months follow-up. Twenty-five participants (19 males and 6 females; mean age 37.4 years [SD: 11.6]) with Hill-Sachs lesions requiring remplissage were evaluated with a CT performed a mean of 14.1 [3.74] months after surgery. Fifty-five all-suture anchors (19 2.3 mm Iconix and 36 1.7 mm Suturefix) were used. The volume of the bone defects was measured in the CT. Every anchor was classified into one of four groups: (1) no bone defect. (2) Partial bone defect (bone defects smaller than the drill used for anchor placement). (3) Tunnel enlargement (bone defect larger than the drill volume but smaller than twice that volume). (4) Cystic lesion (bone defect larger twice the drill volume). RESULTS No bone defect was identified in only two anchors (3.6%, 95% CI 0.4-12.5%). A partial bone defect was found in eight anchors (14.5%, 95% CI 6.5-26.7%). In 35 anchors (63.6%, 95% CI 49.6-76.2%), there was enlargement of the bone defect that was smaller than 200% the size of the drill used. Ten anchors caused bone defects larger than twice the size of the drill used (18.2%, 95% CI 9.1-30.9%). The defect size was a mean of 89 mm3 (SD: 49 mm3, minimum 0 mm3, maximum 230 mm3). CONCLUSION When using all-suture anchors in arthroscopic remplissage during instability surgery, relevant bone osteolytic defects are common at 1-year-follow-up. Cystic defects larger than twice the volume of the resected bone during implantation develop in one in six anchors and significant tunnel widening will develop in another three out of five anchors. This bone loss effectively increases the size and depth of the Hill-Sachs lesions but does not seem to affect short-term clinical outcomes. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Rosa Vega Rodriguez
- Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
| | - Raquel Ruiz Díaz
- Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
| | - Roque Pérez Expósito
- Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
| | - Irene Zarcos Paredes
- Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
| | - Jorge Diaz Heredia
- Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
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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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Postoperative bone marrow edema lasts no more than 6 months after uncomplicated arthroscopic double-row rotator cuff repair with PEEK anchors. Knee Surg Sports Traumatol Arthrosc 2021; 29:162-169. [PMID: 32055881 DOI: 10.1007/s00167-020-05897-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess the natural evolution of the osseous reaction following arthroscopic double-row rotator cuff repair with PEEK anchors and to analyze its correlation with clinical shoulder function. METHODS Between 2015 and 2017, 159 patients received arthroscopic double-row rotator cuff repair with PEEK anchors and underwent serial clinical and radiological follow-up (3, 6, 12, and 24 months). Radiological results were analyzed by tendon integrity, bone marrow edema, and peri-implant osteolysis. Clinical shoulder function was evaluated with the Constant score. RESULTS One-hundred and seventeen patients were enrolled; among them, 63% demonstrated bone marrow edema around the anchors on postoperative 3-month MRI. The edema area percentage was 41% ± 7%. At 6 months, edema was only seen in 12% of cases, with an area percentage of 18% ± 5%. At 12 and 24 months, edema was rarely present. Fluid signals around the anchor were observed in 17.6%, 42.7%, 33.3%, and 21.0% of patients at 3, 6, 12, and 24 months, respectively; the tunnel widening values were 1.1 ± 0.4 mm, 1.8 ± 0.5 mm, 2.3 ± 0.6 mm, and 2.2 ± 0.7 mm at each follow-up, respectively. The sign of osteolysis was significantly more obvious around the lateral anchor than around the medial anchor. The presence of an osseous reaction was not correlated with worse clinical outcome. CONCLUSION Osseous reactions following arthroscopic rotator cuff repair are common and significant even with PEEK anchors. Bone marrow edema does not last more than 6 months in patients without complications. Peri-implant osteolysis is more evident around the lateral anchor than around the medial anchor and improves gradually over time. The sign of osteolysis is not correlated with clinical shoulder function. Based on these findings, surgeons should be cautious about bone marrow edema lasting more than 6 months following arthroscopic rotator cuff repair. LEVEL OF EVIDENCE Level IV.
