Pullout Strength of All-Suture and Metallic Anchors in Repair of Lateral Collateral Ligament Injuries of the Elbow

Arthroscopic Anterior Talofibular Ligament Repair Combined With All-Inside Suture Tape Augmentation for Treatment of Chronic Lateral Ankle Instability With Generalized Joint Laxity

BACKGROUND

To analyze the feasibility and clinical results of the modified Broström operation (MBO) combined with suture tape augmentation under arthroscopy for chronic lateral ankle instability (CLAI) in patients with generalized joint laxity (GJL).

METHODS

From October 2019 to October 2021, a total of 111 patients (111 ankles) treated with MBO combined with suture tape augmentation under arthroscope were retrospectively divided into a GJL group (29 patients) and a control group (82 patients). Mechanical stability of the affected ankle joint was evaluated radiographically preoperatively, at 6 months postoperatively, and the last follow-up. Complications and surgical failures, as well as visual analog scale (VAS) score, the Foot and Ankle Ability Measure (FAAM), and the Karlsson score were also recorded. All statistical analyses were completed using SPSS 20.0.

RESULTS

The average follow-up time was 21.7 ± 5.2 months for the GJL group, and 20.9 ± 5.3 months for the control group. Pain and symptoms in both groups were effectively relieved by the procedure reflected by decreased VAS scores, improved FAAM and Karlsson scores at 6 months postoperatively, and the final follow-up (P < .05). Preoperative talar tilt angle and anterior talar translation were significantly greater in the GJL group than those in the control group (P < .05). Postoperatively, both talar tilt angle and anterior talar translation were reduced in both groups at 6 months postoperatively and the last follow-up (P < .05), and we found no significant difference between the two groups (P > .05). Furthermore, we found no significant difference in VAS, FAAM, and Karlsson scores between the 2 groups 6 months postoperatively and at the last follow-up.

CONCLUSION

Arthroscopic MBO combined with suture tape augmentation is a reliable procedure for treating CLAI with GJL. At short-term follow-up, we found that the GJL group achieved an equivalent level of stability compared with the control group.

Regional distribution prevalence of heterotopic ossification in the elbow joint: a 3D study of patients after surgery for traumatic elbow injury

BACKGROUND

Heterotopic ossification (HO) is a common complication after elbow fracture surgery and can lead to severe upper extremity disability. The radiographic localization of postoperative HO has been reported previously. However, there is no literature examining the distribution of postoperative HO at the three-dimensional (3D) level. This study aimed to investigate 1) the distribution characteristics of postoperative HO and 2) the possible risk factors affecting the severity of postoperative HO at a 3D level.

METHODS

A retrospective review was conducted of patients who presented to our institution with HO secondary to elbow fracture between 13 January 2020 and 16 February 2023. Computed tomography scans of 56 elbows before elbow release surgery were reconstructed in 3D. HO was identified using density thresholds combined with manual identification and segmentation. The elbow joint and HO were divided into six regions according to three planes: the transepicondylar plane, the lateral ridge of the trochlear plane, and the radiocapitellar joint and coronoid facet plane. The differences in the volume of regional HO associated with different initial injuries were analyzed.

RESULTS

Postoperative HO was predominantly present in the medial aspect of the capsule in 52 patients (93%), in the lateral aspect of the capsule in 45 patients (80%), in the medial supracondylar in 32 patients (57%), and in the lateral supracondylar, radial head, and ulnar region in the same number of 28 patients (50%). The median and interquartile range volume of total postoperative HO was 1683 (777-4894) mm3. The median and interquartile range volume of regional postoperative HO were: 584 (121-1454) mm3 at medial aspect of capsule, 207 (5-568) mm3 at lateral aspect of capsule, 25 (0-449) mm3 at medial supracondylar, 1 (0-288) at lateral supracondylar, 2 (0-478) at proximal radius and 7 (0-203) mm3 at the proximal ulna. In the subgroups with Injury Severity Score > or = 16, Gustilo-Anderson II, normal uric acid levels, elevated alkaline phosphatase, and body mass index > or = 24, the median HO volume exceeds that of the respective control groups.

CONCLUSION

The medial aspect of the capsule was the area with the highest frequency and median volume of postoperative HO among all initial elbow injury types. Patients with higher Gustilo-Anderson grade, Injury Severity Score, alkaline phosphatase or Body Mass Index had higher median volume of postoperative HO.

