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Jerome JTJ, C. PK. Chronic proximal ulnar collateral ligament injuries thumb-a case report. J Clin Orthop Trauma 2023; 46:102283. [PMID: 38059054 PMCID: PMC10696455 DOI: 10.1016/j.jcot.2023.102283] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/11/2023] [Indexed: 12/08/2023] Open
Abstract
A 55-year-old woman presented with multiple episodes of falls that injured her right thumb and restricted her daily activities because of pain and instability. Ultrasound found the rare proximal metacarpal UCL avulsion. The repair was done using suture anchors under wide-awake anaesthesia with no tourniquet (WALANT). The patient regained her thumb movements, got a stable MCP joint, and remained symptom-free at one year of follow-up. Proximal avulsion of the UCL is rare. Ultrasound confirms the avulsion, and surgical reconstruction under wide-awake anaesthesia allows the surgeon and the patient to assess and appreciate the MCP joint stability, thereby efficiently rehabilitating the patient. The functional outcome of proximal UCL repair is good. This report describes a rare presentation of the proximal metacarpal attachment avulsion injury of the ulnar collateral ligament (UCL) in a thumb and reviews the management.
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Affiliation(s)
| | - Palani Kumar C.
- Olympia Hospital & Research Centre, Trichy, Tamilnadu, India
- Spine Endoscopy and Ortho Clinic, Erode, Tamilnadu, India
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Kajita Y, Iwahori Y, Harada Y, Takahashi R, Sagami R, Deie M. Comparison of clinical outcome and repair integrity after arthroscopic suture-bridge and triple-row rotator cuff repairs of Fosbury flop tears. J Orthop Sci 2023:S0949-2658(23)00131-8. [PMID: 37236874 DOI: 10.1016/j.jos.2023.05.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/08/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The Fosbury flop tear (FFT) has recently been described as a rotator cuff tear that has flipped upon itself and adhered medially. FFT is known to have a high retear rate after arthroscopic rotator cuff repair. The cause of the high postoperative retear rate after arthroscopic rotator cuff repair is believed to be due to the inability to achieve anatomical reduction because of difficulties in reducing the torn tendon stump. Arthroscopic rotator cuff repairs using the triple-row technique may allow better anatomical reduction of the cuff tear when compared with the suture-bridge technique. We compared the clinical outcomes and cuff integrity of the triple-row and suture-bridge techniques in arthroscopic rotator cuff repair for FFT. METHODS Patients with small-to-medium sized cuff tears of the supraspinatus tendon alone who were diagnosed with FFT, underwent arthroscopic rotator cuff repair, and had 2 or more years of follow-up were included. A total of 34 shoulders underwent the triple-row technique and 22 shoulders underwent the suture-bridge technique. The following were compared between the two techniques: patient background, operation time, number of anchors used during the operation, Japanese Orthopedic Association (JOA) score, active range of motion, and retear rate. RESULTS No significant difference in patient background was found between the two techniques. Although active range of motion was significantly improved compared with preoperative scores, no significant difference was observed between techniques. The triple-row technique demonstrated a significantly higher 24-month postoperative JOA score, significantly shorter surgery time, significantly lower retear rate, and significantly larger number of anchors used during the operation. CONCLUSIONS The triple-row technique was an effective method compared with the suture-bridge technique in cases with FFT.
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Affiliation(s)
- Yukihiro Kajita
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan.
| | - Yusuke Iwahori
- Department of Orthopaedic Surgery, Asahi Hospital, Japan
| | - Yohei Harada
- Department of Orthopaedic Surgery, Hiroshima University, Japan
| | | | - Ryosuke Sagami
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
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Piatti M, Gorla M, Alberio F, Omeljaniuk RJ, Rigamonti L, Gaddi D, Turati M, Bigoni M. Comparison of all- suture anchors with metallic anchors in arthroscopic cuff repair: Structural and functional properties and clinical suitability. J Orthop 2023; 39:66-69. [PMID: 37125016 PMCID: PMC10139856 DOI: 10.1016/j.jor.2023.04.006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/07/2023] [Indexed: 05/02/2023] Open
Abstract
Purpose This study examined and compared all-suture anchors with metallic anchors in the arthroscopic repair of small to medium supraspinatus tears; a multi-dimensional evaluation protocol assessed (i) clinical, (ii) ultrasonographical, and (iii) functional criteria at mid-term. Materials and methods A sample of 40 patients, prescreened from a larger group who had undergone arthroscopic rotator cuff repair, were resolved into two groups of 20, based on the type of anchor used in their surgery (all-suture or metallic) and were evaluated postoperatively (mean = 44.3 months, SEM = 22.4 months, minimum period = 10.3 months). Clinical assessments included (i) objective and subjective scores (Constant, DASH, SPADI, SST), (ii) ultrasonographical examination, as well as (iii) isometric and isokinetic strength testing. Raw data from the operated side was compared with those from the contralateral side within each group. Raw data for the PROMs and for the US evaluation were compared between groups. Strength data, as well as the Constant score values, were further analyzed based on (i) the difference between operated and intact sides, as well as (ii) the strength ratio between operated and intact sides; the transformed data were then compared between the two groups. Results We found no statistically significant differences in any of the parameters considered between shoulders operated using ASAs or MAs, nor between operated and non-operated sides in each group. Conclusion Our findings indicate that the reliability and performance characteristics of all-suture anchors and metallic anchors are practically indistinguishable for arthroscopic treatment of small to medium lesions of the supraspinatus tendon.
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Affiliation(s)
- Massimiliano Piatti
- Department of Orthopaedic and Traumatology, Policlinico Ponte San Pietro, Ponte San Pietro, BG, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Massimo Gorla
- Department of Orthopaedic and Traumatology, Policlinico Ponte San Pietro, Ponte San Pietro, BG, Italy
| | - Federico Alberio
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Luca Rigamonti
- Department of Orthopaedic and Traumatology, Policlinico Ponte San Pietro, Ponte San Pietro, BG, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Diego Gaddi
- Department of Orthopaedic and Traumatology, Policlinico Ponte San Pietro, Ponte San Pietro, BG, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Turati
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Orthopaedic Department, San Gerardo Hospital, Monza, Italy
- Department of Paediatric Orthopaedic Surgery, Hospital Couple Enfant, Grenoble Alpes University, Grenoble, France
| | - Marco Bigoni
- Department of Orthopaedic and Traumatology, Policlinico Ponte San Pietro, Ponte San Pietro, BG, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Yang YS, Shih CA, Fang CJ, Huang TT, Hsu KL, Kuan FC, Su WR, Hong CK. Biomechanical comparison of different suture anchors used in rotator cuff repair surgery-all-suture anchors are equivalent to other suture anchors: a systematic review and network meta-analysis. J Exp Orthop 2023; 10:45. [PMID: 37067646 PMCID: PMC10110812 DOI: 10.1186/s40634-023-00608-w] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/03/2023] [Indexed: 04/18/2023] Open
Abstract
PURPOSE Suture anchors are commonly used to repair rotator cuff tendons in arthroscopy surgery, and several anchor materials have been created to maximize pull-out strength and minimize iatrogenic damage. We hypothesized that all-suture anchors have biomechanical properties equivalent to those of conventional anchors. Our purpose is to compare the biomechanical properties of different anchors used for rotator cuff repair. METHODS The Embase, PubMed, Cochrane, and Scopus databases were searched for biomechanical studies on various suture anchors. The search keywords included rotator cuff tears and suture anchors, and two authors conducted study a selection, risk of bias assessment, and data extraction. The failure load, stiffness, and displacement were calculated using the mean differences with 95% confidence intervals (CIs). Failure modes were estimated using summary odds ratios with 95% CIs. The surface under the cumulative ranking curve was used for the relative ranking probabilities. A sensitivity analysis was performed by excluding studies using synthetic bones. RESULTS The polyetheretherketone (PEEK) (p < 0.001) and all-suture anchors (p < 0.001) had higher failure loads than the biocomposite anchors, whereas no significant difference was observed in stiffness among the anchors. The all-suture (p = 0.006) and biocomposite anchors (p < 0.001) had displacements higher than the metal anchors. The relative ranking of the included anchors in failure loads and displacement changed in sensitivity analysis. The meta-analysis did not find significant differences, but the relative ranking probabilities suggested that all-suture anchor had a higher rate of anchor pull-out and a lower rate of eyelet or suture breakage. In contrast, the metal anchors were associated with a higher number of eyelet breakage episodes. CONCLUSIONS All-suture anchors showed significantly higher failure loads than the biocomposite anchors and similar cyclic displacements to the biocomposite and PEEK anchors. There were no significant differences in stiffness between all-suture and conventional suture anchors. The relative ranking of biomechanical properties changed in sensitivity analysis, suggesting the potential effect of bone marrow density. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Yi-Shiuan Yang
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-An Shih
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Ju Fang
- Department of Secretariat, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Medical Library, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Teng Huang
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Tran DV, Yetter TR, Somerson JS. Surgical repair of distal triceps rupture: a systematic review of outcomes and complications. JSES Rev Rep Tech 2022; 2:332-339. [PMID: 37588859 PMCID: PMC10426566 DOI: 10.1016/j.xrrt.2022.04.001] [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] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Triceps tendon injury is rare and accounts for only 2% of all tendinous injuries. It typically occurs after trauma or physical strain with eccentric loading. Treatment involves surgical repair, commonly with either transosseous bone tunnels or suture anchors. Nonsurgical management is typically reserved for low-demand or high-risk patients, as this is associated with deficits in strength and functional disability. Despite several recent high-quality observational studies that have added to our understanding of outcomes after surgical repair, we are not aware of a systematic review that includes literature published after 2015. In addition, prior reviews did not compare outcomes between different surgical repair methods, particularly transosseous bone tunnel and suture anchor techniques. Methods This systematic review examines published literature between January 1970 and May 2021 in PubMed, Scopus, and Cochrane databases to further examine reported functional outcomes and compare those outcomes between the two surgical repair methods. Results Our literature search yielded 309 results, of which only 16 met inclusion criteria. At the latest follow-up, the mean Disabilities of Arm, Shoulder, and Hand score was 4, the mean Quick Disabilities of Arm, Shoulder, and Hand score was 8, the mean Mayo Elbow Performance Score was 92, the mean American Shoulder and Elbow Surgeons-Elbow score was 99, the mean modified American Shoulder and Elbow Surgeons score was 94, the mean Oxford Elbow Score was 43, and the mean isokinetic muscle strength testing was 87%. A very high percentage (95%) of patients reported being satisfied with the repair. Preinjury levels of function were achieved in 92% of patients, and 100% regained at least a score of 4 of 5 for gross muscle strength. Complications occurred in 15% of cases, of which retears accounted for 5%. Subanalysis of cases with reported repair types revealed a significantly higher overall complication rate with transosseous repairs than with suture anchor repairs (18% vs. 8%, P = .008) as well as a higher retear rate in the transosseous repair group (7% vs. 2%, P = .03). Conclusion Patient-reported outcome measures were favorable for both suture anchor and transosseous tunnel repair methods. Suture anchor repair showed significantly better results with regard to isokinetic strength testing, complication rates, and retear rates. Further study is needed to establish superiority of either technique and cost-efficacy. In light of the evidence supporting greater biomechanical strength and lower clinical rates of failure, surgeons may consider use of a suture anchor technique for repair of distal triceps ruptures.