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Lee JH, Kang JS, Park I, Shin SJ. Serial Changes in Perianchor Cysts Following Arthroscopic Labral Repair Using All-Suture Anchors. Clin Orthop Surg 2020; 13:229-236. [PMID: 34094014 PMCID: PMC8173234 DOI: 10.4055/cios20024] [Citation(s) in RCA: 4] [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: 02/04/2020] [Revised: 06/14/2020] [Accepted: 07/10/2020] [Indexed: 11/21/2022] Open
Abstract
Backgroud Changes in perianchor cysts around the all-suture anchors, which demonstrate distinguished features from the biocomposite anchors, have not been revealed sufficiently. The purpose of this study was to investigate serial changes of perianchor cysts according to the location of the inserted anchor in the glenoid in arthroscopic labral repair using all-suture anchors. Methods We enrolled 43 patients who underwent computed tomography (CT) immediately postoperatively and CT arthrogram (CTA) at 1 year or 2 years after arthroscopic labral repair using a 1.3-mm all-suture anchor for recurrent anterior shoulder dislocation with or without a superior labral tear from anterior to posterior and a posterior labral tear. The mean diameter and tissue density (HU) of perianchor cysts were measured depending on the location in the glenoid. Clinical outcomes, labral healing, and redislocation rate were evaluated at 2 years after surgery. Results On functional assessment, the mean American Shoulder and Elbow Surgeons score and Rowe score improved statistically significantly after surgery (from 47.9 ± 14.3 preoperatively to 90.1 ± 9.6 postoperatively and from 45.3 ± 12.4 preoperatively to 92.2 ± 10.1 postoperatively, respectively; p < 0.01). Postoperative redislocations were found in 2 patients (4.7%). In radiological evaluation, the mean diameter of perianchor cysts at postoperative 1 year (3.24 ± 0.65 mm) was significantly larger than the immediate postoperative diameter; however, there was no significant difference between postoperative 1 year and 2 years (3.23 ± 0.57 mm). Tissue density at the center of cysts demonstrated no significant difference between 1 and 2 year postoperatively (107.7 ± 29.8 HU [superior], 99.7 ± 31.7 HU [anteroinferior], and 105.1 ± 25.0 HU [posterior] vs. 109.1 ± 26.1 HU [superior], 106.4 ± 30.3 HU [anteroinferior], and 111.0 ± 32.9 HU [posterior]). The mean diameter of perianchor cysts in the anteroinferior position was largest compared with that in superior or posterior positions. Conclusions Perianchor cysts associated with all-suture anchors enlarged significantly within 1 year after arthroscopic labral repair regardless of the insertion location in the glenoid. However, the size and tissue density of perianchor cysts were similar at postoperative 1 and 2 years, and satisfactory stability and clinical outcomes were obtained.
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Affiliation(s)
- Jae-Hoo Lee
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jun-Seok Kang
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - In Park
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Seoul, Korea
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Jin S, Chun YM. Peri-anchor cyst formation after arthroscopic bankart repair: comparison between biocomposite suture anchor and all-suture anchor. Clin Shoulder Elb 2020; 23:178-182. [PMID: 33330255 PMCID: PMC7726366 DOI: 10.5397/cise.2020.00290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 11/30/2022] Open
Abstract
Background The purpose of this study is to investigate clinical outcomes and radiological findings of cyst formation in the glenoid around suture anchors after arthroscopic Bankart repair with either biocomposite suture anchor or all-suture anchor in traumatic anterior shoulder instability. We hypothesized that there would be no significant difference in clinical and radiological outcomes between the two suture materials. Methods This retrospective study reviewed 162 patients (69 in group A, biocomposite anchor; 93 in group B, all-suture anchor) who underwent arthroscopic Bankart repair of traumatic recurrent anterior shoulder instability with less than 20% glenoid defect on preoperative en-face view three-dimensional computed tomography. Patient assignment was not randomized. Results At final follow-up, the mean subjective shoulder value, Rowe score, and University of California, Los Angeles shoulder score improved significantly in both groups. However, there were no significant differences in functional shoulder scores and recurrence rate (6%, 4/69 in group A; 5%, 5/93 in group B) between the two groups. On follow-up magnetic resonance arthrography/computed tomography arthrography, the incidence of peri-anchor cyst formation was 5.7% (4/69) in group A and 3.2% (3/93) in group B, which was not a significant difference. Conclusions Considering the low incidence of peri-anchor cyst formation in the glenoid after Bankart repair with one of two anchor systems and the lack of association with recurrence instability, biocomposite and all-suture anchors in Bankart repair yield satisfactory outcomes with no significant difference.
