Arthroscopic Suture Technique Research Articles

Arthroscopic surgery for injuries to the popliteal tendon area of the lateral meniscus

To investigate the mid-term effect and complications of arthroscopic popliteal tendon suture in the treatment of lateral meniscus injury. From January 2016 to December 2020, the data of 57 patients with lateral meniscus popliteal tendon injury treated by arthroscopic popliteal tendon suture fixation were retrospectively analyzed, including 35 males and 22 females, aged from 18 to 47 years old with an average of (32.9±7.9) years old. Knee function was evaluated using the International Knee Documentation Committee (IKDC) and Lysholm scores both before the operation and at the final follow-up. Meniscus healing was evaluated according to the postoperative Barrett standard. Wound healing complications, such as vascular injury, nerve injury, and lower extremity venous thrombosis, were recorded. All 57 patients were followed up for 12 to 58 months with an average of (38.1±14.9) months.The incisions of the patients after the operation were all Grade A healing without infection, popliteal tendon injury, blood vessel injury, nerve injury and lower extremity venous thrombosis.The IKDC score increased from (49.7±3.6) points preoperatively to (88.5±4.4) points in the final follow-up (P<0.05). The Lysholm score increased from (48.8±4.9) points preoperatively to (91.9±3.9) points at the final follow-up (P<0.05). At 3, 6 months and 1 year after operation, according to Barrett's criteria, 54 cases were clinically healed, the healing rate was 94.7% (54/57). This study preliminarily confirmed that arthroscopic suture technique can result in clinical stability through suture and fixation of the meniscus in the injured lateral popliteal tendon area. No adverse effects on knee joint function were found in the mid-term follow-up after the operation.

An Arthroscopic Pull-Out Suture Technique to Repair Incomplete Radial Tears of the Lateral Meniscus Posterior Horn Adjacent to the Root Attachment Combined With Anterior Cruciate Ligament Reconstruction

Radial tears of the lateral meniscus posterior horn are one of the most common lateral meniscal injuries accompanied by acute anterior cruciate ligament disruption. Meniscus-preserving therapy is recommended in the case of a radial lateral meniscal tear to preserve its dynamic behavior. We introduce an arthroscopic pull-out technique for repairing incomplete radial tears of the lateral meniscus posterior horn combined with anterior cruciate ligament reconstruction. In this technique, a ring hoop is made through which the tear ends of lateral meniscus on both sides are tightened by adjusting tension of stitches, providing annular and downward tension for lateral meniscus, both of which are critical to the stability of the lateral meniscus. The resident part of lateral meniscus adjacent to the posterior root is not subject to much tension in this technique because of the pull-out fixation of lateral meniscus posterior horn, thus providing support for healing and restoring the hoop action of the lateral meniscus.

Transosseous-Equivalent/Suture Bridge Technique in Combination With Platelet-Rich Plasma Application Yield Optimal Clinical Outcomes in Arthroscopic Rotator Cuff Repair: A Bayesian Network Analysis of Randomized Controlled Trials

To assess the clinical evidence defining the optimal combination of arthroscopic suture technique and platelet-rich products (PRP), and application for arthroscopic rotator cuff repair (ARCR). All level of evidence (LOE) I randomized controlled trials (RCT) focusing on arthroscopic suture technique and/or PRP application in ARCR were included. The exclusion criteria were LOE II or worse, studies with other interventions, studies reported none of the predetermined clinical outcomes; studies unable to extract any precise data; studies from the same patient group of included studies. A pair-wise meta-analysis and Bayesian network analysis were performed on each comparison. The intervention options were ranked by Bayesian network analysis. 27 studies comprising 1,947 individuals met the inclusion criteria. The application of transosseous equivalent/suture bridge repair (SB) with PRP (SB+PRP) significantly reduced retear rate (risk ratio [RR], 0.29; 95% confidence interval [CI], [0.15, 0.55].) and increased Constant-Murley score (mean difference, 1.90; 95% CI, [0.14, 3.74]), compared to SB repair. Single-row repair (SR) with PRP usage (SR+PRP) significantly reduced retear rate (RR, 0.27; 95% CI, [0.12, 0.55]) and pain visual analog scale (VAS) (mean difference:-0.84; 95% CI [-1.39,-0.46].), increased University of California, Los Angeles (UCLA) shoulder score (mean difference: 1.48; 95% CI [0.50, 2.58]) and Constant-Murley score (mean difference: 4.53; 95% CI [2.65, 6.38]), compared to SR repair. The ranking for outcomes demonstrated SB+PRP resulted in the best retear rate, UCLA shoulder score, with the second-best postoperative pain, Constant-Murley score, while SR+PRP resulted in the best postoperative pain, Constant-Murley score, with the second-best retear rate and UCLA score. Arthroscopic rotator cuff repair utilizing SB+PRP yields optimal retear rate and UCLA shoulder score, with the second-best postoperative pain and Constant-Murley shoulder outcome score, while SR+PRP yields the best in these two parameters. Level I, Bayesian network analysis of level I RCT.

