Anchor Constructs Research Articles

Clinical Outcomes of Adolescents With Anterior Shoulder Instability and Glenolabral Articular Disruption Lesions Compared With Isolated Bankart Lesions.

Glenolabral articular disruption (GLAD) lesions may occur in adolescents with anterior shoulder instability, resulting in articular cartilage loss and reduced functional glenoid surface area. To compare failure rates and patient-reported outcomes (PROs) between adolescents with versus without GLAD lesions who were treated for anterior shoulder instability with arthroscopic stabilization. It was hypothesized that the comparison would yield no significant differences. Cohort study; Level of evidence, 3. Patients aged ≤18 years who were treated for anterior shoulder instability with arthroscopic stabilization between 2010 and 2021 were retrospectively identified. Those patients with a GLAD lesion identified at the time of surgery were compared with patients with >2 years of retrospective follow-up who were matched to the no-GLAD cohort according to pathology and management. Demographic and patient characteristics including recurrent instability, complications, and reoperations were recorded. All patients in the GLAD cohort were contacted to obtain PRO data, including the Single Assessment Numeric Evaluation; the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire; and the Pediatric Adolescent Shoulder Survey. Patients were also asked about recurrent instability and additional shoulder problems. Of 35 included patients (mean age, 15.4 ± 1.6 years; 80% male), 15 patients (43%) with GLAD lesions and 26 patients without GLAD lesions were identified. Both cohorts had similar patient characteristics, number of anchors, and anchor constructs; the mean follow-up period was significantly different (GLAD vs no-GLAD, 6.9 ± 3.3 vs 3.4 ± 1.2 years, respectively; P < .001). Seven of 15 GLAD patients (46.7%) underwent loose body removal; 4 of 15 GLAD patients (26.6%) and 9 of 26 no-GLAD patients (34.6%) had recurrent subjective instability (P = .7). No significant group differences were found in PRO scores, reoperation rates (15% no-GLAD vs 20% GLAD), or percentage of patients with recurrent instability between cohorts (P > .05). Adolescent patients with and without GLAD lesions treated arthroscopically for anterior shoulder instability had similar PROs and failure rates at intermediate duration of follow-up. GLAD lesions may be managed in a similar surgical manner as isolated Bankart tears in teenagers, with expectations of similar outcomes.

Single- and Double-Loaded All-Suture Anchor Repairs of Anteroinferior Labral Tears Are Biomechanically Similar in a Cadaveric Shoulder Model

To compare the biomechanical strength of single- versus double-loaded all-suture constructs in an anteroinferior glenoid labral repair. Anteroinferior labral lesions were created on 6 matched pairs of cadaveric shoulder specimens. Each shoulder in a matched pair was randomized to either receive capsulolabral repair with 3 single-loaded all-suture anchors or 3 double-loaded all-suture anchors. Immediately following capsulolabral repair, the specimens underwent mechanical testing, which included cyclic testing (5 N to 50 N for 500 cycles) and load-to-failure testing (rate of 15 mm/min). The gap formation between the repaired labrum and glenoid (measured at 1, 25, 100, and 500 cycles), the load at 2-mm gap formation, the maximum load at failure and the method of failure were recorded. Data were analyzed with paired Student t tests and Bonferroni correction factor. The single and double all-suture constructs did not differ significantly in gap formation at any number of cycles, load to 2-mm gap formation (P= .75), or maximum load to failure (P= .46) between the 2 groups. In this study, single-loaded and double-loaded all-suture anchor constructs demonstrated comparable biomechanical performance and did not significantly differ in gap formation, load to 2-mm gap formation, or maximum load to failure when used in the capsulolabral repair of anteroinferior glenoid labral tears in human cadaveric specimens. Although studies have evaluated the biomechanical properties of various arthroscopic labral stabilization techniques, the biomechanical properties of all-suture anchors with regard to labral stabilization are not well understood.