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Affiliation(s)
- Seokhwan Jin
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Min Chun
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Okutan AE, Ayas MS, Gül O. Editorial Commentary: What is the Difference That Makes the Differences? The Practical Rationality of the All-Suture Anchor. Arthroscopy 2020; 36:2103-2105. [PMID: 32747058 DOI: 10.1016/j.arthro.2020.05.047] [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: 05/12/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
Suture anchor technologies are constantly being innovated in the quest for improved stability, biological integration and clinical outcomes. However, the decision about the choice of suture-anchor materials remain elusive. There are some factors, including reliability, effectiveness, simplicity, familiarity, and cost, that affect a surgeon's preference. The relative weights placed on different factors by different surgeons play decisive roles in individual choice. But decisions and choices are not arbitrary or merely subjective. Alternative options can be warranted or contested by rational argumentation. At the end, there may be losses and gains in the change of 1 suture anchor for another, but science does progress.
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Godry H, Jettkant B, Seybold D, Venjakob AJ, Bockmann B. Pullout strength and failure mode of industrially manufactured and self-made all-suture anchors: a biomechanical analysis. J Shoulder Elbow Surg 2020; 29:1479-1483. [PMID: 32197807 DOI: 10.1016/j.jse.2019.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study presents a new technique for assembling an all-suture anchor from existing medical products. The biomechanical characteristics of this self-made anchor (SMA) are compared with those of an industrially manufactured all-suture anchor. METHODS The SMAs were made from established medical products (FiberWire #2 and 2-mm FiberTape; Arthrex, Naples, FL, USA). Pretesting was performed in biphasic polyurethane foam blocks. In the next step, 10 SMAs and 10 industrially made anchors (IMAs; 1.8-mm double-loaded Y-Knot Flex all-suture anchor; ConMed Linvatec, Largo, FL, USA) were applied with an insertion tool and tested in fresh porcine femora using a servohydraulic testing system, with a preload of 10 N and a displacement rate of 12.5 mm/s. Pullout strength and failure mode were recorded. RESULTS The mean load at failure in the foam blocks was 459 ± 124 N in the SMA group and 538 ± 83 N in the IMA group. In porcine bone, failure occurred at 461 ± 102 N in the SMA group and 431 ± 135 N in the IMA group. The differences in pullout strength between the 2 types of anchor were not statistically significant, either in the foam blocks (P = .17) or in porcine bone (P = .62). CONCLUSION A handmade all-suture anchor using 2 high-strength sutures woven into a 2-mm strip of high-strength tape did not show statistically different failure loads in polyurethane foam or in porcine metaphyseal bone in comparison with a commercially produced double-loaded all-suture anchor. The principal mode of failure in porcine bone in both groups was anchor pullout.
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Affiliation(s)
- Holger Godry
- Department of Rheumatology and Arthroscopy, Marienkrankenhaus Düsseldorf-Kaiserswerth, Düsseldorf, Germany
| | - Birger Jettkant
- Institution for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr University Bochum, Bochum, Germany
| | - Dominik Seybold
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Arne Johannes Venjakob
- Department of Rheumatology and Arthroscopy, Marienkrankenhaus Düsseldorf-Kaiserswerth, Düsseldorf, Germany
| | - Benjamin Bockmann
- Department of Orthopaedics and Trauma Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.