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Affiliation(s)
- Danny V. Tran
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Thomas R. Yetter
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Jeremy S. Somerson
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
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Gao YC, Wang XF, Zhao LC, Wang PF, Zhong LM, Chen JS. [Treatment of avulsion fracture of inferior pole of patella with improved angle of anchor and double pulley technique]. Zhongguo Gu Shang 2022; 35:683-687. [PMID: 35859382 DOI: 10.12200/j.issn.1003-0034.2022.07.017] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the angle of modified anchor nail placement and the curative effect of double pulley technology for the treatment of extreme avulsion fracture of lower patella. METHODS From December 2015 to December 2018, a total of 22 patients(10 males and 12 females) with avulsion fracture of the inferior pole of patella were retrospectively analyzed. The average age was (44.00±15.24) years old(range, 19 to 70 years). All patients were treated with modified anchor angle and double pulley technique. The range of motion(ROM) and Bostman score system were used to evaluate the functional recovery of knee joint. RESULTS All 22 cases were followed up with an average of (30.86±8.00) weeks (18 to 46 weeks). At the last follow-up, ROM of the affected knee was (130.82±4.69) °, and the contralateral knee was (133.23 ± 3.15) °, there was no significant difference between two groups (P>0.05). The average Bostman score was (28.45±1.41) scores, 18 cases were excellent results, 4 cases were good. CONCLUSION Improved anchor placement angle and double pulley technique for treatment of extreme avulsion fracture of lower patella is easy to operate, with satisfactory curative effect and good recovery of knee joint function.
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Affiliation(s)
- Yue-Chuan Gao
- Zhangzhou No.3 Hospital, Zhangzhou 363000, Fujian, China
| | - Xin-Feng Wang
- Zhangzhou No.3 Hospital, Zhangzhou 363000, Fujian, China
| | | | - Peng-Fei Wang
- Zhangzhou No.3 Hospital, Zhangzhou 363000, Fujian, China
| | - Li-Ming Zhong
- Zhangzhou No.3 Hospital, Zhangzhou 363000, Fujian, China
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Yeh KT, Wu WT, Wang JH, Shih JT. Arthroscopic foveal repair with suture anchors for traumatic tears of the triangular fibrocartilage complex. BMC Musculoskelet Disord 2022; 23:634. [PMID: 35788222 PMCID: PMC9252030 DOI: 10.1186/s12891-022-05588-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Foveal tears of the traumatic triangular fibrocartilage complex (TFCC) are the most commonly neglected high-energy injuries of the wrist joint, and the patients with such tears often experience unrecovered ulnar-sided wrist pain and poor wrist function. This study investigated the functional outcomes of patients who underwent arthroscopic repair of foveal TFCC tears with suture anchors and adjuvant platelet-rich plasma (PRP) injections after the surgery. Methods From September 2014 to August 2018, 156 men and 45 women with diagnoses of foveal TFCC tears without wrist fractures underwent arthroscopic repair by using the outside-in method with 1.3-mm suture anchors and subsequent PRP injection. After surgery, splinting was applied for 6 weeks, and the patients underwent rehabilitation, re-examination, and follow-up at our clinic. The patients’ wrist functional scores and grip strength data were retrospectively collected. Results The mean follow-up period was 32.6 months, and the mean age was 26.7 years. The mean modified Mayo wrist score improved from 48.5 ± 2.6 to 82.4 ± 2.5, whereas the mean Disabilities of the Arm, Shoulder and Hand (DASH) score decreased from 39.2 ± 6.7 to 10.6 ± 7.5. Overall, the wrist functions of 186 (92.5%) of the patients were satisfactory according to their modified Mayo wrist scores, and the patients with satisfactory scores returned to sports or work activities. These patients retained normal ranges of motion, and their average grip strength in the affected hand was restored to at least 85% of that of the other hand. Conclusions According to the postoperative 25–36 months surgical results of our study, arthroscopic repair with adjuvant PRP injections is a satisfactory method of repairing early foveal tears of the TFCC and can enhance wrist function by relieving pain and increasing tolerance for work or sports.
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Affiliation(s)
- Kuang-Ting Yeh
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wen-Tien Wu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jui-Tien Shih
- Department of Orthopaedic Surgery, Taoyuan Armed Forces General Hospital, NO. 168, Zhongxing Road, Longtan Dist, Taoyuan City, 32551, Taiwan.
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Lee HY, Cheon SJ, Seo H, Lee BY, Nam JH, Lee DY. Periimplant osteolysis does not affect the outcome of rotator cuff repair: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:3910-3920. [PMID: 33090240 DOI: 10.1007/s00167-020-06328-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/21/2020] [Accepted: 10/08/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The goal of this study was to perform a systematic review and meta-analysis to compare the clinical and radiologic outcomes of rotator cuff repair, depending on the presence of developed periimplant osteolysis (PIO) after using suture anchors. METHODS The electronic databases of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for articles published up until October 2019 to find relevant articles comparing the outcomes of rotator cuff repair between the periimplant osteolysis group and non-periimplant osteolysis group. Data searching, extraction, analysis, and quality assessment were performed according to the Cochrane Collaboration guidelines. The results are presented as risk ratio (RR) for binary outcomes and standardised mean difference (SMD) for continuous outcomes with 95% confidence intervals (CI). RESULTS Six clinical studies were included. No significant differences were found between the group with periimplant osteolysis and the group without periimplant osteolysis regarding retear rate (RR = 1.34; 95% CI 0.93-1.94; I2 = 28%), postoperative clinical scores (SMD = 0.29; 95% CI - 0.26 to 0.83; I2 = 80%) and range of motion (ROM); forward flexion (SMD = 0.39; 95% CI - 0.16 to 0.93; I2 = 0%), external rotation (SMD = - 0.10; 95% CI - 0.64 to 0.45; I2 = 0%) and internal rotation (SMD = - 0.37; 95% CI - 0.92 to 0.17; I2 = 0%). CONCLUSION The presence of periimplant osteolysis after rotator cuff repair with suture anchor does not affect the clinical outcomes such as retear rate, clinical scoring, and ROM. However, as there was no standard consensus on the criteria for evaluating periimplant osteolysis, this result may not fully reflect the effect of periimplant osteolysis depending on its severity. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hyo Yeol Lee
- Department of Orthopaedic Surgery, The Armed Forces Daegu Hospital, Gyeongsan, Republic of Korea
| | - Sang Jin Cheon
- Department of Orthopaedic Surgery, BioMedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Haneol Seo
- Department of Orthopaedic Surgery, BioMedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Beom Yeol Lee
- Faculty of Nanotechnology Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Jun Ho Nam
- Department of Orthopaedic Surgery, The Armed Forces Daegu Hospital, Gyeongsan, Republic of Korea.,Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Dong-Yeong Lee
- Department of Orthopaedic Surgery, The Armed Forces Daegu Hospital, Gyeongsan, Republic of Korea. .,Department of Orthopaedic Surgery, Barun Hospital, Jinju, 52725, Republic of Korea.
