Outcomes of distal biceps repair at two-year follow-up

PURPOSE

This single-centre study aimed to review the postoperative outcomes of distal biceps avulsion repair using a single incision with the endo-button technique.

METHODS

A retrospective cohort study was performed of a single surgeon series of distal biceps repairs performed consecutively from September 2016 to September 2020. At two years, outcome measures included Oxford Elbow Score (OES), range of movement (ROM), complications and ongoing issues.

RESULTS

Forty-five distal biceps tendon repairs were performed on 43 patients with a mean follow-up of 3.2 years (1.1-5.3). The average OES was 46 (11-48), and 90% of patients recovered a comparable range of movement to the contralateral side. Two patients developed re-rupture (4%) on days 0 and 9 of surgery, but there were no late re-ruptures of the repair.

CONCLUSION

Short-term outcomes from distal biceps tendon repair show low complication rates, high patient satisfaction and good functional outcomes. The results would support acute surgical treatment of active, working-age, patients with distal biceps tendon ruptures.

Effectiveness of suture anchor and transosseous suture technique in arthroscopic foveal repair of the triangular fibrocartilage complex: a systematic review

BACKGROUND

Currently, there were two major surgical methods for arthroscopic triangular fibrocartilage complex (TFCC) foveal repair: suture anchor (SA) and transosseous suture (TOS). The purpose of this systematic review is to examine the relevant outcome improvement and safety of SA and TOS technique.

METHODS

Literature review of electronic databases for studies investigating the effects of SA and TOS in patients undergoing arthroscopic TFCC foveal repair was performed. We compared the pre-operative and postoperative functional outcomes, clinical outcomes [pain, range of motion (ROM) and grip strength], and complications of two methods. Minimal clinically important difference (MCID) was used to determine clinically meaningful improvement.

RESULTS

There were 1263 distinct studies identified, with 26 (904 patients) meeting the inclusion criteria. The mean age of participants ranged from 21.4 to 41 years, and the mean follow-up time ranged from 6 to 106 months. Both SA and TOS groups reported significant improvement in the modified mayo wrist score, the disabilities of the arm, shoulder, and hand (DASH) score, quick DASH score, patient-reported wrist evaluation (PRWE) score, and the visual analog scale (VAS) score. According to MCID, all the studies from both groups reporting DASH, quick DASH, PRWE and VAS score achieved clinically meaningful improvement. (MCID: 10 for DASH, 14 for quick DASH, 14 for PRWE and 1.6-18 for VAS). The ROM changes in both groups varied from improvement to deterioration. Grip strength improved in both SA and TOS group. Most complications were self-limited. The reoperation rates in SA and TOS ranged from 0 to 20% and 0 to 27.3%, respectively.

CONCLUSIONS

Both SA and TOS technique for arthroscopic TFCC foveal repair could achieve improvement in postoperative functional outcomes, pain, and grip strength with low reoperation rate. However, the ROM improvement was still inconclusive.

LEVEL OF EVIDENCE IV

Systematic review of level III and IV studies.

[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.

Ligament reconstruction with modified suture anchor fixation technique for chronic distal radioulnar joint instability: A case report and literature review

INTRODUCTION

The chronic instability of the DRUJ should be appropriately treated. Ligament reconstruction in the original technique needs an adequate length of the graft, which needs to be modified in such a case.

CASE PRESENTATION

A 27-year-old male presented with right wrist pain accompanied by limited movement that has been felt for the last two months. There was an obvious deformity with tenderness. Palpation revealed a positive ballottement and piano-key sign test. An X-ray examination revealed a union fracture one-third distally on the right radius bone with dorsal dislocation of the right distal radioulnar joint. The result of an MRI confirmed a triangular fibrocartilage complex tear. The patient was diagnosed with chronic DRUJ instability.

DISCUSSION

We performed a chronic DRUJ reconstruction using the harvesting palmaris longus tendon. However, the length of the graft is too short. Further, we performed a modified technique with suture anchor fixation for this patient. This technique could be a helpful alternative if the length of the graft is insufficient. As a result, there was an improvement in the DASH score and EQ5D questionnaires.

CONCLUSION

Chronic DRUJ instability could be treated by ligament reconstruction with modified suture anchors fixation in the inadequate length of the graft situation.

A comparison of characteristics and outcomes of operative treatment for Achilles tendon sleeve avulsion in older versus younger patients

INTRODUCTION

Achilles tendon sleeve avulsion (ATSA) is a rare injury that often results from pre-existing insertional Achilles tendinopathy and occurs when a tendon avulses from the insertion as a continuous sleeve. To date, outcomes of operative treatment for ATSA in older patients have not been reported. Therefore, this study aims to compare the characteristics and outcomes of Achilles tendon (AT) reattachment with or without tendon lengthening for ATSA between older and younger patients.

MATERIALS AND METHODS

This study enrolled 25 consecutive patients who underwent operative treatment following a diagnosis of ATSA between January 2006 and June 2020. The inclusion criterion was a minimum follow-up duration of one year. The enrolled patients were divided into two groups according to their age at operation: ≥ 65 years (group 1, 13 patients) and < 65 years (group 2, 12 patients). AT reattachment was performed in all patients using two 5.0-mm suture anchors after an inflamed distal stump resection in the 30° plantar-flexed ankle position.

RESULTS

The degree of active dorsiflexion and plantar flexion, mean visual analog scale score, and Victorian Institute of Sports Assessment-Achilles scores at the final follow-up were not significantly different between the two groups (P > 0.05 each). The rate of satisfactory clinical outcomes (defined as fair or greater) was 84.6% and 91.7% in groups 1 and 2, respectively.

CONCLUSION

We observed that comparable clinical outcomes could be achieved after AT reattachment with or without lengthening for ATSA between older and younger patients.

Concomitant posterior anchoring further reduces posterior meniscal extrusion during pullout repair of medial meniscus posterior root tears: a retrospective study

PURPOSE

Transtibial pullout repair improves the clinical outcomes of medial meniscus (MM) posterior root tears (PRTs); however, reducing MM extrusion remains challenging. Thus, the purpose of this study was to examine the role of additional posterior anchoring (PA) during pullout repair in reducing the severity of MM extrusion compared to pullout repair alone.

METHODS

Patients who underwent pullout repair with two-cinch stitches (TCS) only or TCS combined with PA (TCS-PA)-deployment of an additional suture anchor in the posteromedial corner of MM-were included retrospectively. MM medial and posterior extrusion (MMME and MMPE), MM extrusion and remaining volume (MMEV and MMRV), and corresponding ratios were evaluated pre-operatively and three months post-operatively using a three-dimensional meniscal model at 10° and 90° of knee flexion and compared within and between groups.

RESULTS

A total of 15 and 16 patients treated with TCS and TCS-PA, respectively, were enrolled. At 90° knee flexion, both techniques significantly reduced MMPE (TCS: 4.2 ± 0.7 mm to 3.5 ± 0.6 mm, p < 0.05; TCS-PA: 3.7 ± 0.8 mm to 2.8 ± 0.7 mm, p < 0.05) at three months post-operatively. TCS-PA reduced MMPE more significantly than TCS alone (p < 0.05). Only TCS-PA significantly improved the MMEV and MMRV ratios (39.6 ± 8.9% to 28.1 ± 6.0%, p < 0.05 and 60.4 ± 8.9% to 71.9 ± 6.0%, p < 0.05, respectively). Significance was not found in all other comparisons.

CONCLUSIONS

Both techniques improved MMPE at knee flexion at the three month follow-up, with TCS-PA providing significantly superior results. Our findings support the evidence that the application of PA may be an effective surgical option for alleviating persistent MMPE.

[Locking loop stitch with suture-bridge technique in repair of acute closed distal Achilles tendon rupture by using suture anchors]

OBJECTIVE

To explore clinical efficacy of Locking loop stitch with suture-bridge technique in repair of acute closed distal Achilles tendon rupture by using suture anchors.

METHODS

From July 2019 to March 2021, 20 patients with acute closed distal Achilles tendon rupture were treated by minimally invasive suture anchor locking suture bridging repair technique. Among them, including 18 males and 2 females, aged from 19 to 52 years old with an average of(40.0±9.0) years old. Complications were observed, and recovery of ankle function was evaluated by American Orthopaedic Foot & Ankle Society(AOFAS) ankle and hindfoot function scoring system before operation and 1 year after operation.

RESULTS

All patients followed up from 6 to 18 months with an average of (12.0±3.2) months. The incisions were healed at stageⅠwithout infection and skin necrosis occurred;no gastrocnemius nerve injury and deep vein thrombosis of the lower extremities occurred;and no heel pain and Achilles tendon re-rupture occurred. AOFAS scores of ankle and hindfoot increased from(59.0±4.3) before opertaion to(95.1±2.6) at 1 year after operation (t=-32.1, P<0.05).

CONCLUSION

The effect of locking suture bridging with suture anchor nails to repair acute distal Achilles tendon rupture is definite, and it could reduce incidence of complications such as Achilles tendon re-rupture, nerve injury, and skin necrosis, which has advantages of small surgical trauma, reliable anastomosis method and good functional recovery, and is an ideal method for treating acute closed distal Achilles tendon rupture.