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Ergün S, Akgün U, Barber FA, Karahan M. The Clinical and Biomechanical Performance of All-Suture Anchors: A Systematic Review. Arthrosc Sports Med Rehabil 2020; 2:e263-e275. [PMID: 32548592 PMCID: PMC7283965 DOI: 10.1016/j.asmr.2020.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/18/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose This systematic review aimed to clarify the relative strengths and weaknesses of the all-suture anchors (ASAs) in both clinical and experimental studies. Our hypothesis was that there would be similar clinical and experimental data for ASAs regarding the biomechanical properties, clinical outcomes and complication rates. Methods A systematic review of MEDLINE and Embase databases was performed. The inclusion criteria for clinical studies were both retrospective or prospective study design and minimum 1-year follow-up; for biomechanical studies, the inclusion criteria were performance on either cadaver and animal bones or synthetic surfaces. Studies were excluded if the studies were not in English or if they were review articles, commentaries, letters, case reports, or technical notes. The risk of bias assessment was done using the Methodological Index for Non-randomized Studies (MINORS) tool. Results We included 13 experimental and 3 clinical studies. The least displacement under cyclic loading was recorded with Q-Fix. Failure mode was mostly by suture breaking for the Q-Fix, whereas anchor pullout was the most common for the others. Cadaver humerus’ greater tuberosity seemed to be less durable for the ASAs. Tests on cadaver glenoid showed similar biomechanical properties when compared to a control anchor. Studies investigating clinical and radiologic findings were very few, and only 3 case series were included in this review. Clinical findings of patients treated with ASAs for instability and rotator cuff repair showed satisfactory results and little increase in the complication rate (retear or revision surgery because of loose anchor). Conclusions ASAs have similar or better biomechanical properties compared to regular anchors. Low-profile design seems to be an important advantage. Case series can not distinguish between the possible clinical benefits and/or risks. Clinical Relevance ASAs have similar biomechanical properties when compared with other types of anchors. Their strength and performance vary with anatomic location, which may influence clinical success.
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Affiliation(s)
- Selim Ergün
- Department of Orthopedics and Traumatology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Umut Akgün
- Department of Orthopedics and Traumatology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - F Alan Barber
- Plano Orthopedic and Sports Medicine Center, Plano, Texas, U.S.A
| | - Mustafa Karahan
- Department of Orthopedics and Traumatology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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Kim SH, Yang SH, Rhee SM, Lee KJ, Kim HS, Oh JH. The formation of perianchor fluid associated with various suture anchors used in rotator cuff repair. Bone Joint J 2019; 101-B:1506-1511. [DOI: 10.1302/0301-620x.101b12.bjj-2019-0462.r2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to compare the osseous reactions elicited by all-suture, polyetheretherketone (PEEK), and two different biodegradable anchors used during rotator cuff repair. Patients and Methods Transosseous-equivalent rotator cuff repair was performed in 73 patients. The patients were divided into two groups, in both of which two different medial-row anchors were used. In group 1, anchor A comprised 30% β-tricalcium phosphate (TCP) + 70% fast-absorbing poly lactic-co-glycolic acid copolymer (85% polylactic acid enantiomers + 15% polyglycolic acid) and anchor B comprised all-sutures. In group 2, anchor C comprised 23% micro β-TCP + 77% polylactic acid enantiomers and anchor D comprised PEEK polymer. There were 37 patients in group 1 and 36 patients in group 2. The presence and severity of fluid collection around anchors and healing of the rotator cuff were assessed using MRI scans, approximately one year postoperatively. The severity of the collection was graded as 0 (no perianchor fluid signal), 1 (minimal perianchor fluid), 2 (local collection of fluid), 3 (fluid collection around the whole length of the anchor but of a diameter less than twice the anchor diameter), or 4 (fluid collection around the whole length of the anchor and of a diameter greater than twice the anchor diameter). Results A perianchor fluid signal was seen in three patients (8.1%) with anchor A, four (10.8%) with anchor B, 15 (41.7%) with anchor C, and 15 (41.7%) with anchor D. The severity of the collection around anchor was grade 2:1:0:0 for anchor A, grade 2:2:0:0 for anchor B, grade 12:2:0:1 for anchor C, and grade 11:3:0:1 for anchor D (grade 1:2:3:4, respectively). The prevalence and severity of fluid formation was not significantly different between anchors A and B, and anchors C and D. However, on intergroup analysis, there were significant differences for the prevalence and severity of fluid formation between anchors in group 1 and group 2. The prevalence of failure to heal was not significant in group 1 (seven, 18.9%) or group 2 (nine, 25.0%). There was no relationship between the presence of perianchor fluid and each type of anchor, and the integrity of the rotator cuff repair, in either group. Conclusion Despite the nonabsorbable nature of all-suture and PEEK anchors, all-suture anchors produced less osseous reaction after rotator cuff repair. In deciding which kind of anchor to use, consideration should be given not only to the strength of the initial fixation, but also to the postoperative biological reaction. Cite this article: Bone Joint J 2019;101-B:1506–1511
