Anchor Insertion Research Articles

Clinical Outcomes for Arthroscopic Anterior Talofibular Ligament Repair After Suture Anchor Insertion Through the Anterolateral Portal vs the Lateral Accessory Portal.

Two types of suture anchor insertion pathways (anterolateral portal vs lateral accessory portal) are used in arthroscopic anterior talofibular ligament (ATFL) repair. However, it is not clear which one is the better choice. This study aims to compare the clinical outcomes of these 2 suture anchor insertion pathways when performing arthroscopic ATFL lasso-loop repair for the treatment of chronic lateral ankle instability (CLAI). From 2019 to 2021, patients with CLAI who underwent arthroscopic ATFL lasso-loop repair were retrospectively reviewed and divided into the anterolateral portal (ALP) group and the lateral accessory portal (LAP) group. A 1:1 propensity score matching was used to control confounding factors based on age, sex, body mass index, follow-up duration, preoperative visual analog scale (VAS) score, and Tegner score (ALP group, n = 26; LAP group, n = 26). Karlsson score, VAS score, Tegner score, operation time, anterior drawer test results, patient symptoms, and magnetic resonance (MR) evaluation of ATFL quality were used to describe the outcomes. The patient characteristics and follow-up durations were similar between the 2 groups. After a mean follow-up duration of 28.8 ± 2.3 months, the ALP group had significantly better Karlsson score, VAS score, and Tegner score improvement than the LAP group, with fewer symptoms. Seven patients in the LAP group still had a feeling of ankle instability, and 3 of them exhibited ankle laxity. In this study, we found that inserting the suture anchor through the anterolateral portal was associated with better outcomes compared to that through the lateral accessory portal when performing arthroscopic ATFL lasso-loop repair for CLAI patients. The improvement was greater for pain relief and function and was associated with a lower frequency of subjective ankle instability.

Optimized design of an enthesis-mimicking suture anchor-tendon hybrid graft for mechanically robust bone-tendon repair

Repair of functionally graded biological interfaces requires joining dissimilar materials such as hard bone to soft tendon/ligament, with re-injuries/re-tears expected to be minimized by incorporating biomimicking, stress-reducing features within grafts. At bone-tendon interfaces (entheses), stress can be reduced via angled insertion, geometric flaring, mechanical gradation, and interdigitation of tissues. Here, we incorporated enthesis attributes into 3D in silico and physical models of a unique suture anchor-tendon hybrid graft (SATHG) and investigated their effects on stress reduction via finite element analyses (FEA) studies. Over 20 different simulations altering SATHG angulation, flaring, mechanical gradation, and interdigitation identified an optimal design, which included 90° angulation, 25° flaring, and a compliant (ascending then descending) mechanical gradient in SATHG's bone-to-tendon-like transitional region. This design reduced peak stress concentration factor (SCF) by 43.6 % relative to an ascending-only mechanical gradient typically used in hard-to-soft tissue engineering. To verify FEA results, SATHG models were fabricated using a photocrosslinkable bone-tendon-like polyurethane (QHM polymer) for ex vivo tensile assessment. Tensile testing showed that ultimate load (132.9 N), displacement-at-failure (1.78 mm), stiffness (135.4 N/mm), and total work-to-failure (422.1 × 10−3 J) were highest in the optimized design. Furthermore, to assess envisioned usage, SATHG pull-out testing and 6-week in vivo implantation into large, 0.5-cm segmental supraspinatus tendon defects was performed. SATHG pull-out testing showed secure bone attachment while histological assessment such as hematoxylin and eosin (H&E) together with Safranin-O staining showed biocompatibility including enthesis regeneration. This work demonstrates that engineering biomaterials with FEA-optimized, enthesis-like attributes shows potential for enhancing hard-to-soft tissue repair. Statement of significanceSuccessful repair of hard-to-soft tissue injuries is challenging due to high stress concentrations within bone-tendon/ligament grafts that mechanically compromise repair strength. While stress-reducing gradient biomaterials have been reported, little-to-no attention has focused on other bone-tendon/ligament interface (enthesis) features. To this end, a unique bone-tendon graft (SATHG) was developed by combining two common orthopaedic devices along with biomimetic incorporation of four enthesis-like features to reduce stress and encourage widespread clinician adoption. Notably, utilizing designs based on natural stress dissipation principles such as anchor insertion angle, geometric flaring, and mechanical gradation reduced stress by 43.6 % in silico, which was confirmed ex vivo, while in vivo studies showed SATHG's ability to support native enthesis regeneration. Thus, SATHG shows promise for hard-to-soft tissue repairs.

