1
|
Belyea CM, Abbasi P, Sanghavi KK, Giladi AM, Means KR. All-Suture Anchor Repair of the Flexor Digitorum Profundus Insertion: A Biomechanical Comparison of 2 Suturing Techniques. J Hand Surg Am 2023; 48:1276.e1-1276.e7. [PMID: 35778231 DOI: 10.1016/j.jhsa.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/22/2022] [Accepted: 05/11/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE We compared 2 suturing techniques for reattachment of the flexor digitorum profundus (FDP) via all-suture anchor. METHODS We used fresh, matched-pair, cadaveric hands. We disarticulated the fingers at the proximal interphalangeal joints, preserving the proximal FDP. We released the FDPs at their distal insertion and placed an all-suture, 1.0-mm anchor at the center of each FDP footprint. Each anchor's sutures were used to reattach each FDP using 1 of 2 techniques: group H (n = 14) via horizontal mattress; group H + K (n = 12) via horizontal mattress with knots thrown and, with each suture tail, 3 proximal, running-locking, Krackow-type passes on the radial and ulnar FDP sides with the suture ends tied together. We excluded 2 specimens from the H + K group because of improper anchor placement. All other fingers in both groups were individually mounted in an MTS machine for FDP loading in the following sequence for 500 cycles each: (1) to 15 N to simulate passive motion forces; (2) to 19 N for short-arc active motion forces; and (3) to 28 N for full active motion forces. Specimens that had not failed during cyclic testing were then loaded to failure. We measured FDP-to-bone gapping via a digital transducer. We defined failure as >3-mm gapping. RESULTS The H + K group had significantly less gapping during cyclic loading up to 19 N and significantly higher load to failure. The H + K group failed exclusively at the anchor-bone level; the H group failed mostly by suture-tendon pullout. CONCLUSIONS The H + K group performed significantly better regarding cyclic and load-to-failure testing after FDP reattachment. CLINICAL RELEVANCE The H + K technique combines the benefits of horizontal-mattress tendon-to-bone apposition and Krackow-tendon locking. It converts the point of failure to the bone level rather than the suture-tendon level.
Collapse
Affiliation(s)
- Christopher M Belyea
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Pooyan Abbasi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Kavya K Sanghavi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Aviram M Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Kenneth R Means
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
| |
Collapse
|
2
|
Nicolay RW, Jahandar A, Retzky JS, Kontaxis A, Verma NN, Fu MC. Biomechanical properties of suprapectoral biceps tenodesis with double-anchor knotless luggage tag sutures vs. subpectoral biceps tenodesis with single-anchor whipstitch suture using all-suture anchors. JSES Int 2023; 7:2393-2399. [PMID: 37969507 PMCID: PMC10638590 DOI: 10.1016/j.jseint.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background As the use of all-suture anchors continues to increase, limited biomechanical data on the use of these anchors in various configurations for tenodesis of the long head biceps tendon (LHBT) exists. The aim of this study was to compare the biomechanical properties of a 2-anchor luggage tag suprapectoral biceps tenodesis (Sup-BT) vs. a single-anchor whipstitch subpectoral biceps tenodesis (Sub-BT) using all-suture anchors. The hypothesis was that the Sub-BT will have a higher ultimate load to failure and less creep relative to the Sup-BT construct. Methods Eighteen fresh frozen cadaveric humeri were used. The specimens were randomly divided into 2 groups of 9; i) The Sup-BT were performed with 2 1.8 mm knotless all-suture anchors using a luggage-tag fixation configuration, ii) The Sub-BT were performed using a single 1.9 mm all-suture anchor and a whipstitch suture configuration with a tied knot. The humeri were tested on a hydraulic MTS machine where the specimens were preloaded at 5 N for 2 minutes and then cyclically loaded from 5 to 50 N for 1000 cycles at 1 Hz while maximum displacement was recorded with a motion system and markers attached to the bone and bicep tendon. The tendon was then tensioned at a rate of 1 mm/s to obtain the ultimate load to failure. CT scans of the specimens were used to calculate the bone mineral density at the site of the anchor/bone interface and video recordings were captured during load to failure to document all modes of failure. Results There was no significant difference in the average load to failure of the Sup-BT and Sub-BT groups (197 N ± 45 N (SD), 164 N ± 68 N (SD) respectively; P = .122) or creep under fatigue between the Sup-BT vs. Sub-BT specimens (3.1 mm, SD = 1.5 vs. 2.2 mm, SD = 0.9; P = .162). The bone mineral density was statistically different between the 2 groups (P < .001); however, there were no observed failures at the anchor/bone interface and no correlation between failure load and bone mineral density. Conclusion The ultimate load to failure and creep between a Sup-BT with 2 knotless all-suture anchors using a luggage tag suture configuration was equivalent to a Sub-BT with 1 all-suture anchor using a whipstitched suture configuration and a tied knot. Surgeons can perform either technique confidently knowing that they are biomechanically equivalent in a cadaver model at time zero, and they offer similar strength to other fixation methods cited in the literature.