Development of in vitro osteoporosis model in minipig proximal humerus and femur: validation in histological and biomechanical study

BACKGROUND

The minipig has been used for research in various fields of medicine, even in orthopedics. Though previous studies have already suggested other methods to create osteoporotic bone, those methods had some disadvantages for taking time and efforts. Therefore, we aimed to generate osteoporotic proximal humerus and proximal femur of minipig using EDTA solution and validate their properties through dual energy X-ray absorptiometry (DEXA), micro-CT study, histological and biomechanical ways.

METHODS

Six minipigs were used. Out of a total of 12 proximal humerus (PH) and 12 proximal femurs (PF), 6 PH and 6 PF were used as the decalcified group and the opposite side as the non-decalcified group. In vitro decalcification with Ca-chelating agents (0.5 M EDTA solution, pH 7.4) was used. Area BMD (aBMD) was measured using DEXA, Volumetric BMD (vBMD), and microstructure were measured using micro-CT. Universal testing machine was used to measure ultimate load to failure (ULTF). Each group was compared using two types of suture anchors (all-suture anchor, ASA, and conventional screw type anchor, CA).

RESULTS

There was a significant difference in aBMD and cortical thickness (aBMD: decalcified, 0.433 ± 0.073 g/cm2, undecalcified, 0.962 ± 0.123 g/cm2, p < 0.001; cortical thickness: decalcified, 0.33 ± 0.34 mm, undecalcified, 1.61 ± 0.45 mm, p < 0.001). In the case of ASA, the ULTF was significantly lower in the decalcified group (decalcified: 176.6 ± 74.2 N, non-decalcified: 307.7 ± 116.5 N, p = 0.003). In the case of CA, there was no significant difference (decalcified: 265.1 ± 96.0 N, undecalcified: 289.4 ± 114.5 N, p = 0.578).

CONCLUSION

We demonstrated that decalcification with EDTA solution significantly decreased aBMD, vBMD, and cortical thickness. Decalcified minipig bone using EDTA resulted in similar biomechanical properties as osteoporotic human bone with respect to anchor pull-out.

A Transosseous Suture as an Alternative to Suture Anchor on Anterior-Avulsion Greater Tuberosity Fragment Fixation in Neer Three-Part Proximal Humeral Fracture: A Biomechanical Study

OBJECTIVE

Greater tuberosity (GT) fragments were communicated, and additional techniques to increase the GT fragment stability after the locking plate fixation was necessary. This study aimed to analyze the reinforcement effects on the anterior-avulsion GT fragment in Neer three-part proximal humeral fractures (PHFs) using transosseous suture and suture anchor techniques.

METHODS

Eighteen fresh-frozen human cadaveric shoulder specimens were used in the study. Standardized fracture of the GT and surgical neck was created in 18 human cadaveric proximal humerus. The GT fragments were reinforced with transosseous suture (TS), suture anchor (SA), and suture in addition to the PHILOS plate fixation. The fixed humerus was tested by applying static loading to the supraspinatus tendon. Load forces and fragment displacement were evaluated by a biomechanical testing machine, and the load to 3- and 5-mm displacements, load to failure, and mode of failure were recorded for all specimens. Nonparametric variables were examined by the Kruskal-Wallis test, and the Bonferroni post hoc test was used to analyze the mean loads to create 3- and 5-mm displacements as well as the failure load.

RESULTS

The age, female proportion, and bone mineral density showed no statistically significant differences between the three groups. The mean loading force to create 3-mm and 5-mm displacement in the TS group (254.9 ± 77.4, 309.6 ± 152.7) were significantly higher than those in the suture group (136.1 ± 16.7, 193.4 ± 14.5) (P = 0.024, P = 0.005). For the SA group, the force to create 3- and 5-mm displacement (204.3 ± 60.9, 307.8 ± 73.5) were comparable to those in the TS group (P = 0.236, P = 0.983). Moreover, the loading force to failure in the TS group (508.6 ± 217.7) and SA group (406.6 ± 114.9) was significantly higher than that in the suture group (265.9 ± 52.1) (P = 0.021, P = 0.024). In the TS group, three failed due to tendon-bone junction rupture; bone tunnel broken occurred in two specimens; suture rupture could also be seen in one specimen. All specimens in the suture group failed because of suture rupture. In the SA group, three specimens failed due to suture rupture; two failed secondary to tendon-bone junction rupture; and one failed because of shaft fracture.

CONCLUSIONS

Transosseous suture is a new type of reinforcement for GT fragment in Neer-three part PHFs. The transosseous suture was superior to the suture only in the reinforcement of the anterior-avulsion GT fragment of Neer three-part PHFs, and it had comparable biomechanical strength to the suture anchor.

A Simple and Cost-effective Approach to Make a Modified Suture Anchor in Orthopaedics

The purpose of this study is to describe a technique of using an affordable suture anchor for various soft tissue repairs of both upper and lower limb surgeries in our series of patients. Eighteen patients with minimum 1-year follow-up after various upper limb surgeries using modified suture anchor were assessed both clinically and radiographically. In all 18 cases, the purpose of the suture anchor was served in terms of attachment of ligament or the tendon. There was no incidence of breakage of suture material or loosening of the implant seen during the insertion. There were no complications related to the implant noted. This novel technique turns a simple screw and suture material into an efficient suture anchor while saving time, being quick, easy, affordable and repeatable. Level of Evidence: Level V (Therapeutic).

Degradation behavior of ZE21C magnesium alloy suture anchors and their effect on ligament-bone junction repair

Current materials comprising suture anchors used to reconstruct ligament-bone junctions still have limitation in biocompatibility, degradability or mechanical properties. Magnesium alloys are potential bone implant materials, and Mg²⁺ has been shown to promote ligament-bone healing. Here, we used Mg-2 wt.% Zn-0.5 wt.% Y-1 wt.% Nd-0.5 wt.% Zr (ZE21C) alloy and Ti6Al4V (TC4) alloy to prepare suture anchors to reconstruct the patellar ligament-tibia in SD rats. We studied the degradation behavior of the ZE21C suture anchor via in vitro and in vivo experiments and assessed its reparative effect on the ligament-bone junction. In vitro, the ZE21C suture anchor degraded gradually, and calcium and phosphorus products accumulated on its surface during degradation. In vivo, the ZE21C suture anchor could maintain its mechanical integrity within 12 weeks of implantation in rats. The tail of the ZE21C suture anchor in high stress concentration degraded rapidly during the early implantation stage (0-4weeks), while bone healing accelerated the degradation of the anchor head in the late implantation stage (4-12weeks). Radiological, histological, and biomechanical assays indicated that the ZE21C suture anchor promoted bone healing above the suture anchor and fibrocartilaginous interface regeneration in the ligament-bone junction, leading to better biomechanical strength than the TC4 group. Hence, this study provides a basis for further research on the clinical application of degradable magnesium alloy suture anchors.

Application of the suture anchor in the treatment of Hoffa fractures of the lateral femoral condyle

BACKGROUND

To evaluate the feasibility and clinical effect of the suture anchor combined with external fixation in the treatment of the lateral femoral condyle Hoffa fracture.

METHODS

In this study, a retrospective study was conducted to analyze the feasibility of treating fourteen patients (eight men and six women) with Hoffa fractures admitted to our Hospital from January 2016 to October 2021 with combined external fixation using incisional reduction anchor nailing. The age of the patients ranged from 23 to 45 years, with an average of 37.5 years. According to Letenneur's classification, there were eight cases of type I, three cases of type II, and three cases of type III. The functional assessment of Letenneur was used to measure the clinical outcome.

RESULTS

All patients had one-stage wound healing, and all patients were followed up for 12 to 18 months after surgery, and all fractures healed well, with normal knee flexion and extension activities, and no complications such as fracture displacement, anchor nail loosening, or fracture malunion were observed. The clinical outcome was evaluated according to the functional evaluation criteria of Letenneur et al. The clinical outcome of fourteen patients: excellent in thirteen cases and good in one case, with an overall excellent rate of 100%.

CONCLUSIONS

Our study results indicate that the use of anchor nailing combined with external fixation for Hoffa fractures of the femoral condyle has some clinical reference significance because it is less invasive, has fewer complications, does not require secondary removal, and is worthy of clinical application.

TRIAL REGISTRATION

Retrospectively registered.

Original surgical technique for the treatment of patellofemoral instability after failure of conservative treatment

INTRODUCTION

Acute patellar dislocation is a common but serious injury that can significantly impact a patient's functional prognosis. The objective of this retrospective study is to evaluate the clinical outcomes of arthroscopic medial patellofemoral ligament (MPFL) reconstruction and plication of the medial patellar retinaculum using suture anchors in adolescent patients with first-time acute patellar dislocation (APD) and MPFL insertion injury.

HYPOTHESIS

Tightening repair of the medial retinaculum complex can result in favorable clinical and functional outcomes in this patient population.

MATERIALS AND METHODS

A total of 84 adolescent patients with first-time APD and with an average age of 15.5 years (range from 10 to 22 years) were included in the study. Of these patients, 61 (7 male and 54 female) underwent arthroscopic suture anchor plication for medial patellar retinaculum, while the other 23 were successfully treated non-operatively. Radiographic outcomes, including the congruence angle (CA), lateral patellofemoral angle (LPA), and patellar tilt angle (PTA), were evaluated preoperatively and at the last follow-up visit in the surgical group. Functional outcomes were assessed using the Lille Patello-Femoral Score, Lysholm Score, and Kujala Score at the same time points. In addition, the surgical and non-operative treatment success groups were compared in terms of both radiographic and functional outcomes.