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García-Vega M, De La Cuadra-Virgil P, Jiménez-Cristobal J, Occhi-Gómez B, Boserman-Pérez-de Villaamil M. Arthroscopic bankart repair for the management of anterior shoulder instability: Mid- and long-term results. ACTA ACUST UNITED AC 2021. [PMID: 34112445 DOI: 10.1016/j.recote.2021.04.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Arthroscopic stabilisation is a well-recognised surgical technique with a variable rate of failure reported between 0-35%. The aim of this study was to evaluate the outcome of this technique and our second aim was to identify risk factors that could be associated to recurrence rate. MATERIAL AND METHODS 41 patients that underwent arthroscopic shoulder stabilisation for glenohumeral instability between 2001-2015 were included. Different items such as epidemiologic, recurrence, age at first dislocation, preoperative sport practice, and number of fixation devices used were collected. The results were evaluated using functional scales (WOSI, Rowe y Walch-Duplay) and radiological study was assessed using the Samilson-Prieto score. Data from the medical history were recognised in order to assess possible risk factors. RESULTS The overall redislocation rate was 9.4%. The average follow-up was 83 months. The 54.3% of the patients achieved excellent/good results in the functional assessment scales. The range of motion was complete in 90% of the cases. On the radiographs, only 4.88% of the patients present advanced osteoarthritis. It was not possible to identify risk factors related to a worse outcome after surgery. CONCLUSION The arthroscopic Bankart repair with suture anchors is considered the gold standard for treatment of anterior glenohumeral instability. The long-term follow-up shows a favourable outcome, with a redislocation rate of 9% and low complication rate.
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Affiliation(s)
- M García-Vega
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | | | | | - B Occhi-Gómez
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Abstract
Postoperative complications can be burdensome on both the patient and the surgeon. Attention in literature is often directed toward different forms of treatment and successful outcomes in surgery. The incentive of this article is to bring insight toward postoperative complications in rearfoot surgery, more specifically, the repair of the Achilles tendon with suture tape and suture anchors. This article directs attention to the recent reports on hypersensitivity reactions seen with the use of suture tape and nonabsorbable suture anchors and may encourage physicians to make patients aware of this potential complication when using these materials.
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García-Vega M, De La Cuadra-Virgil P, Jiménez-Cristobal J, Occhi-Gómez B, Boserman-Pérez-de Villaamil M. Arthroscopic bankart repair for the management of anterior shoulder instability: Mid- and long- term results. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [PMID: 33773949 DOI: 10.1016/j.recot.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Arthroscopic stabilization is a well-recognized surgical technique with a variable rate of failure reported between 0-35%. The aim of this study was to evaluate the outcome of this technique and our second aim was to identify risk factors that could be associated to recurrence rate. MATERIAL AND METHODS 41 patients that underwent arthroscopic shoulder stabilization for glenohumeral instability between 2001-2015 were included. Different items such as epidemiologic, recurrence, age at first dislocation, preoperative sport practice, and number of fixation devices used were collected. The results were evaluated using functional scales (WOSI, Rowe y Walch-Duplay) and radiological study was assessed using the Samilson-Prieto score. Data from the medical history were recognized in order to assess possible risk factors. RESULTS The overall redislocation rate was 9.4%. The average follow-up was 83 months. The 54.3% of the patients achieved excellent / good results in the functional assessment scales. The range of motion was complete in 90% of the cases. On the radiographs, only 4.88% of the patients present advanced osteoarthritis. It was not possible to identify risk factors related to a worse outcome after surgery. CONCLUSION The arthroscopic Bankart repair with suture anchors is considered the gold standard for treatment of anterior glenohumeral instability. The long-term follow-up shows a favorable outcome, with a redislocation rate of 9% and low complication rate.
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Affiliation(s)
- M García-Vega
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
| | | | | | - B Occhi-Gómez
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
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Chu Y, Hu T, Chen M, Jiang C, Wu Z, Shi J. Preliminary clinical outcomes of the double-row anchor suture-bridge technique for the fixation of tibial intercondylar eminence fractures in adults: a 12-months minimal follow-up. BMC Musculoskelet Disord 2021; 22:74. [PMID: 33441126 PMCID: PMC7807492 DOI: 10.1186/s12891-021-03948-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Tibial intercondylar eminence avulsion fractures occur primarily in adolescents and young adults. However, the incidence of such fractures is increasing in adults, concurrent with an increase in sports injuries and traffic accidents. This study describes the fixation-based double-row anchor suture-bridge technique, a novel technique for treating tibial intercondylar eminence fractures in adults; and evaluates its preliminary clinical outcomes. Methods A retrospective evaluation of adult patients with tibial intercondylar eminence fractures treated at our institution from June 2016 to June 2018 was conducted. Seven such patients, treated with the anchor suture-bridge technique, were included. All patients were assessed for knee joint range of motion (ROM), Lysholm knee score, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form score, Tegner activity score pre-surgery, and the healing of the fracture at 3, 6 and 12 months minimal post-surgery follow-up. Results Patients were followed for a mean of 12.43 months (range 9-15 months). By the final follow-up, all fractures had fully healed. The mean Lysholm score improved from 27.86 (range, 2 to 54) pre-surgery to 88.14 (range, 81 to 100) 3 months post-surgery (p < 0.05). Similarly, the mean IKDC score improved from 48.86 (range, 43 to 55) to 84.29 (range, 75 to 90) (P < 0.05); and the mean Tegner activity score improved from 1.71 (range, 0 to 4) to 3.29 (range, 2 to 4) (p < 0.05). Furthermore, knee joint ROM, Lysholm scores, IKDC scores, and Tegner activity scores displayed excellent outcomes at the 6 and 12 months minimal follow-up. Conclusion The arthroscopic anchor suture-bridge technique is a valid and secure method for achieving effective fixation of tibial intercondylar eminence fractures in adults.
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Affiliation(s)
- Yupeng Chu
- Department of Orthopaedic Surgery, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
| | - Ting Hu
- Department of Orthopaedic Surgery, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Mangmang Chen
- Department of Orthopaedic Surgery, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Chendi Jiang
- Department of Orthopaedic Surgery, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Zhuqi Wu
- Department of Orthopaedic Surgery, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Junwu Shi
- Department of Orthopaedic Surgery, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
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Lee JH, Kang JS, Park I, Shin SJ. Serial Changes in Perianchor Cysts Following Arthroscopic Labral Repair Using All- Suture Anchors. Clin Orthop Surg 2020; 13:229-236. [PMID: 34094014 PMCID: PMC8173234 DOI: 10.4055/cios20024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/14/2020] [Accepted: 07/10/2020] [Indexed: 11/21/2022] Open
Abstract
Backgroud Changes in perianchor cysts around the all-suture anchors, which demonstrate distinguished features from the biocomposite anchors, have not been revealed sufficiently. The purpose of this study was to investigate serial changes of perianchor cysts according to the location of the inserted anchor in the glenoid in arthroscopic labral repair using all-suture anchors. Methods We enrolled 43 patients who underwent computed tomography (CT) immediately postoperatively and CT arthrogram (CTA) at 1 year or 2 years after arthroscopic labral repair using a 1.3-mm all-suture anchor for recurrent anterior shoulder dislocation with or without a superior labral tear from anterior to posterior and a posterior labral tear. The mean diameter and tissue density (HU) of perianchor cysts were measured depending on the location in the glenoid. Clinical outcomes, labral healing, and redislocation rate were evaluated at 2 years after surgery. Results On functional assessment, the mean American Shoulder and Elbow Surgeons score and Rowe score improved statistically significantly after surgery (from 47.9 ± 14.3 preoperatively to 90.1 ± 9.6 postoperatively and from 45.3 ± 12.4 preoperatively to 92.2 ± 10.1 postoperatively, respectively; p < 0.01). Postoperative redislocations were found in 2 patients (4.7%). In radiological evaluation, the mean diameter of perianchor cysts at postoperative 1 year (3.24 ± 0.65 mm) was significantly larger than the immediate postoperative diameter; however, there was no significant difference between postoperative 1 year and 2 years (3.23 ± 0.57 mm). Tissue density at the center of cysts demonstrated no significant difference between 1 and 2 year postoperatively (107.7 ± 29.8 HU [superior], 99.7 ± 31.7 HU [anteroinferior], and 105.1 ± 25.0 HU [posterior] vs. 109.1 ± 26.1 HU [superior], 106.4 ± 30.3 HU [anteroinferior], and 111.0 ± 32.9 HU [posterior]). The mean diameter of perianchor cysts in the anteroinferior position was largest compared with that in superior or posterior positions. Conclusions Perianchor cysts associated with all-suture anchors enlarged significantly within 1 year after arthroscopic labral repair regardless of the insertion location in the glenoid. However, the size and tissue density of perianchor cysts were similar at postoperative 1 and 2 years, and satisfactory stability and clinical outcomes were obtained.