COMPARISON BETWEEN PORTALS FOR PLACEMENT OF ANCHORS IN SHOULDER INSTABILITY.

to radiographically compare the effects of anchor positioning in the arthroscopic treatment of shoulder instability, in the 3- and 5-o'clock portals. retrospective study of 36 patients, operated by two shoulder surgeons at the Unimed BH hospital, between January 2013 and January 2018. Each surgeon used only one of either the 3- or the 5-o'clock portal. After postoperative radiographs we performed angle comparisons between the greatest glenoidal axis, the angle of anchor insertion and distance from the inferior pole. the 5-o'clock portal provided better placement than its 3-o'clock counterpart, which allowed for greater orthogonality in relation to the glenoid rim (p < 0.05). the 5-o'clock portal allowed for better anchor placement than the 3 o'clock one. Level of Evidence II, Clinical Trial.

Portal Selection for Suture Anchor Placement During Hip Arthroscopic Labral Repair: A Study Based on 3-Dimensional Model Reconstruction.

Arthroscopic suture repair is the main treatment option for hip labral tears; however, anchor insertion and placement from arthroscopic portals is difficult. To quantitatively evaluate the safety of various arthroscopic portals for suture anchor placement during hip labral repair. Descriptive laboratory study. The computed tomography scans of 20 patients with normally developed hip joints were used to create 3-dimensional models. The distances from the anchor to the articular cartilage (DAC) and from the acetabular insertion point to the cortical bone (DCB) were measured in the anterolateral portal (AL), posterolateral portal (PL), midanterior portal (MAP), medial MAP, and 3 distal anterolateral accessory portals (DALAs): DALA-proximal, DALA-middle, and DALA-distal. Labral tears were divided into anterior (4, 3, and 2 o'clock), lateral (1, 12, and 11 o'clock), and posterior (10, 9, and 8 o'clock) acetabular zones, and the Kruskal-Wallis and Mann-Whitney U test were used to compare DAC and DCB in the zones. The success rate was defined as anchors placed with DAC ≥1 mm and DCB ≥15 mm. The DAC was significantly smaller in the AL at 1 o'clock (0.68 ± 0.32 mm; P < .001) and 12 o'clock (0.37 ± 0.30 mm; P < .001), and in the PL at 12 o'clock (-0.35 ± 0.38 mm; P < .001) and 11 o'clock (0.60 ± 0.24 mm; P < .001). The DCB was significantly smaller in the DALA-P at 3 o'clock (8.93 ± 2.12 mm; P < .001) and 11 o'clock (9.59 ± 2.84 mm; P < .001), the MAP at 12 o'clock (13.76 ± 3.89 mm; P < .001) and 11 o'clock (0.27 ± 0.27 mm; P < .001), and the MMA at 12 o'clock (5.96 ± 2.31 mm; P < .001) and 11 o'clock (0 mm; P < .001). Success rates were high for MAP and MMA between 4 o'clock and 1 o'clock, for DALA-proximal at 12 o'clock, for AL at 11 o'clock, and for PL between 10 o'clock and 8-o'clock. There were significant differences in the success rate of anchor placement using different portals during hip arthroscopic labral repair. MAP is recommended for labral repair between 4 o'clock and 1 o'clock, DALA-P is recommended between 2 o'clock and 12 o'clock, AL is suitable at 11 o'clock, and PL is suitable between 10 o'clock and 8 o'clock.

Anatomic Fibular Collateral Ligament and Anterior Cruciate Ligament Reconstruction With Concomitant Biceps Femoris Avulsion Repair