RESULTS

Mean follow-up was 40.9 months (24-60 months). 59 knees showed excellent or good results postoperatively, 2 patients had a recurrent patellar subluxation. The Lille Patello-Femoral Score was 96.9±4.7 at the last follow-up. The subjective Lysholm Score and Kujala Score improved significantly, from 58.6 to 91.9 and from 60.4 to 88.9, respectively. The radiographic CA, LPA and PTA improved significantly, from 19.8±2.1° to -6.7±1.7°, from -7.4±2.2° to 5.7±1.8° and from 23.8±2.9° to 12.3±2.3°, respectively. There was no statistically significant difference in functional and radiographic assessments between the success with nonoperative treatment group and the surgery group.

CONCLUSION

The results of this study suggest that arthroscopic MPFL insertion reconstruction and plication using suture anchors, which is less invasive and improves patella stability, can lead to favorable clinical and functional outcomes in adolescent patients with first-time acute patellar dislocation and insertion injury. This treatment approach should be considered as a viable option for this patient population.

LEVEL OF EVIDENCE

IV; monocentric retrospective descriptive study.

No difference in load to failure or stiffness between transosseous tunnels, suture anchors, and cortical buttons for pectoralis major tendon repair: a systematic review & meta-analysis

PURPOSE

Surgical options for pectoralis major tendon tears include primary repair, though there is no consensus as to which constructs are biomechanically superior for repair.

METHODS

A systematic review was performed by searching PubMed, the Cochrane library, and Embase using PRISMA guidelines to identify studies that analyzed the biomechanical properties of bone tunnels (BT), cortical buttons (CB) and suture anchors (SA) techniques for pectoralis major tendon repair. The search phrase implemented was 'pectoralis major tendon repair biomechanics'. Studies that did not evaluate biomechanical outcome data, evaluated partial pectoralis major tendon tears, and non-English articles were excluded. Evaluated outcomes included ultimate load to failure (N) and stiffness (N/mm).

RESULTS

Six studies met inclusion criteria, including a total of 124 cadaveric specimens, for pectoralis major tendon repair comparing BT with SA and CB. Pooled analysis from four studies reporting on ultimate load to failure between BT and SA failed to reveal a difference between BT and SA (p = 0.489). Pooled analysis from two studies reporting on stiffness failed to reveal a difference in favor of BT compared to SA (p = 0.705). Pooled analysis from four studies reporting on ultimate load to failure between BT and CB failed to reveal a difference between BT and CB (p = 0.567). Pooled analysis from two studies reporting on stiffness failed to reveal a difference in favor of BT compared to CB (p = 0.701).

CONCLUSIONS

There was no difference in load to failure or stiffness when using BT, CB, or SA in pectoralis major tendon repairs. This review reveals that clinical outcomes may better inform which fixation construct to implement in pectoralis major tendon repairs.

LEVEL OF EVIDENCE

I.

Tension-band wiring through a single cannulated screw combined with suture anchors to treat inferior pole fracture of the patella

PURPOSE

To evaluate the feasibility and clinical outcomes of tension-band wiring through a single cannulated screw combined with two suture anchors in treating inferior pole fracture of the patella.

METHODS

Between September 2018 and September 2021, a total of 22 patients with a mean age of 55 years who sustained inferior pole fracture of the patella and were treated by tension-band wiring through a single cannulated screw combined with two suture anchors were enrolled. X-ray radiographs were performed to observe the bone union time. The duration of each operation was recorded to reflect the complexity of surgical treatment. Functional measurements, comprising range of motion (ROM), the Böstman scale, and the Knee Injury and Osteoarthritis Outcome Score (KOOS), were taken. Postoperative complications including fixation failure, incision infection, loss of reduction, and malunion were evaluated.

RESULTS

All patients were followed up for an average of 17 months (range: 12-25 months). The average clinical bone union time was 8 weeks (range: 6-12 weeks), and the radiographic bone union time was 11 weeks (range: 8-12 weeks). At the final follow-up, the mean ROM was 136° (range: 115°-140°), the KOOS was 85 (range: 68-100) and the Böstman score was 28 (range: 20-30); these outcomes were classified as excellent in 17 cases and good in 5 cases, with no instances of poor results. Loss of reduction occurred in one case, while no cases of incision infection, fixation failure or malunion were observed.

CONCLUSION

For inferior pole fracture of the patella, tension-band wiring through a single cannulated screw combined with suture anchors can offer sufficient fixation stability to achieve a satisfactory clinical outcome with reduced operational complexity; this procedure should be recommended in clinical practice.

Arthroscopic double-row bridge fixation provided satisfactory shoulder functional restoration with high union rate for acute anterior glenoid fracture

PURPOSE

To introduce a novel surgical technique for arthroscopic reduction and double-row bridge fixation using trans-subscapularis tendon portal for anterior glenoid fracture and to evaluate the clinical and radiological outcomes.

METHODS

A total of 22 patients who underwent arthroscopic reduction and double-row bridge fixation for an acute anterior glenoid fracture were retrospectively evaluated. Arthroscopic surgery was performed using four portals including a trans-subscapularis tendon portal. All patients underwent 3D-CT preoperatively and one day and one year postoperatively to evaluate the fracture fragment size, reduction status, and presence of fracture union. To evaluate the degree of fragment displacement, articular step-off and medial fracture gap were measured using 3D-CT. Clinical outcomes were assessed based on the ASES and Constant scores. Postoperative glenohumeral joint arthritis was evaluated using plain radiographs with the Samilson and Prieto classification.

RESULTS

The average preoperative fracture fragment size was 25.9 ± 5.6%. Articular step-off (preoperative: 6.0 ± 3.3 mm, postoperative one day: 1.1 ± 1.6 mm, P < 0.001) and medial fracture gap (preoperative: 5.2 ± 2.6 mm, postoperative one day: 1.9 ± 2.3 mm, P < 0.001) were improved after surgery. On the postoperative one year 3D-CT, 20 patients achieved complete fracture union, and two patients showed partial union. Postoperative glenohumeral joint arthritis was observed in four patients. At the last visit, the ASES score was 91.8 ± 7.0 and the Constant score was 91.6 ± 7.0.

CONCLUSION

Arthroscopic reduction and double-row bridge fixation using a trans-subscapularis tendon portal for acute anterior glenoid fracture achieved satisfactory clinical outcomes and anatomical reduction as demonstrated by a low degree of articular step-off and medial fracture gap.

LEVEL OF EVIDENCE

Level IV.

Arthroscopic Bankart repair: how many knotless anchors do we need for anatomic reconstruction of the shoulder?-a prospective randomized controlled study

PURPOSE

The optimal strategy for surgical repair of traumatic anterior shoulder instability remains controversial. While several study groups have reported that the clinical and radiological outcomes of arthroscopic procedures performed with two anchors are not fully adequate, these conclusions are not supported by the findings published in other studies. A prospective randomized study was conducted to compare the structural and clinical outcomes of surgical procedures involving two vs. three anchors.

METHODS

Patients who underwent arthroscopic Bankart repair were randomly assigned to either Group I, which underwent procedures involving two double-loaded 3.5-mm knotless anchors, or Group II, which underwent procedures involving three single-loaded 2.9-mm knotless anchors. All patients underwent bilateral MRI assessments at a minimum of 12 months and clinical assessment at a minimum of 24 months postoperatively. To evaluate the reconstruction of the labral capsular ligamentous complex (LCLC), the labrum-glenoid height index (LGHI), restored labral height (LH), and labral slope (LS) were measured for both shoulders. For clinical assessment, the redislocation rate and functional outcome scores (Constant score (CS), American Shoulder and Elbow Surgeon score (ASES), Walch Duplay score (WDS), and Rowe score (RS)) were evaluated at follow-up visits.

RESULTS

Bankart repair with two knotless anchors showed lower values for anterior reconstruction of the LCLC compared to the uninjured contralateral shoulder. Likewise, significant differences were noted when comparing these measurements to those from patients who underwent reconstruction with three anchors. No differences were demonstrated with regard to the reconstruction of the inferior LCLC. Clinical assessment showed good to excellent results in both groups. In total, three patients experienced redislocation of the shoulder: two in group I and one in group II. No significant differences were found with respect to clinical outcomes and redislocation rates.

CONCLUSION

Bankart repair with both two and three knotless anchors results in effective anatomical reconstruction of the labral capsular ligamentous complex. Although the two-anchor technique yields significantly lower values for the anterior portion compared with the contralateral side, none of these differences reach clinical relevance as per our original definition.

Comparison of suture-bridge and independent double-row techniques for medium to massive posterosuperior cuff tears: a two-year retrospective study

BACKGROUND

Transosseous-equivalent suture-bridge (TOE-SB) and independent double-row (IDR) repair techniques were developed to treat rotator cuff tears. The study was designed to prove that both TOE-SB and IDR techniques provided comparable clinical results and retear rate for medium to massive posterosuperior rotator cuff tears, while the surgical time and number of suture anchor used were less in the IDR group.

STUDY DESIGN

Level of evidence: level III, Retrospective comparative study.

METHODS

Patients with medium to massive posterosuperior rotator cuff tears receiving arthroscopic TOE-SB and IDR between November 2016 to October 2019 were retrospectively enrolled. All patients were confirmed to have grade ≤ 2 fatty infiltration in the muscles of the torn tendons. Revision, concomitant subscapularis tear, acromiohumeral distance < 7 mm, glenohumeral osteoarthritis, partial repair, incomplete repair, partial thickness, or irreparable posterosuperior cuff tear were excluded. Surgical time, number of suture anchor used for the surgery, pre-operative, and post-operative clinical scores such as Constant-Murley score, subjective shoulder value (SSV), and visual analog scale (VAS) were compared. The retear rates between groups were evaluated by ultrasound.

