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Huang B, Yang M, Kou Y, Jiang B. Absorbable implants in sport medicine and arthroscopic surgery: A narrative review of recent development. Bioact Mater 2024; 31:272-283. [PMID: 37637087 PMCID: PMC10457691 DOI: 10.1016/j.bioactmat.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/29/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
Over the past two decades, advances in arthroscopic and minimally invasive surgical techniques have led to significant growth in sports medicine surgery. Implants such as suture anchors, interference screws, and endo-buttons are commonly used in these procedures. However, traditional implants made of metal or inert materials are not absorbable, leading to complications that affect treatment outcomes. To address this issue, absorbable materials with excellent mechanical properties, good biocompatibility, and controlled degradation rates have been developed and applied in clinical practice. These materials include absorbable polymers, absorbable bioceramics, and absorbable metals. In this paper, we will provide a comprehensive summary of these absorbable materials from the perspective of clinicians, and discuss their clinical applications and related research in sport medicine.
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Affiliation(s)
- Boxuan Huang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
| | - Ming Yang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
| | - Yuhui Kou
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
| | - Baoguo Jiang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
- Medical School, Shenzhen University, Shenzhen, 518060, Guangdong, China
- Shenzhen University General Hospital, Shenzhen, 518055, Guangdong, China
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2
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Götschi T, Hodel S, Kühne N, Bachmann E, Li X, Zimmermann SM, Snedeker JG, Fucentese SF. Osteoconductive Scaffold Placed at the Femoral Tunnel Aperture in Hamstring Tendon ACL Reconstruction: A Randomized Controlled Trial. Orthop J Sports Med 2023; 11:23259671231174478. [PMID: 37347015 PMCID: PMC10280525 DOI: 10.1177/23259671231174478] [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: 01/13/2023] [Accepted: 02/22/2023] [Indexed: 06/23/2023] Open
Abstract
Background Bone tunnel enlargement after single-bundle anterior cruciate ligament reconstruction remains an unsolved problem that complicates revision surgery. Hypothesis Positioning of an osteoconductive scaffold at the femoral tunnel aperture improves graft-to-bone incorporation and thereby decreases bone tunnel widening. Study Design Randomized controlled trial; Level of evidence, 1. Methods In a 1:1 ratio, 56 patients undergoing primary anterior cruciate ligament reconstruction were randomized to receive femoral fixation with cortical suspension fixation and secondary press-fit fixation at the tunnel aperture of the tendon graft only (control) or with augmentation by an osteoconductive scaffold (intervention). Adverse events, patient-reported outcomes, and passive knee stability were recorded over 2 years after the index surgery. Three-dimensional bone tunnel widening was assessed using computed tomography at the time of surgery and 4.5 months and 1 year postoperatively. Results The intervention group exhibited a similar number of adverse events as the control group (8 vs 10; P = .775) including 2 partial reruptures in both groups. The approach was feasible, although 1 case was encountered where the osteoconductive scaffold was malpositioned without adversely affecting the patient's recovery. There was no difference between the intervention and control groups in femoral bone tunnel enlargement, as expressed by the relative change in tunnel volume from surgery to 4.5 months (mean ± SD, 36% ± 25% vs 40% ± 25%; P = .644) and 1 year (19% ± 20% vs 17% ± 25%; P =.698). Conclusion Press-fit graft fixation with an osteoconductive scaffold positioned at the femoral tunnel aperture is safe but does not decrease femoral bone tunnel enlargement at postoperative 1 year. Registration NCT03462823 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Tobias Götschi
- Department of Orthopaedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich,
Zurich, Switzerland
| | - Sandro Hodel
- Department of Orthopaedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
| | - Nathalie Kühne
- Department of Orthopaedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Xiang Li
- ZuriMED Technologies AG, Zurich,
Switzerland
| | - Stefan M. Zimmermann
- Department of Orthopaedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
| | - Jess G. Snedeker
- Department of Orthopaedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich,
Zurich, Switzerland
| | - Sandro F. Fucentese
- Department of Orthopaedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
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Moeinnia H, Nourani A, Mohseni M, Borjali A, Ghias N, Korani H, Chizari M. Effect of the core bone engaged length on the BASHTI fixation strength, an in-vitro study on bovine tendons using identical-density surrogate bones. BMC Musculoskelet Disord 2023; 24:226. [PMID: 36964514 PMCID: PMC10039572 DOI: 10.1186/s12891-023-06311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/10/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND BASHTI is an implant-less anterior cruciate ligament (ACL) reconstruction technique, which resolves the problems caused by implants such as interference screws. This study aims to investigate the effect of the drill bit and tendon's diameter on the Core Bone Engaged Length (CBEL) and the fixation strength. CBEL is the length of core bone which has a full engagement with both tunnel and graft at the same time. METHODS 60 in-vitro tests were conducted for 6, 7, 8, and 9 mm tendon sizes with a 10 mm bone tunnel. In this study bovine tendons and dummy bone blocks were used to model the fixation. Drill bits were used to extract the core bone for securing the auto-graft. A three-stage tensile test including a force-controlled cyclical preloading of 10-50 N with a frequency of 0.1 Hz for 10 cycles, followed by the main force-controlled cyclical loading of 50-200 N with a frequency of 0.5 Hz for 150 cycles, and immediately a displacement-controlled single cycle pull-out load with a rate of 20 mm/min were carried out to discover the fixation strength of each sample. RESULTS The 6 mm group had the greatest CBEL. However, all cases in this group failed in loadings below 200 N, which is the minimum required strength after ACL reconstruction. The fixation strength of cases with more than 200 N fixation strength for 7, 8, and 9 mm tendon diameters were 275 ± 42, 330 ± 110, and 348 ± 93 N, respectively, showing insignificant difference between groups (P-value = 0.45). Nevertheless, CBELs for these groups were 16.6 ± 3.4, 9.6 ± 2.4, and 11.7 ± 3.8 mm, respectively, implying a significant increase in CBEL in the 7 mm group than that for 8 and 9 mm groups (P-value = 0.002 and 0.049, respectively). CONCLUSION Results showed that CBEL could assess the quality of BASHTI technique. However, CBEL was an inverse function of tendon compression, so it was not an independent parameter to determine BASHTI strength. Also, the CBEL of 7 mm group which fulfilled the 200 N threshold was higher than that of 8 and 9 mm groups, so its healing process speed may be higher, which is recommended for a future study in this field.