Background: Injuries to the fibular collateral ligament (FCL) seldom occur in isolation and may present with a concomitant injury to the biceps femoris tendon and anterior cruciate ligament (ACL). Injuries to structures of the posterolateral corner (PLC) lead to varus and rotational instability of the knee, subjecting the cruciate ligaments to increased forces that may result in graft failure. Therefore, reconstruction of these structures should be performed concurrently with the ACL. Indications: Grade III FCL injuries heal poorly without operative treatment and often result in residual varus instability of the knee that increases medial knee compartment forces, and forces on both the native ACL and the graft status post ACL reconstruction. Therefore, preservation of biomechanical stability and long-term health of the knee are reliant on addressing injuries to the PLC surgically. Technique Description: A key concept of this surgical technique is a meticulous peroneal nerve neurolysis in the setting of altered biceps femoris anatomy, and the proper order of the surgical steps for tunnel creation, graft passage, and fixation and suture anchor insertion to achieve optimal patient outcomes. The described technique involves a lateral surgical approach, peroneal neurolysis, and preparation of fibular and femoral FCL tunnels, followed by a Bone-patellar tendon-bone graft (BTB) graft harvest. Attention is then turned to intra-articular work including the diagnostic arthroscopy, femoral and tibial tunnel preparation, passage of the ACL graft, and fixation of the grafts in femoral tunnels. Last, fixation is achieved in the following order: FCL graft on fibula, ACL graft on tibia, and biceps femoris tendon to fibular head. Results: Compared with the preoperative state, Moulton et al reported significant improvements in the average Lysholm and Western Ontario scores at 2.7 years postoperatively following anatomic FCL reconstrution. Furthermore, Thompson et al reported on primary suture anchor repair of distal biceps femoris in 22 elite athletes and reported that all patients had returned to their preinjury level of sporting activity at 2-year follow-up. Discussion: Anatomic reconstructions of the FCL and ACL, such as the one described in our technique, effectively restore near native knee biomechanics and offer superior clinical outcomes compared with nonanatomic-based FCL reconstructions. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

The role of protein-membrane electrostatic interactions in the adaptive gating cycle of MscS.

Bacterial mechanosensitive channels MscS and MscL directly respond to tension in the cytoplasmic membrane. It appears not to be a coincidence that both channels are anchored to membrane lipids with positively charged residues primarily at the cytoplasmic interface of the inner membrane, leaving the periplasmic side of the barrel the freedom to move and tilt. The functional cycle of MscS involving opening ↔ closing and inactivation ↔ recovery transitions relies on two prominent anchors, R46 and R74, that reside at the level of cytoplasmic phosphates. WT MscS exhibits voltage-dependent inactivation and recovery, showing deeper inactivation and slower recovery under depolarizing voltages (+60 mV) compared to hyperpolarizations (−60 mV). Substitutions of both R46 and R74 with poor interfacial anchors (A or D) result in no expression, whereas G, I, L, or V substitutions express but produce non-functional channels. Patch-clamp experiments showed that polar substitutions in positions 46 and 74, which maintain H-bonding capability to lipid phosphate groups (N, Q, S), preserve expression, activation, voltage-dependence of inactivation and recovery, as well as osmotic rescuing. Aromatic (W, Y) substitutions produce channels that completely lack voltage sensitivity of inactivation and recovery, but are otherwise functional. Insertion of periplasmic anchors (R or W) in flexible N-terminal segments (positions 3-21) did not produce strong phenotypes, however, the A22R substitution, which faces outer-leaflet phosphates, abolishes inactivation without affecting opening. These data show that the inactivation and recovery transitions are sensitive to the polarity of the cytoplasmic ends of TM1 and TM2 and are likely associated with the change of hydration near these segments which can be altered by voltage. The insertion of a periplasmic anchor (R22) restrains the position of the TM1-TM2 pair of helices, which require a higher degree of freedom during inactivation.

Anchor Arthropathy Caused by Cartilage Penetration: An Approach to Revision Hip Arthroscopy With Removal of Problematic Anchors

Hip arthroscopy has been proven to effectively treat labral tears in the setting of femoroacetabular impingement. Anchors used for this treatment have constantly evolved and improved to ensure safety and minimal invasion. However, acetabular drilling and anchor placement are technically challenging due to the concavity of the acetabular articular surface, limited angles for anchor insertion, and finite bone availability in the anterior and posterior column. Inadequate technique can result in protruding anchors, which may lead to full-thickness articular cartilage damage, manifesting in pain, mechanical symptoms, and impaired function. This Technical Note demonstrates arthroscopic removal of protruding anchors and management of the iatrogenic grade IV cartilage damage. In this description, the technical pearls and pitfalls of acetabular anchor placement to treat labral pathology are presented along with the aforementioned technique.

Perianchor cyst formation in all-suture anchor after rotator cuff repair: an evaluation of anchor insertion angle.