RESULTS

Thirty-five IDR and thirty-five TOE-SB repairs were enrolled. The IDR technique required much fewer anchors than TOE-SB did to complete the cuff repair. The mean operation time in IDR and TOE-SB group were 86(18.23), and 114(18.7) (min), respectively (P <  0.01). The mean number of anchors used to complete the cuff repair was 2(0.17) in IDR and 3(0.61) in TOE-SB (P <  0.01). The Constant-Murley score improved from 34.9 ± 6.6 to 80.6 ± 9.4 in the IDR group, and 37.4 ± 6 to 81.9 ± 4.6 in the TOE-SB group (both P <  0.001). SSV improved from 24.6 ± 9.6 to 79.3 ± 10.6 in the IDR, and 27.9 ± 9 to 82.9 ± 6.9 in the TOE-SB group (both P <  0.001). VAS improved from 7.9 ± 0.6 to 1.5 ± 0.7 in the IDR, and 8 ± 0.5 to 1.3 ± 0.6 in the TOE-SB group (both P <  0.001) at final follow-up. No significant difference was found between the retear rates (14.3% in the IDR vs. 17.1% in the TOE-SB, respectively) in the 2-year follow-up.

CONCLUSIONS

Both IDR and TOE-SB group provided comparable clinical results and retear rates for medium to massive posterosuperior rotator cuff tears. The surgical time and number of anchors used were less in the IDR group than in the TOE-SB group.

One double-loaded suture anchor is sufficient for all-inside arthroscopic anterior talofibular ligament repair

PURPOSE

All-inside anterior talofibular ligament (ATFL) repair using anchors is frequently used to manage chronic lateral ankle instability (CLAI) with satisfactory functional outcomes. It remains unclear whether there are differences in the functional results between the use of one or two double-loaded anchors.

METHODS

This retrospective cohort study included 59 CLAI patients who underwent an all-inside arthroscopic ATFL repair procedure from 2017 to 2019. Patients were divided into two groups according to the number of anchors used. In the one-anchor group (n = 32), the ATFL was repaired with one double-loaded suture anchor. In the two-anchors group (n = 27), the ATFL was repaired with two double-loaded suture anchors. At the last follow-up time point, the Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Function Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports in both groups were compared.

RESULTS

All the patients were followed up for at least 24 months. Improvement in the functional results (VAS, AOFAS, KAFS, ATT, and AJPS) were recorded at the final follow-up time point. No significant differences were observed regarding VAS, AOFAS, KAFS, ATT, and AJPS between the two groups.

CONCLUSION

In patients with CLAI undergoing all-inside arthroscopic ATFL repair, the use of either one or two double-loaded suture anchors produces comparable and predictably good functional outcomes.

LEVEL OF EVIDENCE

Level III.

Treatment of Hoffa fracture of femoral condyle with anchor combined with auxiliary fixation

BACKGROUND

A Hoffa fracture is an unstable intra-articular break that is generally treated with surgery.

OBJECTIVE

To evaluate the feasibility and clinical outcomes of using a suture anchor combined with auxiliary fixation for the treatment of a lateral femoral condyle Hoffa fracture.

METHODS

The study retrospectively reviewed 8 patients (5 males and 3 females) with a lateral femoral condyle Hoffa fracture who had been treated by combining a suture anchor with auxiliary fixation between January 2016 and April 2020. The mean age of patients was 37.5 years (ranging from 23 to 45). According to Letenneur's classification, there were 4 cases of type I, 2 cases of type II, and 2 cases of type III fractures. The clinical outcomes were assessed using Letenneur's functional assessment.

RESULTS

The follow-up duration ranged between 14-24 months. All patients achieved primary healing of the incision and fracture union, as well as normal flexion and extension of the knee joint, with 7 cases showing excellent outcomes and 1 case showing a good outcome. No postoperative complications, such as fracture displacement, anchor loosening, or fracture malunion, occurred in this series.

CONCLUSION

Our results indicated that a suture anchor, combined with external fixation, was an effective treatment for a lateral femoral condyle Hoffa fracture. Accordingly, this procedure is worthy of wider clinical application.

The lasso-loop technique is equivalent to the simple suture technique in arthroscopic anterior talofibular ligament repair

PURPOSE

To compare the clinical outcomes of the lasso-loop and simple suture techniques in arthroscopic anterior talofibular ligament (ATFL) repair for the treatment of chronic lateral ankle instability (CLAI).

METHODS

From 2018 to 2020, patients with CLAI who underwent arthroscopic ATFL repair using the lasso-loop or simple suture technique were matched 1:1 (arthroscopic lasso-loop [AL] group, n = 29; simple arthroscopic suture [AS] group, n = 29) based on age, sex, affected side, body mass index, and follow-up duration using propensity score matching and retrospectively evaluated. Karlsson score, visual analogue scale (VAS) score, Tegner score, anterior drawer test (ADT) results, complications, patient-reported satisfaction, and magnetic resonance (MR) re-evaluation findings of ATFL quality were used to describe the outcomes.

RESULTS

The patient characteristics or follow-up durations did not significantly differ between the two groups. The Karlsson score, VAS score, and Tegner score improved significantly in both groups after a mean follow-up duration of 29.6 ± 2.8 months. The postoperative clinical scores, ADT results, satisfaction rates, complication rates and MR re-evaluation findings were not significantly different between the two groups at the latest follow-up.

CONCLUSION

The lasso-loop technique was equivalent to the simple suture technique in arthroscopic ATFL repair for the treatment of CLAI after a minimum follow-up of 2 years, suggesting that the simple suture technique is sufficient for arthroscopic ATFL repair in most patients without the need to add a lasso loop.

LEVEL OF EVIDENCE

Level III.

Transosseous suture versus suture anchor fixation for inferior pole fractures of the patella in osteoporotic bone: a biomechanical study

BACKGROUND

The surgical treatment of inferior patellar pole fractures can be a challenge, especially in geriatric patients, who are particularly frequently affected by osteoporosis. The objective of this biomechanical study was to compare the performance of suture anchor and transosseous suture fixation in fractures of the inferior patellar pole in context of bone mineral density.

METHODS

Twelve fresh-frozen human cadaveric knees received a transverse osteotomy, simulating an AO/OTA 34C1.3 inferior pole fracture of the patella. These fractures were fixated with either suture anchors (SA; Corkscrew^® FT 4.5 mm) or transosseous suture (TS; #2 FiberWire^®). Cyclic loading tests were performed by pulling the quadriceps tendon against gravity from 90° flexion to almost full extension (5°) for 1000 cycles. Motion and fracture gap displacement were tracked until failure occurred. Subsequently, loading to failure tests followed. Differences between groups were compared using unpaired t-tests, and correlations were calculated with Pearson's correlation coefficient.

RESULTS

The suture anchor group showed significantly fewer cycles to failure than the transosseous suture group (SA: 539.0 ± 465.6 cycles, TS: 1000 ± 0 cycles, P = 0.04). Bone mineral density correlated positively with cycles to failure in the suture anchor group (Pearson's r = 0.60, P = 0.02). No differences in fracture gap displacement could be proven after 100 cycles (SA: 4.1 ± 2.6 mm, TS: 6.5 ± 2.6 mm, P = 0.19); 500 cycles (SA: 6.4 ± 6.1 mm, TS: 9.6 ± 3.8 mm, P = 0.39); and 1000 cycles (SA: 4.0 ± 0.4 mm, TS: 11.0 ± 4.5 mm, P = 0.08). Furthermore, the mean destructive load to failure in the suture anchor group was also significantly lower than in the transosseous suture group (SA: 422.4 ± 212.2 N, TS: 825.7 ± 189.3 N, P = 0.04).

CONCLUSIONS

Suture anchors may be a viable alternative to transosseous suture in younger patients for clinical advantages, but in osteoporotic bone, the more stable osteosynthesis with transosseous suture continues to prove superior. Therefore, trauma surgeons might consider the use of transosseous suture in elderly patients, especially in those presenting with low bone mineral density values.

Outcome Following Acute Suture Anchor Repair of the Ulnar Collateral Ligament of the Thumb

Background: The aim of this study was to evaluate the outcomes following acute repair of the ulnar collateral ligament of the thumb metacarpophalangeal joint (thumb UCL) using a suture anchor technique. Methods: From 2011 to 2019, we retrospectively identified 40 adult patients from a single centre who had undergone an acute thumb UCL repair (≤6 weeks post-injury). The mean age of the study cohort was 37 years (range 16-70) and 68% (n = 27/40) were male. The short-term outcomes included postoperative complications and failure of repair. The long-term outcomes were QuickDASH, the EuroQol 5-Dimension (EQ-5D), Visual Analogue Scale (EQ-VAS), return to sport and work and satisfaction with outcome. Results: The outcomes survey was completed at a mean of 4.3 years (range 1.0-9.2) for 33 patients (83%). Postoperative complications included self-limiting sensory disturbance (7.5%, n = 3/40), superficial infection (requiring oral antibiotics; 5%, n = 2/40) and wound dehiscence (requiring surgical debridement and re-closure; 2.5%, n = 1/40). No failures of repair were reported. The mean QuickDASH was 3.7 (range 0-27.3), EQ-5D 0.821 (range -0.041 to 1) and EQ-VAS 84 (range 60-100). Of the 32 employed patients, all returned to work at a median of 0.5 weeks (range 0-416) and the mean QuickDASH Work Module was 4.1 (range 0-50). Of the 24 patients playing sport prior to injury, 96% (n = 23/24) returned at a median of 16 weeks (range 5-52) and the mean QuickDASH Sport Module was 4.6 (range 0-25). All the patients were satisfied with their outcome (mean satisfaction score 9.8/10 [8-10O]). Conclusions: Thumb UCL repair using a suture anchor technique is safe and effective up to 6 weeks post injury. Pain and stiffness may persist in the longer term, but most patients report excellent upper limb function and health-related quality of life. The majority return to work and sport and are highly satisfied with their outcome. Level of Evidence: Level IV (Therapeutic).