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Affiliation(s)
- Hadi Moeinnia
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Amir Nourani
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
| | - Mahdi Mohseni
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Amirhossein Borjali
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Narges Ghias
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Hossein Korani
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Mahmoud Chizari
- School of Engineering, Physics and Computer Sciences, University of Hertfordshire, Hatfield, UK
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4
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Haslhofer DJ, Gotterbarm T, Klasan A. High Complication Rate and High Percentage of Regressing Radiolucency in Magnesium Screw Fixation in 18 Consecutive Patients. J Pers Med 2023; 13:jpm13020357. [PMID: 36836591 PMCID: PMC9960705 DOI: 10.3390/jpm13020357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
(1) Background: Magnesium-based implants use has become a research focus in recent years. Radiolucent areas around inserted screws are still worrisome. The objective of this study was to investigate the first 18 patients treated using MAGNEZIX® CS screws. (2) Methods: This retrospective case series included all 18 consecutive patients treated using MAGNEZIX® CS screws at our Level-1 trauma center. Radiographs were taken at 3-, 6- and 9-month follow-ups. Osteolysis, radiolucency and material failure were assessed, as were infection and revision surgery. (3) Results: Most patients (61.1%) had surgery in the shoulder region. Radiolucency regressed from 55.6% at 3-month follow-ups to 11.1% at 9-month follow-ups. Material failure occurred in four patients (22.22%) and infection occurred in two patients, yielding a 33.33% complication rate. (4) Conclusion: MAGNEZIX® CS screws demonstrated a high percentage of radiolucency that regressed and seems to be clinically irrelevant. The material failure rate and infection rate require further research.
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Affiliation(s)
- David J. Haslhofer
- Department for Orthopedics and Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040 Linz, Austria
- Correspondence:
| | - Tobias Gotterbarm
- Department for Orthopedics and Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040 Linz, Austria
| | - Antonio Klasan
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040 Linz, Austria
- Department for Orthopedics and Traumatology, AUVA Graz, Göstinger Straße 24, 8020 Graz, Austria
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Scorsato PS, Rahal SC, Cestari TM, Mamprim MJ, Doiche DP, Teixeira DDB, Siqueira RC, Felix M. Evaluation of the degradation of two bioabsorbable interference screws: an in-vivo study in sheep. Acta Cir Bras 2022; 37:e370405. [PMID: 35766671 PMCID: PMC9239560 DOI: 10.1590/acb370405] [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: 12/12/2021] [Accepted: 03/13/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate in-vivo degradation of two bioabsorbable interference screws. METHODS Twenty-two crossbred Santa Inês ewes were used. A poly-DL-lactide (PDLLA) screw (70%/30%) was inserted in the right pelvic limb, and a PDLLA screw (70%) + β-tri-calcium phosphate (β-TCP) (30%) in the left pelvic limb. Animals were euthanized at one, four, seven and a half and 18 months after surgery. Plain radiography, computed tomography (CT), microCT, and histological analysis were accomplished. RESULTS PDLLA screw was hypodense at all evaluation moments, but with progressive density increase along the central axis, whereas PDLLA/β-TCP was initially hyperdense and progressively lost this characteristic. No adverse reactions were observed on histological evaluation. CONCLUSIONS The inclusion of β-TCP favors screw degradation since the PDLLA/β-TCP screws evidenced a more intense degradation process than the PDLLA screws at the last evaluation. PDLLA screws showed higher bone production, evident around the screw thread, inside the lateral perforations, and in the central canal, whereas the PDLLA/β-TCP screws presented less bone tissue at the implantation site.