Arthroscopic assessment for lateral collateral ligament complex deficiency of the elbow: a cadaveric study

PURPOSE

To evaluate whether elbow instability due to lateral collateral ligament complex injury can be assessed reliably through arthroscopy.

METHODS

Eight fresh human cadaveric elbows were placed in a simulated lateral decubitus position. The radiocapitellar joint (RCJ) gap and ulnohumeral joint (UHJ) gap (mm) were measured with different sizes of probes from the posterolateral viewing portal. The elbow was 90 degrees flexed with neutral forearm rotation for RCJ gap measurement and 30 degrees flexed with full supination for UHJ gap measurement. Sequential testing was performed from Stage 0 to Stage 3 (Stage 0: intact; Stage 1: the release of the anterior 1/3 LCL complex; Stage 2: the release of the anterior two thirds of the LCL complex; and Stage 3: the release of the entire LCL complex) on each specimen. The mean gap of RCJ and lateral UHJ was used for the comparison between stages with the intact elbow.

RESULTS

The mean RCJ gap distance in Stage 2 and Stage 3 was significantly increased compared to that in Stage 0 (Stage 0 vs. Stage 2: P = .008; Stage 0 vs. Stage 3: P = .010). The mean UHJ gap distance of Stage 1, Stage 2, and Stage 3 was significantly increased compared to that in Stage 0 (Stage 0 vs. Stage 1: P = 0.025; Stage 0 vs. Stage 2: P = .010; Stage 0 vs. Stage 3: P = .011). In contrast, the release of the anterior 1/3 of the LCL complex (Stage 1) was not significantly increased compared to the mean joint gap distance of RCJ (P = .157).

CONCLUSION

Arthroscopic measurement of joint gap widening in RCJ and UHJ is a reliable assessment method to detect LCL complex deficiency that involves the anterior two thirds or more.

Outcomes of Double-Row Rotator Cuff Repair Using a Novel All-Suture Soft Anchor Medial Row

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.

Single- and Double-Loaded All-Suture Anchor Repairs of Anteroinferior Labral Tears Are Biomechanically Similar in a Cadaveric Shoulder Model

Purpose

To compare the biomechanical strength of single- versus double-loaded all-suture constructs in an anteroinferior glenoid labral repair.

Methods

Anteroinferior labral lesions were created on 6 matched pairs of cadaveric shoulder specimens. Each shoulder in a matched pair was randomized to either receive capsulolabral repair with 3 single-loaded all-suture anchors or 3 double-loaded all-suture anchors. Immediately following capsulolabral repair, the specimens underwent mechanical testing, which included cyclic testing (5 N to 50 N for 500 cycles) and load-to-failure testing (rate of 15 mm/min). The gap formation between the repaired labrum and glenoid (measured at 1, 25, 100, and 500 cycles), the load at 2-mm gap formation, the maximum load at failure and the method of failure were recorded. Data were analyzed with paired Student t tests and Bonferroni correction factor.

Results

The single and double all-suture constructs did not differ significantly in gap formation at any number of cycles, load to 2-mm gap formation (P = .75), or maximum load to failure (P = .46) between the 2 groups.

Conclusions

In this study, single-loaded and double-loaded all-suture anchor constructs demonstrated comparable biomechanical performance and did not significantly differ in gap formation, load to 2-mm gap formation, or maximum load to failure when used in the capsulolabral repair of anteroinferior glenoid labral tears in human cadaveric specimens.

Clinical Relevance

Although studies have evaluated the biomechanical properties of various arthroscopic labral stabilization techniques, the biomechanical properties of all-suture anchors with regard to labral stabilization are not well understood.

Editorial Commentary: All-Suture Anchors Are Small, Easier to Revise, and Biomechanically Equivalent to Conventional Implants: They Are the Way of the Future

All-suture anchors (ASAs) show biomechanical equivalence to conventional implants. The smaller size and easier ability to revise are important advantages of ASAs. A more vertical insertion angle increases ASA pullout strength. Proper depth of insertion is required to optimally seat ASAs on cortical bone. ASA pullout strength also results from compression of cancellous bone between the anchor and the cortex, and appropriately pretensioning the suture before loading is critical. A larger anchor (and a higher the number of sutures loaded per anchor) leads to a higher pullout strength of the anchor. Understanding the correct implantation technique is important to optimize the strength of ASAs.