Anchor Technique Research Articles

The double-lasso loop technique of Biceps tenodesis has lower displacement after cyclic loading, compared to interference screw fixation: Biomechanical analysis in an ovine model.

Biceps tenodesis is an effective treatment for symptomatic long head of biceps tendon pathology. Recently the arthroscopic "double lasso-loop" suture anchor (DLSA) technique was described, advantaged by reduced cost, complexity, and operative time. We aimed to compare the in vitro strength of DLSA with conventional interference screws (IS). A biomechanical analysis was conducted on 14 sheep shoulders (8 DLSA, 6 IS), consisting of a 500-cycle cyclic loading experiment of 5-70 N and ultimate failure load (UFL) test where each specimen was pulled until failure. Displacement (mm) was recorded every 100 cycles, while stiffness and UFL were observed. Cyclic displacement was significantly lower with DLSA at 100 cycles, but not above. During the UFL test, IS was stiffer (27.68 ± 6.56 N/mm versus 14.10 ± 5.80 N/mm, p = .005) and had higher UFL (453.67 ± 148.55 N versus 234.22 ± 44.57 N, p = .001) than DLSA. All DLSA failures occurred with suture/anchor pull-out, while all IS constructs failed at the muscle/tendon. Comparison of the novel DLSA technique with a traditional IS method found lower initial displacement. While our IS constructs could withstand higher UFL, peak load characteristics of DLSA were similar to previous ovine studies. Hence, the DLSA technique is a viable alternative to IS for biceps tenodesis with its purported non-biomechanical advantages.

Analysis of the effect of double button plate combined with strengthened anchor in the treatment of acromioclavicular dislocation

To evaluate the efficacy and prognosis of double button plate combined with strengthened anchor technique and clavicular hook plate internal fixation for complete acromioclavicular joint dislocation. From July 2017 to September 2020, a total of 42 patients with acromioclavicular joint dislocation treated by surgery were choosen as study objects and divided into observation group (21 cases) and control group (21 cases). In the observation group, there were 14 males and 7 females, aged 21 to 63 years old, with an average of (45.05±8.70) years old. In the control group, there were 16 males and 5 females, aged 25 to 68 years old, with an average of(45.00±9.44) years old. The patients in the observation group were treated with double button plate combined with strengthened anchor technique, whereas those in the control group received clavicular hook plate internal fixation. The two groups were compared in terms of operating time, intraoperative blood loss, postoperative hospital stay, shoulder pain(visual analogue scale, VAS) score, shoulder function Constant-Murley score and postoperative complications. There was no significant difference between the two groups in intraoperative blood loss or postoperative hospital stay(P>0.05). The operating time of double button plate combined with strengthened anchor technique group (65.24±5.36) min was significantly longer than that of the clavicular hook plate group (48.81±4.72) min, and the difference was statistically significant (P<0.05). There was no significant difference in shoulder function or pain degree between the two groups before operation (P>0.05). After 1 month, 3 months and 6 months, the Constant-Murley score of the observation group was 73.29±2.15, 85.43±1.47, 93.86±1.24 separately, which were significantly higher than those of the control group;and the VAS score was 2.76±0.62, 1.71±0.64, 0.57±0.51 separately, which were significantly lower than those of the control group (P<0.05). One instance of shoulder discomfort was found in the observation group, while 5 cases of shoulder pain, 2 cases of restricted shoulder mobility, and 1 case of subacromial bone absorption were found in the control group. In both group, there was no loss of reduction. In the treatment of complete acromioclavicular joint dislocation double button plate combined with strengthened anchor technique achieves favorable clinical result. Internal fixation does not need to be removed. The recovery of shoulder joint function and pain relief are superior than clavicular hook plate internal fixation, which is more worthy of clinical promotion.

Management of Insertional Achilles Tendinopathy.

Insertional Achilles tendinopathy is a common condition that can lead to chronic, debilitating heel pain in athletes and nonathletes alike. Conservative treatment options include activity and shoe wear modification, physical therapy, injections, and extracorporeal shock wave therapy. When nonsurgical treatment fails, surgical treatment is recommended. Although there are options aimed at preserving the tendon and débriding the retrocalcaneal bursa and excess bone formation, others are aimed at detaching the Achilles tendon to perform a thorough débridement and subsequent reattachment. Additional or alternate procedures may include a calcaneal closing wedge osteotomy, gastrocnemius lengthening, and flexor hallucis longus tendon transfer. Recent advances in suture anchor techniques further add to the complexity of available options. This review discusses the relevant anatomy, biomechanics, and pathophysiology as well as the recent available evidence for nonsurgical and surgical management of this condition to guide surgeons in selecting the most appropriate treatment for their patients.