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Affiliation(s)
- Paulo Sérgio Scorsato
- PhD. Universidade de Marília - Faculty of Veterinary Medicine - Department of Veterinary Surgery and Anesthesiology - Marilia (SP), Brazil
| | - Sheila Canevese Rahal
- PhD. Universidade Estadual Paulista "Júlio de Mesquita Filho" - School of Veterinary Medicine and Animal Science - Department of Veterinary Surgery and Animal Reproduction - Botucatu (SP), Brazil
| | - Tania Mary Cestari
- PhD. Universidade de São Paulo - Bauru School of Dentistry - Department of Biological Sciences - Bauru (SP), Brazil
| | - Maria Jaqueline Mamprim
- PhD. Universidade Estadual Paulista "Júlio de Mesquita Filho" - School of Veterinary Medicine and Animal Science - Department of Veterinary Surgery and Animal Reproduction - Botucatu (SP), Brazil
| | - Danuta Pulz Doiche
- PhD. Universidade Estadual Paulista "Júlio de Mesquita Filho" - School of Veterinary Medicine and Animal Science - Department of Veterinary Surgery and Animal Reproduction - Botucatu (SP), Brazil
| | | | - Rafael Cerântola Siqueira
- PhD. Universidade Estadual Paulista "Júlio de Mesquita Filho" - School of Veterinary Medicine and Animal Science - Department of Veterinary Surgery and Animal Reproduction - Botucatu (SP), Brazil
| | - Marcílio Felix
- PhD. Universidade de Marília - Veterinary Medicine School - Marília (SP), Brazil
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Dehestani P, Farahmand F, Borjali A, Bashti K, Chizari M. Bone density may affect primary stability of anterior cruciate ligament reconstruction when organic core bone plug fixation technique used. J Exp Orthop 2022; 9:5. [PMID: 34989893 PMCID: PMC8739403 DOI: 10.1186/s40634-021-00441-z] [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: 08/01/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose Core Bone Plug Fixation (CBPF) technique is an implant-less methodology for ACL reconstruction. This study investigates the effect of bone density on CBPF stability to identify the bone quality that is likely to benefit from this technique. Methods Artificial blocks with 160 (Group 1), 240 (Group 2), and 320 (Group 3) kg/m3 densities were used to simulate human bone with diverse qualities. These groups are representative of the elderly, middle age and young people, respectively. A tunnel was made in each test sample using a cannulated drill bit which enabled harvesting the core bone plug intact. Fresh animal tendon grafts were prepared and passed through the tunnel, so the core bone was pushed in to secure the tendon. The fixation stability was tested by applying a cyclic load following by a pullout load until the failure occurred. The selected group was compared with interference screw fixation technique as a gold standard method in ACL reconstruction. Results The Group 2 stiffness and yield strength were significantly larger than Group 1. The graft slippage of Group 1 was significantly less than Group 3. The ultimate strengths were 310 N and 363 N, in Groups 2 and 3, significantly larger than that of Group 1. The ultimate strength in fixation by interference screw was 693.18 N, significantly larger than the bone plug method. Conclusions The stability of CBPF was greatly affected by bone density. This technique is more suitable for young and middle-aged people. With further improvements, the CBPF might be an alternative ACL reconstruction technique for patients with good bone quality. Clinical relevance The CBPF technique offers an implant-less organic ACL reconstruction technique with numerous advantages and likely would speed up the healing process by using the patient’s own bones and tissues rather than any non-biologic fixations.
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Affiliation(s)
- Pouya Dehestani
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Farzam Farahmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.,Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Borjali
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Kaveh Bashti
- Department of Orthopedics, Division of Knee Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Chizari
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.,School of Physics, Engineering and Computer Sciences, University of Hertfordshire, College Ln, Hatfield, AL10 9AB, UK
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Cho CH, Bae KC, Kim DH. Biomaterials Used for Suture Anchors in Orthopedic Surgery. Clin Orthop Surg 2021; 13:287-292. [PMID: 34484619 PMCID: PMC8380519 DOI: 10.4055/cios20317] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 11/09/2022] Open
Abstract
Suture anchors are broadly used for attaching soft tissue (e.g., tendons, ligaments, and meniscus) to the bone and have become essential devices in sports medicine and during arthroscopic surgery. As the usage of suture anchors has increased, various material-specific advantages and challenges have been reported. As a result, suture anchors are continually changing to become safer and more efficient. In this ever-changing environment, it is clinically essential for the surgeon to understand the key characteristics of existing anchors sufficiently. This paper aims to summarize the current concepts on the characteristics of available suture anchors.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Ki-Cheor Bae
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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8
