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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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Retzky JS, Chipman DE, Mintz DN, Cordasco FA, Green DW. Association of Lateral Extra-Articular Tenodesis With Improved Graft Maturity on MRI 2 Years After ACL Reconstruction With Quadriceps Tendon Autograft in Skeletally Immature Athletes. Orthop J Sports Med 2024; 12:23259671231211885. [PMID: 38188621 PMCID: PMC10768604 DOI: 10.1177/23259671231211885] [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: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 01/09/2024] Open
Abstract
Background Quadriceps tendon autograft (QTA) has recently gained popularity in the treatment of anterior cruciate ligament (ACL) ruptures in pediatric patients. The addition of lateral extra-articular tenodesis (LET) to an ACL reconstruction (ACLR) has been found to reduce the risk of ACL retear in high-risk patients. Purpose To (1) compare ACL graft maturity using signal intensity ratios (SIRs) on magnetic resonance imaging (MRI) scans in skeletally immature patients undergoing ACLR with QTA either with or without concomitant LET and (2) evaluate LET safety by calculating the physeal disturbance-related reoperation rate in the ACLR+LET group. Study Design Cohort study; Level of evidence, 3. Methods The records of patients aged ≤18 years who underwent ACLR between 2015 and 2021 were reviewed retrospectively. Patients undergoing ACLR with QTA who had open distal femoral and proximal tibial physes on MRI scans and a minimum 2-year follow-up data were included. SIR values were measured on sagittal MRI scans by averaging the signal at 3 regions of interest along the ACL graft and dividing by the signal of the posterior cruciate ligament at its insertion. Statistical analysis was performed to evaluate differences in SIR values at 6 months, 1 year, and 2 years postoperatively in patients who underwent ACLR alone versus ACLR+LET. Results Overall, 29 patients were included in the study: 16 patients in the ACLR+LET group and 13 patients in the ACLR-only group. There were no significant differences in SIR values between groups at the 6-month or 1-year postoperative timepoints. At 2 years postoperatively, the median SIR of the ACLR+LET group was significantly lower than that of the ACLR-only group on both univariate (1.33 vs 1.86, respectively, P = .0012) and multivariate regression analyses adjusting for both sex and surgical technique (β = -0.49 [95% CI, -0.91 to -0.05]; P = .029). There were no cases of reoperation for physeal disturbance in patients who underwent ACLR+LET. Conclusion The addition of LET to an ACLR with QTA was associated with lower average SIR values and thus improved graft maturity at 2 years postoperatively compared with ACLR alone in skeletally immature patients. The addition of LET to an ACLR was found to be safe in skeletally immature patients.
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Suroto H, Anindita Satmoko B, Prajasari T, De Vega B, Wardhana TH, Samijo SK. Biodegradable vs nonbiodegradable suture anchors for rotator cuff repair: a systematic review and meta-analysis. EFORT Open Rev 2023; 8:731-747. [PMID: 37787481 PMCID: PMC10562948 DOI: 10.1530/eor-23-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Purpose The use of non-biodegradable suture anchors (NBSA) in arthroscopic rotator cuff repair (RCR) has increased significantly. However, several complications such as migration, chondral damage, revision, and imaging difficulties have been reported. Meanwhile, the effectiveness of biodegradable suture anchors (BSA) in overcoming such complications and achieving functional outcomes requires further study. Thus, we aim to compare the clinical outcomes and complications of RCR using BSA and NBSA using direct comparison studies. Methods Two independent reviewers conducted systematic searches in PubMed, Embase, Cochrane Library, and Web of Science from conception to September 2022. Using the RoB 2 and ROBINS-I tools, we assessed the included studies for bias. We applied GRADE to appraise our evidence. Our PROSPERO registration number is CRD42022354347. Results Six studies (two randomized controlled trials, one retrospective cohort, and three case-control studies) involving 423 patients were included (211 patients received BSA and 212 patients received NBSA). BSA was comparable to NBSA in forward flexion, abduction, external rotation, Constant-Murley score, and perianchor cyst formation (P = 0.97, 0.81, 0.56, 0.29, and 0.56, respectively). Retear rates were slightly higher while tendon healing was reduced in BSA compared to NBSA, but the differences were not significant (P = 0.35 and 0.35, respectively). Conclusion BSA and NBSA appear to yield similar shoulder functions and complications in rotator cuff repairs.
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Affiliation(s)
- Heri Suroto
- Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | | | - Tabita Prajasari
- Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Brigita De Vega
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital Campus, United Kingdom
| | - Teddy Heri Wardhana
- Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Steven K Samijo
- Department of Orthopedic and Traumatology, Zuyderland Medisch Centrum, Heerlen, Netherlands
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Rotator cuff repair with biodegradable high-purity magnesium suture anchor in sheep model. J Orthop Translat 2022; 35:62-71. [PMID: 36186661 PMCID: PMC9471965 DOI: 10.1016/j.jot.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/01/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Rotator cuff tear has become one of the diseases affecting people's living quality. Conventional anchor materials such as titanium alloy and poly-lactic acid can lead to postoperative complications like bone defects and aseptic inflammation. Magnesium (Mg)-based implants are biodegradable and biocompatible, with strong potential to be applied in orthopaedics. Methods In this study, we developed a high-purity (HP) Mg suture anchor and studied its mechanical properties and degradation behavior in vitro. Furthermore, we described the use of high-purity Mg to prepare suture anchor for the rotator cuff repair in sheep. Results The in vitro tests showed that HP Mg suture anchor possess proper degradation behavior and appropriate mechanical property. Animal experiment indicated that HP Mg suture anchor provided reliable anchoring function in 12 weeks and showed no toxic effect on animal organs. Conclusion In summary, the HP Mg anchor presented in this study had favorable mechanical property and biosecurity. The translational potential of this article: The translational potential of this article is to use high-purity Mg to develop a degradable suture anchor and verify the feasibility of the application in animal model. This study provides a basis for further research on the clinical application of biodegradable high-purity Mg suture anchor.
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