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Affiliation(s)
- Sae H. Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Seok H. Yang
- Department of Orthopaedic Surgery, KS Hospital, Seongnam, South Korea
| | - Sung-Min Rhee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kwang J. Lee
- Department of Orthopaedic Surgery, Sun Orthopaedic Hospital, Seongnam, South Korea
| | - Hyong S. Kim
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Joo H. Oh
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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Ro K, Rhee SM, Kim JY, Kim MS, Kim JD, Lee H, Rhee YG. All-Suture Anchor Settling After Arthroscopic Repair of Small and Medium Rotator Cuff Tears. Am J Sports Med 2019; 47:3483-3490. [PMID: 31718248 DOI: 10.1177/0363546519886547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND All-suture anchors are increasingly being used in rotator cuff repair. However, there are debates on the micromotion of all-suture anchors. PURPOSE To perform rotator cuff repair on patients with rotator cuff tears and different shoulder bone mineral densities (BMDs) and investigate (1) where the anchor is located under the cortex, (2) if there is any anchor migration settling during follow-up, and (3) if structural outcome differs according to shoulder BMD. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We retrospectively investigated 88 patients who underwent arthroscopic single-row repair for small- to medium-sized rotator cuff tears (age [mean ± SD], 58.8 ± 7.1 years) from 712 cases of rotator cuff tendon repair between November 2015 and February 2018. Inclusion criteria were as follows: use of an all-suture anchor; preoperative shoulder BMD; and magnetic resonance imaging (MRI) conducted preoperatively, 2 days after surgery, and 10 months after surgery. Patients were excluded from the study if they underwent open rotator cuff repair (n = 118), got surgery with a double-row technique (n = 178), underwent surgery with anchors other than the all-suture type (n = 273), received anchor insertion in sites other than the greater tuberosity owing to concomitant procedures such as biceps tenodesis and subscapularis repair (n = 29), did not take preoperative shoulder BMD (n = 15), had more than a large-size tear (n = 6), and were lost to follow-up (n = 5). After compression of the all-suture anchor during surgery, the strands were pulled multiple times to ensure that the anchor was fixed onto the bone with appropriate tension. BMD was measured before surgery. Depth to anchor (DA), anchor settling, and repaired rotator cuff integrity were measured with MRI. Patients were categorized into 3 groups: group A (BMD, <0.4 g/cm2; n = 31), group B (BMD, 0.4-0.6 g/cm2; n = 32), and group C (BMD, >0.6 g/cm2; n = 25). A total of 65 patients had follow-up MRI. On the basis of rotator cuff tendon integrity, patients were categorized into either a sufficient thickness group (group S, Sugaya classification grade II or lower; n = 44) or an insufficient thickness group (group I, Sugaya classification grade III or higher; n = 21). RESULTS On time-zero MRI, the DA differed significantly among groups (group A, 3.62 ± 2.02 mm; group B, 5.18 ± 2.13 mm; group C, 6.30 ± 3.34 mm) (P = .001). The DA was deeper in patients with a higher BMD at time zero (r = 0.374; P = .001), but the DA did not differ at follow-up MRI (mean, 10.3 months after surgery). On follow-up MRI, anchor settling tended to increase with deeper time-zero DA (r = 0.769; P < .001). Anchor settling was significantly different among groups (group A, 1.33 ± 1.08 mm; group B, 2.78 ± 1.99 mm; group C, 3.81 ± 2.19 mm) (P = .001). The proportion of patients with sufficient thickness in each group did not show a statistical difference (group A, 70.8%; group B, 72.7%; group C, 57.9%) (P = .550). CONCLUSION In conclusion, this study confirmed that the postoperative site of anchor insertion in arthroscopic single-row rotator cuff repair with all-suture anchors was located farther from the cortex in patients with higher shoulder BMD and closer to the subcortical bone in patients with lower BMD. On follow-up MRI, no further settling occurred past a certain distance from the cortex, and there was no significant difference in anchor depth or integrity of the rotator cuff tendon based on shoulder BMD. Therefore, minimal settling in the all-suture anchor did not show clinical significance.