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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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Chu CH, Chen IH, Yang KC, Wang CC. Midterm Results of Fresh-Frozen Osteochondral Allografting for Osteochondral Lesions of the Talus. Foot Ankle Int 2021; 42:8-16. [PMID: 33040601 DOI: 10.1177/1071100720949861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteochondral lesions of the talus (OLT) are relatively common. Following the failure of conservative treatment, many operative options have yielded varied results. In this study, midterm outcomes after fresh-frozen osteochondral allograft transplantation for the treatment of OLT were evaluated. METHODS Twenty-five patients (12 women and 13 men) with a mean age 40.4 (range 18-70) years between 2009 and 2014 were enrolled. Of 25 ankles, 3, 13, 4, and 4 were involved with the talus at Raikin zone 3, 4, 6, and 7 as well as one coexisted with zone 4 and 6 lesion. The mean OLT area was 1.82 cm2 (range, 1.1-3.0). The mean follow-up period was 5.5 years (range, 4-9.3). Outcomes evaluation included the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale score, and 12-item Short Form Health Survey (SF-12). RESULT AOFAS ankle-hindfoot score increased from 74 preoperatively to 94 at 2 years postoperatively (P < .001) and the SF-12 physical health component scores increased from 32 to 46 points (P < .001). Incorporation was inspected in all patients in the latest follow-up, and graft subsidence and radiolucency were observed in 2 and 7 cases, respectively, whereas graft collapse and revision OLT graft were not observed. Bone sclerosis was found in 6 of 25 patients. CONCLUSION With respect to midterm results, fresh, frozen-stored allograft transplantation might be an option in the management of symptomatic OLT. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Chung-Hua Chu
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Ing-Ho Chen
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,Department of Orthopedic Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Department of Orthopedics, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Kai-Chiang Yang
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei
| | - Chen-Chie Wang
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,Department of Orthopedics, School of Medicine, Tzu Chi University, Hualien, Taiwan
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Lind M, Nielsen T, Sørensen OG, Mygind-Klavsen B, Faunø P, Leake-Gardner S. Bone ingrowth into open architecture PEEK interference screw after ACL reconstruction. J Exp Orthop 2020; 7:68. [PMID: 32948982 PMCID: PMC7501394 DOI: 10.1186/s40634-020-00285-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/08/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Open or fenestrated interference screw design that allow bone ingrowth is a concept for improved bone healing to softtissue graft and bone filling in bone tunnels after anterior cruciate ligament reconstruction (ACLR) The aim of the current study was to assess CT scanning evaluated bone ingrowth into an open architecture interference screws in the tibial tunnel of patients undergoing ACL with soft tissue grafts. It was hypothesized that open architecture interference screws would stimulate bone ingrowth into the screw cavities. METHODS Twelve patients requiring ACLR were included. They underwent arthroscopic ACLR with semitendinosus-/gracilis tendon graft and an open architecture polyetheretherketone (PEEK) interference screw. The patients were scanned with a multi-slice CT scanner two weeks, six and twelve months postoperatively. On CT reconstruction slices bone ingrowth into the screw was measured. Subjective and objective clinical outcome international knee documentation committee score and instrumented knee laxity determination were collected. RESULTS At six months no implants demonstrated more than 10% bone ingrowth. At twelve months 42% (5/12) implants had more than 10% bone ingrowth (p = 0.009). The average bone filling into the screws was 7.7%. There was no tunnel widening or cyst formation seen in relation to any of the implants. Subjective IKDC score improved significantly from 50.6 baseline to 80.1 at 24 month follow-up. Preoperative side-to-side knee laxity improved from 3.7 (2.1) to 1.4 (1.2) mm at twelve months. There were no serious adverse events in relation to the new open architecture thread PEEK interference screw during or after hamstring ACL reconstruction. CONCLUSION The present study demonstrated that open architecture thread PEEK interference screw can stimulate bone ingrowth into the screws after soft tissue ACL reconstruction with at 12 months with an average bone filling into screws was 7.7%. Knee stability, functional, subjective and objective outcomes were similar to large volume ACL outcome studies. TRIAL REGISTRATION The study was registered at ClinicalTrials # NCT02382341 . 12-09-2014. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Martin Lind
- Department of Orthopedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Torsten Nielsen
- Department of Orthopedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Ole Gade Sørensen
- Department of Orthopedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Bjarne Mygind-Klavsen
- Department of Orthopedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Peter Faunø
- Department of Orthopedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Stacy Leake-Gardner
- Smith & Nephew Clinical, Scientific & Medical Affairs, Global R&D, 7135 Goodlett Farms Parkway, Cordova, TN, 38016, USA
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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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Arıcan M, Turhan Y. Comparison of Clinical and Functional Results After Arthroscopic Bankart Repair With The Conventional Metal Anchor and The All-Soft Suture Anchor. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2019. [DOI: 10.33631/duzcesbed.584210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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13