Collapse
Affiliation(s)
- Richard W. Nicolay
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Amirhossein Jahandar
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Julia S. Retzky
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Andreas Kontaxis
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Nikhil N. Verma
- Section of Shoulder and Elbow Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael C. Fu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| |
Collapse
|
3
|
Otto A, Siebenlist S, Baldino JB, Murphy M, Muench LN, Mehl J, Obopilwe E, Cote MP, Imhoff AB, Mazzocca AD. All-suture anchor and unicortical button show comparable biomechanical properties for onlay subpectoral biceps tenodesis. JSES Int 2020; 4:833-837. [PMID: 33345223 PMCID: PMC7738569 DOI: 10.1016/j.jseint.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Hypothesis The purpose of this study was to biomechanically evaluate onlay subpectoral long head of the biceps (LHB) tenodesis with all-suture anchors and unicortical buttons in cadaveric specimens. Methods After evaluation of bone mineral density, 18 fresh-frozen, unpaired human cadaveric shoulders were randomly assigned to 2 groups: One group received an onlay subpectoral LHB tenodesis with 1 all-suture anchor, whereas the other group received a tenodesis with 1 unicortical button. The specimens were mounted in a servo-hydraulic material testing system. Tendons were initially loaded from 5 N to 100 N for 5000 cycles at 1 Hz. Displacement of the repair constructs was observed with optical tracking. After cyclic loading, each specimen was loaded to failure at a rate of 1 mm/s. Results The mean displacement after cyclic loading was 6.77 ± 3.15 mm in the all-suture anchor group and 8.41 ± 3.17 mm in the unicortical button group (P = not significant). The mean load to failure was 278.05 ± 38.77 N for all-suture anchor repairs and 291.36 ± 49.69 N for unicortical button repairs (P = not significant). The most common mode of failure in both groups was LHB tendon tearing. There were no significant differences between the 2 groups regarding specimen age (58.33 ± 4.37 years vs. 58.78 ± 5.33 years) and bone mineral density (0.50 ± 0.17 g/cm2 vs. 0.44 ± 0.19 g/cm2). Conclusion All-suture anchors and unicortical buttons are biomechanically equivalent in displacement and load-to-failure testing for LHB tenodesis. All-suture anchors can be considered a validated alternative for onlay subpectoral LHB tenodesis.
