Endobutton Group Research Articles

Comparison of Double Endobutton and Clavicular Hook Plate in Acromioclavicular Joint Disruption: A Systematic Review and Meta-analysis.

Acromioclavicular joint (ACJ) disruptions are corrected by surgery either with an endobutton or a hook plate. The results in the long term were found to be similar in many randomized controlled trials. This study aims to conduct a meta-analysis to evaluate the functional outcome and complications of double endo button versus clavicular hook plate (CHP) for ACJ disruption (Rockwood types III-VI). Two authors independently searched related articles from electronic databases (PubMed, Google Scholar, MEDLINE, SCOPUS, and Web of Science) till January 26, 2022. The data were extracted from the related articles and analyzed by Stata software. For bias calculation of each study, the Newcastle-Ottawa scale and the RevMan 5.4 software were used. 14 cohort studies, 2 randomized control trial studies, and 1 case-control study including patients were selected in this meta-analysis. The results of our study showed a significantly higher Constant-Murley Score (WMD 5.79, 95% confidence interval [CI] 2.23-9.36), Visual Analog Scale (WMD- 0.63, 95% CI [-0.79, -0.46]) and University of California at Los Angeles shoulder score (UCLA) scale (WMD 3.32, 95% CI [2.87, 3.77]) for double endobutton group. At the same time, some complications like implant failure were more common in the double endobutton group. This meta-analysis shows better functional and clinical outcomes of shoulder joint for the treatment of acromioclavicular joint (ACJ) disruption cases (Rockwood types III-VI) with no need for secondary operation, unlike the CHP. Complications like subacromial erosion, ACJ arthrodesis, and infection rate are higher in the CHP group, whereas the chance of implant failure is higher in the double endobutton group.

Comparison of Radiological, Functional and Plantar Pressure Disturbance Results of Two Different Surgical Techniques on Syndesmosis Injuries with Malleolus Fractures

Background and objectives This study compared the clinical and radiological results of three cortex conventional metal screw fixation and EndoButton implant techniques. We applied dynamic pedobarographic analysis to the cases to reveal the effect of the postoperative functional levels on the gait and plantar pressure distribution parameters and to determine the differences between the groups. Materials and methods In our retrospective study, 42 patients were evaluated in two groups, divided into metal screw (Group I; n=24) and button-stitch implant technique (Group II; n=18). After the groups were formed, the functional and clinical outcomes of the patients were evaluated and measured prospectively by an investigator blinded to the surgical procedures of the patients clinically and radiologically. Results We found the AOFAS score significantly higher in the EndoButton group (p=0.041), while the Weber and Freiburg scores were similar between the two groups (p=0.07 and p=0.49, respectively). When the plantar pressure distribution analyzes of the operated sides were examined, the loading percentages in the forefoot and midfoot were found to be statistically significantly higher in the metallic screw group providing static fixation, while the percentage of lateral heel loading was found to be statistically significantly lower. The medial heel loading percentage was also lower in the screw group, but no statistically significant difference was detected. Conclusions We observed that the conventional screw static fixation technique used to repair syndesmosis injuries causes limitation in ankle dorsiflexion, increases the pressure percentages in the forefoot and midfoot, and causes a later return to work/daily life.

Biomechanical testing of three coracoclavicular ligament reconstruction techniques with a 3D printing navigation template for clavicle-coracoid drilling.