All-suture anchors for distal biceps tendon repair: a preliminary outcome study

INTRODUCTION

The aim of this study was to retrospectively evaluate the clinical outcome of double intramedullary all-suture anchors' fixation for distal biceps tendon ruptures.

MATERIALS AND METHODS

A retrospective case series of patients who underwent primary distal biceps tendon repair with all-suture anchors was conducted. Functional outcome was assessed at a minimum follow-up of at 12 months based on the assessments of the Mayo Elbow Performance Score (MEPS), Andrews-Carson Score (ACS), Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), and the Visual Analog Scale (VAS) for pain. Maximum isometric strength test for flexion and supination as well as postoperative range of motion (ROM) were determined for both arms.

RESULTS

23 patients treated with all-suture anchors were assessed at follow-up survey (mean age 56.5 ± 11.4 years, 96% male). The follow-up time was 20 months (range Q_0.25-Q_0.75, 15-23 months). The following outcome results were obtained: MEPS 100 (range Q_0.25-Q_0.75, 100-100); ACS 200 (range Q_0.25-Q_0.75, 195-200); QuickDASH 31 (range Q_0.25-Q_0.75, 30-31); VAS 0 (range Q_0.25-Q_0.75, 0-0). The mean strength compared to the uninjured side was 95.6% (range Q_0.25-Q_0.75, 80.9-104%) for flexion and 91.8 ± 11.6% for supination. There was no significant difference in ROM or strength compared to the uninjured side and no complications were observed in any patient.

CONCLUSION

Distal biceps tendon refixation using all-suture anchors provides good-to-excellent results in terms of patient-reported and functional outcome. This repair technique appears to be a viable surgical option, although further long-term results are needed.

LEVEL OF EVIDENCE

Level IV (case series).

Complications after traumatic distal triceps tears: an analysis of 107 cases

Background

The major complication and reoperation rates after distal triceps repair are poorly defined. The purpose of this large retrospective cohort study of distal triceps repairs performed by multiple surgeons within a large orthopedic group was to more clearly define the rates and risk factors of clinically impactful major complications and reoperations.

Methods

All distal triceps tendon repairs for traumatic injuries performed from January 2006 to April 2017 with a minimum 2-month follow-up were identified using the Current Procedural Terminology code 24342. A total of 107 patients were included in this study. The primary outcome measure was total major complication rate. Reoperations, minor complications, and risk factors were also tracked.

Results

Repairs were performed via bone tunnels (63.5%), suture anchors (13%), or a combination of the two (17.8%). A 14% complication rate and 13.1% reoperation rate were observed. Indication for reoperation included 9 reruptures, 3 infections, and 2 others. The time between injury and surgery was not found to be a risk factor for tendon rerupture. Smoking status, gender, utilization of a splint or controlled motion brace, and time to first active mobilization were not shown to influence rates or rerupture.

Conclusion

Distal triceps repair for traumatic injuries is associated with 14% complication and 13.1% reoperation rates. Patient, rehabilitation, and surgeon-specific factors did not influence the complication rate.

Augmentation in the repair of traumatic patellar tendon ruptures. A novel mechanical and biological construct: Technical note

Patellar tendon ruptures are infrequent and potentially disabling injuries. These injuries are usually repaired with transosseous suture tunnels. However, this technique can produce a significant gap formation and prolonged postoperative immobilization. Although several techniques have been described to improve the integrity of the repair, the surgical technique of choice is a matter of debate especially when there is tissue loss due to high-energy trauma. This study aims to evaluate the clinical outcomes of patients with acute patellar tendon ruptures due to high-energy trauma treated with a novel construct configuration that includes a suture anchor and a figure-of-eight augmentation with hamstring autograft with medial and lateral reinforcement. To determine the clinical outcomes the International Knee Documentation Committee (IKDC) score was obtained pre-surgery and at 12 months of follow-up. A total of six patients were recruited, with a median age of 27.5 years, five of these were male. Three lesions were in the proximal pole of the tendon, two were mid-substance and one was in the junction with tibial tuberosity. The IKDC clinical score significantly increased from pre-surgery to the 12-month follow-up with a median difference of 32.8 (95% CI, 19.5-42.6, p = 0.0313). Likewise, the patients presented a post-surgery quadriceps strength level with a median of 5/5. All patients had full active knee extension with a median of 0-120°. There was no statistical difference in the range of motion comparing the surgical knee to the contralateral knee (p = 0.6883). No patient presented any type of reintervention or complication during the follow-up period. The configuration of the construct presented in the technique had not been reported before in the literature and combines the advantages of the use of suture anchors and biological augmentation with lateral and medial reinforcement. This technique may be useful in patients with traumatic injuries with and without loss of tissue. Although it is a small series with concomitant injuries, satisfactory clinical results were presented during follow-up.

Managing acute acromioclavicular joint dislocation during COVID 19 pandemic by minimally invasive technique with suture anchor and miniplate: A pilot study

Background

Acromioclavicular (AC) joint dislocation is common in sportsmen and physically active population. Its management depends upon the grade of injury and functional demands of the patient. A variety of surgical procedures have been described with different limitations and advantages. The present study has assessed the clinical and radiological outcome of acute AC joint dislocation managed with a 3.5 mm Titanium suture anchor and 2 mm miniplate construct which requires lesser dissection, surgical time and thus contact with the patient as mandated by COVID-19 pandemic.

Methods

We enrolled 10 patients of Rockwood type-III, IV and V acute AC joint injury (<3 weeks old) reporting at this hospital from Feb 2020 to May 2021. All were tested for COVID-19 using reverse transcriptase polymer chain reaction test (RTPCR) and managed by closed/open reduction and fixation with a 3.5 mm Titanium Suture Anchor and a 2 mm Titanium miniplate construct. Follow-up was done at 3, 6 and 9 month post-operatively.

Results

The average age of patients was 31 yrs. RTPCR test for COVID-19 was negative in all patients. Median surgical time was 25 min (Interquartile Range[IQR] = 16-34 min) and median follow-up duration was 36 weeks (IQR = 33-39 weeks). Median visual analogue scale score and IQR at pre-operative, 3 month, 6 month and 9 month follow-up was 7(IQR = 6-8), 3.5(IQR = 2.5-4.5), 2(IQR = 0) and 1(IQR = 0), respectively. Median constant score at pre-operative, 3 month, 6 month and 9 month follow-up were 34(IQR = 25-43), 65.5(IQR = 60.5-70.5), 82.5(IQR = 77.5-87.5) and 88(IQR = 81-95). There was significant improvement in clinical status (non parametric-Friedman test p < 0.001). Radiographs showed no loss of reduction, fracture or implant failure till last follow-up.

Conclusions

Minimally invasive technique with a 3.5 mm Ti-suture anchor and 2 mm plate is an easy, fast and reliable construct for the management of acute AC dislocation in physically active population.

Open reduction and tunneled suspensory fixation for lateral end of clavicle fractures: surgical technique

Unstable distal end clavicle fractures are associated with significant rates of nonunion and poor functional outcomes. Surgical treatment is paramount for unstable fracture patterns; however, treatment options are various, with each having its advantages and drawbacks. Recently, suture-based coracoclavicular fixation techniques using suture buttons have been implemented with high union rates, satisfactory shoulder function, and low rates of complications. In this report, we demonstrate a modified fixation of unstable lateral clavicle fractures. Our technique entails open reduction and suspensory coracoclavicular fixation using suture anchors and suture button devices with supplemental acromioclavicular suspensory fixation.

Acute patellar tendon rupture with tibial tubercle avulsion repair using suture anchors: Tiny avulsed fragment which affects the strength of construction-a case report

INTRODUCTION AND IMPORTANCE

Patellar tendon is one of the most important components of the knee extensor mechanism, which consisted of quadriceps femoris muscle, quadriceps tendon, patellar bone and patellar tendon. The total disruption of patellar tendon will lead to disability and significant morbidity of the patient, or even worse, the patient is disabled to walk. The incidence of patellar tendon rupture is uncommon and most commonly found in the third to fourth decade of life. We present a case of total patellar tendon rupture in a teenager with primary repair with suture anchor.

CASE PRESENTATION

We presented a case of 14-year-old male with acute patellar tendon rupture accompanied by tibial tubercle avulsion after injury during basketball game. We treated by four-strands Krakow's suture that stitched to three sutures anchor, while cancellous screw plus washer introduced as internal fixation of bony avulsion at tibial tubercle.