Collapse
Affiliation(s)
- Alexander Otto
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA.,Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Joshua B Baldino
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| | - Matthew Murphy
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julian Mehl
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| |
Collapse
|
4
|
Rhee SM, Jeong HY, Ro K, Pancholi S, Rhee YG. Double on-lay fixation using all suture-type anchor for subpectoral biceps tenodesis has favorable functional outcomes and leads to less cosmetic deformities than single on-lay fixation. Knee Surg Sports Traumatol Arthrosc 2019; 27:4005-13. [PMID: 31410527 DOI: 10.1007/s00167-019-05663-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE This study aimed to compare the clinical outcomes between single on-lay and double on-lay subpectoral biceps tenodesis (SPBT) using all-suture type anchor in patients with concomitant long head of the biceps tendon (LHBT) lesions and rotator cuff tears. METHODS The study included 130 patients who underwent SPBT using all-suture type anchor and arthroscopic rotator cuff repair. Single and double anchor on-lay fixations were performed in 69 patients (group A) and 61 patients (group B), respectively. In 16 patients of group A and 36 patients of group B, a metallic wire was embedded at tenodesis site and difference of wire location pre-and postoperatively was measured using simple radiography. RESULTS In both groups, the mean visual analogue scale (VAS) score during motion, the mean UCLA and constant scores significantly improved at the last follow-up (all p < 0.001). These scores were not significantly different between two groups. However, postoperatively, a significant difference was observed in the incidence of cosmetic deformity between two groups (p = 0.019). The cosmetic deformity was noted in 9 (13.0%) patients (Popeye deformity 7.2% and biceps softening 5.8%) in group A and 1 (1.6%) patient (Popeye deformity) in group B. In the subgroup analysis on biceps migration after the surgery, the mean migration distance of metal wire was 2.5 ± 3.0 mm in group A and 1.9 ± 2.6 mm in group B (n.s.). No patient had migration of > 10 mm. CONCLUSIONS SPBT using all-suture type anchor was a favorable treatment option for lesions of the LHBT with rotator cuff tear. The clinical relevance of this study is the finding that double on-lay fixation with all-suture type anchor would result less cosmetic deformity than the single on-lay fixation for those who need subpectoral biceps tenodesis. LEVEL OF EVIDENCE III.
Collapse
|
5
|
Kramer JD, Robinson S, Purviance C, Montgomery W. Analysis of glenoid inter-anchor distance with an all-suture anchor system. J Orthop 2018; 15:102-106. [PMID: 29657449 DOI: 10.1016/j.jor.2018.01.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 01/14/2018] [Indexed: 01/02/2023] Open
Abstract
Background All-suture anchors used in arthroscopic shoulder stabilization employ small diameter anchors, which allow greater placement density on narrow surfaces such as the glenoid. There is no consensus in the literature about how close to one another two anchors may be implanted. Purpose The purpose of the present study is to compare the strength characteristics of two all-suture anchors placed in cadaveric human glenoid at variable distances to one another, in order to determine the minimum distance required for optimal strength. Methods Twelve fresh-frozen human cadaveric glenoids were implanted with 1.4 mm all-suture anchors at varying inter-anchor distances. Each glenoid was used for four tests, for a total of 48 tests. Anchors were implanted adjacent to one another or with 2, 3, or 5 mm bone bridges between pilot holes. The glenoids then underwent pullout testing using a test frame with a 5N preload followed by displacement of 12.5 mm/s. The primary outcomes were stiffness, failure strength, and ultimate strength. Results Stiffness was 13.52 ± 3.8, 17.97 ± 5.02, 17.59 ± 4.65 and 18.95 ± 4.67 N/mm for the adjacent, 2, 3, and 5 mm treatment groups, respectively. The adjacent group had a significantly lower stiffness compared to the other treatment groups. Failure strength was 48.68 ± 20.64, 76.16 ± 23.78, 73.19 ± 35.83 and 87.04 ± 34.67 N for the adjacent, 2, 3, and 5 mm treatment groups, respectively. The adjacent group had a significantly lower failure strength compared to the other treatment groups. Ultimate strength was also measured to be 190.59 ± 140.93, 268.7 ± 115.1, 283.23 ± 118.43, and 291.28 ± 118.24 for the adjacent, 2, 3, and 5 mm treatment groups, respectively. Conclusions This biomechanical study provides evidence that 1.4 mm all-suture anchors demonstrate similar strength characteristics when placed at least 2 mm or greater from one another. When 1.4 mm all-suture anchors were placed adjacent to one another, there was an observed decrease in failure strength and stiffness. Clinical relevance This study suggests that 1.4 mm all-suture anchors may be placed as close as 2 mm to one another while preserving strength characteristics.