Margin Convergence Continuous Lasso-Loop Overlocking Technique for the Repair of Horizontal and Longitudinal Knee Meniscal Tears

Horizontal and longitudinal tears are the most common injuries of the meniscus. The arthroscopic all-inside suture technique using meniscal repair devices involving preloaded sutures and nonabsorbable implants is the most popular technique. The 2 main disadvantages of this technique are the high cost and complications associated with implants. We have adopted some modern shoulder surgery techniques to repair horizontal and longitudinal meniscal tears. Our technique is based on the continuous lasso-loop margin convergence technique for rotator cuff repair (Lafosse’s continuous stitches). The technique is an implant-free, cost-effective procedure, which can be performed using general arthroscopic instruments.

Arthroscopic Disk Repositioning After Failed Open Disk Repositioning.

Open disk repositioning has been long achieving excellent functional and stability outcomes. However, still remains some relapses for whom a second open surgery is often challenging. This study aimed to evaluate the effectiveness of arthroscopic disk reposition as an alternative surgery for unsuccessful cases of anterior disk displacement (ADD) after an initial open disk repositioning. This retrospective study included all patients who underwent secondary arthroscopy for disk repositioning of the relapsed ADD after an initial open surgery between January 2012 to June 2017. The redo arthroscopic disk repositioning and suturing procedure was the primary predictor input variable in this study. Outcome evaluation was based on both clinical (visual analog scale and maximal interincisal opening) and magnetic resonance imaging data. Twenty-seven joints fulfilling the inclusion criteria were included. A significant improvement was detected at 24-month postoperatively compared with the baseline visual analog scale. The maximal interincisal opening showed a statistical improvement from 25.07mm preoperatively to 38.44mm at 24-month postoperatively. Twenty-six joints maintained a stable disk position with only 1 joint relapsed to ADD without reduction. Arthroscopic disk reposition and suturing technique is a reliable and effective repeat surgery after failed initial open disk repositioning for management of ADD.

Functional outcome of acute tibial eminence fractures treated with arthroscopic assisted pull-through suture technique: A prospective case series

Background and Objective: There is an increased incidence of tibial eminence fractures in skeletally mature adults due to increased road traffic accidents and participation in sports activities (reference). The study has been undertaken to evaluate the functional outcome of acute tibial eminence fractures treated arthroscopically with a pull-through suture technique.Methods: This study included thirty-one patients with acute tibial eminence fractures treated arthroscopically between November 2019 and March 2021. All the fractures were fixed using a pull-through suture technique and tied over the suture disc.Results: Among the thirty-one patients treated, the most common cause of injury was a road traffic accident, followed by sports injuries. Two patients were injured due to a kick by the bull. In sports injuries, Kabaddi was the most prevalent cause of anterior cruciate ligament damage. Males made up 29 (94%) cases, while females made up just 2 (6%). The majority of the patients were between the ages of 40 and 49 (45 per cent). 64.5 per cent of patients (n=20) had surgery within five days of their accident. In our study, the mean preoperative IKDC scores were 50.94, and the mean postoperative IKDC scores were 87.73, indicating a considerable improvement. The mean pre-operative Lysholm score was 60.1, and postoperative Lysholm scores were 91.5. One patient had five degrees of extensor lag, and one patient had a fixed flexion deformity at ten degrees due to poor compliance to rehabilitation. Patients showed significant improvement by the end of 3 months and were allowed to return to daily activities by the end of 3 months and sports by six months. The percentage of patients who ended up having good to excellent outcomes is 83.8 and the percentage of patients returning to pre-injury level is 70.Conclusion: Treating acute tibial eminence fractures with an arthroscopic pull-through suture technique gives good rigid fixation and improves the functional outcome.