Paper 59: Comparison of Knotless versus Knotted Suture Anchors in the Arthroscopic Management of Adolescent Shoulder Instability

Objectives:Shoulder instability among adolescent athletes remains a complex challenge with high recurrence rates. Knotted suture anchors have provided consistently reliable biomechanical and clinical results. In recent years, the advent of the knotless suture anchor technology has come with proposed advantages of minimizing technical difficulty and knot migration, as well as reducing subsequent intra-articular cartilage irritation and damage. While several studies have analyzed the utility of knotless suture anchors in the adult population, to our knowledge, there has not been a direct comparison within this more at risk for surgical failure adolescent population. The purpose of this study was to compare the effect of knotted versus knotless suture anchor use on postoperative outcomes of arthroscopic shoulder instability surgery in the adolescent athlete.Methods:A multicenter comparative cohort was conducted of patients that underwent primary arthroscopic shoulder labral repair with suture anchor implants for shoulder instability between June 2015 and November 2017. Additional inclusion criteria included patient age <20 years and minimum follow up duration of 3.5 years. Data collected included demographics, number and type of suture anchor (knotted or knotless), number of instability events, type of instability, and presence of bony Bankart lesions. All included patients had <20% glenoid bone loss at the time of surgery. Type of instability was also recorded and was classified as either: anterior, posterior, or multidirectional (MDI). The primary outcome measure was surgical failure, which was defined as any recurrent instability event post-surgery. Incidence of secondary surgery (including revision or need for additional procedure), surgical times, and return to sport (RTS) data were also recorded. Patient-reported outcomes were evaluated using the Pediatric and Adolescent Shoulder Survey (PASS), SANE (Single Assessment Numeric Evaluation) scores, and the Quick version of Disabilities of the Arm, Shoulder and Hand (QuickDASH) survey.Results:Eighty-eight shoulders (54 male, 34 female) from 84 patients met inclusion criteria and were analyzed. 43 received knotless anchors and 45 received knotted anchors. Mean follow-up duration was 4.5 years (range, 3.5-6 years) for the knotless cohort and 4.8 years (range, 3.7-5.8 years) for the knotted cohort. Demographics and type of instability by suture anchor type is shown in Table 1. Surgical failure rate was significantly lower in the knotless cohort (knotless, 16%; knotted, 53%; P<.001). Patients with knotless suture anchors reported significantly higher mean PASS scores (knotless, 90.2; knotted, 81.3; P=.002). There was no difference in both RTS rates (knotless, 86%; knotted, 68%; P=.055) and incidence of repeat surgery between cohorts (knotless, 9%; knotted, 13%; P=.551).Surgical times, SANE scores, and QuickDASH scores were available for approximately three-quarters of shoulders (total, 65; knotless, 36; knotted, 29) in the cohort. Mean surgical time was approximately 18 minutes shorter for knotless anchors (knotless, 84.4 minutes; knotted, 102.7 minutes; P<.001). SANE scores were significantly higher in the knotless group (knotless, 88.8; knotted, 74.3; P=0.004). QuickDASH scores, of which a lower score is considered a better outcome, were not different (knotless, 5.7; knotted, 11.4; P=.063).Conclusions:Our initial intent was to demonstrate that knotless anchors would be just as successful as labral repairs with knotted anchors, but our results indicate several promising advantages, including: better patient reported outcome measures (PASS and SANE scores), reduced surgical times, and lower failure rates at a mean 4.5 years. There were some non-significant differences in the two cohorts regarding the type of instability that likely contributed to the differences in the number of anchors utilized. Future studies with larger sample sizes may serve to confirm our observed benefits associated with knotless anchors. In summary, the utilization of knotless suture anchor constructs for the repair of labral tears in adolescent shoulder instability may be safely considered with potentially improved outcomes over knotted anchors.Table 1.Demographic characteristics of included patients

A novel supplementary anchor fixation technique for reinforcing fixation in bone grafting procedures for shoulder instability

Bony stabilization procedures are a reliable solution for recurrent shoulder instability, but have a steep learning curve due to technical difficulties. Meticulous capsular closure is critical and can be augmented with suture anchor constructs. In addition, although fracture or fragmentation of the coracoid graft is relatively uncommon, it is devastating. Here, we describe the use of additional circumferential suture fixation to improve compression across the graft/glenoid interface and help mitigate the risk of fracture bony augmentation procedures.