Collapse
Affiliation(s)
- Jonathan D Kramer
- St. Mary's Medical Center, San Francisco Orthopedic Residency Program, 450 Stanyan St, San Francisco, CA 94115, United States
| | - Sean Robinson
- St. Mary's Medical Center, San Francisco Orthopedic Residency Program, 450 Stanyan St, San Francisco, CA 94115, United States
| | - Connor Purviance
- The Taylor Collaboration, 450 Stanyan St, San Francisco, CA 94115, United States
| | - William Montgomery
- St. Mary's Medical Center, San Francisco Orthopedic Residency Program, 450 Stanyan St, San Francisco, CA 94115, United States
| |
Collapse
|
6
|
Dwyer T, Willett TL, Dold AP, Petrera M, Wasserstein D, Whelan DB, Theodoropoulos JS. Maximum load to failure and tensile displacement of an all-suture glenoid anchor compared with a screw-in glenoid anchor. Knee Surg Sports Traumatol Arthrosc 2016; 24:357-64. [PMID: 24201901 DOI: 10.1007/s00167-013-2760-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 10/28/2013] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the biomechanical behavior of an all-suture glenoid anchor in comparison with a more conventional screw-in glenoid anchor, with regard to maximum load to failure and tensile displacement. METHODS All mechanical testing was performed using an Instron ElectroPuls E1000 mechanical machine, with a 10 N pre-load and displacement rate of 10 mm/min. Force-displacement curves were generated, with calculation of maximum load, maximum displacement, displacement at 50 N and stiffness. Pretesting of handset Y-Knots in bone analog models revealed low force displacement below 60 N of force. Subsequently, three groups of anchors were tested for pull out strength in bovine bone and cadaver glenoid bone: a bioabsorbable screw-in anchor (Bio Mini-Revo, ConMed Linvatec), a handset all-suture anchor (Y-Knot, ConMed Linvatec) and a 60 N pre-tensioned all-suture anchor (Y-Knot). A total of 8 anchors from each group was tested in proximal tibia of bovine bone and human glenoids (age range 50-90). RESULTS In bovine bone, the Bio Mini-Revo displayed greater maximum load to failure (206 ± 77 N) than both the handset (140 ± 51 N; P = 0.01) and the pre-tensioned Y-Knot (135 ± 46 N; P = 0.001); no significant difference was seen between the three anchor groups in glenoid bone. Compared to the screw-in anchors, the handset all-suture anchor displayed inferior fixation, early displacement and greater laxity in the bovine bone and cadaveric bone (P < 0.05). Pre-tensioning the all-suture anchor to 60 N eliminated this behavior in all bone models. CONCLUSIONS Handset Y-Knots display low force anchor displacement, which is likely due to slippage in the pilot hole. Pre-tensioning the Y-Knot to 60 N eliminates this behavior. LEVEL OF EVIDENCE I.
Collapse
Affiliation(s)
- Tim Dwyer
- Women's College, Toronto Western Hospital, University of Toronto Orthopaedic Sports Medicine, 76 Grenville St, Toronto, ON, M5S 1B1, Canada.
| | - Thomas L Willett
- Musculoskeletal Research Laboratory, Division of Orthopaedic Surgery, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, 25 Orde Street, Room 416, Toronto, ON, M5T 3H7, Canada
| | | | | | - David Wasserstein
- University of Toronto Orthopaedic Sports Medicine, Toronto, ON, Canada
| | - Danny B Whelan
- Women's College Hospital, Toronto, ON, Canada.,St. Michael's Hospital, University of Toronto Orthopaedic Sports Medicine, Toronto, ON, Canada
| | - John S Theodoropoulos
- Women's College Hospital, Toronto, ON, Canada.,Mt. Sinai Hospital, University of Toronto Orthopaedic Sports Medicine, Toronto, ON, Canada
| |
Collapse
|