CLINICAL DISCUSSION

Range of motion and International Knee Documentation Committee (IKDC) score had been followed up within 2 years with good result. Full range of motion and the IKDC score 89.7 were achieved without major complication such as pain and infection. The patient was able to return into sport activities.

CONCLUSION

The combination of cancellous screw with washer and three suture anchors lead to a good result in acute total rupture of patellar tendon with bony avulsion at tibial tubercle.

Biomechanical properties of a suture anchor system from human allogenic mineralized cortical bone matrix for rotator cuff repair

Background

Suture anchors (SAs) made of human allogenic mineralized cortical bone matrix are among the newest developments in orthopaedic and trauma surgery. Biomechanical properties of an allogenic mineralized suture anchor (AMSA) are not investigated until now. The primary objective was the biomechanical investigation of AMSA and comparing it to a metallic suture anchor (MSA) and a bioabsorbable suture anchor (BSA) placed at the greater tuberosity of the humeral head of cadaver humeri. Additionally, we assessed the biomechanical properties of the SAs with bone microarchitecture parameters.

Methods

First, bone microarchitecture of 12 fresh frozen human cadaver humeri from six donors was analyzed by high-resolution peripheral quantitative computed tomography. In total, 18 AMSAs, 9 MSAs, and 9 BSAs were implanted at a 60° angle. All three SA systems were systematically implanted alternating in three positions within the greater tuberosity (position 1: anterior, position 2: central, position 3: posterior) with a distance of 15 mm to each other. Biomechanical load to failure was measured in a uniaxial direction at 135°.

Results

Mean age of all specimens was 53.6 ± 9.1 years. For all bone microarchitecture measurements, linear regression slope estimates were negative which implies decreasing values with increasing age of specimens. Positioning of all three SA systems at the greater tuberosity was equally distributed (p = 0.827). Mean load to failure rates were higher for AMSA compared to MSA and BSA without reaching statistical significance between the groups (p = 0.427). Anchor displacement was comparable for all three SA systems, while there were significant differences regarding failure mode between all three SA systems (p < 0.001). Maximum load to failure was reached in all cases for AMSA, in 44.4% for MSA, and in 55.6% for BSA. Suture tear was observed in 55.6% for MSA and in 22.2% for BSA. Anchor breakage was solely seen for BSA (22.2%). No correlations were observed between bone microarchitecture parameters and load to failure rates of all three suture anchor systems.

Conclusions

The AMSA showed promising biomechanical properties for initial fixation strength for RCR. Since reduced BMD is an important issue for patients with chronic rotator cuff lesions, the AMSA is an interesting alternative to MSA and BSA. Also, the AMSA could improve healing of the enthesis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05371-0.

Knotless PEEK and double-loaded biodegradable suture anchors ensure comparable clinical outcomes in the arthroscopic treatment of traumatic anterior shoulder instability: a prospective randomized study

PURPOSE

To compare the clinical outcome of arthroscopic capsulolabral repair for traumatic anterior shoulder instability with PEEK knotless and knotted biodegradable suture anchors.

METHODS

Arthroscopic stabilization was performed in 78 patients with recurrent traumatic anterior shoulder instability. They were divided into 2 groups of 39 patients each, according to suture anchors used: knotless PEEK anchors in group 1, and biodegradable anchors in group 2. Exclusion criteria were: instability without dislocation, posterior or multidirectional instability, glenoid bone loss > 20%, off-track lesions, concomitant rotator cuff tears and previous surgery. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) self-administered questionnaire. Secondary outcomes were: Work-DASH, Sport-DASH, Rowe score, recurrent instability and subsequent surgery. The following independent variables were considered: age, gender, dominance, generalized ligamentous hyperlaxity, duration of symptoms, age at first dislocation, number of dislocations, type of work, type of sport, sports activity level, capsule-labral injury pattern, SLAP lesion and number of anchors. Differences between groups for numerical variables were analyzed by use of the Student's t-test or Mann-Whitney U-test. Fisher's exact test was used for analysis of categorical variables. Significance was set at p < 0.05.

RESULTS

Seven patients (9%) were lost at follow-up, 5 from group 1 and 2 from group 2. Follow-up ranged from 36 to 60 months (median: 44; IQR: 13). Comparison between groups did not show significant differences for each independent variable considered. No differences could be found either for DASH (n.s.) or Rowe (p = n.s.) scores between the two groups. Overall recurrence rate was 7%. Three re-dislocations were reported in group 1 and two in group 2 (n.s.). Only one patient in each group underwent re-operation.

CONCLUSIONS

The study showed no significant differences in clinical outcomes after arthroscopic treatment of traumatic anterior shoulder instability using PEEK knotless or biodegradable knotted anchors at mid-term follow-up.

LEVEL OF EVIDENCE

I.

Fixation of Transverse Olecranon Fractures by Suture Bridge Method Using Suture Anchor: Biomechanical Comparison with Tension Band Wiring Technique

Background: Olecranon fractures are common in motorcycle accidents, falls, or in direct elbow injury. In cases of transverse olecranon fracture, surgery is frequently required in adults. The aim of this study is to compare the biomechanical durability of suture anchor fixation in olecranon fractures to conventional tension band wiring technique in saw bones. Methods: 12 plastic saw bones were divided into 3 groups: tension band wiring fixation, modified Cha-Batman method, and a modified simple suture method using a suture anchor. After fixation, cyclic load tests were conducted for 1,000 cycles, at 5 Hz with a force of 10 N to 250 N. After cycling loading, the extent of displacement was measured using a non-contact coordinate measuring instrument, and statistical analysis performed. Results: The average displacement was significantly smaller in the modified Cha-Bateman method (1.4 mm) than in the tension band wiring method (3.8 mm, p = 0.007) and the modified simple suture method using suture anchor (3.3 mm, p = 0.012). There was no significant difference in displacement between tension band wiring fixation and the modified simple suture method (p = 0.564). Conclusions: This study provides a biomechanical basis for the hypothesis that the suture anchor technique in weak bone model could obtain results comparable to those of conventional tension band wiring. In particular, the modified Cha-Bateman method, showed stronger biomechanical properties than the tension band wiring method and modified simple suture method using a suture anchor. The current study could also provide pilot data that can be used in future experiments.

A novel technique of pulley creation for additional sagittal band reconstruction

Because surgical treatment of chronic extensor tendon dislocation with sagittal band injury is complex and often requires donor grafts, we suggest a new technique: pulley creation for additional sagittal band reconstruction. A 76-year-old man diagnosed with chronic extensor tendon dislocation with radial sagittal band injury was treated by resecting the distended portion of the radial sagittal band, followed by plication. Using the remnant tissue obtained after resection, additional sagittal band reconstruction was performed using two mini soft suture anchors in the form of a pulley surrounding the extensor tendon. Three-year outcome was satisfactory. Pulley creation for additional sagittal band reconstruction with direct repair of the radial sagittal band is a new surgical option for chronic extensor tendon dislocation. The technique is quick and easy, with good patient satisfaction and no donor site complications.

Biomaterials Used for Suture Anchors in Orthopedic Surgery

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.

Modified mini-incision "internal splinting" versus percutaneous repair technique of acute Achilles tendon rupture: five year retrospective case-controlled study

PURPOSE

Several kinds of minimally invasive surgical techniques are applied to acute Achilles tendon rupture. The risks of sural never injury and re-ruptures are still major issues. The purpose of this study was to compare the middle-term results of two different minimally invasive repair techniques for acute Achille tendon rupture.

METHODS

Twenty-four cases underwent the modified mini-incision "internal splinting" repair technique in group A, and 29 cases underwent a percutaneous repair technique in group B and were evaluated. The intra-operative data, complications, the time of recovery, and the post-operative magnetic resonance imaging were analyzed. At the final follow-up, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Thermann score were evaluated.

RESULTS

The mean follow-up time was 59.96 ± 4.16 months (range 48-67). At the final follow-up, the AOFAS score and Thermann score in both groups had similar feedback. No nerve injury, infection, or re-rupture was encountered in group A, except two cases with anchor irritation. One case with sural nerve injury and one with a re-rupture were recorded in group B, respectively. The final MRI showed thicker regeneration of the tendon in both groups.

CONCLUSIONS

The middle-term results indicated the modified mini-incision "internal splinting" technique for acute Achilles tendon rupture is similar to the percutaneous repair technique. A lower risk of sural nerve injury and re-rupture may be advantages.

Metastasis of renal cell carcinoma around suture anchor implants

We present an unusual case of bone metastases from renal cell carcinoma around orthopedic implants in a 78-year-old female with osteolytic, expansile, highly vascularized, malignant infiltration around suture anchors in the proximal humerus. The patient had undergone arthroscopic rotator cuff repair using suture anchor implants 6 years previously. After diagnosis of bone metastasis, she was successfully treated with metastasectomy and internal fixation using a plate and screws, with cement augmentation. This report is the first to document metastases around a suture anchor in a bone and suggests the vulnerability of suture anchor implants to tumor metastasis.

Anatomic Repair of the Central Slip with Anchor Suture Augmentation for Treatment of Established Boutonniere Deformity

Backgroud

The rupture of the central slip of an extensor tendon of a finger causes a boutonniere (or buttonhole) deformity, characterized by pathologic flexion at the proximal interphalangeal (PIP) joint and hyperextension at the distal interphalangeal (DIP) joint. Currently, there are no standard treatment guidelines for this deformity. This study aimed to report clinical results of surgery to correct chronic boutonniere deformity.