Pullout Strength of All-Suture and Metallic Anchors in Repair of Lateral Collateral Ligament Injuries of the Elbow

To compare the biomechanical properties of metallic anchor (MA) and all-suture anchor (ASA) constructs in the anatomic reattachment of the lateral ulnar collateral ligament complex to its humeral insertion. Twenty paired male human cadaveric elbows with a mean age of 46.3 years (range: 33-58 years) were used in this study. Each pair was randomly allocated across 2 groups of either MA or ASA. A single 3.5-mm MA or 2.6-mm ASA was then inserted flush into the lateral epicondyle. A dynamic tensile testing machine was used to perform cyclic loading followed by a load to failure test. During the cyclic loading phase, the anchors were sinusoidally tensioned from 10 N to 100 N for 1,000 cycles at a frequency of 0.5 Hz. In the load to failure test, the anchors were pulled at a rate of 3 mm/s. Load at 1-mm and 2-mm displacement, as well as load to ultimate failure were assessed. Clinical failure was defined as displacement of more than 2 mm. Normality of data was assessed with the Shapiro-Wilk test. Continuous data are presented as medians and compared with the Mann-Whitney U test and categorical data was compared with the χ2 test or Fisher exact test. Displacement was significantly greater for the ASA group during cyclic loading starting from the tenth cycle (P < .05). Displacement of more than 5 mm within the first 100 cycles was observed in 2 anchors in the ASA group. No difference was observed in loads required to displace 1 mm (MA: 146 N [6-169] vs ASA: 144 N [2-153]; P= .53) and 2 mm (MA: 171 N [13-202] vs ASA: 161 N [9-191]; P= .97), but there was a statistically significant difference between ultimate loads in favor of ASA in the load to failure test (MA: 297 N [84-343] vs 463 N [176-620]; P < .01). In the cyclic test, no difference in clinical failure defined as pull-out of more than 2 mm was observed between 3.5 mm MAs and 2.6 mm ASAs. In the ultimate load to failure analysis, no difference was observed between groups in force causing 1 and 2 mm of displacement, but there was a significant difference in favor of ASA in the pull to ultimate failure test. Potential benefits of all-suture anchors include preservation of bone stock, reduced radiographic artifacts, and easier revisions. Although their use has been investigated thoroughly in the shoulder, there remains a paucity of literature regarding displacement and pull-out strength in the elbow.

Knotless Suture Anchors: A Comparative Biomechanical Study of Acetabular Rim Anchor Fixation with Implications for Hip Labral Repair

AbstractThe purpose of this study was to analyze relevant initial-implantation biomechanical properties of five knotless suture anchors available for use in acetabular labral repair. Five knotless suture anchor constructs were tested: Arthrex PushLock 2.9, Arthrex PushLock 2.4, Arthrex SutureTak 3.0, Stryker CinchLock SS 2.4, and Stryker CinchLock Flex 2.4. Anchors were placed in synthetic bone blocks and in acetabular bone of cadaveric specimens. Constructs were subjected to cyclic and load-to-failure (LTF) testing. Displacement at 1, 100, 250, and 500 cycles, yield load, ultimate load, and failure mode were compared with statistically significant (p &lt; 0.005) differences. PushLock 2.9 mm and CinchLock SS 2.4 anchor constructs had significantly less displacement than PushLock 2.4 mm after 1 cycle (p = 0.017) and 500 cycles (p = 0.043). Excluding “tare” displacement after the first cycle, all anchor constructs were associated with less than 2.0 mm of displacement after 500 cycles. Arthrex PushLock 2.4 and SutureTak 3.0 had the highest number of failures prior to completing cyclic loading. Arthrex PushLock 2.9 was associated with the highest LTF in cadaver (p = 0.00013) and synthetic (p = 0.009) bone models. Most common failure mode in cadaver bone was eyelet failure for all anchor types. Knotless suture anchors used for arthroscopic hip surgery (2.9 mm PushLock, 2.4 mm PushLock, 3.0 mm SutureTak, 2.4 mm CinchLock SS, and 2.4 mm CinchLock Flex) were associated with material properties that met or exceeded the reported thresholds for successful periarticular soft tissue repair surgeries. Based on cyclic and LTF testing in synthetic bone blocks and cadaveric acetabulums, 2.9 mm PushLocks and 2.4 mm CinchLock SS anchors may have potential biomechanical advantages over the other constructs tested. Further functional ex vivo and preclinical animal model studies are recommended to further characterize suture anchor constructs designed for acetabular labrum repair. These results provide novel and relevant biomechanical testing data that contribute to assessing knotless suture anchor constructs for use in acetabular labral repair.