BackgroundThe identification and precise clavicle-coracoid drilling during coracoclavicular (CC) ligament reconstruction for acromioclavicular (AC) joint dislocation require a high level of experience and surgical skills. Furthermore, the improvement of flexible fixation, such as Endobutton techniques for CC ligament reconstructions is ongoing. We have developed a 3D printing technique navigation template for clavicle-coracoid drilling and a novel implant for the reconstruction. This study aimed to determine the efficiency of the navigation template for clavicle-coracoid drilling and to evaluate the biomechanical performance of the novel CC ligament reconstruction technique.MethodsA total of 24 fresh-frozen human cadaveric shoulders were randomly assigned to 1 of 3 reconstruction groups or a control group: TightRope, Triple Endobutton, and the Adjustable Closed-Loop Double Endobutton technique. Computed tomography scans, navigation template designs, and 3D printing were performed for the shoulders. Then, AC joint dislocation was simulated in the reconstruction groups, and 3 CC ligament reconstruction techniques were operated via the 3D printing template separately. Furthermore, biomechanical protocols including the translation test (load from 5 to 70 N) and the load-to-failure test were performed to characterize the behaviors and strengths. One-way ANOVA test analyzed differences in displacement under the translation load and the load at failure.ResultsCC ligament reconstructions were performed successfully along with the 3D printing navigation template in the 3 reconstruction groups. During the translation test, no significant difference was found in displacements among the 4 groups. Meanwhile, the mean load of all reconstruction groups at failure (Adjustable Closed-Loop Double Endobutton, 722.1620 N; TightRope, 680.4020 N; Triple Endobutton, 868.5762 N) was significantly larger than the control group (564.6264 N, P<0.05). The Triple Endobutton group had the maximum load at failure (P<0.05), however, no significant difference was noticed between the other 2 reconstruction groups (P>0.05).ConclusionsThe 3D printing navigation template may become helpful and reliable for AC joint dislocation surgery. Among the 3 CC ligament reconstruction techniques, the Triple Endobutton technique has the best strength in terms of biomechanics, while the biomechanical strength of the Adjustable Closed-Loop Double Endobutton technique is reliable in comparison with the TightRope technique.

Biomechanical comparison of screw, tightrope and novel double endobutton in the treatment of tibiofibular syndesmotic injuries

BackgroundAdequate reduction and stabilization of the syndesmosis are significant to prevent early degeneration of the ankle joint and get better clinical outcomes. However, the routine surgical methods have diffierent limitations. The purpose of this study was to develop a novel double Endobutton fixation to treat the distal tibiofibular syndesmotic injuries, and determine whether the novel double Endobutton fixation demonstrates a better biomechanical property compare with the intact syndesmosis, the screw fixation and the Tightrope fixation. MethodsTwenty-four normal fresh-frozen ankle specimens with a mean age of 42 ± 8 (range, 28–62) years were randomly divided equally into four groups: (1) the intact group, (2) the screw group, (3) the Tightrope group, (4) the Endobutton group. 3D printer technology was used to establish the personalized distal tibiofibular syndesmotic navigation modules to determine the accurate bone tunnel. Axial loading was applied in five ankle positions: neutral position, dorsiflexion, plantar flexion, varus and valgus. Rotation torque was applied in two ankle rotation of the neutral position: internal and external. ResultsIn most situations, the displacements of the intact group were larger than the screw group, the Tightrope group and the Endobutton group (P < .05), and the displacements of the screw group were smaller than other three groups (P < .05). The displacements of the double Endobutton group were slightly larger than the Tightrope group but no significant differences were found between these two groups except in the dorsiflexion position of axial loading experiments (P < .05). The novel double Endobutton fixation was steadier than intact syndesmosis and more micromotional than screw fixation. ConclusionOur study demonstrated that the novel double Endobutton can be considered as the better fixation in treatment of distal tibiofibular syndesmotic injuries. Level of EvidenceLevel III, retrospective comparative study

Higher failure rate of suture anchors in partial distal biceps tendon ruptures in comparison with Endobutton fixation.