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Affiliation(s)
- Jae-Hoo Lee
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jun-Seok Kang
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - In Park
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Seoul, Korea
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14
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Liu T, Bao F, Jiang T, Ji G, Li J, Jerosch J. Acromioclavicular Joint Separation: Repair Through Suture Anchors for Coracoclavicular Ligament and Nonabsorbable Suture Fixation for Acromioclavicular Joint. Orthop Surg 2020; 12:1362-1371. [PMID: 32893498 PMCID: PMC7670157 DOI: 10.1111/os.12771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To evaluate the clinical and radiographic outcomes of patients undergoing coracoclavicular (CC) ligament repair by two suture anchors and acromioclavicular (AC) joint (ACJ) fixation using heavy nonabsorbable sutures for the treatment of types III-V ACJ injuries with a minimum of 1-year follow-up. METHODS The clinical and radiographic outcomes of 36 consecutive patients (26 men and 10 women) who underwent anatomic reduction for acute ACJ dislocation using two suture anchors for CC ligament reconstruction and two strands of non-absorbable stitches for ACJ fixation between December 2013 and December 2018 were reviewed. Two 3.5 mm suture anchors with double-loaded sutures were separately inserted into the anterolateral and posteromedial portions of the coracoid process. The suture strands were passed through the hole created in the clavicle using 2.0 mm drill and tied over the clavicle. Additional ACJ augmentation using two strands of non-absorbable heavy sutures was performed in all patients. At 3, 6, and 12 months and last follow-up visit, the scores on the visual analog scale (VAS), the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and simple shoulder test (SST) questionnaires were used to provide a final evaluation of shoulder function. Comparison between baseline and treatment results was performed. Radiographic analysis included vertical displacement and horizontal shift. RESULTS A total of 29 patients (20 men and nine women) were included in the study. A total of seven, six, and 16 patients had Rockwood type III, type IV, and type V ACJ dislocations, respectively. The mean patient age was 42.8 ± 13.5 years, with a mean follow-up of 28 months (range, 12-56 months). At the 12-month follow-up, the mean ASES score was 92.1 ± 3.5, with a mean pain score of 0.5 ± 0.7 on the VAS and mean Constant-Murley score of 93.0 ± 2.4. The new number of positive answers on the SST was 11.5 ± 0.6. Compared with the baseline, the clinical results improved significantly (P < 0.05). No significant difference could be found between the 6- and 12-month follow-up evaluations (P > 0.05). Radiographs showed two partial loss of reduction, whereas no horizontal displacement was found in all patients. One patient developed a superficial wound infection 3 weeks postoperation. The wound healed after routine wound care. No neurovascular complications were recorded. CONCLUSIONS CC ligament reconstruction using two suture anchors and ACJ augmentation using two strands of non-absorbable heavy sutures on high-grade AC dislocation is a reliable technique for restoring stability to the ACJ and can obtain good to excellent clinical results.
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Affiliation(s)
- Tao Liu
- Department of Orthopaedic SurgeryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Fei‐long Bao
- Department of Orthopaedic SurgeryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Tao Jiang
- Department of Orthopaedic SurgeryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Guang‐wei Ji
- Department of Orthopaedic SurgeryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Jian‐min Li
- Department of Orthopaedic SurgeryCheeloo College of Medicine, Shandong UniversityJinanChina
| | - Jörg Jerosch
- Clinic for Orthopaedics and Orthopaedic SurgeryJohanna‐Etienne HospitalNeussGermany
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15
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Hong C, Hu HK, Li C, Li X, Gu XH. [Plate and screw with suture anchors for repair deltoid ligament in treating Bosworth fracture:a case report]. Zhongguo Gu Shang 2020; 33:665-6. [PMID: 32700493 DOI: 10.12200/j.issn.1003-0034.2020.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Chao Hong
- Department of Orthopaedics, the Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China
| | - Hong-Kui Hu
- Department of Orthopaedics, the Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China
| | - Chao Li
- Department of Orthopaedics, the Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China
| | - Xu Li
- Department of Orthopaedics, the Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China
| | - Xiao-Hua Gu
- Department of Orthopaedics, the Seventh People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China
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Benca E, Dlaska CE, DiFranco MD, Hobusch GM, Windhager R, Angeli T, von Skrbensky G. Biomechanical comparison of knotless vs. knotted suture anchors in the acetabular rim with respect to bone density. Clin Biomech (Bristol, Avon) 2020; 74:21-26. [PMID: 32109719 DOI: 10.1016/j.clinbiomech.2020.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/01/2019] [Revised: 02/03/2020] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acetabular labral tears are managed with suture anchors providing good clinical outcomes. Knotless anchors are easier to use and have a quicker insertion time compared to knotted anchors. The purpose of this study was to compare the biomechanical behavior of two different anchor designs (knotted vs. knotless) in ultimate load testing in correlation with bone density in the acetabular rim. METHODS Eighteen knotted Bio-FASTak and seventeen knotless PushLock anchors (both: Arthrex Inc., Naples, FL, USA) were inserted in the rims of two human acetabula, with known bone density distribution. The anchors were subjected to load-to-failure tests. Anchors were additionally tested in solid polyurethane foam with defined densities. FINDINGS The Bio-FASTak group showed higher survival rates at 1, 2, and 3 mm displacement and was able to withstand significantly higher loads at 3 mm displacement (p = 0.031). There was no statistically significant difference in stiffness (p = 0.087), yield- (p = 0.190), and ultimate load (p = 0.222) between the two groups. Only the PushLock group showed correlation between bone volume over total volume (BV/TV) and stiffness (R = 0.750, p = 0.086) and between BV/TV and yield load (R = 0.838, p = 0.037). Experiments on solid polyurethane foam confirmed the correlation between the mechanical properties and tissue density for the same anchor. INTERPRETATION PushLock shows similar biomechanical properties to the Bio-FASTak, but eliminates knot tying and potentially abrasive knots. In addition, biomechanical properties of the PushLock are governed by local bone density.
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Affiliation(s)
- Emir Benca
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Constantin E Dlaska
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; Center for Anatomy and Cell Biology, Medical University of Vienna, Währinger Straße 13, 1090 Vienna, Austria
| | - Matthew D DiFranco
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Gerhard M Hobusch
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Thomas Angeli
- Institute of Engineering Design and Product Development, TU Wien, Getreidemarkt 9/307, 1060 Vienna, Austria
| | - Gobert von Skrbensky
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Panzram B, Kentar Y, Maier M, Bruckner T, Hetto P, Zeifang F. Mid-term to long-term results of primary arthroscopic Bankart repair for traumatic anterior shoulder instability: a retrospective study. BMC Musculoskelet Disord 2020; 21:191. [PMID: 32220253 PMCID: PMC7102425 DOI: 10.1186/s12891-020-03223-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/19/2020] [Indexed: 01/26/2023] Open
Abstract
Background The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. The aim of the study is to determine the mid−/long-term functional outcome, failure rates and predictors of failure after primary arthroscopic Bankart repair for traumatic anterior shoulder instability. Methods A total of 100 patients were primarily operated using arthroscopic Bankart repair after traumatic anterior shoulder instability. Medical records were retrospectively reviewed, and patients were assessed using postal questionnaire after a mean follow-up of 8.3 years [3–14]. Clinical assessment was performed using Constant score, Rowe score, and American Shoulder and Elbow Surgeons score. Results The overall recurrence rate was 22%. The Kaplan-Meier failure-free survival estimates. were 80% at 5 years and 70% at 10 years. Nearly half (54.5%) of recurrences occurred at 2 years postoperative. Compared with normal shoulder, there were statistical differences in all 3 scores. Failure rate was significantly affected by age at the time of surgery with 86% of recurrence cases observed in patients aged 30 years or younger. Nevertheless, Younger age at the time of surgery (P = 0.007) as well age at the time of initial instability (P = 0.03) was found to correlate negatively with early recurrence within 2 years of surgery. Among those with recurrent instability, recurrence rate was found to be higher if there had been more than 5 instability episodes preoperatively (P = 0.01). Return to the preinjury sport and occupational level was possible in 41 and 78%, respectively. Conclusion Failure-free survival rates dropped dramatically over time. Alternative reconstruction techniques should be considered in those aged ≤30 years due to the high recurrence rate.
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Affiliation(s)
- Benjamin Panzram
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany. .,Heidelberg University Hospital, Clinic for Orthopaedics and Trauma Surgery, Schlierbacher Landstraße 200A, 69118, Heidelberg, Germany.