A Comprehensive Synthesis of Theories of Mobile Shopping Adoption and Narrative Review

This paper aims to synthesize and integrate the existing literature on MSA adoption and provide directions for future research through narrative review by classifying and organizing the accumulated knowledge into a thematic framework. The paper's theoretical, conceptual approaches, and results were organized into three themes: online distribution channel (theoretical approaches and antecedent factors of MSA adoption, consumer characteristics), advanced technology for in-store shopping (marketing aspects of MSA), and technology perspectives (technology aspects of MSA). The 25 theories of mobile shopping app (MSA) adoption and usage (at the individual level) from 22 reviewed papers were summarized, defined, and mapped with authors. Research questions have been proposed for theories used in reviewed papers and new theories. MSA adoption is at an emergent stage of evolution with fragmentation of theoretical and methodological approaches. While theories of technology adoption and behavioral intentions have been used predominantly, most studies have adopted a multi-theoretic approach or have extended/modified the model with hedonic, situational, and behavioral constructs. The findings related to consumer characteristics of MSA adoption, anchor constructs, moderator and mediator variables, and marketing and technology features of MSA are synthesized and organized according to the themes. Theoretical and practical implications are drawn, research limitations are identified, and future research directions are suggested.

Mobile shopping apps adoption: a systematic literature review

The study aims to contribute by evaluating and synthesising the findings across various strata of populations in developed and developing countries and by unifying the diverse streams of research into a more coherent and cohesive knowledge entity. The theoretical models and determinants of M-shopping apps adoption intentions and behaviours from selected papers in literature are reviewed to synthesise the findings and identify the gaps and contradictions. Recommendations for future research are made as regards to theoretical approaches, research methodology, anchor constructs, consumer profiles to be researched, and technological and marketing perspectives are to be explored. The research findings in literature are limited by exclusive focus on smartphones, selective geographical regions, theoretical models, consume profiles and methodological approaches and hence not generalisable.

Mobile shopping apps adoption: a systematic literature review

The study aims to contribute by evaluating and synthesising the findings across various strata of populations in developed and developing countries and by unifying the diverse streams of research into a more coherent and cohesive knowledge entity. The theoretical models and determinants of M-shopping apps adoption intentions and behaviours from selected papers in literature are reviewed to synthesise the findings and identify the gaps and contradictions. Recommendations for future research are made as regards to theoretical approaches, research methodology, anchor constructs, consumer profiles to be researched, and technological and marketing perspectives are to be explored. The research findings in literature are limited by exclusive focus on smartphones, selective geographical regions, theoretical models, consume profiles and methodological approaches and hence not generalisable.

Distal Patellar Tendon SpeedBridge Repair

Patellar tendon ruptures are rare injuries in young athletes, resulting in disruption of the extensor mechanism, and require surgery for functional recovery. Several techniques have been reported, including end-to-end repair and single-row suture anchor constructs. The strength of these repairs has been questioned, and they are commonly augmented. We endorse a double-row repair technique that provides an anatomic restoration of the footprint, has high fixation strength, eliminates the need for graft augmentation, and allows early motion.

Optimizing the Double-Row Construct: An Untied Medial Row Demonstrates Equivalent Mean Contact Pressures in a Rotator Cuff Model.