BackgroundLittle is known about the preferred repair technique of partial tears of the distal biceps tendon. In this study, suture anchors were compared with the Endobutton technique for repair of partial distal biceps tendon ruptures, especially regarding failure rate.MethodsA total of 59 patients with 62 partial distal biceps ruptures underwent surgical treatment between 2008 and 2019. Repair of the partially ruptured distal biceps tendon was performed using suture anchors (n = 21) or an Endobutton (n = 41). Postoperative evaluation consisted of integrity and physical examination of the distal biceps tendon, range of motion, stability, neurologic status, and radiographs in AP view and lateral direction of the elbow.ResultsAt a median follow-up of 14 (1-82) months in all patients, a total of 5 patients had a rerupture of the reconstructed distal biceps tendon (8.1%). A significant higher rerupture rate was seen in the suture anchor group (n = 4) than in the Endobutton group (n = 1) (P = .04). The other outcome measures were similar between groups. Other than rerupture rate, there were complications in 21 patients (34%). The major symptomatic complication was attributed to lateral antebrachial cutaneous nerve neuropraxia (n = 8, 15%). Heterotopic ossifications were seen in 12 patients (34%), and ossifications were symptomatic in 4 of these patients (33%).ConclusionA significantly higher failure rate was seen after repair of a partial distal biceps rupture using suture anchors than by using an Endobutton technique. Overall, both techniques were accompanied with complications, in particular, lateral antebrachial cutaneous nerve neuropraxia neuropraxia and the formation of heterotopic ossifications, though clinically less relevant than a rerupture.

Résultats cliniques du traitement des fractures déplacées par avulsion tibiale du ligament croisé postérieur : une étude comparative rétrospective entre la suture arthroscopique et les techniques de fixation EndoButton

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.

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.

Comparison of the effect of arthroscopy assisted TightRope plate and Triple-Endobutton plate and Double Endobutton plate in the treatment of acromioclavicular dislocation

To investigate the clinical effect of arthroscopic assisted TightRope plate, Triple-Endobutton plate and Double Endobutton plate in treating of Rockwood type Ⅲ-Ⅴ acromioclavicular dislocation. From January 2014 to January 2018, 128 patients with acromioclavicular dislocation were treated by operation. According to the operation plan, the patients were divided into three groups:Double Endobutton group, Triple-Endobutton group and TightRope group. All patients with acromioclavicular dislocation were operated by the same operation team, and the chief surgeon was the same chief physician. General baseline data such as gender, age, operation time, incision length, intraoperative blood loss, VAS score of pain and Constant-Murley shoulder function score were recorded. The wound healed well and no recent complications occurred. One hundred and eleven patients were followed up for 6 to 12(9.1±3.1) months. There was no significant difference on general data among three groups (P >0.05). Among three groups, the operation time of Triple -Endobutton group was the longest, significantly higher than that of other two groups(P<0.05);the operation time of TightRope group was the shortest, significantly lower than that of other two groups (P<0.05). At 1 month after operation, VAS score comparison of three groups, TightRope group was significantly lower than other two groups, with statistical difference (P<0.05). At 12 months after operation of three groups, the Constant-Murley score of TightRope group was significantly higher than that of two group (P<0.05). The incidence of incision infectionin TightRope group was significantly lower than that of other two groups(P<0.05); the incidence of reduction loss in Double Endobton group was significantly higher than that of other two groups(P<0.05), the incidence of reduction loss in TightRope group was significantly higher than that of Triple endobton group(P<0.05);the incidence of joint adhesion in TightRope group was significantly lower than that of other two groups(P<0.05). TightRope plate fixation with arthroscopy is more advantageous than Double Endobutton plate fixation and Triple-Endobutton plate fixation.

Arthroscopic anterior cruciate ligament reconstruction: Comparison of functional outcome between femoral fixations by suspensory fixation versus aperture fixation