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Lee JH, Park I, Hyun HS, Kim SW, Shin SJ. Comparison of Clinical Outcomes and Computed Tomography Analysis for Tunnel Diameter After Arthroscopic Bankart Repair With the All-Suture Anchor and the Biodegradable Suture Anchor. Arthroscopy 2019; 35:1351-1358. [PMID: 30987905 DOI: 10.1016/j.arthro.2018.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 12/04/2018] [Accepted: 12/07/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical outcomes and radiological findings at the anchor site after arthroscopic Bankart repair with all-suture anchors and biodegradable suture anchors in patients with recurrent anterior shoulder dislocation. METHODS The patients who underwent arthroscopic Bankart repair were divided into 2 groups depending on the type of the suture anchor used in different periods. Power analysis was designed based on the postoperative Rowe score. Clinical outcomes, including the Rowe score, American Shoulder and Elbow Surgeons score, subjective instability, and redislocation rates were evaluated. In all patients enrolled, the tunnel diameter of the anchor was assessed with computed tomography arthrogram at 1 year postoperatively. The Institutional Review Board of Ewha Womans University approved this study (no. EUMC 2017-05-058). RESULTS A total of 67 patients were enrolled: 33 underwent surgery with a 1.3-mm (single-loaded) or 1.8-mm (double-loaded) all-suture anchor (group A), and 34 underwent surgery with a 3.0-mm biodegradable anchor (10.8 mm in length, 30% 1,2,3-trichloropropane/70% poly-lactide-co-glycolic acid) (group B). There were no significant differences in clinical outcomes between groups A and B in the American Shoulder and Elbow Surgeons score (preoperatively, 51.2 ± 13.7 vs 47.7 ± 12.2; 2 years postoperatively, 88.5 ± 12.3 vs 89.7 ± 10.9; P = .667) and Rowe score (preoperatively, 41.4 ± 10.5 vs 41.3 ± 9.4; 2 years postoperatively, 87.9 ± 14.9 vs 88.5 ± 14.6; P = .857). Postoperative redislocation (6.1% vs 5.9%, P = .682) and subjective instability rate (12.2% vs 17.7%, P = .386) of both groups showed no significant difference. Average tunnel diameter increment was significantly greater with the 1.8-mm all-suture anchor (2.8 ± 0.9 mm) than the 1.3-mm all-suture anchor (1.2 ± 0.8 mm) and 3.0-mm biodegradable anchor (0.8 ± 1.2 mm) (P < .001). CONCLUSIONS Arthroscopic Bankart repair with the all-suture anchor showed comparable clinical outcomes and postoperative stability as the conventional biodegradable suture anchor at 2 years after surgery. Tunnel diameter increment of the all-suture anchor was significantly greater than that of the biodegradable suture anchor at the 1-year computed tomography analysis. Although tunnel diameter increment was greater with the all-suture anchor, it did not influence the clinical outcomes. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Jae-Hoo Lee
- Department of Orthopedic Surgery, Ewha Womans University, School of Medicine, Seoul, Korea
| | - In Park
- Department of Orthopedic Surgery, Ewha Womans University, School of Medicine, Seoul, Korea
| | - Hwan-Sub Hyun
- Department of Orthopedic Surgery, Ewha Womans University, School of Medicine, Seoul, Korea
| | - Sang-Woo Kim
- Department of Orthopedic Surgery, Ewha Womans University, School of Medicine, Seoul, Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, Ewha Womans University, School of Medicine, Seoul, Korea.
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Xu R, Zhang Z, Toftdal MS, Møller AC, Dagnaes-Hansen F, Dong M, Thomsen JS, Brüel A, Chen M. Synchronous delivery of hydroxyapatite and connective tissue growth factor derived osteoinductive peptide enhanced osteogenesis. J Control Release 2019; 301:129-139. [PMID: 30880079 DOI: 10.1016/j.jconrel.2019.02.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/21/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
In bone tissue engineering, electrospun fibrous scaffolds can provide excellent mechanical support, extracellular matrix mimicking components, such as 3D spacial fibrous environment for cell growth and controlled release of signaling molecules for osteogenesis. Here, a facile strategy comprising the incorporation of an osteogenic inductive peptide H1, derived from the cysteine knot (CT) domain of connective tissue growth factor (CTGF), in the core of Silk Fibroin (SF) was developed for osteogenic induction, synergistically with co-delivering hydroxyapatite (HA) from the shell of poly(l-lactic acid-co-ε-caprolactone) (PLCL). The core-shell nanofibrous structure was confirmed by transmission electron microscopy (TEM). Furthermore, the sustained released H1 has effectively promoted proliferation and osteoblastic differentiation of human induced pluripotent stem cells-derived mesenchymal stem cells (hiPS-MSCs). Moreover, after 8 weeks implantation in mice, this SF-H1/PLCL-HA composite induced bone tissue formation significantly faster than SF/PLCL as indicated by μCT. The present study is the first to demonstrate that release of short hydrophilic peptides derived from CTGF combined with HA potentiated the regenerative capacity for healing critical sized calvarial defect in vivo.
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Affiliation(s)
- Ruodan Xu
- Department of Engineering, Aarhus University, DK-8000 Aarhus C, Denmark; Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medicine Science, China
| | - Zhongyang Zhang
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, DK-8000 Aarhus C, Denmark
| | | | | | - Frederik Dagnaes-Hansen
- Institute of Biomedicine, Aarhus University, Wilhelm Meyers Allé 4, DK-8000 Aarhus C, Denmark
| | - Mingdong Dong
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, DK-8000 Aarhus C, Denmark.
| | - Jesper Skovhus Thomsen
- Institute of Biomedicine, Aarhus University, Wilhelm Meyers Allé 4, DK-8000 Aarhus C, Denmark
| | - Annemarie Brüel
- Institute of Biomedicine, Aarhus University, Wilhelm Meyers Allé 4, DK-8000 Aarhus C, Denmark
| | - Menglin Chen
- Department of Engineering, Aarhus University, DK-8000 Aarhus C, Denmark; Interdisciplinary Nanoscience Center (iNANO), Aarhus University, DK-8000 Aarhus C, Denmark.