Methods

This retrospective case series was conducted between January 2010 and December 2018 and only 13 patients with trauma-induced chronic deformity were included. After excision of elongated scar tissue, a direct anatomic end-to-end repair using a loop suture technique with supplemental suture anchor augmentation was conducted. Total active motion was assessed before and after surgery and self-satisfaction scores were collected from phone surveys.

Results

All patients presented with Burton stage I deformities defined as supple and passively correctable joints. The initial mean extension lag of the PIP joint (43.5°) was improved by an average of 21.9° at the final follow-up (p < 0.001). The mean hyperextension of the DIP joint averaged 19.2° and improved by 0.8° flexion contracture (p < 0.001). The average total active motion was 220.4° (range, 160°–260°). Based on the Souter's criteria, 69.2% (9/13) of the patients had good results. Only 1 patient reported fair outcome and 23.1% (3/13) reported poor outcome. The average Strickland formula score was 70 (range, 28.6–97.1). In total, 10 patients (77%) had excellent or good results. Of 10 patients contacted by phone, self-reported satisfaction score was very satisfied in 2, satisfied in 3, average in 3, poor in 1, and very poor in 1. Three patients reported a relapse of the deformity during range of motion exercises, 1 of whom underwent revision surgery. One patient complained of PIP joint flexion limitation, and 2 complained of DIP joint flexion limitation at final follow-up.

Conclusions

In chronic boutonniere deformity, central slip reconstruction with anchor suture augmentation can be an easily applicable surgical option, which offers fair to excellent outcome in 77% of the cases. The risk of residual extension lag and recurrence of deformity should be discussed prior to surgery.

Outcomes following quadriceps tendon repair using transosseous tunnels versus suture anchors: A systematic review

INTRODUCTION

Two major techniques are used to repair complete quadriceps tendon ruptures, transosseous tunnel (TT) and the suture anchor (SA). There are multiple studies comparing the biomechanical outcomes of repairs performed with TT or SA. Our purpose was to compare the clinical outcomes following quadriceps tendon repair using SA and TT fixation techniques.

METHODS

Three major search engines were used with predetermined keyword searches to perform a systematic review of literature. These studies were independently scanned by two reviewers using PRISMA criterion. All included studies had to include at least one of the following outcome measures: range of motion (ROM), Lysholm score, complications, and/or re-ruptures.

RESULTS

Using three major search engines, 1039 articles were identified. After removing duplicates and screening for inclusion, 49 articles were reviewed. Two independent reviewers searched the studies to meet the inclusion criteria, and eight studies were selected. These eight studies included 156 knees in the TT group and 54 knees in the SA group. The TT group had a significantly better ROM after QT repair (132.5° versus 127.0°, p = 0.02). There was no significant difference in Lysholm scores between the TT group (92.6) and SA group (91.0, p = 0.11). There were significantly more complications in SA groups (9.3% versus 1.3%, p = 0.013), but not a significant difference in re-rupture rate between those undergoing SA vs. TT repair (3.7% versus 0%, p = 0.065). The SA group had a significantly higher age at time of surgery (63.62 vs. 54.32) CONCLUSION: The current study suggests that, following quadriceps tendon rupture, there are no significant differences in functional outcome between TT and SA techniques. Those undergoing TT repair attained a statistically significantly greater final ROM but this difference may not be clinically relevant. There was a statistically significantly higher rate of post-operative complications using SA technique.

All-suture anchor pullout results in decreased bone damage and depends on cortical thickness

PURPOSE

To evaluate the influence of cortical and cancellous bone structure on the biomechanical properties of all-suture and conventional anchors and compare the morphological bone damage after their failure. The hypothesis of the study is that all-suture anchor pullout is less invasive and that the pullout force is influenced by the cortical thickness.

METHODS

Thirty human humeri were biomechanically tested as follows: starting with a load cycle from 20 to 50 N, a stepwise increase of the upper peak force by 0.05 N for each cycle at a rate of 1 Hz was performed. Analysis included maximum pullout strength for three different anchor implantation angles (45°, 90°, 110°) of the two anchor types. After anchor pullout, every sample underwent micro-CT analysis. Bone mineral density (BMD) and cortical thickness were determined at the anchor implantation site. Furthermore, the diameter of the cortical defect and the volume of the bone cavity were identified.

RESULTS

The maximum pullout strength of all-suture anchors demonstrates a strong correlation to the adjacent cortical thickness (r = 0.82, p ≤ 0.05) with at least 0.4 mm needed to withstand 200 N. No correlation could be seen in conventional anchors. Moreover, no correlation could be detected for local BMD in both anchors. All-suture anchors show a significantly narrower cortical defect as well as a smaller bone cavity following pullout (4.3 ± 1.3 mm vs. 5.3 ± 0.9 mm, p = 0.037; 141 mm³ vs. 212 mm³; p = 0.009). The cortical defect is largest if the anchors are placed at a 45° angle.

CONCLUSION

In contrast to conventional anchors, the pullout force of all-suture anchors depends on the thickness of the humeral cortex. Furthermore, all-suture anchors show a significantly smaller cortical defect as well as decreased bone damage in the case of pullout. Therefore, the clinical implication of this study is that all-suture anchors are advantageous due to their bone preserving ability. Also, intraoperative decortication should not be performed and cortical thickness should be preoperatively evaluated to decrease the risk of anchor failure.

Navigation-assisted anchor insertion in shoulder arthroscopy: a validity study

BACKGROUND

This study aimed to compare conventional and navigation-assisted arthroscopic rotator cuff repair in terms of anchor screw insertion.

METHODS

The surgical performance of five operators while using the conventional and proposed navigation-assisted systems in a phantom surgical model and cadaveric shoulders were compared. The participating operators were divided into two groups, the expert group (n = 3) and the novice group (n = 2). In the phantom model, the experimental tasks included anchor insertion in the rotator cuff footprint and sutures retrieval. A motion analysis camera system was used to track the surgeons' hand movements. The surgical performance metric included the total path length, number of movements, and surgical duration. In cadaveric experiments, the repeatability and reproducibility of the anchor insertion angle were compared among the three experts, and the feasibility of the navigation-assisted anchor insertion was validated.

RESULTS

No significant differences in the total path length, number of movements, and time taken were found between the conventional and proposed systems in the phantom model. In cadaveric experiments, however, the clustering of the anchor insertion angle indicated that the proposed system enabled both novice and expert operators to reproducibly insert the anchor with an angle close to the predetermined target angle, resulting in an angle error of < 2° (P = 0.0002).

CONCLUSION

The proposed navigation-assisted system improved the surgical performance from a novice level to an expert level. All the experts achieved high repeatability and reproducibility for anchor insertion. The navigation-assisted system may help surgeons, including those who are inexperienced, easily familiarize themselves to of suture anchors insertion in the right direction by providing better guidance for anchor orientation.

LEVEL OF EVIDENCE

A retrospective study (level 2).

Peri-anchor cyst formation after arthroscopic bankart repair: comparison between biocomposite suture anchor and all-suture anchor

Background

The purpose of this study is to investigate clinical outcomes and radiological findings of cyst formation in the glenoid around suture anchors after arthroscopic Bankart repair with either biocomposite suture anchor or all-suture anchor in traumatic anterior shoulder instability. We hypothesized that there would be no significant difference in clinical and radiological outcomes between the two suture materials.

Methods

This retrospective study reviewed 162 patients (69 in group A, biocomposite anchor; 93 in group B, all-suture anchor) who underwent arthroscopic Bankart repair of traumatic recurrent anterior shoulder instability with less than 20% glenoid defect on preoperative en-face view three-dimensional computed tomography. Patient assignment was not randomized.

Results

At final follow-up, the mean subjective shoulder value, Rowe score, and University of California, Los Angeles shoulder score improved significantly in both groups. However, there were no significant differences in functional shoulder scores and recurrence rate (6%, 4/69 in group A; 5%, 5/93 in group B) between the two groups. On follow-up magnetic resonance arthrography/computed tomography arthrography, the incidence of peri-anchor cyst formation was 5.7% (4/69) in group A and 3.2% (3/93) in group B, which was not a significant difference.

Conclusions

Considering the low incidence of peri-anchor cyst formation in the glenoid after Bankart repair with one of two anchor systems and the lack of association with recurrence instability, biocomposite and all-suture anchors in Bankart repair yield satisfactory outcomes with no significant difference.

Traumatic avulsion of the anterior medial meniscus root combined with PCL injury: a case report

Background

Avulsion of the anterior medial meniscus root (AMMR) has a low incidence rate, especially when it is combined with posterior cruciate ligament (PCL) injury, which hasn’t been reported in any literature to date. The aim of this study was to share our experience in the diagnosis and treatment of a patient with traumatic avulsion of AMMR combined with PCL injury.

Case presentation

This article reports a 26-year-old male patient diagnosed with traumatic avulsion of the AMMR with PCL injury. After arthroscopic surgery, he achieved remission of symptoms and recovery of functions.

Conclusions

Anterior meniscus root injuries are relatively rare. Its diagnosis can be made preliminarily based on clinical manifestations, physical examinations, and magnetic resonance imaging (MRI), and then confirmed by arthroscopic exploration. Arthroscopic suture anchor fixation of the injured anterior meniscus horn shows a good therapeutic effect.