Previous studies reported that micromotion after all-suture anchor implantation can lead to perianchor cyst formation (PCF), leading to risk of retear. Modifying anchor insertion angle (AIA) is known to be one of the various ways to increase anchor stability. However, there currently are few studies that assess the correlation between PCF, AIA, and retear. To find the correlation of PCF and the repaired rotator cuff integrity with AIA after arthroscopic double-row suture-bridge rotator cuff repair (RCR) using an all-suture anchor in the medial row. A total of 218 patients who underwent arthroscopic double-row suture-bridge RCR were retrospectively reviewed. All patients underwent RCR using all-suture anchors and polyether ketone anchors in the medial and lateral rows, respectively. Magnetic resonance imaging was conducted 6 months after the surgery to evaluate PCF, AIA, and integrity of the repaired cuff. The all-suture anchor insertion angle in the medial row was measured with reference to the greater tuberosity to assess the relationship between the AIA and PCF. The correlations between PCF, AIA, and post-RCR integrity were evaluated including various demographic and radiologic factors. Perianchor cysts were formed in 93 patients (42.7%). Mediolateral tear size (2.1±1.2 cm vs. 1.7±0.9 cm, P=.034) and AIA (61.9°±15.2° vs. 68.4°±13.0°, P=.001) were significantly different between patient groups with and without perianchor cysts. Multivariate logistic regression analysis showed that mediolateral tear size (odds ratio [OR] 1.318, 95% confidence interval [CI] 1.008-1.724; P=.043) and AIA (OR 0.967, 95% CI 0.947-0.988; P=.002) were independent risk factors for PCF. In addition, PCF was observed more frequently (69.6% vs. 32.1%, P<.001) and the AIA was lower (59.4°±13.7° vs. 67.8°±13.8°, P<.001) in the retear group than in the healed group. Perianchor cysts were formed in approximately 40% of patients who underwent arthroscopic double-row suture-bridge RCR using all-suture anchors. Low AIA and large mediolateral tear size were risk factors for PCF. Moreover, perianchor cyst and AIA were correlated with post-RCR integrity. Therefore, a high AIA must be carefully considered when all-suture anchors are inserted into the medial row when performing RCR.

Knotless Tendoscopic Peroneal Retinaculum Repair Technique for Recurrent Peroneal Tendon Dislocation

Peroneal tendon dislocation (PTD) is sometimes diagnosed as a sports-related injury, of which many cases lead to recurrent PTD (RPTD). Superior retinaculum repair is the major operative treatment of RPTD. The technique described herein comprises 8 steps: (1) Standard tendoscopic examination, (2) debridement of the pseudo-pouch base, (3) first anchor insertion, (4) suture relay, (5) second anchor insertion and suture relay, (6) third anchor insertion and suture relay, (7) suture tightening, and (8) suture bridge. Although this tendoscopic peroneal retinaculum repair technique is complicated, expensive, and requires a longer operation time, it incorporates a double-row suture bridge. Therefore, it has a wider contact surface between the superior retinaculum repair and fibula bone and tighter fixation than does a single-row technique. Moreover, our technique is knotless and thereby avoids knot-related complications. Tendoscopy has additional advantages in terms of less postoperative pain, fewer complications, and better cosmesis. In conclusion, this knotless tendoscopic peroneal retinaculum repair technique for RPTD is a patient-friendly surgery compared with previous procedures.

Pull-out Strength of Suture Anchor and Torque of Buddy Anchor for an Osteoporotic Humeral Head in Rotator Cuff Repair: Parallel Versus Divergent Insertion

Background: The buddy anchor technique is useful to reinforce loose anchors in the osteoporotic humeral head during arthroscopic rotator cuff repair. However, theoretical parallel insertion of the buddy anchor to index a loose anchor is challenging in arthroscopy and can widen the entry site and decrease structural integrity. Purpose: To investigate and compare the biomechanical stability between 2 buddy anchor insertion techniques (parallel insertion vs divergent insertion) in the osteoporotic humeral head. Study Design: Controlled laboratory study. Methods: A total of 24 paired fresh-frozen cadaveric shoulders were used, and each pair was randomly assigned to either the parallel insertion group or the divergent insertion group. In the parallel insertion group, the buddy anchor was inserted parallel to the index loose anchor. In the divergent insertion group, the buddy anchor was inserted at a 20° angle in the medial direction to the index loose anchor. The insertion torque of the buddy anchor and ultimate pull-out strength of the index anchor were measured and compared between the 2 groups. Results: The mean maximum insertion torque was significantly higher in the parallel insertion group (16.1 ± 1.8 cN·m) compared with the divergent insertion group (12.0 ± 1.5 cN·m) (P < .001). The mean ultimate pull-out strength was significantly higher with divergent insertion (192.2 ± 28.6 N) than with parallel insertion (147.7 ± 23.6 N) (P < .001). Conclusion: For application of the buddy anchor system in the cadaveric osteoporotic humeral bone model, divergent insertion showed better ultimate pull-out strength than conventional parallel insertion, despite inferior maximum insertion torque. Clinical Relevance: The results of this study widen the applicability and accessibility for the buddy anchor system.