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The history of suture anchors in orthopaedic surgery. Clin Biomech (Bristol, Avon) 2019; 61:70-78. [PMID: 30502638 DOI: 10.1016/j.clinbiomech.2018.11.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 11/12/2018] [Accepted: 11/20/2018] [Indexed: 02/07/2023]
Abstract
The suture anchor allows secure fixation of soft tissue to bone and has become an invaluable tool for the orthopaedic surgeon. The original suture anchor was developed over 3 decades ago when a suture was bonded to a headless screw. Since then anchors have undergone a wide variety of design modifications to increase strength and allow for new applications based on biomechanical and clinical evidence. The suture anchor chain consists of the anchor to bone fixation, anchor suture interface, suture itself and suture to soft tissue interface. The early suture anchors failed most commonly from anchor pull out or breakage, with the strongest early design being a bone-screw-suture complex. Early concerns of metalwork complications saw the introduction of biodegradable suture anchors, originally lactic acid polymers and then osteoconductive bio-composites. Improvements in anchor design saw the suture become the main link of failure until the advent of novel suture materials made of ultrahigh molecular weight polyethylene. A form failure of suture at the anchor eyelet via cut-out led to redesign of the anchor suture interface with novel eyelet designs. Further innovations in the anchor suture interface have seen the advent of knotless anchors, especially useful in arthroscopic surgery. The newest products are all-suture anchors which show impressive strength whilst reducing the iatrogenic damage caused by insertion. The further biomechanical development of suture anchors is likely to produce new designs that continue to increase strength whilst managing size requirements for tailored clinical applications.
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Putnam JG, Chhabra A, Castañeda P, Walker JB, Barber CC, Lendrum JA, Hartigan DE. Does Greater Trochanter Decortication Affect Suture Anchor Pullout Strength in Abductor Tendon Repairs? A Biomechanical Study. Am J Sports Med 2018; 46:1668-1673. [PMID: 29554437 DOI: 10.1177/0363546518759033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Greater trochanter decortication is frequently performed at the time of abductor tendon repair to theoretically increase healing potential. No previous studies have determined the effect that greater trochanter decortication has on the pullout strength of suture anchors. Hypothesis/Purpose: The purpose of this study is to determine whether greater trochanter decortication and bone mineral density affect suture anchor pullout strength in abductor tendon repair. The authors hypothesize that both will have a significant detrimental effect on suture anchor pullout strength. STUDY DESIGN Controlled laboratory study. METHODS Nineteen cadaveric proximal femurs with accompanying demographic data and computed tomography scans were skeletonized to expose the greater trochanter. Bone density measurements were acquired by converting Hounsfield units to T-score, based on a standardized volumetric sample in the intertrochanteric region of the femur. The gluteus medius insertion site on the lateral facet of the greater trochanter was evenly divided into 2 regions, anterior-distal and posterior-proximal, and each region was randomly assigned to receive either no decortication or 2 mm of bone decortication. A single biocomposite anchor was implanted in each region and initially tested with cyclic loading for 10 cycles at 0-50 N, 0-100 N, 0-150 N, and 0-200 N, followed by load to failure (LTF) tested at 1 mm/s. For each trial, the number of cycles endured, LTF, mechanism of failure, and stiffness were recorded. RESULTS Greater trochanters with no decortication and 2 mm of decortication survived a mean ± SD 35.1 ± 6.4 and 28.5 ± 10.6 cycles, respectively ( P < .01). Load to failure for nondecorticated specimens was 206.7 ± 75.0 N versus 152.3 ± 60.2 N for decorticated specimens ( P < .001). In a multivariate analysis, decortication and bone density were determinants in LTF ( P < .05). CONCLUSION Decortication and decreased bone mineral density significantly decreased the pullout strength of suture anchors in the lateral facet of the greater trochanter. CLINICAL RELEVANCE Bone density should be considered when determining whether to perform greater trochanter decortication in abductor tendon repairs.
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Affiliation(s)
- Jill G Putnam
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Anikar Chhabra
- Department of Orthopedics, Mayo Clinic Scottsdale, Phoenix, Arizona, USA
| | - Paulo Castañeda
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - J Brock Walker
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Collin C Barber
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - James A Lendrum
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - David E Hartigan
- Department of Orthopedics, Mayo Clinic Scottsdale, Phoenix, Arizona, USA
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Tan H, Wang D, Lebaschi AH, Hutchinson ID, Ying L, Deng XH, Rodeo SA, Warren RF. Comparison of Bone Tunnel and Cortical Surface Tendon-to-Bone Healing in a Rabbit Model of Biceps Tenodesis. J Bone Joint Surg Am 2018; 100:479-486. [PMID: 29557864 PMCID: PMC6221377 DOI: 10.2106/jbjs.17.00797] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Many orthopaedic surgical procedures involve reattachment of a single tendon to bone. Whether tendon-to-bone healing is better facilitated by tendon fixation within a bone tunnel or on a cortical surface is unknown. The purpose of this study was to evaluate tendon-healing within a bone tunnel compared with that on the cortical surface in a rabbit model of biceps tenodesis. METHODS Thirty-two rabbits (24 weeks of age) underwent unilateral proximal biceps tenodesis with tendon fixation within a bone tunnel (BT group) or on the cortical surface (SA [surface attachment] group). Postoperatively, rabbits were allowed free-cage activity without immobilization. All rabbits were killed 8 weeks after surgery. Healing was assessed by biomechanical testing, microcomputed tomography (micro-CT), and histomorphometric analysis. RESULTS Biomechanical testing demonstrated no significant difference between the groups in mean failure loads (BT: 56.8 ± 28.8 N, SA: 55.8 ± 14.9 N; p = 0.92) or stiffness (BT: 26.3 ± 16.6 N/mm, SA: 32.3 ± 9.6 N/mm; p = 0.34). Micro-CT analysis demonstrated no significant difference between the groups in mean volume of newly formed bone (BT: 69.3 ± 13.9 mm, SA: 65.5 ± 21.9 mm; p = 0.70) or tissue mineral density of newly formed bone (BT: 721.4 ± 10.9 mg/cm, SA: 698.6 ± 26.2 mg/cm; p = 0.07). On average, newly formed bone within the tunnel represented only 5% of the total new bone formed in the BT specimens. Histological analysis demonstrated tendon-bone interdigitation and early fibrocartilaginous zone formation on the outer cortical surface in both groups. In contrast, minimal tendon-bone bonding was observed within the tunnel in the BT specimens. CONCLUSIONS Tendon fixation in a bone tunnel and on the cortical surface resulted in similar healing profiles. For tendons placed within a bone tunnel, intratunnel healing was minimal compared with the healing outside the tunnel on the cortical surface. CLINICAL RELEVANCE The creation of large bone tunnels, which can lead to stress risers and increase the risk of fracture, may not be necessary for biceps tenodesis procedures.