A Survey of Treatment Trends for Acute Quadriceps Tendon Ruptures Among North American Surgeons.

Background:To date, little clinical evidence exists to support a specific surgical technique or postoperative rehabilitation protocol for quadriceps tendon ruptures. With a lack of evidence-based superiority, assessment of clinical practices and surgeon preferences is pertinent.Purpose:To describe the current surgical technique and rehabilitation preferences among members of the Canadian Orthopaedic Association and American Orthopaedic Society for Sports Medicine pertaining to acute quadriceps tendon rupture.Study Design:Cross-sectional study.Methods:Orthopaedic staff members of the Canadian Orthopaedic Association and American Orthopaedic Society for Sports Medicine were invited to complete an internet-based survey composed of 26 questions assessing current trends in the management and rehabilitation of acute quadriceps tendon rupture. Survey questions were developed after a thorough review of current literature. Survey responses were analyzed and reported using descriptive statistics (absolute values, frequencies, and percentages) where appropriate. Statistical comparisons and contrasts between Canadian and American surgeons were made using chi-square analyses and Student t tests.Results:A total of 264 surgeons participated in the survey (136 Canadians; 128 Americans). Canadian surgeons were more likely to obtain a preoperative ultrasound as compared with Americans (43.0% vs 6.7%; P < .00001), while American respondents were more likely to obtain magnetic resonance imaging scans (65.8% vs 10.2%; P < .00001). The transosseous drill hole technique was the most commonly utilized (70.2%); the suture anchor technique was used 20.6% of the time. Canadian respondents trended toward a higher use of transosseous tunnels; however, this was not statistically significant (75.8% vs 64.2%; P = .068). American respondents were more likely to utilize suture anchors (27.5% vs 14.1%; P = .0096). Most respondents advanced range of motion goals stepwise in 2-week intervals of 30° (Canadians, 54.0% vs Americans, 58.5%; P = .3091); timing of range of motion initiation varied.Conclusion:Among North American surgeons who responded to this study, the transosseous technique was the most commonly used, and range of motion was generally advanced in a 2-week stepwise fashion. We found several differences in practice between Canadian and American respondents, including the type of preoperative imaging and the frequency of using the suture anchor technique.

Anatomic Repair of Deltoid Ligaments in Acute Injury With Suture Anchor Technique.

Acute disruption of the deltoid ligament usually occurs in rotational ankle fracture. If left untreated, its instability may contribute to ankle arthritis. We have designed a suture technique to repair all deltoid ligament layers. It provides anatomic ligament-to-bone repair of the superficial and deep deltoid ligaments and anchor suture reinforcement. This technique may protect the horizontally oriented fibers of the deep deltoid ligaments and allow them to heal with sufficient rest while providing immediate stability of the construct. The superficial ligaments are then repaired with residual anchor sutures. [Orthopedics. 2022;45(3):e168-e173.].

Concomitant Use of Single Suture Anchor and Transosseus Repair Provide Optimal Results in Simultaneous Bilateral Quadriceps Tendon Rupture: A Case Report

Introduction&#x0D; Bilateral quadriceps tendon rupture is a rare condition and often associated with underlying medical comorbidities such as chronic renal insufficiency. This case report is aimed to evaluate the surgical outcome using the combination of suture anchor and transosseus repair technique.&#x0D; &#x0D; Presentation of Case&#x0D; Presenting a 54-year-old male who sustained simultaneous bilateral quadriceps tendon rupture with history of right nephrectomy and chronic kidney disease requiring intermittent hemodialysis. He came with sudden bilateral knee pain, history of falling, and inability to walk since three weeks before admission to the hospital. Tenderness above the superior pole on both patella, accompanied with slight swelling and no active range of motion (ROM) of either knee joint was found on physical examination. Complete rupture of the quadriceps tendon of both knees at their osseus-tendon junction were revealed on magnetic resonance imaging (MRI).&#x0D; &#x0D; Discussion&#x0D; Recent literatures suggested that transosseus technique offers the safest and more stable tendon reattachment, while suture anchor provides biomechanical superiority. We tried to combine these advantages by incorporating both methods. Progressive active knee motion exercise was performed shortly after using the Kocher slab for 2 weeks.Subsequently, the patient can achieve painless, active extension and active 90°-120° knee flexion 1 month post-operatively.&#x0D; &#x0D; Conclusion&#x0D; The application of a single suture anchor with transosseus repair in quadriceps tendon rupture led to an optimal outcome, improved stability, and earlier rehabilitation.