Background and objectives: Anterior cruciate ligament reconstruction is one of the most common knee operations. The graft fixation ways differ from suspensory fixation methods (Endobutton) to aperture fixation (Interference screws). The use of a hamstring tendon autograft has become a common choice among orthopedic surgeons because of less donor site problem. The aim of this study is to compare the functional outcome between suspensory fixation and aperture fixation of arthroscopic anterior cruciate ligament reconstruction. Methods: Arthroscopic autogenous hamstring anterior cruciate ligament reconstruction was performed for forty-one patients who were divided into two groups, with a minimum of six months follow-up evaluation. The suspensory fixation group underwent endobutton fixation on the femoral side and interference screw on tibial side. The aperture fixation group underwent interference screw fixation at both femoral and tibial tunnels. Both groups were assessed and their functional outcomes were compared before surgery, at three months and six months by using Lysholm knee score. Results: There was significant improvement in functional outcome in both groups, at six months of follow-up, the Lysholm score in endobutton group improved from 77.2 to 93.2 and in interference screw group from 71.5 to 89. The endobutton group had better functional outcome when compared to interference screw group. Conclusions: The endobutton fixation provided better functional outcome at the end of six months when comparing the result. We recommend larger population and longer periods of follow-up.

Decellularized porcine xenograft for anterior cruciate ligament reconstruction: A histological study in sheep comparing cross-pin and cortical suspensory femoral fixation.

AimsTo evaluate graft healing of decellularized porcine superflexor tendon (pSFT) xenograft in an ovine anterior cruciate ligament (ACL) reconstruction model using two femoral fixation devices. Also, to determine if pSFT allows functional recovery of gait as compared with the preoperative measurements.MethodsA total of 12 sheep underwent unilateral single-bundle ACL reconstruction using pSFT. Two femoral fixation devices were investigated: Group 1 (n = 6) used cortical suspensory fixation (Endobutton CL) and Group 2 (n = 6) used cross-pin fixation (Stratis ST). A soft screw was used for tibial fixation. Functional recovery was quantified using force plate analysis at weeks 5, 8, and 11. The sheep were euthanized after 12 weeks and comprehensive histological analysis characterized graft healing at the graft-bone interface and the intra-articular graft (ligamentization).ResultsThe pSFT remodelled into a ligament-like structure and no adverse inflammatory reaction was seen. The ground reaction force in the operated leg of the Endobutton group was higher at 11 weeks (p < 0.05). An indirect insertion was seen at the graft-bone interface characterized by Sharpey-like fibres. Qualitative differences in tendon remodelling were seen between the two groups, with greater crimp-like organization and more aligned collagen fibres seen with Endobutton fixation. One graft rupture occurred in the cross-pin group, which histologically showed low collagen organization.ConclusionDecellularized pSFT xenograft remodels into a ligament-like structure after 12 weeks and regenerates an indirect-type insertion with Sharpey-like fibres. No adverse inflammatory reaction was observed. Cortical suspensory femoral fixation was associated with more enhanced graft remodelling and earlier functional recovery when compared with the stiffer cross-pin fixation.

Biomechanical comparative analysis of screw fixation and cortical endo-button fixation in Latarjet procedure for anterior dislocation of shoulder joint

To clarify the value of the cortical endo-button as an internal fixator in Latarjet procedure through biomechanical analysis. Ten pairs of shoulder joints from 6-7 months old male pigs were selected. Each pair was randomly divided into screw group and endo-button group. A 25% glenoid defect model was created, and the porcine infraspinatus tendon and its associated bone were used to simulate conjoint tendon and coracoid process in human body. The bone grafts were fixed with two 3.5 mm screws and double cortical endo-buttons with high-strength sutures in screw group and endo-button group, respectively. The prepared glenoid defect model was fixed on a biomechanical test bench and optical markers were fixed on the glenoid and the bone block, respectively. Then fatigue test was performed to observe whether the graft or internal fixator would failed. During the test, the standard deviations of the relative displacement between the graft and the glenoid of two groups were measured by optical motion measure system for comparison. Finally the maximum failure load comparison was conducted and the maximum failure loads of the two groups were measured and compared. There was no tendon tear, bone fracture, and other graft or internal fixation failure in the two groups during the fatigue test. The standard deviation of the relative displacement of the screw group was (0.007 87±0.001 44) mm, and that of the endo-button group was (0.034 88±0.011 10) mm, showing significant difference between the two groups ( t=7.682, P=0.000). The maximum failure load was (265±39) N in screw group and (275±52) N in endo-button group, showing no significant difference between the two groups ( t=1.386, P=0.199). There were 3 ways of failure: rupture at bone graft's tunnel (6/10 from screw group, 3/10 from endo-button group), tendon tear at the cramp (2/10 from screw group, 2/10 from endo-button group), and tendon tear at the internal fixator interface (2/10 from screw group, 5/10 from endo-button group), showing no significant difference between the two groups ( P=0.395). Although the endo-button fixation fails to achieve the same strong fixation stability as the screw fixation, its fixation stability can achieve the clinical requirements. The two fixation methods can provide similar fixation strength when being used in Latarjet procedure.