Background:The merits of a double-row rotator cuff repair (RCR) construct are well-established for restoration of the footprint and lateral-row security. The theoretical benefit of leaving the medial row untied is to prevent damage to the rotator cuff by tissue strangulation, and the benefit of suture tape is a more even distribution of force across the repair site. These benefits, to our knowledge, have not been evaluated in the laboratory.Hypothesis:Leaving the medial row untied and using a suture bridge technique with suture tape will offer more even pressure distribution across the repair site without compromising total contact force.Study Design:Controlled laboratory study.Methods:A laboratory model of RCR was created using biomechanical research-grade composite humeri and human dermal allografts. The pressure distribution in a double-row suture bridge repair construct was analyzed using the following testing matrix: double-loaded suture anchors with the medial row tied (n = 15) versus untied (n = 15) compared with double-loaded suture tape and anchors with the medial row tied (n = 15) versus untied (n = 15). A digital pressure sensor was used to measure pressure over time after tensioning of the repair site. A multivariate analysis of variance was used for statistical analysis with post hoc testing.Results:The total contact force did not significantly differ between constructs. The contact force between double-loaded suture anchors and double-loaded suture tape and anchors was similar when tied (P = .15) and untied (P = .44). An untied medial row resulted in similar contact forces in both the double-loaded suture anchor (P = .16) and double-loaded suture tape and anchor (P = .25) constructs. Qualitative increases in focal contact pressure were seen when the medial row was tied.Conclusion:An untied medial row did not significantly affect the total contact force with double-loaded suture anchors and with double-loaded suture tape and anchors. Tying the medial row qualitatively increased crimping at the construct’s periphery, which may contribute to tissue strangulation and hinder clinical healing. Qualitative improvements in force distribution were seen with double-loaded suture tape and anchors.Clinical Relevance:Both tied and untied medial rows demonstrated similar pressures across the repair construct.

Proximal Anchor Constructs and Its Influence on Surgical Outcome in Growth Rod Technique; A Comparison Between Rib Hooks and Pedicle Screws

Study DesignRetrospective. ObjectivesTo compare outcomes and complications of all-pedicle screw against hybrid constructs as proximal anchors in traditional growth rod technique. Summary of Background DataTraditional distraction-based growth rods, although the preferred technique in treating progressive curves in early-onset scoliosis (EOS) is not free from complications. Surgical outcome and implant-related complications can be influenced by the choice of construct, but there is a paucity of evidence in literature comparing different constructs with these techniques. MethodsA retrospective review was performed of 28 consecutive patients with progressive EOS treated between 2009 and 2015 with growth rod technique. Patients were divided into two groups; Standard group (SG), where all pedicle screw construct was used; and Hybrid group (HG), where proximal rib hooks and distal pedicle screws were used. Pre- and postoperative clinical and radiologic parameters and complications were recorded and compared. ResultsThere were 13 patients (8 females, 5 males) in SG and 15 patients (13 females, 2 males) in HG. There was statistically significant improvement in scoliosis correction and length gain after initial surgery in both groups, where patients in SG showed better correction than HG. However, neither the radiologic parameters nor the complication rates showed any statistically significant difference between the two groups. ConclusionData from our study indicate that the proximal anchors, whether spine-based or rib-based, do not differ much in their outcome and complication rates, and the success of growing-rod technique depends largely on the security of cephalad and caudal foundations. Level of EvidenceLevel IV.

Three anchor concepts for rotator cuff repair in standardized physiological and osteoporotic bone: a biomechanical study

Previous biomechanical studies used single-pull destructive tests in line with the anchor and are limited by a great variability of bone density of cadaver samples. To overcome these limitations, a more physiological test setting was provided using titanium, bioresorbable, and all-suture anchors. In this controlled laboratory study, 3 anchor constructs were divided into 2 groups: physiological and osteoporotic. Sixty standardized artificial bone specimens (=10 for each anchor in each group) were used for biomechanical testing. The anchors were inserted at a 45° angle as during surgery. Cyclic loading for 1000 cycles followed by ultimate load-to-failure (ULTF) testing was performed. Elongation, ultimate load at failure, and the mode of failure were noted. In the physiological group, the ULTF for the all-suture anchor (mean [standard deviation], 632.9 [96.8 N]) was found to be significantly higher than for the other anchors (titanium, 497.1 [50.5] N, and bioresorbable, 322.4 [3.1 N], P < .0001). The titanium anchor showed a significantly higher ULTF than the bioresorbable anchor (P < .0001). In the osteoporotic group, the all-suture anchor again showed a higher ULTF compared to the bioresorbable anchor (500.9 [50.6] N vs. 315.1 [11.3] N, P< .0001). In the osteoporotic group, cyclic loading revealed a higher elongation after 1000 loading cycles for the bioresorbable (0.40 [0.12] mm) compared to the titanium (0.22 [0.11] mm; P = .01) as well as the all-suture anchor (0.19 [0.15] mm, P = .003). Regarding ULTF, the all-suture anchor outperformed the other anchors in physiologicalbone, but in osteoporotic bone, significance was reached only compared to the bioresorbable anchor. Although cyclic loading revealed significant differences, these might not be clinically relevant.