Subpectoral Biceps Tenodesis Using an All-Suture Anchor

Long head biceps tendon pathology is a substantial contributor to anterior shoulder pain and often requires surgical intervention to offer a return to normal functionality. Surgical treatment options consist of both open and arthroscopic tenodesis or tenotomy of the long head biceps brachii. Several techniques exist for tenodesis and tenotomy of the biceps, although current debate continues regarding which surgical approach is the optimal intervention for symptomatic bicep pathology. In this technical note, we describe a subpectoral biceps tenodesis of the long head bicep tendon using an all-suture anchor. Our technique offers the advantages of using an all-suture anchor that incorporates a self-tensioning mechanism with direct visualization of the tendon during biceps tenodesis and anchor insertion.

Needle-Arthroscopic Ankle Lateral Ligament Repair Using a Knotless Suture Anchor

Category:Arthroscopy; Ankle; Arthroscopy; SportsIntroduction/Purpose:Arthroscopic techniques have been increasingly used to repair the anterior talofibular ligament (ATFL) for lateral ankle instability, however there are still concerns on complications, such as nerve injury, iatrogenic cartilage damage and wound scar. Additionally, standard suture anchors can cause prominent knots. Recently, a novel needle-arthroscopic system (NanoScopeTM) has been introduced, with a 1.9-mm diameter arthroscope and semirigid frame, which can reduce conventional arthroscopic-related complications by minimizing the skin incisions and provide excellent visualization without ankle distraction due to its small and semirigid features. The purpose of this surgical technical note is to describe a new, very minimally invasive surgical technique for the ATFL repair using this needle-arthroscopy with a knotless suture anchor, which has the potential to reduce both conventional arthroscopic-related and knot-related complications.Methods:We have developed a novel surgical treatment of the ATFL repair for lateral ankle instability in a cadaveric model. The arthroscopic system (NanoScopeTM, Arthrex, Naples, FL) is used during the procedures. The handpiece tube is 9.5-cm long, semi-rigid and has a 1.9-mm outer diameter. The scope's direction of view is 0°, with a 120° field of view. The patient is placed in a supine position and no distraction is applied to the ankle joint. Standard anteromedial and anterolateral portals are first used. An accessory anterolateral (AAL) portal is then created around 1.5 cm anterior to the tip of the fibula, of which the portal position is determined under the visualization through the anterolateral portal.Results:Almost all of the talar and tibial surfaces are reachable without distraction, due to its small and semirigid features. There is no difficulty problem obtaining proper visualization of the ATFL and the surrounding structures during the whole procedures, due to a wide 120°-field of view. The major steps of the procedure are (1) suture anchor insertion into the distal fibula through the AAL portal using a Knotless SutureTak Anchor (Arthrex), (2) penetration of suture string into the ATFL remnant using a Micro SutureLassoTM (Arthrex), (3) capture of the ATFL remnant using a suture-relay technique, (4) reattachment of the ATFL remnant by pulling out the passing wire without knot-tying, in the dorsiflexed ankle position (Figure). All skin-incisions are tiny and require only paper skin closures. This method requires neither blunt dissection of subcutaneous tissue to pass the suture nor knot-tying to reattach the ATFL.Conclusion:Our technique is a simple, feasible, and very minimally invasive anatomic repair of the ATFL for lateral ankle instability using a 1.9-mm diameter needle-arthroscopy with a knotless suture anchor. However, the long-term clinical results need to be evaluated in future studies.