Absorbable suture anchor and knotless anchor techniques produced similar outcomes in arthroscopic anterior talofibular ligament repair.

The purpose of this study is to compare absorbable suture anchor with knotless anchor techniques for arthroscopic anterior talofibular ligament (ATFL) repair. A multicenter retrospective study was performed with 185 patients, who had undergone an arthroscopic ATFL repair procedure using absorbable suture anchor or knotless anchor between May 2017 and October 2019. The follow-up time was a minimum of 18months. Karlsson-Peterson score, visual analogue scale (VAS), and Cumberland ankle instability tool (CAIT) were evaluated. The complications were also recorded. One hundred and seven patients underwent one absorbable suture anchor repair procedure (Group A [A]), and the other seventy-eight patients underwent one knotless anchor repair procedure (Group B [B]). At the final follow-up, both Karlsson-Peterson score (A, pre 61.0 ± 8.0 vs post 93.5 ± 5.3, P < 0.001; B, pre 59.5 ± 8.2 vs post 92.4 ± 6.3, P < 0.001), VAS score (A, pre 5.0 ± 1.3 vs post 0.5 ± 0.7, P < 0.001; B, pre 5.5 ± 1.2 vs post 0.9 ± 1.0, P < 0.001), and CAIT score (A, pre 53.1 ± 12.0 vs post 93.1 ± 6.6, P < 0.001; B, pre 51.6 ± 12.0 vs post 93.1 ± 6.5, P < 0.001) improved significantly in both groups. There was no significant difference between the two groups regarding the Karlsson-Peterson score (A, pre 61.0 ± 8.0 vs B, pre 59.5 ± 8.2, n.s; A, post 93.5 ± 5.3 vs B, post 92.4 ± 6.3, n.s), CAIT score (A, pre 53.1 ± 12.0 vs B, pre 51.6 ± 12.0, n.s; A, post 93.1 ± 6.6 vs B, post 93.1 ± 6.5, n.s) and the change ranges of VAS (A, 4.5 ± 1.0 vs B, 4.6 ± 1.2, n.s). Anchor complications were easier to occur in Group B (0/107 vs 6/78, P = 0.007). Knot irritation slightly increased in Group A (10/107 vs 0/78, P = 0.006). No significant difference was found regarding total complication rates (A, 10/107 vs B, 6/78, n.s). Absorbable suture anchor and knotless anchor for arthroscopic ATFL repair produced similar clinical outcomes. The ankle stability scores increased significantly in both groups. However, the knotless anchor has a higher risk to loosen, deviated direction or break, while the absorbable suture anchor still has a slim chance of knot irritation. III.

Arthroscopic Transtibial Pull-Out Repair for Meniscal Posterior Root Tear: The Slip Knot Technique

A meniscal root tear can increase the tibiofemoral contact pressure to approximate that of total meniscectomy and eventually lead to degenerative change. An anatomic and stable meniscal root repair is essential in restoring the tibiofemoral contact pressure back to that of a normal knee. Suture anchor technique and pull-out suture technique are the 2 main arthroscopic root repair procedures with equivalent success; nonetheless, there remains a lack of an optimal technique with a biomechanical property matching that of the intact root. This article presents a technically simple, fast, and robust pull-out suture construct that incorporates 2 slip-knot locking loops at the meniscus-suture interface. This technique can be used for both medial and lateral posterior root repair, as well as concomitantly with cruciate ligament reconstruction.