Proximal Hamstring Repair: A Biomechanical Analysis of Variable Suture Anchor Constructs

Background:Despite an abundance of literature regarding construct strength for a myriad of anchors and anchor configurations in the shoulder, there remains a paucity of biomechanical studies detailing the efficacy of these implants for proximal hamstring repair.Purpose:To biomechanically evaluate the ultimate failure load and failure mechanism of knotless and knotted anchor configurations for hamstring repair.Study Design:Controlled laboratory study.Methods:A total of 17 cadaveric specimens divided into 3 groups composed of intact hamstring tendons as well as 2 different anchor configurations (all-knotted and all-knotless) underwent first cyclic loading and subsequent maximal loading to failure. This protocol entailed a 10-N preload, followed by 100 cycles incrementally applied from 20 to 200 N at a frequency of 0.5 Hz, and ultimately followed by a load to failure with a loading rate of 33 mm/s. The ultimate failure load and mechanism of failure were recorded for each specimen, as was the maximal displacement of each bone-tendon interface subsequent to maximal loading. Analysis of variance was employed to calculate differences in the maximal load to failure as well as the maximal displacement between the 3 study groups. Holm-Sidak post hoc analysis was applied when necessary.Results:The all-knotless suture anchor construct failed at the highest maximal load of the 3 groups (767.18 ± 93.50 N), including that for the intact tendon group (750.58 ± 172.22 N). There was no statistically significant difference between the all-knotless and intact tendon groups; however, there was a statistically significant difference in load to failure when the all-knotless construct was compared with the all-knotted technique (549.56 ± 20.74 N) (P = .024). The most common mode of failure in both repair groups was at the suture-tendon interface, whereas the intact tendon group most frequently failed via avulsion of the tendon from its insertion site.Conclusion:Under biomechanical laboratory testing conditions, proximal hamstring repair using all-knotless suture anchors outperformed the all-knotted suture anchor configuration with regard to elongation during cyclic loading and maximal load to failure. Failure in the all-knotted repair group was at the suture-tendon interface in most cases, whereas the all-knotless construct failed most frequently at the musculotendinous junction.Clinical Relevance:No biomechanical studies have clearly identified the optimal anchor configuration to avert proximal hamstring repair failure. Delineating this ideal suture anchor construct and its strength compared with an intact hamstring tendon may alter the current standards for postoperative rehabilitation, which remain extremely conservative and onerous for these patients.

Greater Tuberosity Decortication Decreases Load to Failure of All-Suture Anchor Constructs in Rotator Cuff Repair

To evaluate the effect of greater tuberosity decortication on ultimate load to failure and displacement after cyclic loading with an all-suture anchor. A 2.9-mm all-suture anchor was evaluated in decorticated and nondecorticated greater tuberosities of 10 matched pairs of human cadaveric shoulders. Greater tuberosity decortication was performed to a mean depth of 1.7mm. Anchors were placed in the anterior, middle, and posterior tuberosity. Anchors were tested under cyclic loads followed by load-to-failure testing. Displacement after 20, 100, and 200 cycles and ultimate failure strength were determined. Clinical failure was defined as displacement greater than 5mm during cyclic loading. After 20 and 100 cycles, there was no difference in mean displacement between the decorticated and nondecorticated cohorts (P= .139 and P= .127, respectively). The mean displacement after 200 cycles was greater in the decorticated cohort, although not significantly (3.4 vs 2.7mm; P= .05). The mean ultimate load to failure was significantly lower in the decorticated cohort (314 vs 386N, P= .049). There were 2 clinical failures in the decorticated specimens and 1 in the nondecorticated specimens. A minimal greater tuberosity decortication significantly decreases the ultimate load to failure of an all-suture anchor. However, decreased biomechanical strength may not necessitate actual clinical failure. A decrease in ultimate load to failure could increase the risk of catastrophic postoperative anchor failure. However, while this decrease in strength is statistically significant, the overall decrease in strength may not be sufficient in magnitude to translate to clinical failure.