Safety and Performance Evaluation of Su2ura Approximation, a New Suturing Device, in Pigs

One of the challenging aspects of minimal invasive surgery (MIS) is intracorporal suturing, which can be significantly time-consuming. Therefore, there is a rising need for devices that can facilitate the suturing procedure in MIS. Su2ura Approximation Device (Su2ura Approximation) is a novel device developed to utilize the insertion of anchors threaded with stitches to allow a single action placement of a suture. The objective of this study was to evaluate the long-term safety and tissue approximation of Su2ura Approximation in comparison to Endo Stitch + Surgidac sutures in female domestic pigs. All incision sites were successfully closed by both methods. Firm consolidation within and around the incision site was noted in several animals in both treatment groups, which corresponded histopathologically to islands of ectopic cartilage or bone spicules within the fibrotic scar. These changes reflect heterotopic ossification that is commonly seen in the healing of abdominal operation sites in pigs. No other abnormal findings were observed throughout the study period. In conclusion, the use of Su2ura Approximation under the present experimental conditions revealed no safety concerns.

Bone Volumes and Trajectory Angles for Acetabular Anchor Placement Can Be Optimized

PurposeThe purpose of this study was to determine the optimal anchor placement and trajectory when repairing acetabular labral tears during hip arthroscopy with the primary focus on the 12 to 3 o’clock positions on the acetabular rim.MethodsThree-dimensional computational models of the pelvis were generated from 13 cadaveric specimens using 3D slicer medical imaging software. A set of cones, consistent with the dimensions of a commonly used sutured anchor, were virtually embedded into the models at the 12, 1, 2, and 3 o’clock positions around the acetabulum. Mirror images of the cone were extended toward the superficial aspect of the hip. The volume of bone occupied by the virtual anchor, the trajectory angle, and the volume of overlap between adjacent anchor locations were calculated.ResultsBone volume was significantly greater at the 1 o’clock position (4196.2 [1190.2] mm3) compared with all other positions (P < .001). The 3 o’clock position had the smallest volume (629.2 [180.0] mm3) and was also significantly less than the 12 (P < .001) and 2 o’clock (P = .014) positions). The trajectory angle of 32.04 [5.05]°) at the 1 o’clock position was significantly greater compared with all other positions (P < .001). The least amount of adjacent position overlap occurred between the 2 and 3 o’clock positions (.12 [.42] mm3), and this was statistically smaller than the overlap between cones at the 12 and 1 o’clock positions (214.28 [251.88] mm3; P = .029) and the 1 and 2 o’clock positions (139.51 [177.14] mm3; P = .044).ConclusionsTrajectory angles and the thickness of bone around the acetabulum were the greatest at the 12 to 1 o’clock positions, with the 1 o’clock position identified as that with the largest trajectory angle for safe anchor insertion.Clinical RelevanceThe use of a single, workhorse portal, for anchor insertion may not be recommended and careful selection of a portal allowing a direct approach should be used for anterior anchor insertion.

Trans-cuff portals heal by 6 weeks: an ultrasonography-based study.

BackgroundVarious arthroscopic portals have been described for repair of superior labrum anterior-posterior (SLAP) lesions. The difficulty in doing repair through the rotator interval and the problems in direction and placement of anchors still persist. Functional outcomes of the patients after treating them using trans-cuff portal are well established in literature, but the actual healing of the portal is not clear. We made a sincere effort to identify healing of the trans-cuff portal with ultrasound guidance and functional outcome using American Shoulder and Elbow Surgeons Shoulder Score (ASES score), Constant Shoulder Score, and Oxford Shoulder Score.Material and methodsTwenty-two patients with SLAP or labral tears and normal contralateral shoulders were included. Surgery was performed using the trans-cuff portal as a viewing or working portal for biceps repair and labral repair. Rehabilitation was initiated from day 1 and followed up on 6 weeks, 3 months and, 6 months with a maximum follow-up duration of 2 years. Ultrasound was used to measure the depth of healing and graded at 6 weeks of follow-up postoperatively. Functional outcomes were measured using ASES score, Constant Shoulder Score, and Oxford Shoulder Score measured at 6 months.ResultsSeventeen patients were of grade 1 (complete healing); 1 patient was of grade 2 (more than 50% healing); 1 of grade 3 (less than 50% healing), and 3 were lost to follow-up. Fourteen patients out of 19 had excellent ASES scores, 4 patients had good scores, and 1 patient was considered as poor with an average ASES score of 84.51 (range 93-48) and standard deviation of 10.37. The ASES score indicated that healing of the rotator cuff portal is directly related to the functional outcome of the shoulder. The Constant Shoulder Score and Oxford Shoulder Score on the contrary were statistically not significant indicating no relation of the Oxford and Constant scores with healing of the rotator cuff portals.ConclusionTrans-cuff portal is safe, gives proper angle for insertion of anchors, and can be used for repair of SLAP lesions with ease. Ultrasonography helps in confirming the healing of portal.