| | - Yasser Kentar
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Michael Maier
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Pit Hetto
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
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Migliorini F, Driessen A, Quack V, Schenker H, Tingart M, Eschweiler J. Patellar fixation graft via suture anchors versus tunnel techniques during isolated MPFL reconstruction for recurrent patellofemoral instability: a systematic review of the literature. Arch Orthop Trauma Surg 2020; 140:1201-1210. [PMID: 32318817 PMCID: PMC8208927 DOI: 10.1007/s00402-020-03420-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There is still a lack of evidence concerning the patellar fixation of the medial patellofemoral ligament (MPFL) graft in selected patient with recurrent instability. The purpose of the present study was to investigate and compare clinical outcomes and further complications of isolated MPFL reconstruction via suture anchors versus tunnel techniques for recurrent patellofemoral instability. MATERIALS AND METHODS This systematic review of the literature was conducted according to the PRISMA guidelines. In September 2019, the main databases were accessed. All the clinical trials performing isolated MPFL reconstruction in patients with recurrent patellofemoral instability were included in the present study. Only articles fixing the MPFL graft through suture anchors and/ or patellar tunnel techniques were included in the analysis. RESULTS Data from 46 papers (1712 patients) were recorded. The mean follow-up was 40 ± 18 months. No differences were found in Kujala, Lysholm and Tegner score, International Knee Documentation Committee, visual analogic scale, range of motion and re-dislocation rate. The suture anchors fixation group detected reduced rate of apprehension test (OR: 0.6; p = 0.03), revision surgeries (OR: 0.4; p = 0.02) and anterior knee pain (OR: 0.05; p < 0.0001) and reduced not-classified complications (OR: 0.18; p < 0.0001). CONCLUSION Both the suture anchors and the bone-tunnels are a feasible option for isolated MPFL reconstruction in patients with recurrent patellofemoral instability. Patellar fixation via suture anchors evidenced a reduced rate of anterior knee pain, revision surgeries, apprehension test and an overall reduced complication compared to the bone-tunnel technique.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Arne Driessen
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Valentin Quack
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Hanno Schenker
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
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Longo UG, Petrillo S, Loppini M, Candela V, Rizzello G, Maffulli N, Denaro V. Metallic versus biodegradable suture anchors for rotator cuff repair: a case control study. BMC Musculoskelet Disord 2019; 20:477. [PMID: 31653247 PMCID: PMC6815043 DOI: 10.1186/s12891-019-2834-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 09/13/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUNDS Repair of full-thickness rotator cuff (RC) tears is routinely performed using suture anchors, which produce secure and effective soft tissue fixation to bone. The aim of this prospective study is to compare the long-term outcomes of single row arthroscopic rotator cuff repair (RCR) performed using metal or biodegradable suture anchors. The null hypothesis is that there is no difference in shoulder function using metal or biodegradable suture anchors as evaluated by UCLA shoulder score, Wolfgang criteria, and Oxford shoulder score. METHODS Arthroscopic RCR was performed in 110 patients included in this case control study. They were divided into 2 groups of 51 and 59 patients respectively. Metal suture anchors were used in group 1, and biodegradable suture anchors in group 2. Results were obtained at a mean follow up of 4.05 + 2 years. Clinical outcomes and functional outcomes were evaluated. RESULTS The mean modified UCLA shoulder score was 26.9 + 7.1 in group 1, and 27.7 + 6.5 in group 2 (P = 0.5); the mean Wolfgang score was 13.3 + 3.3 in group 1, and 14 + 2.6 in group 2 (P = 0.3); the mean OSS was 23.7 + 11.4 in group 1, and 20.7 + 9.2 points in group 2 (P = 0.1). The mean active anterior elevation was 163.5° + 28.2° in group 1 and 163.6° + 26.9 in group 2 (P = 0.9); the mean active external rotation was 46° + 19.7° in group 1 and 44.6° + 16.3° in group 2 (P = 0.7). The mean strength in anterior elevation was 4.8.02 + 23.52 N in group 1, and 43.12 + 17.64 N in group 2 (P = 0.2); the mean strength in external rotation was 48.02 + 22.54 N in group 1 and 46.06 + 17.64 N in group 2 (P = 0.6); the mean strength in internal rotation was 67.62 + 29.4 N in group 1, and 68.6 + 25.48 N in group 2 (P = 0.9). CONCLUSIONS There are no statistically significant differences at a mean follow-up of 4.05 + 2 years in clinical and functional outcomes of single row arthroscopic RCR using metallic or biodegradable suture anchors for RC < 5 cm.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy. .,Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
| | - Stefano Petrillo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.,Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.,Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.,Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Giacomo Rizzello
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.,Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.,Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
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Kim YW, Roh SY, Kim JS, Lee DC, Lee KJ. Volar plate avulsion fracture alone or concomitant with collateral ligament rupture of the proximal interphalangeal joint: A comparison of surgical outcomes. Arch Plast Surg 2018; 45:458-65. [PMID: 30282417 DOI: 10.5999/aps.2018.00346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/03/2018] [Indexed: 11/18/2022] Open
Abstract
Background Volar plate avulsion fracture of the proximal interphalangeal (PIP) joint is one of the most common hand injuries. In this study, we divided patients into two groups: patients with pure volar plate avulsion fracture, and patients with volar plate avulsion fracture concomitant with collateral ligament rupture. The purpose of this study was to compare long-term surgical outcomes between the two groups. As a secondary measure, the Mitek bone anchoring and polydioxanone (PDS) bone suturing techniques were compared. Methods A single-institutional retrospective review of the surgical treatment of volar plate avulsion fracture was performed. The cases were divided into those with pure volar plate avulsion fracture (group A, n=15) and those with volar plate avulsion fracture concomitant with collateral ligament rupture (group B, n=15). Both groups underwent volar plate reattachment using Mitek bone anchoring or PDS bone suturing followed by 2 weeks of immobilization in a dorsal protective splint. Results The average range of motion of the PIP joint and extension lag were significantly more favorable in group A (P<0.05). Differences in age; follow-up period; flexion function; visual analog scale scores; disabilities of the arm, shoulder, and hand scores; and the grip strength ratio between the two groups were non-significant. No significant differences were found in the surgical outcomes of Mitek bone anchoring and PDS bone suturing in group A. Conclusions Overall, the surgical outcomes of volar plate reattachment were successful irrespective of whether the collateral ligaments were torn. However, greater extension lag was observed in cases of collateral ligament injury.
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Zhang H, Liu PZ, Zhang X, Ding C, Cui HC, Ding WB, Wang RK, Wu DJ, Wei Q, Qin S, Wu XL, Tong DK, Wang GC, Tang H, Ji F. A new less invasive surgical technique in the management of acute Achilles tendon rupture through limited-open procedure combined with a single-anchor and "circuit" suture technique. J Orthop Surg Res 2018; 13:198. [PMID: 30097054 PMCID: PMC6086049 DOI: 10.1186/s13018-018-0895-x] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 07/17/2018] [Indexed: 12/26/2022] Open
Abstract
Background Traditional incision repair and minimally invasive repair for acute Achilles tendon repair have limitations. This study aimed to present our series of 23 patients with acute Achilles tendon rupture that was repaired using two small incisions to assist the anchor repair of the tear and a new “circuit” suture technique. Methods This was a retrospective study of 23 patients with acute Achilles tendon rupture treated with the new technique at Changhai Hospital between January 2015 and December 2016 and followed up for 14–33 months. Clinical outcome was assessed using the AOFAS, Leppilahti, and Arner-Lindholm scores. Complications, range of motion (ROM), and time to return to work and light sport activity were assessed. Results The AOFAS score was 85–96 at 3 months and 92–100 at 12 months. The 3-month ROM was 27°–37°, and the 12-month ROM was 36°–48°. The Leppilahti score was 85–95 at 3 months and 90–100 at 12 months. The recovery time of the patients was 10–18 weeks. The postoperative recovery time to exercise was 16–24 weeks. There was only one case of deep venous thrombosis. According to the Arner-Lindholm assessment criteria, patient outcomes were rated as excellent in 20 (87.0%) cases, good in three (13.0%) cases, and poor in 0 cases. The excellent-to-good rate was 100%. Conclusion The limited-open procedure combined with a single-anchor and “circuit” suture technique could be used to repair torn Achilles sites, with a low occurrence of complications. This new and minimally invasive technique could be an alternative in the management of acute Achilles tendon rupture.
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Affiliation(s)
- Hao Zhang
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Pei-Zhao Liu
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Xin Zhang
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Chen Ding
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Hao-Chen Cui
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Wen-Bin Ding
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Ren-Kai Wang
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Da-Jiang Wu
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Qiang Wei
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Sheng Qin
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Xue-Lin Wu
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Da-Ke Tong
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Guang-Chao Wang
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China
| | - Hao Tang
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China.
| | - Fang Ji
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, No 168 Changhai road, Shanghai, 200433, China.
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Malahias MA, Chytas D, Nakamura K, Raoulis V, Yokota M, Nikolaou VS. A Narrative Review of Four Different New Techniques in Primary Anterior Cruciate Ligament Repair: "Back to the Future" or Another Trend? Sports Med Open 2018; 4:37. [PMID: 30094753 PMCID: PMC6085215 DOI: 10.1186/s40798-018-0145-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/02/2018] [Indexed: 01/28/2023]
Abstract
Recently, four different operative techniques, referring to the primary anterior cruciate ligament (ACL) repair, were described. These are the dynamic intraligamentary stabilization (DIS) with Ligamys™, the Bridge-enhanced repair (BEAR), the use of internal brace, and the refixation with suture anchors. The purpose of this study was to assess the already-published, clinical, and pre-clinical results of those techniques. A literature review was conducted and implemented by three independent researchers. Inclusion criteria were clinical or cadaveric or animal studies about patients suffering from ACL rupture, who were treated with one of those four different arthroscopic techniques of primary ACL repair. There were 10 clinical trials dealing with the different techniques of primary ACL repair and 12 cadaveric or animal studies. The majority of the published clinical trials investigated the dynamic intraligamentary stabilization (DIS), while only four studies referred to the three other surgical techniques. Most of the clinical trials suggested that primary ACL repair should be done during the first 14–21 days after a proximal ACL rupture and not later. Further clinical evidence is needed for the techniques of bridge-enhanced ACL repair, internal brace, and suture anchors ACL refixation in order to support the animal and cadaveric biomechanical studies. Till now, the existing clinical trials were not enough to establish the use of those techniques in the ACL-ruptured patients. On the contrary, the Dynamic intraligamentary stabilization with Ligamys™ device demonstrated very promising results in different types of clinical studies.