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Affiliation(s)
- Hongbo Tan
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research Program (H.T., D.W., A.H.L., I.D.H., L.Y., X.-H.D., S.A.R., and R.F.W.) and Sports Medicine and Shoulder Service (D.W., S.A.R., and R.F.W.), Hospital for Special Surgery, New York, NY
| | - Dean Wang
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research Program (H.T., D.W., A.H.L., I.D.H., L.Y., X.-H.D., S.A.R., and R.F.W.) and Sports Medicine and Shoulder Service (D.W., S.A.R., and R.F.W.), Hospital for Special Surgery, New York, NY
| | - Amir H. Lebaschi
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research Program (H.T., D.W., A.H.L., I.D.H., L.Y., X.-H.D., S.A.R., and R.F.W.) and Sports Medicine and Shoulder Service (D.W., S.A.R., and R.F.W.), Hospital for Special Surgery, New York, NY
| | - Ian D. Hutchinson
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research Program (H.T., D.W., A.H.L., I.D.H., L.Y., X.-H.D., S.A.R., and R.F.W.) and Sports Medicine and Shoulder Service (D.W., S.A.R., and R.F.W.), Hospital for Special Surgery, New York, NY
| | - Liang Ying
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research Program (H.T., D.W., A.H.L., I.D.H., L.Y., X.-H.D., S.A.R., and R.F.W.) and Sports Medicine and Shoulder Service (D.W., S.A.R., and R.F.W.), Hospital for Special Surgery, New York, NY
| | - Xiang-Hua Deng
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research Program (H.T., D.W., A.H.L., I.D.H., L.Y., X.-H.D., S.A.R., and R.F.W.) and Sports Medicine and Shoulder Service (D.W., S.A.R., and R.F.W.), Hospital for Special Surgery, New York, NY
| | - Scott A. Rodeo
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research Program (H.T., D.W., A.H.L., I.D.H., L.Y., X.-H.D., S.A.R., and R.F.W.) and Sports Medicine and Shoulder Service (D.W., S.A.R., and R.F.W.), Hospital for Special Surgery, New York, NY
| | - Russell F. Warren
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research Program (H.T., D.W., A.H.L., I.D.H., L.Y., X.-H.D., S.A.R., and R.F.W.) and Sports Medicine and Shoulder Service (D.W., S.A.R., and R.F.W.), Hospital for Special Surgery, New York, NY
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Anterior cruciate ligament fixation devices: Expected imaging appearance and common complications. Eur J Radiol 2018; 99:17-27. [DOI: 10.1016/j.ejrad.2017.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/23/2017] [Accepted: 12/08/2017] [Indexed: 11/21/2022]
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Delayed Tibial Osteomyelitis after Anterior Cruciate Ligament Reconstruction with Hamstrings Autograft and Bioabsorbable Interference Screw: A Case Report and Review of the Literature. Case Rep Orthop 2017; 2017:6383526. [PMID: 29163995 PMCID: PMC5661094 DOI: 10.1155/2017/6383526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 09/01/2017] [Accepted: 09/07/2017] [Indexed: 12/05/2022] Open
Abstract
Osteomyelitis following arthroscopically assisted anterior cruciate ligament (ACL) reconstruction has rarely been reported in the literature. We report a case of a 20-year-old female who had delayed tibial osteomyelitis and a pretibial cyst with culture-positive, oxacillin sensitive Staphylococcus epidermidis 15 months after an ACL reconstruction with hamstring autograft. Soft tissue fixation within the tibial tunnel was with a poly-L-D-lactic acid (PLDLA) bioabsorbable interference screw. The patient underwent surgical treatment with curettage, debridement, hardware removal, and bone grafting of the tibial tunnel followed by a course of intravenous antibiotics. Arthroscopic evaluation demonstrated an intact ACL graft without any evidence of intra-articular infection. The patient returned to collegiate athletics without any complications. While the most common biologic complications include pretibial cysts, granuloma formation, tunnel widening, and inflammatory reactions, infection is exceedingly rare. Late infection and osteomyelitis are also rare but can occur and should be considered in the differential diagnosis.