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.

A comparison of the transtibial pullout technique and all-inside meniscal repair in medial meniscus posterior root tear: Prognostic factors and midterm clinical outcomes

IntroductionThere is a paucity of comparative clinical data between arthroscopic all-inside end-to-end meniscal root suture and transtibial pullout technique in medial meniscus posterior root tears (MMPRT). Therefore, this study aimed to compare treatment failure, mid-term clinical and radiological outcomes of all-inside meniscus root repair versus the transtibial pullout technique and to analyze prognostic factors of postoperative clinical and radiological outcomes. Material and methodsForty-four patients were included in two therapeutic group: arthroscopic all-inside meniscal suture (MS: 13 knees) and transtibial pullout technique (TP: 31 knees).Primary clinical outcomes at a minimum of 27.2 months postoperatively included Knee injury and Osteoarthritis Outcome Score (KOOS) and Lysholm Knee Questionnare (LKQ). Radiographic assessment of the knee was performed to determine osteoarthritis severity using the Kellgren-Lawrence (KL) grading system.In addition, pre and postoperative MRI scans and intraoperative arthroscopic findings were recorded and the correlations between these findings, as outcome predictors and postoperative patients reported subjective outcome were assessed. ResultsNo significant differences in postoperative KOOS and LKQ scores were found between the MS and TP group (p = 0.38 and 0.17, respectively).During follow-up one patients (7.7%) in the MS group and two (6.5%) in the TP group underwent total knee arthroplasty. The difference did not reach the statistical significance (p = 0.88).No differences were observed in postoperative MRI findings such as meniscal extrusion, osteochondral defect, chondromalacia patella, and bone morrow edema (p = 0.25, 0.97, 0.97, and 0.88, respectively).A univariate model revealed that the presence of postoperative meniscal extrusion; osteochondral defect; chondromalacia patella; increased BMI; age (>40 years) and longer time lapse between clinical onset to surgery (>6 months) were predictors of poor clinical outcome. The presence of meniscal extrusion, osteochondral defect and chondropatia patella portended worst postoperative outcomes in a multiple linear regression model. ConclusionsIt can be concluded that both techniques can reach good results when performed properly and if the injury pattern allows meniscal suture may be considered a treatment option for the management of MMPRT in well-selected patients.Patients with increased BMI, preoperative meniscal extrusion, chondromalacia patella, and osteochondral defect were at higher risk of poor clinical outcomes.

Bucket-handle meniscal tears in children under the age of 10: a literature review.

Background and aim of the work:Traumatic meniscal tears are raising in skeletally immature patients due to increasing participation in sport activities. Nonetheless, meniscal tears remain a rare injury in children, with a lack of evidence regarding treatment and outcome. The aim of the study is to review the literature on BHMT in children aged under 10 years.Methods:Two independent reviewers conducted a systematic search of Embase, Medline and Pubmed databases to report a summary of literature evidence about epidemiology, clinical presentation, diagnosis, treatment and outcome of BHMTs in children under the age of 10.Result:Eight papers have been considered, including seven case reports and one case series, for a total amount of 21 cases of BHMTs in children under 10 years. Complete clinical information was retrieved for 12 cases, which were analyzed in detail. The injury occurred in the medial meniscus in 8 cases (66,7%), while in 4 cases (33,3%) on a lateral discoid meniscus. The mean reported age is 4,6 years (range 2 years - 9 years), with prevalence of the female sex (62,5%).Conclusion:BHMT is an uncommon lesion in children under 10 years old. It can be suspected after a history of knee trauma in patients with knee pain, effusion and locking. MRI is the best technique for the diagnosis. Current strategy of treatment is to preserve the meniscus through different arthroscopic suture techniques, unless the lesion occurs on a discoid meniscus. (www.actabiomedica.it)

Clinical outcomes of acute displaced posterior cruciate ligament tibial avulsion fracture: A retrospective comparative study between the arthroscopic suture and EndoButton fixation techniques