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Affiliation(s)
- Michael-Alexander Malahias
- 2nd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. .,ATOS Hospital, Heidelberg, Germany. .,Orthopaedic Surgeon, ATOS Klinik, Schlossberg 21, 69117, Heidelberg, Germany.
| | - Dimitrios Chytas
- 2nd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kaori Nakamura
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.,ATOS Hospital, Heidelberg, Germany
| | - Vasileios Raoulis
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.,ATOS Hospital, Heidelberg, Germany
| | - Masashi Yokota
- Department of Sports Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Vasileios S Nikolaou
- 2nd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Aziz KT, Shi BY, Okafor LC, Smalley J, Belkoff SM, Srikumaran U. Pullout strength of standard vs. cement-augmented rotator cuff repair anchors in cadaveric bone. Clin Biomech (Bristol, Avon) 2018; 54:132-136. [PMID: 29587146 DOI: 10.1016/j.clinbiomech.2018.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 07/10/2017] [Revised: 03/01/2018] [Accepted: 03/19/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND We evaluate a novel method of rotator cuff repair that uses arthroscopic equipment to inject bone cement into placed suture anchors. A cadaver model was used to assess the pullout strength of this technique versus anchors without augmentation. METHODS Six fresh-frozen matched pairs of upper extremities were screened to exclude those with prior operative procedures, fractures, or neoplasms. One side from each pair was randomized to undergo standard anchor fixation with the contralateral side to undergo anchor fixation augmented with bone cement. After anchor fixation, specimens were mounted on a servohydraulic testing system and suture anchors were pulled at 90° to the insertion to simulate the anatomic pull of the rotator cuff. Sutures were pulled at 1 mm/s until failure. FINDINGS The mean pullout strength was 540 N (95% confidence interval, 389 to 690 N) for augmented anchors and 202 N (95% confidence interval, 100 to 305 N) for standard anchors. The difference in pullout strength was statistically significant (P < 0.05). INTERPRETATION This study shows superior pullout strength of a novel augmented rotator cuff anchor technique. The described technique, which is achieved by extruding polymethylmethacrylate cement through a cannulated in situ suture anchor with fenestrations, significantly increased the ultimate failure load in cadaveric human humeri. This novel augmented fixation technique was simple and can be implemented with existing instrumentation. In osteoporotic bone, it may substantially reduce the rate of anchor failure.
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Affiliation(s)
- Keith T Aziz
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, USA.
| | - Brendan Y Shi
- The Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, MD 21205, USA
| | - Louis C Okafor
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, USA.
| | - Jeremy Smalley
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, USA.
| | - Stephen M Belkoff
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, USA.
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, USA.
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Ockert B, Biermann N, Nebelung W, Wiedemann E. [Arthroscopic soft tissue stabilization of posttraumatic anterior shoulder instability : Techniques, limitations and long-term results]. Unfallchirurg 2017; 121:108-116. [PMID: 29134236 DOI: 10.1007/s00113-017-0438-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Arthroscopic soft tissue stabilization is a well-established and broadly accepted procedure to treat posttraumatic shoulder instability. Advantages in comparison to open stabilization procedures include improved visualization of the structural damage and a less invasive approach. Technical developments in recent years have led to further improvement of the arthroscopic technique for shoulder instability. This article presents a description of principles and new developments as it contains basic techniques including patient positioning, access portals, preparation of the glenoid bone, soft tissue handling and shuttle techniques. Modern suture anchor systems to achieve arthroscopic stabilization with the corresponding advantages and disadvantages are also presented. Furthermore, the limitations and long-term results of arthroscopic soft tissue stabilization are discussed.
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Affiliation(s)
- B Ockert
- Sektion Schulter- und Ellenbogenchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München (LMU), Nußbaumstr. 20, 80336, München, Deutschland.
| | - N Biermann
- Sektion Schulter- und Ellenbogenchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München (LMU), Nußbaumstr. 20, 80336, München, Deutschland
| | - W Nebelung
- Sportorthopädie Düsseldorf, Marienkrankenhaus, Düsseldorf-Kaiserswerth, Deutschland
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Yoo JI, Ha YC, Hwang SC, Oh JY, Chang EC, Lee YK, Koo KH. Factors Associated with the Risk of Articular Surface Perforation during Anchor Placement for Arthroscopic Acetabular Labral Repair. Clin Orthop Surg 2017; 9:405-412. [PMID: 29201292 PMCID: PMC5705298 DOI: 10.4055/cios.2017.9.4.405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/15/2017] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of this study was to evaluate factors associated with the risk of articular surface perforation during anchor placement for arthroscopic acetabular labral repair using follow-up computed tomographic arthrography (CTA). Methods Forty-six patients (29 males and 17 females) underwent arthroscopic labral repair using 142 suture anchors (55 large anchors and 87 small anchors). The patients were followed with CTA 1 year postoperatively. Anchor position was assessed by the insertion angle and the distance of the suture anchor tip from the articular cartilage. The incidence of malposition of suture anchors was assessed in follow-up CTA. The location and incidence of malposition were compared between two groups divided according to the diameter of suture anchor. Results The mean insertion angle and distance were significantly different between the groups. Of the 142 anchors, 15 (11%) were placed in the cartilage-bone transitional zone. Articular involvement was most common at the 3 o'clock position of the suture anchor (six out of 33 anchors, 18.2%). Both the insertion angle and distance showed small values in the articular involvement group. Conclusions The radiographic analysis of the placement of suture anchors after arthroscopic labral refixation based on follow-up CTA demonstrates that articular involvement of anchors is related to the location on the acetabular rim (clock position) and anchor diameter.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sun-Chul Hwang
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jin-Young Oh
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Eui-Chan Chang
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Dolkart O, Chechik O, Bivas A, Brosh T, Drexler M, Weinerman Z, Maman E. Subacromial corticosteroid injections transiently decrease suture anchor pullout strength: biomechanical studies in rats. J Shoulder Elbow Surg 2017; 26:1789-1793. [PMID: 28689827 DOI: 10.1016/j.jse.2017.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 01/23/2017] [Revised: 05/06/2017] [Accepted: 05/08/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthroscopic rotator cuff (RC) repair incorporates suture anchors to secure torn RC tendons to the greater tuberosity (GT) bone. RC repair strength depends on the anchor-bone interface and on the quality of the GT. We evaluated the effect of single and multiple corticosteroid injections on the pullout strength of suture anchors. METHODS Fifty rats were divided into those receiving saline solution injection (control group), a single methylprednisolone acetate (MTA) injection (MTA1 group), or 3 once-weekly MTA injections (MTA3 group). Rats were killed humanely at 1 or 4 weeks after the last injection. A mini-suture anchor was inserted into the humeral head through the GT. Specimens were tested biomechanically. RESULTS At 1 week after the last injection, the mean maximal pullout strength was significantly reduced in the MTA1 group (63.5%) and MTA3 group (56%) compared with the control group (P < .05 for both). Mean stiffness decreased significantly in both treatment groups compared with controls (P < .05). At 4 weeks after the last injection, there was a significant increase in the mean maximal pullout strength after single and triple MTA injections compared with values recorded at the 1-week time point (P < .05). At 4 weeks, the mean maximal pullout strength after a single MTA injection was 92.8% of the pullout strength measured in the control group. CONCLUSIONS We showed a significant detrimental effect of corticosteroid exposure on the pullout strength of a suture anchor at 1 week. However, this effect was transient and resolved within a relatively short period. These findings indicate that a waiting period is required between subacromial corticosteroid injection and RC repair surgery that involves the use of suture anchors.
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Affiliation(s)
- Oleg Dolkart
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ofir Chechik
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Bivas
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Brosh
- Biomechanics Laboratory, School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Drexler
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zachary Weinerman
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Maman
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Severyns M, Renard G, Guillou R, Odri GA, Labrada-Blanco O, Rouvillain JL. Arthroscopic suture repair of acute quadriceps tendon ruptures. Orthop Traumatol Surg Res 2017; 103:377-380. [PMID: 28212989 DOI: 10.1016/j.otsr.2016.12.018] [Citation(s) in RCA: 5] [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: 09/27/2016] [Revised: 12/19/2016] [Accepted: 12/29/2016] [Indexed: 02/02/2023]
Abstract
Acute quadriceps tendon ruptures disrupt the continuity of the extensor mechanism and must be treated surgically. Tendon reattachment with suture anchors has recently been shown to be biomechanically superior to reattachment through transosseous tunnels. In this context, arthroscopy is an interesting alternative. It can limit postoperative wound healing and infectious complications, while ensuring functional outcomes that are equivalent to standard techniques. The goal of this technical note is to describe an original, reproducible method for arthroscopic reattachment of the quadriceps tendon with suture anchors. Four patients were operated using this technique in a pilot study. No wound healing, infectious complications or re-tears were observed. At 6 months' postoperative, the mean subjective IKDC score was 85.8/100.