Parallel Proximal Fixation in Rib-Based Growing Rod System: A Novel Approach to Deal With Proximal Anchor Migration.

Retrospective case control. To report on differences in implant failure rates and complications requiring reoperation in children with early-onset scoliosis (EOS) treated with rib-based distraction utilizing four proximal fixation points in either a parallel or in-line configuration. Proximal anchor failure continues to be a significant problem in growth-friendly surgery using rib-based distraction to treat children with EOS. Differences between parallel and in-line proximal anchor constructs have not been previously assessed. A multicenter registry was reviewed to identify children treated for EOS with rib-based distraction between 2011 and 2014 with a minimum of 2 years follow-up after implantation. Patients were divided into those with in-line and parallel proximal rib-cradle configurations, and only those with exactly four fixation points (two per side) were included. Charts were reviewed for demographic, clinical, and radiographic information. A total of 56 patients were identified-31 with in-line constructs and 25 with parallel constructs. Follow-up in the in-line group was a mean of 4.06 years versus 3.16 in the parallel group (P = 0.001). Controlling for the different lengths of follow-up in the two groups there was a significantly higher rate of implant failure (P = 0.043) and requirement for nonroutine surgical intervention (P = 0.029) in the in-line group. There was a trend toward increased complications in the in-line group (P = 0.058). Failure of proximal fixation is the most common complication in management of EOS with rib-based distraction. This study identifies that when the number of proximal fixation points are matched, parallel constructs result in lower rates of implant failure and need for unplanned reoperation than in-line constructs. Although this study was limited to patients in whom the VEPTR device was employed, these principles are likely applicable to other rib-based distraction devices used to treat EOS. 3.

Outcomes of Insertional Achilles Tendinopathy in Active Duty Military Population

Category: Hindfoot Introduction/Purpose: Insertional Achilles tendinopathy is a common musculoskeletal disorder that can impair physical function in daily living and athletic and occupational performance. It has been previously reported that up to one-third of patients who present with this condition will undergo surgical treatment due to failure of conservative management. To date, insertional Achilles tendinopathy outcomes within the military have not been reviewed. Furthermore, surgical correction of symptomatic Achilles tendinopathy often does not lead to a return to restriction-free active duty. Therefore, it is of great interest to evaluate the outcomes of non-operative and operative management and the ability for the service member to return to duty following treatment of insertional Achilles tendinopathy. Methods: A single center retrospective review of consecutive patients with ICD-9, ICD-10 and CPT codes for diagnosis of Achilles tendon and calcaneal coding were reviewed from January 2007-May2017. Inclusion criteria included active duty military, failure of at least 3 months of conservative management and surgical treatment utilizing a retrocalcaneal exostectomy, Achilles tendon debridement followed by reattachment as necessary. Radiographic and clinical data collection was completed on all patients who met inclusion criteria to determine pre- and post-operative changes in pain and function. VAS pain scores were collected pre-op, and at 3, 6 12 and 24mo post-op. Operative reports were reviewed to confirm specific operative findings and repair technique. Surgical treatment was achieved with medial incision, fluoroscopy guided spur/Haglund deformity resection and reattachment of the Achilles tendon utilizing suture anchor constructs. Return to duty and profile status were recorded as outcome measures. Results: Our data analysis included 70 patients with the majority of patient from the Army (41 pts). Average age at treatment was 36.6yo (range, 21-54). Tobacco use was observed in 13 patients (18.57%). Length of pre-operative physical therapy averaged 6.5 months (range, 2-36mo). Other modalities prior to operative correction were also recorded with 20% receiving a PRP injection, 1.43% received a steroid injection, 14% of patients received ECSWT. Surgical treatment complications were observed in 16 patients (13%). VAS scores significantly improved at one year from 5.6 pre-op to 3.2 post-op (n=26.) At 1 year,60% of patient went onto return to full duty, 25% of patients remained on profile, 5% of patients retired, 10% of patients went onto medical evaluation board for separation from the military. Conclusion: To our knowledge, this is the first study to evaluate the outcomes of insertional Achilles tendinopathy in an active military population. Insertional Achilles tendinopathy prevalence within the military is a common condition with incidence rates likely higher than the general population which previously reported to between 15-24%. In conclusion, with a 60% return to duty rate and significant reduction of subjective pain scores, this is a viable treatment option for patients who could not otherwise remain on active duty but the complication rate is high (13%) and patients and providers should consider the risks during their shared decision making process.