Surgical management of ulnar styloid fractures: comparison of fixation with anchor suture and tension band wire

BACKGROUND

Limited reference is available regarding surgical management in symptomatic ulnar styloid fractures with small bony avulsion. The study goal is to report the surgical outcomes using anchor suture fixation with comparison to traditional tension band wire fixation.

METHODS

We retrospectively reviewed the medical records in patients who underwent surgical repair for unilateral ulnar styloid fractures with distal radioulnar instability between 2004 and 2017. A total of 31 patients were enrolled including two kinds of fixation methods. Anchor suture fixation plus distal radioulnar joint pinning was performed in ten patients with tiny avulsion bony fragments (group A); tension band wire fixation was performed in 21 patients with big styloid fracture fragments (group B). Patient characteristics and 2-year treatment outcomes were compared between two groups based on Mayo Modified Wrist Score (MMWS); Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH); visual analog scale (VAS), and surgical complication. Descriptive statistics were used for calculation of key variables; a p value of < 0.05 was considered statistically significant.

RESULTS

Based on Gaulke classification, there were five subtypes in group A and three subtypes in group B. Incidence of concomitant distal radius fractures was significantly higher in group B; other patient characteristics including age, sex, injury side, and time to surgery showed no significant difference. Outcome assessment regarding MMWS, QuickDASH, and VAS was comparable between two groups. Bone-related complications including nonunion, DRUJ subluxation, and styloid resorption were analyzed; the difference was not significant. Incidence of implant-related complications including migration and secondary removal surgery was significantly higher in group B (p = 0.021).

CONCLUSION

Surgical fixation in symptomatic ulnar styloid fractures yields comparable treatment outcomes in both fracture patterns. Implant-related complication with secondary removal surgery is more common in tension band wire group. Anchor suture fixation is a feasible option for tiny styloid avulsion fragments with limited surgical complication.

two suture anchors after non-simultaneous bilateral distal biceps brachii tendon rupture: a case report and review of the literature

BACKGROUND

Surgical reattachment of the tendon is still the gold standard for ruptures of the distal biceps brachii tendon. Several fixation techniques have been described in the literature, with suture anchors being one of the most common fixation techniques. Currently, there is no data available on how many anchors are required for a safe and stable refixation. In this case report clinical data of a patient with non-simultaneous bilateral distal biceps tendon ruptures treated with a different number of suture anchors for each side (one vs. two) are demonstrated.

CASE PRESENTATION

A 47-year-old factory worker suffered a rupture of the distal biceps tendon on both arms following two different occasions. The left side was fixed using a single suture anchor, while refixation on the right side was performed with two anchors. The patient was prospectively followed for one year. Functional outcome was assessed using the Andrews Carson Score (ACS), the Oxford Elbow Score (OES), and the Disabilities of Arm, Shoulder and Hand (DASH) Score after six, twelve, 24 and 48 weeks. Furthermore, an isokinetic strength measurement for flexion strength was performed after 24 and 48 weeks. After 48 weeks the patient presented with excellent functional outcome scores and no follow-up complications. During the follow-up period, no differences in the functional scores nor in the isokinetic flexion strength measurement could be detected. Furthermore, no radiological complications (like heterotopic ossifications) could be detected in the postoperative radiographs after one year.

CONCLUSIONS

Anatomic reattachment of the distal biceps tendon is a successful operative treatment option for distal biceps tendon ruptures. Suture anchor fixation remains one of the most common techniques, as it allows fast surgery and provides good results with respect to range of motion (ROM) and functional scoring according to the current literature. However, the number of anchors required for a stable fixation remains unclear. As indicated by our presented case, we hypothesize, that there are no significant differences between a one-point or a two-point fixation. In the presented case report, no intraindividual differences between the usage of one versus two suture anchors were evident in the short-term follow-up.

Biomechanical evaluation of a new technique for acromioclavicular stabilization

BACKGROUND

The most commonly used repair techniques to treat an acromioclavicular dislocation imply a suspension mechanism by substituting the supero-inferior oriented coracoclavicular structures with a tight rope mechanism or allograft. Recently, the importance of restoring the antero-posterior stability by addressing the acromioclavicular structures has also been demonstrated. If an in situ repair at the acromioclavicular joint itself could achieve a reposition and would be strong enough, the suspension of the CC structures might become obsolete. Possible advantages would be minimal dissection, lower risk in damaging neurovascular structures, greater stability, reduction of the surgical time and even the possibility of locoregional anesthesia.

HYPOTHESIS

In this biomechanical study, the feasibility of different in situ repair techniques is explored thereby testing both compression and translation characteristics. Our hypothesis is that an in situ repair technique results in an adequate repair for the AC joint.

METHODS AND MATERIALS

Polyurethane foam blocks will be used as a model for the acromioclavicular joint and the repair techniques will be done by using a combination of sutures and bone anchors or using a transosseous technique. Compression will be measured by means of a Tekscan pressure sensor and translation will be tested in three orthogonal directions using a tensile testing machine. Four different knot anchor configurations (nice knot, surgical knot in two different configurations, Nicky's knot) will be tested for compression. The strongest knot anchor configuration will then be compared side to side with a transosseous configuration for translation.

RESULTS

The nice knot in combination with bone anchors provides the strongest compression. In the side to side comparison of a nice knot anchor configuration versus a transosseous nice knot configuration, the transosseous technique shows more resistance to translation.

DISCUSSION

An in situ repair by a combination of the nice knot with an anchor or a transosseous nice knot configuration can theoretically be used as a repair technique for an acromioclavicular dislocation. In comparison with existing techniques, this model shows favorable results for translation.

LEVEL OF EVIDENCE

III, controlled laboratory study.

Treatment of Osteochondral Fracture of the Lateral Femoral Condyle with TWINFIX Ti Suture Anchor "X"-Shaped Internal Fixation under Arthroscopy: A Surgical Technique and Three Cases Report

Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. At present, open reduction is often used to treat osteochondral fractures. In recent years, with the development of arthroscopy, we have been able to complete the reduction and internal fixation of fractures under arthroscopy. In this paper, three cases of osteochondral fracture of lateral femoral condyle were treated with arthroscopic TWINFIX Ti suture anchor internal fixation, and good results were obtained. After operation, the fracture of femoral condyle healed well and the function of knee joint recovered gradually. Suture anchor system is mostly used to repair rotator cuff and patellar tendon. This is the first case to apply the suture anchor system to the reduction and fixation of fracture.

[Repair of the fracture of the joint of tendon and bone of the quadriceps femoris tendon with wire anchor and transverse drilling of the patella]

OBJECTIVE

To explore the effect of suture anchor combined with transverse drilling of patella to repair the fracture of the joint of bone and tendon of quadriceps femoris tendon.

METHODS

From April 2016 to January 2018, 6 patients (8 knees) with complete rupture of the joint of the tendon and bone tendon of the quadriceps femoris were treated with the combination of anchor with wire and transverse drilling of the patella, including 5 males (7 knees) and 1 female, aged from 43 to 74 years with an average age of 53 years old. All the patients had pain in knee joint and could not extend the knee actively after trauma. X-ray, CT and MRI were performed on the knee joints, and it was clear that the joint of bone and tendon of quadriceps femoris tendon was completely broken. The X-ray of knee joint was reviewed regularly after operation, and Lysholm score was used to evaluate the function of knee joint.

RESULTS

The average operation time of all patients was 60 minutes. Tourniquets were used during the operation, no drainage was placed after the operation, and no blood transfusion was performed in all patients. Six patients were followed up for 15 to 36 months with an average of 26 months. Lysholm score of 6 patients (8 knees) was 79 to 95 in the last follow-up with an average of 89 points. One of the patients with mandatory spondylitis developed infection and healed after 2 debridements.

CONCLUSION

The suture structure of the joint of bone and tendon of quadriceps femoris tendon repaired with suture anchor and lateral drilling of patella is simple, reliable and effective.

Mid-Term Results of the Use of a Suture Anchor Fixation for Chronic Reducible Scapholunate Dissociation

Background: Scapholunate dissociation (SLD) is a common and sometimes disabling ligamentous injury of the wrist. The aim of the treatment is to restore carpal alignment and to prevent joint degeneration. In the current study, we reported mid-term results of our technique using suture anchor fixation within the SL interface. Methods: Nine male patients with an average age of 35 years underwent scapholunate suture anchor fixation (SLAF) for chronic and symptomatic dynamic or reducible static SLD from 2011 to 2016 with a mean follow-up of 36 months. After dorsal wrist exposure, a 2.8 mm suture anchor was inserted in the dorsoproximal lateral articular surface of the lunate bone. The two ends of the sutures were passed through the two divergent canals in the scaphoid. The sutures were tied over the tuberosity after reducing the SL alignment. Two K-wires supported SL and scaphocapitate (SC) alignment for 8 weeks. Radiographic parameters, wrist range of motion and grip strength were measured. Quick-DASH and Modified Mayo Wrist Score (MMWS) were used to assess the functional outcome. Results: The grip strength and passive motion reached to 75% and 88% of the other side, respectively. The SL gap was 5.4 mm, 2.6 mm and 3.4 mm before surgery, after pin removal, and on the follow-up stress radiographs, respectively. The SL angle was 82, 52 and 65 degrees at any time point, respectively. Average Quick-DASH score was improved from 60 to 25. According to MMWS score, one patient was excellent, one was good, five were fair, and two were poor. Conclusions: SLAF is a simple technique with minimal soft tissue manipulation that enables correction and maintaining of the carpal alignment with favorable mid-term results.