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Affiliation(s)
- M Severyns
- Service de chirurgie orthopédique et traumatologique, CHU de Martinique, CS90632, 97261 Fort-de-France, Martinique.
| | - G Renard
- Service de chirurgie orthopédique et traumatologique, CHU de Martinique, CS90632, 97261 Fort-de-France, Martinique
| | - R Guillou
- Clinique chirurgicale orthopédique et traumatologique, Hôtel-Dieu, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes, France
| | - G A Odri
- Service de chirurgie orthopédique, CHU Lariboisière, rue Ambroise-Paré, 75010 Paris, France
| | - O Labrada-Blanco
- Service de chirurgie orthopédique et traumatologique, CHU de Martinique, CS90632, 97261 Fort-de-France, Martinique
| | - J L Rouvillain
- Service de chirurgie orthopédique et traumatologique, CHU de Martinique, CS90632, 97261 Fort-de-France, Martinique
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de S Leão R, da S Júnior EZ, de Alencar MG, Catunda RQ, de Moraes SL, do E Vasconcelos BC. Use of Mini-anchors and Rehabilitation with 0° Cusp Angle Teeth Complete Denture in Recurrent Condylar Dislocation: Technical Adequacy and Procedure. J Contemp Dent Pract 2017; 18:337-341. [PMID: 28349915 DOI: 10.5005/jp-journals-10024-2042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM To report a case of association between the surgical treatment of temporomandibular dysfunction and rehabilitation with denture total prosthesis (TP) using nonanatomic teeth (cusp 0°) in patients with anterior recurrent dislocation of the temporo-mandibular joint (TMJ) and persistent uncontrolled mandibular movement, showing a technical adaptation and conduct. INTRODUCTION There are several treatment approaches available for dislocation of the TMJ. The use of condylar mini-anchors for recurrent TMJ dislocation is a valid option and should be considered since it does not alter the joint anatomy. In edentulous patients undergoing TMJ surgical procedures, prosthetic rehabilitation can be seen as a means of treatment preservation. CASE REPORT A 73-year-old female patient attended the oral and maxillofacial surgery clinic presenting with joint instability, ligament laxity, and chronic recurrent TMJ dislocations. She had already been through three previous unsuccessful surgical procedures. A treatment plan was done based on the installation of a mini-anchor in the patient's TMJ through the preauricular surgical access. Dislocations were then resolved, but the lack of mandibular control even to a lesser extent after surgery precluded the use of prosthetics even at rest. Thus, it was planned to manufacture two conventional TPs with 0° cusp angle teeth, a clinical protocol shortened to three sessions in an attempt to improve the stability of the prosthesis. CONCLUSION The use of an individual mini-anchor is simple and effective, and the use of artificial teeth is well suited to the case. CLINICAL SIGNIFICANCE A multidisciplinary intervention (surgery/ prosthesis) is of utmost importance for the resolution and preservation of the treatment of these complex cases.
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Affiliation(s)
- Rafaella de S Leão
- Department of Restorative Dentistry, Dentistry School University of Pernambuco, Recife, Brazil, Phone: +005581996933610 e-mail:
| | | | | | - Raisa Q Catunda
- Department of Dentistry, Federal University of Pernambuco Recife, Brazil
| | - Sandra Ld de Moraes
- Department of Prosthodontics, Dentistry School, University of Pernambuco, Recife, Brazil
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Omar M, Petri M, Dratzidis A, El Nehmer S, Hurschler C, Krettek C, Jagodzinski M, Ettinger M. Biomechanical comparison of fixation techniques for medial collateral ligament anatomical augmented repair. Knee Surg Sports Traumatol Arthrosc 2016; 24:3982-3987. [PMID: 25266229 DOI: 10.1007/s00167-014-3326-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 03/08/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Although the majority of medial collateral ligament (MCL) ruptures can be treated conservatively with good results, some injuries require operative treatment. Besides MCL reconstruction, anatomical augmented repair may be considered. This study was to assess biomechanical properties of different fixation techniques regarding elongation and ultimate load to failure. METHODS MCL anatomical augmented repair was simulated by fixation of porcine superficial digital flexor tendon grafts at porcine tibiae. Ten different fixation techniques were assessed. Fixation of the tendon graft was performed using 4.0-mm cancellous screws and either (1) 13.5-mm spiked polyether ketone (PEEK) washers; (2) 14-mm spiked washers; (3) 14-mm suture washers; (4) 14-mm customized washers; (5-8) combination of washers and No. 2 polyester sutures (FiberWire©); or using (9) single or (10) double 5.5-mm titanium suture anchors with No. 2 polyethylene sutures (Ultrabraid®). Biomechanical analysis included pretensioning of the constructs at 20 N for 30 s following cyclic loading of 250 cycles between 20 and 100 N at 1 Hz for measurement of elongation. Additionally, ultimate failure load and failure mode analysis were performed. RESULTS Spiked PEEK washers secured with polyester sutures (5) yielded best biomechanical properties at time zero for both, elongation during cyclic loading (2.9 ± 0.7 mm) and ultimate failure load (469.8 ± 64.3 N). CONCLUSIONS These results suggest that spiked PEEK washers secured with polyester sutures are the most appropriate fixation technique for MCL anatomical augmented repair, thus providing best requirements to allow early knee mobilization and prevent secondary knee laxity.
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Affiliation(s)
- Mohamed Omar
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Maximilian Petri
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Antonios Dratzidis
- Orthopaedic Surgery Department, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Simon El Nehmer
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Christof Hurschler
- Laboratory for Biomaterials and Biomechanics, Orthopaedic Surgery Department, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Michael Jagodzinski
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Max Ettinger
- Orthopaedic Surgery Department, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
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Nascimento ATD, Claudio GK. Functional and radiological evaluation of acute acromioclavicular dislocation treated with anchors without eyelet: comparison with other techniques. Rev Bras Ortop 2016; 51:561-568. [PMID: 27818978 PMCID: PMC5091025 DOI: 10.1016/j.rboe.2016.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Received: 11/07/2015] [Accepted: 02/23/2016] [Indexed: 11/26/2022] Open
Abstract
Objective To assess the repair results of acromioclavicular dislocations (ACJD) grades III and V, with anchors without eyelet, when compared with other techniques, and to evaluate factors that can affect the final result. Methods A retrospective study of 36 patients with ACJD grades III and V in the Rockwood classification, 12 treated with anchors without eyelet, 11 with one tightrope, six with two tightropes, and six with subcoracoid cerclage, operated from September 2012 to February 2015. Patients were assessed radiographically and through DASH, UCLA, the visual analog scale of pain (VAS) and the Short-Form 36 (SF-36). Surgical time and the possible influence of some factors in the outcome were also assessed. Results The mean DASH score was 6.7; UCLA, 32.9; VAS, 1.2; and SF-36, 79.47. Radiographically, the final mean measurement was 9.93 mm, with no statistical difference between the groups. The mean surgical time for Group I was 31 min; Group II, 19 min; Group III, 29 min; and Group IV, 59 min. There was a significant difference between Groups II and IV when compared with the study group. The initial and immediate post-operative ACJD measurements ACJD were correlated with the final measure. Conclusion The repair of acute ACJD with anchors without eyelet is as effective as the other methods, with significantly shorter operative time when compared with the subcoracoid cerclage technique. The final radiological result is influenced by the coracoclavicular initial distance and the immediate postoperative measurement.
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Euler SA, Horan MP, Ellman MB, Greenspoon JA, Millett PJ. Chronic rupture of the long head of the biceps tendon: comparison of 2-year results following primary versus revision open subpectoral biceps tenodesis. Arch Orthop Trauma Surg 2016; 136:657-63. [PMID: 26810192 DOI: 10.1007/s00402-015-2393-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 11/20/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the clinical results of surgical repair for proximal long head of the biceps (LHB) tendon ruptures comparing chronic primary and postsurgical revision LHB tendon ruptures. MATERIALS AND METHODS Patients who underwent subpectoral LHB tenodesis for chronic ruptures with a minimum of 2 years from surgery were identified. ASES and SF-12 PCS scores and surgical and demographic data were collected prospectively. At final follow-up, patients were interviewed regarding symptoms related to their biceps. Symptoms were converted into a Subjective Proximal Biceps Score (SPBS). RESULTS Twenty-seven patients (22 males, 5 females) with a mean age of 61 years (range 40-76 years) underwent LHB tenodeses. Twenty patients (74.1 %) were primary repairs for chronic ruptures and seven patients (25.9 %) were revision repairs after failed prior LHB tenodesis. Twenty-five patients (92.6 %; n = 18 primary; n = 7 revision) were available for follow-up a mean of 3.8 years (range 2-6.1). The overall median postoperative SPBS showed significant improvement over the preoperative baseline (p < 0.001). Individual components of the SPBS showed substantial improvements. The SPBS significantly correlated with the postoperative ASES score (r = -0.478; p = 0.038). There were no differences in postoperative SPBSs between the primary and revision tenodesis groups. The mean postoperative ASES score was 90.3 and SF-12 PCS was 52.6. CONCLUSIONS Open subpectoral LHB tenodesis was a safe and effective method for the treatment of chronic LHB tendon ruptures and for the revision of failed post-surgical LHB ruptures. Patients had less pain, cramping, and deformity after LHB tenodesis. The SPBS, ASES, and SF-12 PCS scores significantly improved among this group of patients. LEVEL OF EVIDENCE Level III; Retrospective comparative study.
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Affiliation(s)
- Simon A Euler
- Center for Outcomes-based Orthopaedic Research (COOR), Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA. .,The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA. .,Department of Trauma Surgery and Sports Traumatology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Marilee P Horan
- Center for Outcomes-based Orthopaedic Research (COOR), Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA
| | - Michael B Ellman
- Center for Outcomes-based Orthopaedic Research (COOR), Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA.,The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA
| | - Joshua A Greenspoon
- Center for Outcomes-based Orthopaedic Research (COOR), Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA
| | - Peter J Millett
- Center for Outcomes-based Orthopaedic Research (COOR), Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA.,The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA
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Martel ÉM, Rodrigues A, Dos Santos Neto FJ, Dahmer C, Ranzzi A, Dubiela RS. Evaluation of postoperative results from videoarthroscopic treatment for recurrent shoulder dislocation using metal anchors. Rev Bras Ortop 2016; 51:45-52. [PMID: 26962500 DOI: 10.1016/j.rboe.2015.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/31/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To clinically and radiologically evaluate the results from videoarthroscopic treatment using metal anchors in patients with recurrent shoulder dislocation and its complications. METHODS This was a retrospective study on 47 patients (47 shoulders) operated by the shoulder group of the orthopedic hospital between February 2010 and February 2012. A questionnaire, interview and physical and radiographic examinations were used, with the classification of Samilson and Pietro. The mean postoperative follow-up was 33 months (range 12-47 months). The statistical analysis consisted of using Fisher's exact test through the IBM SPSS 22 statistical software. The significance level used was 5%. RESULTS Recurrence was observed in nine cases. The patients were, on average, 26.5 years old at the first episode, and 19.1% were aged 20 years or under. Among these, 55.6% presented recurrence. In relation to age at the time of the surgical procedure, the average age was 27 years, and 12.8% were aged 20 years or under. Nineteen patients presented prominent anchors and, of these, 21% manifested arthrosis. CONCLUSION There was a statistically identified correlation between the recurrence rate and age less than or equal to 20 years at the times of first dislocation and the surgical procedure. Further studies should be conducted in order to compare the use of absorbable anchors, which despite higher cost, may provide lower risk of developing glenohumeral arthrosis in some cases.