The effect of the number of anchors used in the medial row on clinical outcomes in arthroscopic double row repair of rotator cuff tears: retrospective evaluation of patients with 3 to 7 years of follow-up

Aim: Arthroscopic double row (DR) suture anchor repair is one of the most frequently applied methods in the surgical treatment of rotator cuff tear (RCT). Various modifications have been tried to eliminate some of the disadvantages of this technique such as operation time, high cost, and the high risk of retearing. In this study, we aimed to investigate whether placing a single or double suture anchor in the medial row affects clinical and functional outcomes and retear rates in patients with RCT who were operated with the DR suture anchor technique.&#x0D; Material and Method: A retrospective study including 58 patients aged 18-65 years who underwent DR suture anchor repair due to medium-sized RCT and had a minimum follow-up period of 3 years was conducted. One knotless anchor was placed in the lateral row in all patients. In the medial row, we placed 1 all suture anchor (ASA) in group 1 and 2 ASAs in group 2. Visual pain scale (VAS), University of California Los Angeles Score (UCLA), American shoulder and elbow score (ASES) scales were used for preoperative and postoperative clinical and functional evaluation, and complications and retears were recorded.&#x0D; Results: When the preoperative and postoperative VAS, UCLA and ASES scores were compared within groups, there were significant difference from pre- to post-operative findings in both groups (p 0.05). Operation time in Group 1 was significantly shorter than in Group 2 (p

Comparative study of transosseous suture and suture anchor technique in medial patellofemoral ligament double bundle reconstruction

To investigate the effectiveness of transosseous suture in medial patellofemoral ligament (MPFL) double bundle reconstruction. The clinical data of 75 patients with recurrent patella dislocation who met the selection criteria between January 2014 and December 2017 were retrospectively analyzed. All of them were treated with MPFL double bundle reconstruction, and divided into study group (39 cases, using new transosseous suture technique) and control group (36 cases, using traditional suture anchor fixation) depending on the intraoperative fixation technique. There was no significant difference in gender, age, body mass index, affected knee side, preoperative tibial tuberosity-trochlear groove distance, Insall-Salvati ratio, knee range of motion, Kujala score, International Knee Documentation Committee (IKDC) score, congruence angle, and tilt angle between the two groups ( P>0.05). The operation time, intraoperative blood loss, hospital stay, and postoperative complications were recorded and compared between the two groups. Kujala score, IKDC score, and knee range of motion were used to evaluate the functional improvement of patients before and after operation. The congruence angle and tilt angle were measured on X-ray films. There was no significant difference in operation time, intraoperative blood loss, and hospital stay between the two groups ( P>0.05). Patients in both groups were followed up 24-36 months, with an average of 29.4 months. There was no complication such as incision infection, fat liquefaction, patellar redislocation, and prepatellar pain during follow-up. At last follow-up, the Kujala score, IKDC score, knee range of motion, congruence angle, and tilt angle of two groups significantly improved when compared with those before operation ( P<0.05), while there was no significant difference between the two groups ( P>0.05). The application of suture anchor or transosseous suture to complete MPFL double bundle reconstruction can restore patellar stability, and there is no significant difference in the short-term effectiveness between them.

Flexible Fixation Technique for Subtle Lisfranc Injuries

Background: Subtle Lisfranc injuries represent a primarily ligamentous Lisfranc complex injury involving the Lisfranc ligament and the medial and middle cuneiform ligaments. Static radiographic displacement or dynamic instability of the medial cuneiform and 2nd metatarsal typically warrants operative intervention to prevent chronic functional pain, allow for timely return-to-sport, and mitigate posttraumatic osteoarthritis. Flexible fixation techniques offer a unique solution to the issues seen with transarticular screws, plates, and arthrodesis for ligamentous Lisfranc injuries. Indications: We present the case of a 16-year-old female basketball player with a subtle Lisfranc injury sustained during practice. X-rays show isolated widening of the 1st and 2nd metatarsal bases and dynamic diastasis between the medial and middle cuneiforms. Magnetic resonance imaging (MRI) confirmed a rupture of the plantar Lisfranc ligament. After extensive discussion regarding treatment options, the patient and her family decided to proceed with surgical intervention using a suture anchor and button technique to restore stability to the Lisfranc ligament and intercuneiform complexes. Technique Description: A standardized dynamic examination under anesthesia identifies the extent of the injury. Exposure of the base of the 2nd metatarsal and medial cuneiform is performed. Reduction clamps are applied to restore the intercuneiform relationship and interval between the medial cuneiform and base of 2nd metatarsal. The suture anchor and button construct is placed using fluoroscopic guidance. A final dynamic examination is performed to confirm stability of the construct. Results: Biomechanical studies have shown that flexible fixation maintains physiologic motion about the Lisfranc articulations and has comparable stability to transarticular screws in cadaveric models of isolated Lisfranc ligament insufficiency. Clinical results are limited but demonstrate excellent postoperative functional outcome scores with very few fixation-related complications at 1 to 3 years. Discussion: Flexible fixation techniques for subtle Lisfranc injuries offer unique benefits to transarticular screws, plates, and arthrodesis. We highlight the appropriate evaluation of patients with a suspected subtle ligamentous Lisfranc injury, the surgical technique using a suture button and anchor construct, and review postoperative management and expected outcomes based on the present literature.