A retrospective comparative study in the treatment of acromioclavicular joint dislocation: ligaments reconstruction with allogenic tendon versus Endobutton technique

Objective To compare the clinical efficacy of reconstruction of trapezium ligament, conoid ligament and acromioclavicular ligament with allogeneic tendon and Endoboutton reduction and fixation in the treatment of acromioclavicular joint dislocation. Methods From February 2010 to August 2016, 16 patients with acromioclavicular joint dislocation were treated, including 8 patients who used allogeneic tendons to reconstruct trapezoid ligament, conoid ligament and the upper and lower parts of acromioclavicular ligament, and 8 patients who used Endobouton technique to reconstruct coracoclavicular ligament. The follow-up of patients' overall satisfaction, observation of shoulder shape, measurement of shoulder joint activity, X-ray evaluation of acromioclavicular joint reduction and maintenance were conducted. The Constant-Murley score and DASH score were used to evaluate the functional recovery of shoulder and upper extremity, and the visual analog scale (VAS) was used to obtain the pain of patients. The follow-up results of the two methods were compared. Results The follow-up period ranged from 34 to 60 months with an average of 48.8 months. All the patients were satisfied with the treatment results and the shape of shoulder joint was normal. In the allogeneic tendon group, the Constant-Murley score was 94.5±5.2, the DASH score was 2.1±2.6, and the VAS score was 0.4±1.1; in the Endobutton group, the Constant-Murley score was 92.8±3.7, the DASH score was 2.2±2.0, and the VAS score was 0.3±0.7. There were no significant differences between the two groups (P>0.05). Conclusion The technique of allogeneic tendon reconstruction and Endoboutton in the treatment of acromioclavicular joint dislocation can achieve satisfactory results, and the allogeneic tendon is more close to the biomechanical requirements, which is an effective method. Key words: Acromioclavicular joint; Dislocations; Allogeneic tendon; Ligament reconstruction; Endobutton technique

A Comparison of the Modified Bosworth and Endobutton Techniques in the Surgical Treatment of Rockwood Type III Acromioclavicular Joint Dislocations

Aim: In this study, we aimed to retrospectively compare the long-term clinical and radiological outcomes obtained with the modified Bosworth technique and Endobutton technique in surgical treatment of type III acromioclavicular dislocations.Materials and Methods: Thirty-two patients (26 males, 6 females) (mean age 37, range 15–78 years) were treated surgically for acromioclavicular joint (ACJ) dislocation. All patients had type III dislocation. Twenty-two patients had right ACJ dislocation and 10 patients had left ACJ dislocation. Of the dislocations, 18 occurred due to falls; 9, sports injuries; and 5, traffic accidents. Of the patients, 18 were operated on with the Endobutton technique and 14 with the modified Endobutton technique. Patients were evaluated postoperatively in terms of functional Constant, DASH, and VAS scores and radiologically with coracoclavicular distance (CCD) assessment. The mean follow-up was 52 (37–66) months.Results: The alignment of the acromioclavicular joint was normal in all patients. No joint degeneration was observed in any patient. Shoulder movements were painless and complete in all patients. The mean postoperative 3rd, 12th, and 24th month Constant scores were found significantly higher for the Endobutton group than for the modified Bosworth group (p=0.001). The mean postoperative 3rd, 12th, and 24th month DASH scores were significantly lower for the Endobutton Group than for the modified Bosworth group (p=0.003). The mean postoperative 3rd, 12th, and 24th month VAS scores were significantly lower for the Endobutton group than for the modified Bosworth group (p=0.001). However, no statistically significant difference was found between the mean preoperative and postoperative CCD values of the two groups (p=0.104). Discussion and Conclusion: The Endobutton technique is a good alternative to the modified Bosworth technique in the surgical treatment of acromioclavicular dislocations.