BackgroundTibial avulsion fracture of the posterior cruciate ligament is not rare in the clinic. Arthroscopic treatment is increasingly accepted, but the choice of fixation has been debated. This study aims to compare the clinical outcomes of suture and EndoButton fixation under arthroscopy for acute displaced posterior cruciate ligament avulsion fractures. MethodsA total 68 of 83 PCL tibial avulsion fracture cases from 2009 to 2016 were retrospectively reviewed. Some patients received arthroscopic suture initially, and later the others received arthroscopic EndoButton fixation. Associated lesions were treated if present. The Lysholm and International Knee Documentation Committee (IKDC) scores, KT-1000 arthrometry and plain radiography were evaluated at follow-up. The assessment data at two years of follow-up were used for comparing the two different fixation groups. ResultsThe follow-up time of 63 patients was more than 2 years. In total, 32 of the 63 patients were in the suture group, and 31 were in the EndoButton group. At two years of follow-up, knee function according to the Lysholm score was a mean of 92.5 with a 95% confidence interval [CI] of 89.45 to 96.40 in the suture group and a mean of 93.5 with a 95% CI of 90.52 to 97.28 in the EndoButton group (P=.785). More than 90% of patients in both groups rated their knee function as normal or nearly normal on IKDC subjective evaluation. KT-1000 arthrometry showed that there was no difference between the two groups, with 0 to 3mm of laxity in 91% of the cases in the suture group versus 90% of cases in the EndoButton group. All patients achieved bony healing within 3 months. No significant complications were noted in the study. ConclusionsBoth the arthroscopic suture and EndoButton fixation methods for acute displaced posterior cruciate ligament avulsion fractures resulted in comparably good clinical outcomes, radiologic healing, and stable knees at mid-term follow-up. Level of evidenceIII; retrospective comparative study.

Revisional triangular fibrocartilage complex (TFCC) repair using arthroscopic one-tunnel transosseous suture: preliminary results.

The purpose of this study was to report the clinical outcome of revision arthroscopic triangular fibrocartilage complex (TFCC) foveal repair using a one-tunnel transosseous suture technique after failed primary TFCC repair. Consecutive patients treated with arthroscopic TFCC foveal repair using the uniform one-tunnel transosseous suture technique after failed TFCC repair from 2014 to 2018 were retrospectively reviewed. The clinical outcome was evaluated using the Modified Mayo Wrist Score (MMWS) and the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score. The Visual Analog Scale (VAS) for pain, stability of the distal radioulnar joint (DRUJ), grip strength, and active range of motion (ROM) of the wrist joint also were assessed. This study cohort consisted of eight patients, and their mean time to revision after initial surgery was 15.1months. Previous surgeries were performed using an arthroscopy-assisted mini-open TFCC repair in six cases, an arthroscopic all-inside repair in one case, and an arthroscopic transosseous suture technique in the remaining case. After revisional TFCC foveal repair, all patients demonstrated improved pain and a stable DRUJ. Participants showed improvement in grip strength and mean active wrist ROM. There was improvement in MMWS (from 58.6 to 87.5) and Quick-DASH score (from 46.9 to 12.2) during the mean follow-up of 15.6months (range: 8-36months). Based on the results of this study, remaining ulnar TFCC remnants may be appropriate for sufficient stable repair using an arthroscopic one-tunnel transosseous suture technique after failed primary repair. However, only a small number of patients was examined. A larger number has to be investigated to confirm the promising preliminary results. Level IV, therapeutic case series.

How to Perform a Giant Parameniscal Cyst Exeresis: Step by Step Technique

Parameniscal cysts are usually small cystic lesions, less than 2 cm in size, found along the meniscal periphery. They are rarely associated with extra-articular palpable mass. Magnetic resonance imaging is the diagnostic method of choice; giant meniscal cysts (>5 cm at its greatest diameter) are very rare, with few cases described in the literature. We describe a step-by-step open exeresis and arthroscopic meniscal suture technique for the treatment of a 9-cm giant parameniscal cyst located on the lateral side of the knee. Treatment of giant meniscal lesions requires caution during dissection and exeresis. Because acute meniscal lesions benefit from meniscal suture rather than meniscectomy, horizontal degenerative lesions may also present excellent results with repair techniques. We conclude that the combination of the open excision of the giant cyst with careful dissection and protection of neurovascular structures, combined with the arthroscopic meniscal suture, is a good strategy to approach such lesions.