A Case Report of Reconstruction of a Lower Eyelid in a Patient with Xeroderma Pigmentosum using the Periosteal Anchoring Technique for Prevention of Ectropion

A Case Report of Reconstruction of a Lower Eyelid in a Patient with Xeroderma Pigmentosum using the Periosteal Anchoring Technique for Prevention of Ectropion

Comparison of Outcomes of Arthroscopic Modified Broström Procedure for CLAI in Patients with Solitary ATFL Injury and in Patients with ATFL and CFL Complex Injury

Category:Ankle; ArthroscopyIntroduction/Purpose:ATFL (Anterior talofibular ligament) and CFL (Calcaneofibular ligament) are most commonly injured structures when ankle sprained. There has been debate about whether CFL should be recovered by surgery. Recently, several studies have verified that MBP (Modified Broström procedure) with IER (Inferior extensor retinaculum) augmentation demonstrated good outcomes even in patients with ATFL and CFL complex injury. However, some studies presented that IER augmentation cannot cover CFL injuries because of a different vector. If so, we hypothesized that the patients with solitary ATFL injury would show better outcomes comparing with patients with ATFL and CFL complex injury when same arthroscopic MBP was performed for each group.Methods:208 ankles were included between September 2015 and October 2019. All the patients were underwent arthroscopic MBP with IER augmentation using knotless suture anchor technique. Complete ATFL injuries were determined by arthroscopy and CFL injuries were examined by magnetic resonance image. 26 ankles of which talar tilt angle was less than 9 degrees in ATFL and CFL complex injury group were excluded. Finally, 38 ankles with solitary ATFL injury and 31 ankles with ATFL and CFL complex injury were enrolled. Clinical and radiological outcome were measured and compared between two groups. Clinical outcome was divided into objective and subjective outcome. Objective outcomes were composed of VAS, AOFAS score and FAOS. Subjective outcome was presented as subjective satisfaction score (1: Excellent, 2: Good, 3: Fair, 4: Poor). Improvement of degree of anterior talar translation and talar tilt angle between preoperative and 12 months after surgery was measured as a radiological outcome.Results:P-values of VAS score at preoperative, 3 months, 6 months and 12 months after surgery were 0.3761, 0.2609, 0.3893 and 0.2547 respectively (95% confidence interval[CI]). P-values of AOFAS score at preoperative, 3 months, 6 months and 12 months after surgery were 0.2079, 0.64, 0.6339 and 0.2683 respectively (95% CI). P-values of FAOS and subjective satisfaction score at 12 months after surgery was 0.1379 and 0.6338 respectively (95% CI). P-values of anterior talar translation and talar tilt angle were 0.4371 and 0.0002 respectively (95% CI). The degree of talar tilt angle improvement was -1.91 in solitary ATFL injury group and -5.48 in ATFL and CFL complex injury group.Conclusion:The outcomes of arthroscopic MBP with IER augmentation for chronic lateral ankle instability in patients with Solitary ATFL injury and in patients with ATFL and CFL complex injury showed no differences except talar tilt angle improvement. Though talar tilt angle improvement showed difference between two groups, the degree of improvement was even better in ATFL and CFL complex injury group. It means arthroscopic MBP could be a good treatment options for chronic lateral ankle instability patients regardless of CFL injury.