Proximal Anchor Constructs in Early Onset Scoliosis Patients Treated with Growth Friendly Implants

Proximal Anchor Constructs in Early Onset Scoliosis Patients Treated with Growth Friendly Implants

Functional outcomes of distal triceps tendon repair comparing transosseous bone tunnels with suture anchor constructs

Distal triceps tendon ruptures are relatively rare. Few studies have investigated functional outcomes after repair. There is no consensus on fixation methods for this injury. The purpose of this study was to compare the functional outcomes and the reoperation rates after distal triceps tendon repairs using transosseous tunnels and suture anchors. A multicenter, retrospective review of all primary triceps repairs done between 2006 and 2015 was performed. Patients were included if they had a minimum of 2 years of follow-up. Intraoperative data recorded included repair method and number of anchors used when applicable. Patients were contacted for functional assessment with the Mayo Elbow Performance Score (MEPS). Postoperative complications were also queried. There were 56 cases of primary triceps repair identified in an all-male cohort. Average age at time of surgery was 52.7 years; 58.9% of patients had transosseous repair, and 41.1% had suture anchor repair. The average follow-up was 4.26 years. The average postoperative MEPS score for all patients was 94. There was no difference in MEPS outcomes based on construct type. Postoperative Disabilities of the Arm, Shoulder, and Hand scores had an overall average of 4.81. A statistically significant difference was found, with the transosseous group averaging 2.98 points lower than the suture anchor group. This difference was not found to be clinically relevant. Only 4 patients had rerupture of the triceps requiring revision. Primary repair of distal triceps tendon ruptures yields good, durable patient outcomes with minimal rerupture regardless of repair construct.

Posterior Shoulder Instability in Throwing Athletes: A Case-Matched Comparison of Throwers and Non-Throwers

To evaluate the results of arthroscopic capsulolabral repair for the treatment of posterior shoulder instability in a throwing athlete cohort when compared with non-throwers. Forty-eight overhead-throwing athletes undergoing arthroscopic posterior capsulolabral reconstruction were case matched with 48 non-throwing athletes. These cohorts were followed as they underwent posterior capsulolabral reconstruction by measuring shoulder pain, function, return to sport, and operative failures. Operative details such as intra-articular pathology and repair construct were also recorded. At a mean follow-up of 37 months (range, 12 to 97 months) postoperatively, no statistical differences were noted between throwers and non-throwers regarding American Shoulder and Elbow Surgeons scores, stability, strength, or range of motion. Sixty percent of throwing athletes were able to return to their preinjury level of competitive throwing. Throwers with a discrete labral tear intraoperatively had a 10-fold increased likelihood of returning to sport (odds ratio, 9.6; P= .012). Similarly, throwers who had suture anchor constructs showed a 10-fold increased likelihood of returning to play compared with anchor-less repairs (odds ratio, 9.6; P=.012). Non-throwers showed no variability by labral findings or fixation techniques. Pitchers had equivocal outcome scores when compared with other throwers but had poorer return-to-play rates (50% v 60% full return). Arthroscopic capsulolabral plication for unidirectional posterior shoulder instability is an effective treatment for overhead-throwing athletes. Intraoperatively, achieving an adequate capsular plication and stabilizing the repair with suture anchors will give this athletic population the best odds of returning to competitive sports. Level III, retrospective comparative study.