Arthroscopic simplified double-pulley double row suture technique to fix the bigger glenoid anterior edge fracture

Objective To investigate the clinical results of arthroscopic double-pulley double row suture technique for the treatment of bigger Ideberg Ia glenoid fracture. Methods From January 2014 to July 2017, data of patients with Ideberg Ia glenoid fracture who were treated by arthroscopic double-pulley double row suture technique were retrospectively analyzed. Totally 24 patients were enrolled of whom 13 were males and 11 were females. The mean age was 50.14±10.60 years (range, 34-67). In those patients, there were 8 cases of glenoid fracture alone, 4 cases of glenoid fracture associated with greater tuberosity fracture, 5 cases of glenoid fracture with rotator cuff tear, 4 cases of glenoid fracture with shoulder anterior dislocation and greater tuberosity fracture, 2 cases of glenoid fracture with shoulder anterior dislocation and rotator cuff tear, and 1 case of shoulder anterior dislocation with ipsilateral distal radius fracture. The fragment accounts for 28.91±5.35% (range, 25.1%-38.5%) of the glenoid articular surface. According to the size of the fragment, one medial row anchor was used to implant at the medial edge of the fracture bed of the anterior edge of the glenoid; two to four lateral row suture anchors were used to implant at the margin of the glenoid joint surface sequentially from low level to higher level, and simplified double-pulley technique was finally used to fix the fragment. The situation of fracture reduction and healing and the post-operative complications were evaluated. The Constant-Murley, DASH and VAS were also recorded. Results Satisfactory fracture reduction and fixation were achieved in all 24 patients. The mean follow-up time was 19.5 months (range, 12-36). Mean VAS was 0.8±0.8 (range, 0-2). The range of motion at the latest follow-up was: anterior flexion 145°-180° (mean, 161.00°±5.77°), external rotation at the side 35°-60° (mean, 46.43°±6.63°), internal rotation L3-T10 level. The mean Constant-Murley score was 88.1±3.7 (range, 81-93), and mean DASH score was 8.4±4.7 (range, 0-40.4). All cases except one showed no dislocation or disability of the shoulder. The CT scans showed: 19 cases of which the step-off of articular surface was less than 2 mm; 4 cases of which the step-off was between 2 mm to 4 mm and 1 case of which the step-off was more than 4 mm. No severe osteoarthritis was identified at the latest follow-up, and only 1 patient at the age of 67 showed slight osteoarthritis. Two patients with shoulder anterior dislocation and rotator cuff tear committed significant restricted shoulder range of motion. Conclusion The arthroscopic simplified double-pulley double row suture technique was identified safe, effective and reliable for treating the bigger Ideberg Ia glenoid fracture. The technique is able to provide clear visulization of the fracture and achieve excellent clinical results. Key words: Shoulder fractures; Arthroscopy; Suture anchors

Mid-term outcomes of arthroscopic suture fixation technique in tibial spine fractures in the pediatric population.

Tibial spine fractures are avulsion injuries that are a similar mechanism to anterior cruciate ligament rupture. Although its incidence is not very common, it can cause possible complications and permanent sequelae in the knee joint if not treated correctly. The aim of this study was to evaluate the mid-term results of the arthroscopic suture technique for tibial spine fractures in a pediatric population. Analyzed retrospectively were 28 patients who underwent the arthroscopic suture fixation technique at our clinic, due to type 2 (with >5 mm displacement), 3 and 4 tibial spine fractures, between January 2013 and December 2017. The demographic features, injury mechanism, fracture classification, mean follow-up time, radiographic healing time, return to activity time, instability examination, joint range of motion (ROM), and knee injury and Osteoarthritis Outcome Score (KOOS) parameters of the patients were evaluated both clinically and functionally. The mean age of the patients was 14.2. In addition, 17 patients were male (61%) and 20 had a healthy body mass index (71%). According to the modified Meyer and McKeever classification, type 2 tibial spine fracture was most common. The mean follow-up period was 4.64 years and the mean radiological healing time was calculated as 2.17 months. Of these patients, 27 were fully functional in terms of ROM (96%). Secondary surgery was performed on 1 patient due to arthrofibrosis and severely limited ROM. The mean 6-month KOOS was 82.3, while the 12-month KOOS was 91.4 and the 24-month KOOS was 95.7. A significant difference was observed between these scores (p=0.024). The outcomes of the arthroscopic suture technique for the treatment of tibial spine fractures in a pediatric population were both clinically and functionally satisfactory. Anatomic reduction and early rehabilitation increased the success rate in the treatment of these fractures. Longer follow-up will provide more information.