Perpendicular drill bit alignment provides a practical guidance to determine the appropriate suture anchor insertion angle during acetabular labral repair.

ABSTRACTThe safe acetabular rim angle is an anatomical measurement used to determine the safety margin when inserting suture anchors. The purpose of the present study was to find out whether aligning the drill bit perpendicularly during arthroscopic surgery can provide a reference point for determining an appropriate angle to facilitate the suture anchor insertion and to prevent extra- and intra-articular perforations. One hundred computed tomographic hips were used to reconstruct three-dimensional acetabular hip models. Each model was radially sectioned at the 4 o’clock, 3 o’clock and anterior inferior iliac spine (AIIS) positions (that corresponded mainly to the 2:20 clock position). A perpendicular reference line, representing a perpendicular drill bit alignment, was drawn for each position within the acetabular model, and its relation to the safe acetabular rim angle was measured. The length of the perpendicular reference line and the effect of gender on measurements were also evaluated. The mean safe acetabular rim angle at the 3 o’clock position was significantly smaller compared to other clock positions (P < 0.001). The perpendicular reference line was located out of the safe acetabular rim angle in 28 cases (%28), mostly in female acetabula at the 3 o’clock position, and relative to the perpendicular reference line the required minimal angle was 4° ± 2.3° to place the anchor in the safe acetabular rim angle to avoid extra-articular perforation. The perpendicular reference line was shortest at the 3 o’clock position, and its mean length was shorter in female acetabula at all clock positions (P < 0.001). Aligning the drill bit perpendicular to the acetabular opening plane during an arthroscopic anchor placement is a practical way to estimate and target the position of the safe acetabular rim angle to avoid anchor perforations. Based on measurements from a perpendicularly aligned drill bit, the drill bit should be directed towards the joint minimally by 4° to avoid extra-articular perforations and maximally by 30° to avoid intra-articular perforations.

Fluoroscopy-Guided Suture Anchor Placement Yields Excellent Accuracy for Arthroscopic Acetabular Labral Repair: A Cadaveric Study

PurposeTo determine the accuracy of fluoroscopy-guided suture anchor placement for arthroscopic acetabular labral repair in cadaveric hip specimens.MethodsTwo sports medicine fellowship–trained surgeons performed arthroscopic hip surgery on 6 cadaveric specimens each. Suture anchors were placed at the 11-, 12-, 1-, 2-, 3-, and 4-o’clock positions of the acetabulum in each specimen using a previously described fluoroscopically guided technique. Gross dissection and thin-cut computed tomography scans were performed to assess for accuracy. The insertion angle between the subchondral bone and the drill bit immediately prior to suture anchor insertion was measured, and fluoroscopic visualization of the subchondral bone at each clock-face position was qualitatively graded as good, fair, or poor by 2 independent reviewers.ResultsOverall, 90.3% of attempts (65 of 72) were entirely intraosseous, 5.5% (4 of 72) perforated the articular cartilage, and 4.2% (3 of 72) perforated the far cortex, rates that are comparable with those in previous cadaveric studies. There was no statistically significant difference in accuracy between the surgeons (P = .42) or between the various clock-face positions (P = .63). Neither the insertion angle (P = .26) nor visualization of the subchondral bone (P = .35) was significantly correlated with accuracy by gross dissection.ConclusionsIn a cadaveric hip arthroscopy model, fluoroscopy-guided suture anchor placement yields excellent accuracy rates, similar to non–image-guided techniques.Clinical RelevanceIntra-articular suture anchor placement and intrapelvic suture anchor placement are known complications of arthroscopic acetabular labral repair. Fluoroscopically guided suture anchor placement can be a useful tool for hip arthroscopy surgeons performing acetabular labral repair and reconstruction, potentially reducing the risk of these complications.