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Gülecyüz M, Bortolotti H, Pietschmann M, Ficklscherer A, Niethammer T, Roßbach B, Müller P. Primary stability of rotator cuff repair: can more suture materials yield more strength? Int Orthop 2015; 40:989-97. [PMID: 26442512 DOI: 10.1007/s00264-015-3012-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/22/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION It remains unclear if the increased biomechanical stability of the double-row repair is solely a result of the technique itself or due to the greater number of utilized materials. This study analyses the various rotator cuff (RC) repair interfaces and the influence of doubling the number of suture knots, stitch techniques and suture anchors on the primary stability of the RC reconstruction. MATERIALS AND METHODS Established cyclic testing protocols were used to test the primary stability of the knot interface with a Duncan loop and Roeder knot, the tendon-to-suture interface with a single-stitch and Mason-Allen-stitch and the anchor-to-bone interface with OPUS Magnum 2® and BioCorkscrew® anchors. After doubling the materials, the interfaces were tested again and compared to the yielded solitary values. The maximum failure loads (Fmax), clinical failure (CF), system displacement (SD) and modes of failure were recorded. RESULTS Doubling the amount of knots, stitches and suture anchors improved almost all interface parameters. For example, Fmax, CF and SD of the Roeder knot could be significantly improved from 142.5 N to 256.7 N, from 82.5 N to 155.0 N and from 0.45 mm to 0.20 mm, respectively. The Mason-Allen stitch's Fmax improved from 196.4 N to 324.9 N, and CF from 94.25 N to 139.8 N, with almost identical SD of 0.81 mm and 0.84 mm. Bio-Corkscrew® Fmax improved from 232.5 N to 317.5 N, CF from 182.5 N to 210 N, and SD from 0.85 mm to 0.64 mm. CONCLUSION Doubling the number of knots, stitches and suture anchors increases the primary stability of the various RC repair interfaces and may result in RC rerupture rate reduction. Furthermore, this study suggests that a suture anchor loaded with two or three sutures may yield the same primary stability as two or three suture anchors loaded with a single suture. This in vitro biomechanical study focuses solely on the rotator cuff interfaces at time zero; the biological healing process was therefore not analysed and requires further investigation. CLINICAL RELEVANCE Improved primary stability by increased number of suture materials may reduce rate of RC rerupture.
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Affiliation(s)
- Mehmet Gülecyüz
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Medical Center of the University of Munich, Munich, Germany.
| | - Hannes Bortolotti
- Department of Trauma Surgery and Sports Traumatology, A.Ö. BKH Kufstein, Kufstein, Austria
| | - Matthias Pietschmann
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Medical Center of the University of Munich, Munich, Germany
| | - Andreas Ficklscherer
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Medical Center of the University of Munich, Munich, Germany
| | - Thomas Niethammer
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Medical Center of the University of Munich, Munich, Germany
| | - Björn Roßbach
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Medical Center of the University of Munich, Munich, Germany
| | - Peter Müller
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Medical Center of the University of Munich, Munich, Germany
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Abstract
INTRODUCTION Majority of the current medial patellofemoral ligament (MPFL) reconstruction techniques vary with respect to methods of fixation on the patella. In an effort to maximise the area of patellar footprint coverage and minimise the complication of patellar fracture, we developed a procedure that implemented the double-pulley suture anchors technique. DESIGN Prospective case series. SETTING A primary medical centre in Kaohsiung, Taiwan. PATIENTS AND METHODS Eighteen consecutive patients (18 knees) who met the inclusion criteria underwent the aforementioned operation between January 2010 and March 2012. Patients were evaluated using functional scores (Kujala and Tegner-Lysholm scores), apprehension test, and radiographic examination (congruence angle and patellar tilting angle) preoperatively and at the follow-up. RESULTS The mean follow-up was 35 months. A firm endpoint to lateral patellar translation was noted in all patients at the last follow-up with a mean lateral translation quadrant of 1.5 (improved from 3.5 preoperatively, p<0.001). Both clinical and radiographic assessment improved significantly (p<0.001); the mean Kujala score improved from 55.3±6.8 preoperatively to 95.2±3.5 at the last follow-up; TegnerLysholm from 43.6±8.1 to 93.6±6.8; the mean congruence angle improved from 20.6°±2.1° preoperatively to -5.2°±2.4° at the last follow-up; and the patellar tilting angle from 23.8°±2.3° to 9.6°±1.3°. CONCLUSION The double-pulley patellar fixation technique, by having a result that is comparable with those of other studies that used aperture fixation techniques, can be a promising surgical option for anatomically reconstructing the medial petellofemoral ligament.
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Affiliation(s)
- Kuan-Yu Lin
- Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Dazong 1(st) Road, Kaohsiung City, Taiwan.
| | - Yih-Chau Lu
- Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Dazong 1(st) Road, Kaohsiung City, Taiwan
| | - Jenn-Huei Renn
- Department of Orthopedics, Kaohsiung Veterans General Hospital, 386 Dazong 1(st) Road, Kaohsiung City, Taiwan
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Ansari MT, Kotwal PP, Morey VM. Primary repair of capsuloligamentous structures of trapeziometacarpal joint: A preliminary study. J Clin Orthop Trauma 2014; 5:185-92. [PMID: 25983496 PMCID: PMC4264062 DOI: 10.1016/j.jcot.2014.09.009] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 09/19/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Isolated trapezio-metacarpal joint dislocation is uncommon and challenging since controversy still exists regarding its management. DESCRIPTION We present a short case series in which direct repair of trapezio-metacarpal ligaments was done in three patients who had isolated, unstable dislocation of the thumb carpometacarpal joint. All of them were engaged in tasks where no compromise in hand functions and grip strength was affordable. The dislocation was addressed primarily by repair of volar oblique and dorsoradial ligaments with suture anchors. The joint was immobilised in a cast for 4 weeks followed by gradual mobilisation. RESULTS At an average follow up of 15 months, all the three patients have no restriction in the range of motion. There are no symptoms and signs of instability. In two patients, there is no pain at all; while one patient has occasional pain which is mild and does not interfere with the hand function. Radiographic examination showed normal joint alignment and no signs of subluxation or early osteoarthritis. CONCLUSION Repair of the capsuloligamentous complex with suture anchors may be considered as a treatment option in unstable trapezio-metacarpal joint dislocations in high demand patients.
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Affiliation(s)
| | | | - Vivek Machhindra Morey
- Senior Resident, Department of Orthopaedics, All India Institute of Medical Sciences, Aurobindo Marg, New Delhi 110029, India,Corresponding author. Tel.: +91 9968859509.
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Murena L, Canton G, Camana E, Vulcano E, Cherubino P. Anatomic reinsertion of the distal biceps tendon rupture through a single anterior approach: extensile or mini-invasive approach? A retrospective study at mean 45-month follow-up. Musculoskelet Surg 2014; 98 Suppl 1:71-6. [PMID: 24659195 DOI: 10.1007/s12306-014-0318-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 02/22/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate and compare clinical results and complication rate of a standard and mini-invasive reconstruction technique for distal biceps tendon rupture. METHODS Twenty-eight cases of biceps tendon rupture were evaluated at mean 45-month follow-up. A standard anterior approach was used in 19 cases, and a less invasive anterior approach was used in nine cases. Suture anchors were used for tendon reconstruction in all cases. Elbow range of motion (ROM), subjective strength recovery, time to return to work and sports activities, and complications were recorded. Disability of the Arm, Shoulder and Hand Score (DASH) the Oxford Elbow Score (OES), and the Mayo Elbow Performance Score (MEPS) were obtained for all patients. RESULTS Mean ROM recovery was almost complete. Mean subjective strength recovery allowed full return to sports and work in 93 % of cases, within mean 3-month postoperative. Mean DASH, OES, and MEPS scores were good. The clinically relevant complications rate was 17.8 %, all associated with the standard extensile approach group (Group A). Asymptomatic heterotopic ossifications were detected in four cases (14.3 %), not affecting functional recovery. CONCLUSIONS Clinical results and complications rate of anatomical reconstruction of the distal biceps tendon rupture were comparable to the literature. Comparison between Group A and B showed no significant differences in terms of ROM, and OES and MEPS scores. Strength recovery, time to return to sports and work, and DASH score showed a positive trend in Group B. The clinically relevant complications rate was 0 % in Group B and 26 % in Group A.
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