Comparison of Clinical and Radiologic Outcomes and Second-Look Arthroscopic Findings After Anterior Cruciate Ligament Reconstruction Using Fixed and Adjustable Loop Cortical Suspension Devices

To compare clinical and radiological outcomes, including tunnel widening, and to evaluate graft status by second-look arthroscopy after anterior cruciate ligament (ACL) reconstruction using 2 different femoral cortical suspension devices (fixed and adjustable loop). Seventy-nine patients were included for this study. The patients were divided into 2 groups, 41 patients of fixed loop group (EndoButton) and 38 patients of adjustable loop group (TightRope). The Tegner activity, Lysholm knee score, Lachman test, and pivot-shift test were compared between the 2 groups. Anterior stress radiographs and femoral tunnel widening on plain radiographs were also compared. Twenty-seven patients (66%) in the EndoButton group and 21 patients (55%) in the TightRope group underwent the second-look arthroscopy. At the final follow-up, the mean Tegner activity, Lysholm, and International Knee Documentation Committee scores were improved in both groups and there were no statistically significant differences (5.1 ± 1.6 and 5.5 ± 2.1, P= .312; 90.4 ± 7.8 and 91.0 ± 6.5, P= .525; and 87.4 ± 6.7 and 88.7 ± 5.3, P= .127, respectively). There were no statistical significances in the both groups in terms of Lachman test and pivot-shift tests (P= .392, .559) as well as anterior stress radiographs (mean 3.2 ± 1.4mm and 2.9 ± 1.1mm, P= .343). Moreover, radiologic measurements comparing femoral tunnel widening at proximal and distal half also showed no significant differences (P= .540 and .412 on anteroposterior view; P= .254 and .437 on lateral view). In the second-look arthroscopy findings for graft tear and synovial coverage, there were no significant differences (P= .784 and .897). Both fixed loop and adjustable loop devices in ACL reconstruction provided good clinical and radiological outcomes. In patients with both devices, femoral tunnel widening at proximal and distal portion have no significant differences after ACL reconstruction. Moreover, second-look arthroscopy revealed no significant differences in terms of synovial coverage and rupture of the graft. Level II, prospective comparative study.

Comparative study on fixed versus adjustable-length loop device for femoral fixation of graft in anterior cruciate ligament reconstruction

Aims and Objectives: Cortical suspension devices have been widely used in ACL reconstruction for femoral side graft fixation. Fixed-length and adjustable-length loop devices are two common suspensory loop devices that are used in ACL reconstruction. They both have their own biomechanical pros and cons. The purpose of this study is to determine the difference in functional outcome of anatomical single bundle ACL reconstruction using fixed length versus adjustable length loop in femoral fixation of quadrupled hamstring graft. Material and methods: It is a longitudinal prospective study conducted in Bone and Joint Centre, Kokilaben Dhirbhai Ambani Hospital (KDAH), Mumbai from Jan 2014 to June 2016. There were 60 patients enrolled in the study. The first 30 patients were treated with Arthroscopic ACL reconstruction in the first 30 patients were done with quadrupled hamstring graft from ipsilateral limb fixed with Endobutton on femoral side and bio-absorbable intrafix tibial screw, similarly in subsequent 30 patients ACL reconstruction were done with quadrupled hamstring graft from ipsilateral limb fixed with Tightrope on femoral side and bio-absorbable intrafix tibial screw. Their clinical and functional status were assessed pre-operatively on the day prior to surgery and the last follow up at one following the surgery with Tegner-Lysholm Score and 2000 IKDC scores. Results: The average Tegner- Lysolm score before surgery in Endobutton group was 56.63±6.7 and post op score at last follow up was 93.97±4.1 and for Tightrope group it was 56.5±7.1 and 94.7±3.7 respectively. The average 2000 IKDC score before surgery in Endobutton group was 46.16±6.1and post-op score at last follow up was 82.52±4.2 and for Tightrope group it was 46.57±6.5 and 83.98±4.1 respectively. Two sample student t-test was conducted to compare the mean of post-operative Tegner-Lysolm score and 2000 IKDC for each group it showed P value for Tegner-Lysolm score to be 0.75 and that for 2000 IKDC score to be 0.7, which not statistically significant to reject the null hypothesis. Discussion and conclusion: Cortical suspension devices for femoral tunnel graft fixation are very efficient devices whether Fixed-length or adjustable length. Fixed-length and adjustable loop cortical suspension devices are equally effective in femoral fixation of graft in ACL reconstruction.