Re discussion on arthroscopic repair of rotator cuff tear in aged patients

To investigate the method and clinical effects of modified anchor insertion with single-row suture arthroscopic rotator cuff repair for aged patients with rotator cuff tear. From March 2016 to February 2020, 96 aged patients with rotator cuff tears were retrospectively analyzed, including 29 males and 67 females, aged from 65 to 85 years, with a mean of (68.8±3.9) years. Patients were treated with modified anchor insertion with single-row suture arthroscopic rotator cuff repair technique. Before and after operation, University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder joint function, visual analogue scale (VAS)was used to evaluate patients' pain. Among them, 32 patients underwent magnetic resonance examination one year postoperatively. All operations were completed and the patients were followed up from 11 to 42 months, with a mean of (21.4±7.5) months. The UCLA score increased from preoperative 12.22±3.30 to final follow-up 31.30±2.49 (t=45.21, P<0.01);ASES score increased from preoperative 8.60±1.88 to final follow-up 12.60±0.84 (t=19.05, P<0.01);and the VAS decreased from preoperative 5.00 (2.00 to 8.00)scores to final follow-up 1.00 (0.00 to 3.00)scores (Z=-12.22, P<0.05). One year after operation, one of the 32 patients who underwent MRI showed that the repaired rotator cuff was torn again, but it did not affect the normal life and did not operate again. During the final follow-up, no anchor extraction was found in all 96 aged patients. Modified anchor insertion with single-row suture arthroscopic rotator cuff repair technique for rotator cuff tear in aged patients could achieve satisfactory results and effectively reduce the anchor extraction rate.

Shear behavior of RC T-beams externally strengthened with anchored high modulus carbon fiber-reinforced polymer (CFRP) laminates

This work presents the results of an experimental study on the effect of shear strengthening of reinforced concrete (RC) T-beams with high modulus carbon fiber-reinforced polymer (CFRP) laminates and anchors. The parameters considered were the anchor insertion angle and dowel diameter. Experimental results showed that the addition of U-wraps led to a 61% increase in shear strength compared to the control specimen, but failure was dominated by the brittle debonding of the CFRP laminates, with no ductility exhibited prior to failure. Anchoring the CFRP laminates with CFRP spike anchors further enhanced the shear capacity of the U-wrapped specimen by 14–51% and improved the shear contribution of the FRP by 36–136%, respectively. In addition, the CFRP anchorage system highly utilized the strain in the CFRP laminates and substantially enhanced the ductility of the specimens. A comparison between the shear resistance provided by the FRP reinforcement of the tested specimens and predicted capacity using current design guidelines showed that the current provisions could be safely applied to design RC T-beams strengthened in shear with anchored CFRP U-wraps.

Self-Tensioning Feature of Knotless Suture Anchor Provides Reproducible Knotless Fixation Independent of Initial Tension.

Background:Anterior cruciate ligament (ACL) reconstruction with suture tape reinforcement has been shown to biomechanically reduce elongation and increase ultimate strength. However, the amount and consistency of the achieved tension after primary fixation using knotless suture anchors remains unclear.Purpose:To determine whether initial tensioning of suture tape before fixation with a knotless suture anchor significantly affects final tension of the suture tape.Study Design:Controlled laboratory study.Methods:We secured 15 pairs of Sawbones blocks with predrilled tunnels to a tensile testing machine. Suture tape was inserted through a suspensory fixation button on the representative femoral block and threaded top-down through the base of the tibial block over an attachable button system. The suture tape was attached with a knotless suture anchor in a predrilled and tapped hole on the tibial block under the following pretensioning conditions: (1) slight tension of 5 N, (2) no tension, and (3) initial slack. The suture anchor was inserted as the load-time data were recorded. After initial block testing, a porcine model of 24 tibias was used to test the same pretensioning conditions. The initial loads during anchor insertion and screw-in were measured, as well as final tension.Results:During block testing, no difference in final tensioning was found when comparing the slight-tension, no-tension, and slack groups (42.3 ± 5.3, 37.7 ± 6.4, and 40.2 ± 7.0 N, respectively; P = .528). Similar to block testing, no difference in final tensioning was found when comparing the slight-tension, no-tension, and slack groups using the porcine model (43.64 ± 6.69, 48.09 ± 13.93, and 44.52 ± 6.84 N, respectively; P = .633).Conclusion:The final tension of the suture tape construct appears to be reproducible and consistent, independent of the initial tension introduced with suture anchor placement within the tested parameters.Clinical Relevance:The results of the current study can help optimize the placement technique of independent suture tape reinforcement for ACL reconstruction, which is a promising strategy to help prevent ACL rerupture, particularly in the early phases of postoperative rehabilitation.