Early effectiveness of arthroscopic three-point suture technique in treatment of anterior cruciate ligament tibial eminence avulsion fracture

To investigate the early effectiveness of three-point suture technique in treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture by arthroscopy. Between January 2016 and December 2017, 12 patients with ACL tibial eminence avulsion fractures underwent arthroscopic fixation of avulsion fractures with Ethibon suture using three-point suture technique. There were 9 males and 3 females, with an average of 36.4 years (range, 18-50 years). The fracture caused by traffic accident in 10 cases and sports in 2 cases. Among them, 1 patient was old fracture and 11 was fresh fracture. According to the modified Meyers-McKeever classification criteria, the fractures were rated as type Ⅲ in 7 cases and type Ⅳ in 5 cases. There were 2 cases of medial collateral ligament injury and medial meniscus injury. The preoperative International Knee Documentation Committee (IKDC) score was 37.9±4.7 and Lysholm score was 46.0±3.7. All operations completed smoothly. The operation time was 45-70 minutes (mean, 61.3 minutes). The incisions healed by first intention in all patients. The hospitalization stays ranged from 4 to 9 days (mean, 5 days). All patients were followed up 3-20 months (mean, 9.3 months). The anterior drawer test, Lachman test, and axis shift test in all patients were negative after operation. At last follow-up, the IKDC score was 89.7±2.5 and Lysholm score was 90.2±1.9, which were significantly higher than those before operation ( t=-30.94, P=0.00; t=-33.03, P=0.00). At last follow-up, the X-ray films showed 9 cases of fracture anatomical reduction and 3 cases of almost anatomical reduction, and 12 cases of fracture healing. For ACL tibial eminence avulsion fracture, arthroscopic three-point suture technique can effectively restore the stability of knee joint and obtain satisfactory early effectiveness.

A study of the clinical and radiological outcomes of arthroscopic reduction and fixation of displaced ACL avulsion fracture in adults using arthroscopic pull-out suture technique

A study of the clinical and radiological outcomes of arthroscopic reduction and fixation of displaced ACL avulsion fracture in adults using arthroscopic pull-out suture technique

Use of a Safety Clamp When Performing Arthroscopic Knot Tying Preserves the Suture When It Is Placed Under Excessive Tension.

The purpose of this study was to compare the location of the suture breakage between tying by hand vs with a safety clamp, needle driver. FiberWire No. 2 and 2-0 (Arthrex, Naples, Florida) were fastened onto the hook attachment of the digital force gauge. Sutures were placed under excessive strain using a hand tying technique vs a safety clamp, or instrument tying. Peak forces at which the sutures failed under tension along with locations of the suture breakage, measured from the site of the knot, were recorded. For FiberWire No. 2, the mean load to failure was 142.60±2.33 N for hand tying and 78.79±1.97 N for the safety clamp (P<.0001). For FiberWire 2-0, the mean load to failure was 62.98±4.90 N for hand tying and 34.43±2.46 N for the safety clamp (P<.0001). For FiberWire No. 2, the mean location of suture breakage was 0 cm, at the site of the knot, for hand tying and at the clamping point (10.45±0.34 cm from the knot) for the safety clamp (P<.0001). For FiberWire 2-0, the mean location of suture breakage was 0 cm, at the site of the knot, for hand tying and at the clamping point (10.47±0.22 cm from the knot) for the safety clamp (P<.0001). Use of a safety clamp while mastering arthroscopic suture technique preserves the suture knot when placed under excessive tension. [Orthopedics. 2019; 42(1):e25-e28.].

