Peak load resistance of the JuggerKnot™ soft anchor technique compared with other common fixation techniques for large mallet finger fractures

[Comparison between different anchors for zone I flexor tendon repair]

INTRODUCTION

Transosseous reinsertion has been used to complement the Bunnell pull-out technique in the repair of zone I deep flexor tendon injuries. The aim of this study is to compare the different devices on the market in terms of complication, functional recovery and ease of use.

MATERIAL AND METHOD

This is a single-center study including all patients who underwent transosseous anchor reinsertion from 2010 to 2021 with a minimum of 6 months of follow-up. Twenty-seven patients were included. The anchors used were of different types: Microfix® Quickanchor plus® and Miniquick anchor® from DePuy Mitek; Juggerknot® Soft Anchor 1.0mm from Zimmer-Biomet; or Kerifix® 4.0 from KeriMedical. We analyzed intraoperative data, complications and functional recovery by quickDASH score.

RESULTS

The average age was 38.6 years (± 16.1), the demographic characteristics were identical in the different groups. There was a significant difference in the number of anchors used intraoperatively before definitive placement (P=0.02), to the disadvantage of the Juggerknot® anchors. There was no significant difference in terms of complications and functional recovery evaluated by the quickDASH.

CONCLUSION

Our study did not find significant differences between the different anchors in terms of complications and functional recovery. Some anchors seem to have a better grip during placement than others.

Rupture of finger distal interphalangeal collateral ligament treated with a mini soft anchor

BACKGROUND

Ruptured finger distal interphalangeal (DIP) collateral ligament is a rare injury, with controversial treatment until the present. Our case series aimed to demonstrate feasible surgical intervention using a mini anchor.

METHODS

The present study includes four patients with ruptured finger DIP collateral ligaments who received primary repair in a single institute. They have suffered from joint instability due to ligament loss caused by infection, motorcycle accidents, and work-related accidents. All patients were operated on similarly using a 1.0 mm mini anchor for ligament reattachment.

RESULTS

The finger DIP joint range of motion (ROM) was documented in all patients during follow-up. Joint ROM recovered to almost normal degrees, and the pinch strength recovered to > 90% compared to the contralateral side in all patients. Additionally, collateral ligament re-rupture, DIP joint subluxation or re-dislocation, and infection were not noted during follow-up.

CONCLUSIONS

Ruptured finger DIP joint ligament requiring surgery is usually based on a combination with other soft tissue injuries and defects. However, repair with a 1.0 mm mini anchor is a feasible surgical intervention to reattach the ligament with minimal complication.

Mini All-Suture Anchors for Repairing the Central Slip of the Extensor Tendon at the Proximal Interphalangeal Joint: A Biomechanical Investigation

PURPOSE

This study evaluated 1.0-mm mini suture anchors for repairing the central slip of the extensor mechanism at the proximal interphalangeal joint. Studies have reported a requirement for central slip fixation to withstand 15 N during postoperative rehabilitation exercises and 59 N during forceful contraction.

METHODS

Index and middle fingers from 10 matched pairs of cadaveric hands were prepared with 1.0-mm mini suture anchors with 2-0 sutures or threaded with 2-0 sutures through a bone tunnel (BTP). In total, 10 index fingers from unmatched hands were prepared with suture anchors and fixed to the extensor tendons to evaluate the tendon/suture interface response. Each distal phalanx was secured to a servohydraulic testing machine, and ramped tensile loads were applied to suture or tendon until failure.

RESULTS

All anchors for the all-suture bone tests failed because of pullout from the bone (Mean failure force = 52.5+/-17.3 N). Three anchors from the tendon-suture pull out test failed by pullout from the bone and seven failed at the tendon/suture interface (Mean failure force = 49.0+/-10.1 N).

CONCLUSIONS

The 1.0-mm mini suture anchor provides enough strength for early short-arc motion, but it may not be adequate for forceful contraction in the early postoperative rehabilitation stage.

CLINICAL RELEVANCE

The site of fixation, the type of anchor, and the type of suture used are key factors to consider for early range of motion, after surgery.

Bone fixation techniques for managing joint disorders and injuries: A review study

The majority of surgical procedures treating joint disorders require a technique to realize a firm implant-to-tissue and/or a tissue-to-tissue fixation. Fixation methods have direct effects on survival, performance and integration of orthopedic implants This review paper gives an overview of novel fixation techniques that have been evaluated and optimized for orthopaedic joint implants and could be alternatives for traditional implant fixation techniques or inspirations for future design of joint implantation procedures.

METHOD

The articles were selected using the Scopus search engine. Key words referring to traditional fixation methods have been excluded to find potential innovative fixation techniques. In order to review the recent anchorage systems, only articles that been published during the period of 2010-2020 have been included.

RESULTS

A total of 57 studies were analyzed. The result revealed that three main fixation principles are being employed: using mechanical interlockings, employing adhesives, and performing tissue-bonding strategies.

CONCLUSION

The development of fixation techniques demonstrates a transformation from the general anchoring tools like K-wires toward application-specific designs. Several new methods have been designed and evaluated, which highlight encouraging results as described in this review. It seems that mechanical fixations provide the strongest anchorage. Employing (bio)-adhesives as fixation tool could revolutionize the field of orthopedic surgery. However, the adhesives must be improved and optimized to meet the requirements of an anchorage system. Long-term fixation might be formed by tissue ingrowth approaches which showed promising results. In most cases further clinical studies are required to explore their outputs in clinical applications.