The Safety and Efficacy of Biceps Tenodesis Performed using a Novel Suture Anchor

Introduction: Biceps tendon degeneration or tearing is a significant cause of shoulder discomfort and dysfunction. Biceps tenodesis is commonly performed to treat symptomatic biceps tendon pathology. A variety of fixation techniques can be used including screw fixation, endobutton, or suture anchor techniques. This study examines the patient outcomes when the FOOTPRINT™ Ultra suture anchor system is used for biceps tenodesis. Materials and Methods: Retrospective review of consecutive patients undergoing biceps tenodesis was conducted. All patients underwent biceps tenodesis using the FOOTPRINT™ Ultra suture anchor. The primary endpoint was any device-related complication during the intraoperative or postoperative period. Descriptive and inferential statistics were performed to assess patient characteristics and outcomes. Results: Twenty-nine patients were included in this study; 20 (69.0%) underwent arthroscopic biceps tenodesis and the remainder underwent open surgery. The mean follow-up time was 8.51 ± 5.28 months postoperatively. One patient experienced a postoperative infection within the first 30 days requiring a return to the operating room. Two patients experienced a complication within the first 6 months postoperatively. No patients experienced a device-related complication. No patients experienced a retear of their biceps tendon; two patients experienced a retear to their rotator cuff repair. The mean pain Numeric Rating Scale improved from 5.88 ± 2.58 on a scale of 0–10 preoperatively to 1.94 ± 2.32 postoperatively (P &lt; 0.001). Conclusion: The FOOTPRINT™ Ultra suture anchor appears to be safe for the use in patients undergoing arthroscopic or open biceps tenodesis.

The surgical management of distal triceps tendon ruptures: a systematic review

Distal triceps tendon ruptures (DTTRs) are highly uncommon injuries and can be treated with surgical repair. The purpose of this review was to compare the outcomes and complications of various surgical techniques used for primary repair of DTTRs. The electronic databases MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed were searched from data inception to October 15, 2020. The Methodological Index for Non-randomized Studies tool was used to assess study quality. Data are presented descriptively. A total of 19 studies were identified, comprising 560 patients (565 triceps tendons), of whom 78.6% were male patients. The mean age was 46.1 ± 8.4 years, and the mean follow-up period was 31.8 ± 21.0 months. The overall complication rate across all DTTR repair procedures was 14.9%. The distribution of complications for each technique was 29.2% for the direct repair technique, 15.2% for the transosseous technique (transosseous suture), and 7.7% for the suture anchor technique. Common complications include ulnar neuropathies, infections, and pain. The overall rerupture rate for transosseous suture, suture anchor, and direct repair was 4.3% (n=12), 2.1% (n = 3), and 0% (n = 0), respectively. Patients undergoing DTTR repair experience significant improvements postoperatively regarding pain, strength, and range of motion. Patients undergoing DTTR experience improvements in postoperative outcomes; however, there is a moderate reported risk of rerupture or complication. Owing to the heterogeneity in rupture patterns, surgical procedures, and outcome measures, it is difficult to ascertain the superiority of one surgical technique over another. Future studies should use large prospective cohorts and long-term follow-up to determine more accurate complication rates and outcome scores.

Comparative Study of the Effects of Two Suturing Techniques of End-to-Side Arteriovenous Anastomosis on Early Outcomes of Radio-Cephalic Fistulas

Introduction: Radiocephalic arteriovenous fistulas (AVFs) for dialysis have significantly high maturation failure rate. Many surgical technique-related factors are known to impact the outcomes of AVF surgery; anastomotic suturing technique is one such factor for which the published data is sparse. Patients and Methods: We retrospectively analyzed the data of patients who underwent end-to-side radio-cephalic AVF surgery during a 2-year period and grouped it according to the two techniques of anastomotic suturing: Anchor technique and parachute technique. Comparative analysis was done to study the effect of the technique on well-defined outcomes within the first 6 months of surgery. Results: A total of 119 AVFs (anchor technique = 65, parachute technique = 54) were included in the study. The aggregated primary patency at 6 weeks and 6 months was 85.7% and 78.1% respectively and successful use of fistula was seen in 62.2%. The parachute technique was associated with lower immediate access thrombosis (3.7% vs. 15.4%, P = 0.019) and primary failure (31.5% vs. 43%, P = 0.033) than the anchor technique. The groups did not differ statistically in outcomes like early access failure (P = 0.376), maturation failure (P = 0.105), primary patency at 6 weeks (P = 0.07) and at 6 months (P = 0.083) and successful use of fistula at 6 months (P = 0.196). Conclusion: In this retrospective single-center study, the parachute technique of anastomotic suturing was associated with lower incidence of immediate access failure of radio-cephalic AVF as compared to the anchor technique, although other early outcomes were similar with both techniques. The effects of different suturing techniques on surgical outcomes of AVF should be studied in large randomized trials.