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Affiliation(s)
- Kyunghan Ro
- Shoulder and Elbow Clinic, Bonbridge Hospital, Seoul, Republic of Korea
| | - Sung-Min Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jung Youn Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Myung Seo Kim
- Department of Orthopaedic Surgery, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Republic of Korea
| | - Jong Dae Kim
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hojin Lee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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All-suture Anker. ARTHROSKOPIE 2019. [DOI: 10.1007/s00142-019-0293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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de Campos Azevedo CI, Ângelo ACLPG, Vinga S. Arthroscopic Superior Capsular Reconstruction With a Minimally Invasive Harvested Fascia Lata Autograft Produces Good Clinical Results. Orthop J Sports Med 2018; 6:2325967118808242. [PMID: 30505873 PMCID: PMC6259077 DOI: 10.1177/2325967118808242] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Painful dysfunctional shoulders with irreparable rotator cuff tears (IRCTs)
in active patients are a challenge. Arthroscopic superior capsular
reconstruction (ASCR) is a new treatment option originally described using a
fascia lata autograft harvested through an open approach. However, concerns
about donor site morbidity have discouraged surgeons from using this type of
graft. Hypothesis: ASCR using a minimally invasive harvested fascia lata autograft produces good
6-month and 2-year shoulder outcomes in IRCTs, with low-impact thigh
morbidity at 2 years. Study Design: Case series; Level of evidence, 4. Methods: From 2015 to 2016, a total of 22 consecutive patients (mean age, 64.8 ± 8.6
years) with chronic IRCTs (Hamada grade 1-2; Goutallier cumulative grade ≥3;
Patte stage 1: 2 patients; Patte stage 2: 6 patients; Patte stage 3: 14
patients) underwent ASCR using a minimally invasive harvested fascia lata
autograft. All patients completed preoperative and 6-month evaluations
consisting of the Simple Shoulder Test (SST), subjective shoulder value
(SSV), Constant score (CS), range of motion (ROM), acromiohumeral interval
(AHI), and magnetic resonance imaging. Twenty-one patients completed the
2-year shoulder and donor site morbidity assessments. Results: The mean active ROMs improved significantly (P < .001):
elevation, from 74.8° ± 55.5° to 104.5° ± 41.9° (6 months) and 143.8° ±
31.7° (2 years); abduction, from 53.2° ± 43.3° to 86.6° ± 32.9° (6 months)
and 120.7° ± 37.7° (2 years); external rotation, from 13.2° ± 18.4° to 27.0°
± 16.1° (6 months) and 35.6° ± 17.3° (2 years); and internal rotation, from
1.2 ± 1.5 points to 2.6 ± 1.5 points (6 months) and 3.8 ± 1.2 points (2
years). The mean functional shoulder scores improved significantly
(P < .001): SST, from 2.1 ± 2.9 to 6.8 ± 3.5 (6
months) and 8.6 ± 3.5 (2 years); SSV, from 33.0% ± 17.4% to 55.7% ± 25.6% (6
months) and 70.0% ± 23.0% (2 years); CS, from 17.5 ± 13.4 to 42.5 ± 14.9 (6
months) and 64.9 ± 18.0 (2 years). The mean shoulder abduction strength
improved significantly (P < .001) from 0.0 to 1.1 ± 1.4
kg (6 months) and 2.8 ± 2.6 kg (2 years). The mean AHI improved from 6.4 ±
3.3 mm to 8.0 ± 2.5 mm (6 months) and decreased to 7.1 ± 2.5 mm (2 years).
This 0.7 ± 1.5–mm overall decrease was statistically significant
(P = .042). At 6 months, 20 of 22 patients (90.9%) had
no graft tears. At 2 years, 12 of 21 patients (57.1%) were bothered by their
harvested thigh, 16 (76.2%) noticed donor site changes, 16 (76.2%)
considered that the shoulder surgery’s end result compensated for the
thigh’s changes, and 18 (85.7%) would undergo the same surgery again. Conclusion: ASCR using a minimally invasive harvested fascia lata autograft produced good
6-month and 2-year shoulder outcomes in IRCTs, with low-impact thigh
morbidity at 2 years.
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Affiliation(s)
- Clara Isabel de Campos Azevedo
- Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.,Hospital dos SAMS, Lisbon, Portugal.,Clínica GIGA Saúde, Lisbon, Portugal
| | | | - Susana Vinga
- Instituto de Engenharia de Sistemas e Computadores-Investigação e Desenvolvimento, Lisbon, Portugal.,INESC - ID, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
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