Arthroscopic Fixation of Traumatic Tibial Bone Avulsion of Posterior Cruciate Ligament Using Scorpion Suture Passer: A New Technique

Several operative techniques have been described for operative treatment of posterior cruciate ligament (PCL) avulsion injuries. Here we introduce a new arthroscopic suture technique for the treatment of PCL avulsion fracture using Scorpion suture passer. Three standard portals of anteromedial, anterolateral, and posteromedial are established along with the central trans-patellar tendon portal, if necessary. A Scorpion suture passer and No. 2 FiberWire were used to put two sutures at the base of the PCL-bone interface. After reducing the fragment, a tibial target guide for PCL was used to make a tunnel at the center of the fracture site and the fragment, if possible. An Endotack is used to fix the sutures at the anterior border of the tibia. This is a practical technique with a short learning curve and biomechanically stable fixation.

Management of displaced posterior cruciate ligament avulsion fractures using arthroscopic suture fixation technique versus Burks and Schaffer approach

Purpose The purpose of this study was to analyze and compare the results of management of displaced posterior cruciate ligament (PCL) avulsion fractures using cannulated screws through the Burks and Schaffer open approach versus the arthroscopic suture technique. Patients and methods Forty patients with PCL avulsion fractures were included in this randomized prospective study. Twenty patients in group A were treated using the arthroscopic suture technique, whereas 20 patients in group B underwent open reduction and internal fixation of the avulsed PCL fragment by a 4-mm cannulated screw using the Burks and Schaffer approach. The mean follow-up period was 26.75 and 28.55 months for group A and B, respectively. Functional assessment was done using the Lysholm and International Knee Documentation Committee scores. Radiographic evaluation was done by plain radiographs and computerized tomography to assess the rate and time for bone union. Clinical examination compared the regained flexion range of motion and degree of posterior laxity. Results All patients were available at the final follow-up. All patients in both groups achieved bone union at 7–10 weeks postoperative. The Lysholm and International Knee Documentation Committee scores in both groups increased significantly at the final follow-up. There was no statistically significant difference between both groups apart from the operative time for the arthroscopic group being longer than the open group and the regained flexion range in the arthroscopic group was higher than the open group. Eight (40%) patients in the arthroscopic had associated meniscal pathologies, which were treated during the arthroscopic procedure. No neurovascular, nonunion or wound complications were reported in either group. Conclusion Displaced tibial PCL avulsion fractures can be successfully managed using both the open and arthroscopic techniques. Arthroscopic management required a longer operative time than the open approach; however, the regained flexion range was better than the open technique and concomitant pathologies were managed during the arthroscopic procedure. Level of evidence: Level III; prospective comparative study.

Biomechanical Comparison of Open and Arthroscopic Transosseous Repair of Triangular Fibrocartilage Complex Foveal Tears: A Cadaveric Study

To biomechanically compare the stability between open repair and arthroscopic transosseous repair technique for reattachment of the foveal triangular fibrocartilage complex (TFCC). We also evaluated the feasibility of a new aiming device for the creation of 2 bone tunnels simultaneously during the arthroscopic technique. Six matched pairs of fresh-frozen forearm cadaver specimens were prepared for testing. Group I specimens were treated by open repair with suture anchor. Group II specimens were treated by arthroscopic transosseous suture with a new aiming device. Before and after disruption of the TFCC fovea and after its repair, dorsal and palmar translation of the ulna was measured in both groups in response to a load (3kg) applied in the palmar and then in the dorsal direction. The total translation of the ulna was calculated as the sum of the mean dorsal and palmar translations. The mean total ulnar translation before and after TFCC disruption, and after TFCC repair was 5.94 ± 2.16mm, 9.08 ± 2.64mm, and 6.04 ± 2.18mm, respectively. The specimens demonstrated a significant increase in the total translation of the ulna after disruption of the ulnar attachment of TFCC (P= .003), whereas a significant decrease was observed after TFCC foveal repair (P= .003). The median percentage of eliminated translation after TFCC repair was 64% and 172%, respectively, in groups I and II (P= .043). The athroscopic transosseous suture technique demonstrated superior repair efficacy to the open repair technique in terms of biomechanical strength. This cadaveric study also demonstrated the feasibility of a new aiming device. When making decisions about TFCC foveal repair, arthroscopic transosseous suture technique may provide better biomechanical strength than the open repair technique.