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

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

Outcomes of arthroscopic Bankart repair (ABR) for anterior shoulder instability using two knotless suture anchors fixation.

Objectives: The purpose of this study is to evaluate the short term outcomes of isolated Arthroscopic Bankart Repair (ABR) using knotless suture anchor technique, in young and middle aged patients with post traumatic Anterior Shoulder Instability (ASI). Study Design: Prospective Observational Study. Setting: Sports Units of Hayatabad Medical Complex, Peshawar. Period: January 2018 to December 2020. Material &amp; Methods: 32 patients were included in this study, all of them were male, and who had traumatic anterior shoulder dislocation and underwent Arthroscopic Bankart Repair (ABR), with at least 2 years follow-up and minimum of 4 months of physiotherapy postoperatively. Sample size was calculated through non-probability consecutive sampling technique. Recurrent instability, postoperative glenohumeral osteoarthritis, post-surgical complications and subjective scores (Simple Shoulder Test [SST], American Shoulder and Elbow Surgeon [ASES] and Rowe scores) were evaluated. Results: Among the 32 participants, five patients (15.6%) experienced at least one episode of redislocation, eight patients (25%) had moderate to severe glenohumeral-osteoarthritis. The overall satisfaction rate was 76% with ASES, SST and Rowe scores of 82%, 9% and 79% respectively. One patient (3.12%) had wound infection. Conclusion: Isolated Arthroscopic Bankart Repair (ABR) using knotless suture anchor fixation for anterior shoulder instability followed by physiotherapy has excellent short term outcome in term of low post-surgical complication rate, high patient satisfaction, ability to joint work back and improved subjective scores, although high rate of postoperative glenohum eral osteoarthritis is disappointing necessitating further studies on the matter.

Comparative outcomes between all-inside arthroscopic suture anchor technique versus arthroscopic transosseous suture technique in patients with triangular fibrocartilage complex tear: a retrospective comparative study

BackgroundTriangular fibrocartilage complex (TFCC) has become an interest over the last few decades, discovering its understanding in anatomy, pathomechanism, biomechanics, and management in treatments. Currently, TFCC does not have a golden standard procedure, and not one surgical procedure is superior to the other. This study is to evaluate the comparative outcomes in TFCC patients that underwent either in all-inside arthroscopic suture anchors or the arthroscopic transosseous suture technique.MethodFrom 2017 to 2019, 30 patients were analyzed. Eight patients were in an arthroscopic transosseous group and 22 patients were in an all-inside arthroscopic group. Comparison between patients’ flexion and extension range of motion (ROM), grip strength, and visual analog pain scale (VAS) preoperative and six-month follow-up were analyzed.ResultThere were significant increases in flexion ROM, extension ROM, and VAS between preoperative and postoperative in all-inside arthroscopic and arthroscopic transosseous. Only the all-inside arthroscopic group had a significant increase in grip strength. Postoperative flexion ROM had a significant difference between all-inside arthroscopic and arthroscopic transosseous.ConclusionBoth the all-inside arthroscopic suture anchor technique and the arthroscopic transosseous suture technique are appropriate treatments to treat patients with TFCC. Both procedures have achieved the ultimate goal of improved longevity and optimal function.Level of evidenceLevel III; retrospective comparative cohort study.

Functional outcome of acromioclavicular joint disruption treated using anchor sutures

The Acromioclavicular joint is a diarthrodial articulation which is stabilized by a combination of dynamic muscular and static ligamentous structures. Conservative management is done for Rockwood type 1 and 2 Acromioclavicular joint disruption. Operative management is being done for Rockwood types 3, 4, 5 and 6. The debate about the ideal surgical procedure for Acromioclavicular joint disruption is still unresolved and newer techniques are being evolved continuously. We studied 20 patients who underwent Acromioclavicular joint reconstruction using anchor sutures. Patients were evaluated at pre op and post op follow up period with serial radiography and Constant Murley score was used for functional assessment. The average Constant Murley score used to evaluate the functional outcome showed results to be excellent in 75% of patients, good in 15% of patients, fair in 5% of patients and poor in 5% of patients. Acromioclavicular joint reconstruction using suture anchor technique is a relatively simple technique with good functional outcome and pain relief leading to improved quality of life.