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Nagra NS, Zargar N, Smith RDJ, Carr AJ. Mechanical properties of all-suture anchors for rotator cuff repair. Bone Joint Res 2017; 6:82-89. [PMID: 28167489 PMCID: PMC5331174 DOI: 10.1302/2046-3758.62.bjr-2016-0225.r1] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/08/2016] [Indexed: 12/01/2022] Open
Abstract
Objectives All-suture anchors are increasingly used in rotator cuff repair procedures. Potential benefits include decreased bone damage. However, there is limited published evidence for the relative strength of fixation for all-suture anchors compared with traditional anchors. Materials and Methods A total of four commercially available all-suture anchors, the ‘Y-Knot’ (ConMed), Q-FIX (Smith & Nephew), ICONIX (Stryker) and JuggerKnot (Zimmer Biomet) and a traditional anchor control TWINFIX Ultra PK Suture Anchor (Smith & Nephew) were tested in cadaveric human humeral head rotator cuff repair models (n = 24). This construct underwent cyclic loading applied by a mechanical testing rig (Zwick/Roell). Ultimate load to failure, gap formation at 50, 100, 150 and 200 cycles, and failure mechanism were recorded. Significance was set at p < 0.05. Results Overall, mean maximum tensile strength values were significantly higher for the traditional anchor (181.0 N, standard error (se) 17.6) compared with the all-suture anchors (mean 133.1 N se 16.7) (p = 0.04). The JuggerKnot anchor had greatest displacement at 50, 100 and 150 cycles, and at failure, reaching statistical significance over the control at 100 and 150 cycles (22.6 mm se 2.5 versus 12.5 mm se 0.3; and 29.6 mm se 4.8 versus 17.0 mm se 0.7). Every all-suture anchor tested showed substantial (> 5 mm) displacement between 50 and 100 cycles (6.2 to 14.3). All-suture anchors predominantly failed due to anchor pull-out (95% versus 25% of traditional anchors), whereas a higher proportion of traditional anchors failed secondary to suture breakage. Conclusion We demonstrate decreased failure load, increased total displacement, and variable failure mechanisms in all-suture anchors, compared with traditional anchors designed for rotator cuff repair. These findings will aid the surgeon’s choice of implant, in the context of the clinical scenario. Cite this article: N. S. Nagra, N. Zargar, R. D. J. Smith, A. J. Carr. Mechanical properties of all-suture anchors for rotator cuff repair. Bone Joint Res 2017;6:82–89. DOI: 10.1302/2046-3758.62.BJR-2016-0225.R1
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Affiliation(s)
- N S Nagra
- NDORMS, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, UK and, Oxford University Clinical Academic Graduate School, Medical Sciences Divisional Office, Level 3, John Radcliffe Hospital, Oxford, UK
| | - N Zargar
- University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, UK
| | - R D J Smith
- University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, UK
| | - A J Carr
- University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, UK
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Alkaloids of fascaplysin are effective conventional chemotherapeutic drugs, inhibiting the proliferation of C6 glioma cells and causing their death in vitro. Oncol Lett 2016; 13:738-746. [PMID: 28356953 PMCID: PMC5351310 DOI: 10.3892/ol.2016.5478] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/05/2016] [Indexed: 12/18/2022] Open
Abstract
Glioblastoma multiforme is an invasive malignant glial brain tumor with a poor prognosis for patients. The primary reasons that lead to the development of treatment resistance are associated with tumor cells infiltrating the brain parenchyma and the specific properties of tumor stem cells. A crucial research area in medical science is the search for effective agents that are able to act on these targets. Fascaplysin alkaloids possess potent antitumor activity. Modern methods for the targeted delivery of drugs reveal extensive possibilities in terms of the clinical use of these compounds. The aim of the present study was to establish effective concentrations of fascaplysin that inhibit the growth and kill the cells of glial tumors, as well as to perform a comparative analysis of fascaplysin's effectiveness in relation to other chemotherapy drugs. C6 glioma cells were utilized as an optimal model of glioblastoma. It was established that fascaplysin at 0.5 µM has a strong cytotoxic effect, which is subsequently replaced by tumor cell death via apoptosis as the length of drug exposure time is increased. Fascaplysin kills glioma cells at a dose higher than 0.5 µM. The efficiency of fascaplysin was observed to significantly exceed that of temozolomide. Therefore, a significant feature of fascaplysin is its ability to inhibit the growth of and kill multipotent tumor cells.
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Bell C, Torske K, Lobb B. Collateral ligament reconstruction in two horses following traumatic avulsion fracture using a knotless suture anchor construct. EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- C. Bell
- Elders Equine Veterinary Service; Winnipeg Manitoba Canada
| | - K. Torske
- Elders Equine Veterinary Service; Winnipeg Manitoba Canada
| | - B. Lobb
- Elders Equine Veterinary Service; Winnipeg Manitoba Canada
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