Case control study on the treatment of acromioclavicular dislocation with Endobutton plates combined with an anchor

To compare the clinical effect of Endobutton plates combined with an anchor and clavicle hook plate in the treatment of acromioclavicular dislocation. From January 2012 to August 2014, 83 patients with Rockwood type III acromioclavicular dislocation underwent surgical treatments. Among them, 34 patients were treated with Endobutton plate and anchor repair(Endobutton group), including 23 males and 11 females, and the mean age was(39.0±6.3) years old (26 to 51 years old); the average time from injury to operation was(4.1±1.3) days(3 to 7 days);the injured side:14 left, 20 right; the dislocation in 28 patients dues to fall, 6 patients dues traffic accident. There were 49 patients treated with clavicular hook plate(hook plate group), including 33 males and 16 females;the mean age was(37.9±6.3) years old (27 to 53 years old); the average time from injury to operation was(4.1±1.1) days (2 to 7 days);the injured side: 18 left, 31 right;the dislication in 36 patients dues to fall, 13 patients dues traffic accidents. The indexes such as intraoperative bleeding volume, operation time, incision size, postoperative complication and postoperative coracoclavicular space, shoulder joint function, and life quality were compared between two groups. In the hook plate group with 49 patients, the plates in 43 patients were removed at the secondary operation, and 32 patients had shoulder pain or limited active range. Thirty four patients in the Endobutton group had no pain symptoms and limited active range. All the patients did not suffer acromioclavicular dislocation again. There was no significant difference between the two groups in operation time, and intraoperative bleeding volume(P>0.05). The incision length in the hook plate group was longer than that in Endobutton group(P<0.05). The coracoclavicular space of the uninjured and injured side in two groups respectively had no significant differences, and the coracoclavicular space in the injured side between two group had no significant difference(P>0.05). There were no significant differences of Constant score and SF-36 between two groups 2 months after operation(P>0.05). Sixteen months after operation, the Constant score in the injured side of both groups was higher than that in 2 months postoperative. But the Constant score in the injured side of hook plate group was higher than that in Endobutton group(P<0.05). The Constant score in the uninjured side had no significant differences between two group(P>0.05). In hook plate group, the Constant score in the uninjured side was higher than that in the injured side. In Endobutton group, there were no significant differences of Constant score between two sides. The 16 month postoperative SF-36 in the injured side of both groups was higher than the 2 month postoperative one, but 16 month postoperative SF-36 in hook plate group was lower than that in Endobutton group (P<0.05). Endobutton plate combined with an anchor can effectively fix Rockwood type III or more acute acromioclavicular dislocation. The method has less complications, avoiding secondary removal of internal fixation.

Endobutton and cortical screw fixation for the treatment of distal tibiofibular syndesmosis separated

To analyze the treatment effect of Endobutton plate cable system for the treatment of the distal tibiofibular syndesmosis injury. Total 38 patients with tibiofibular syndesmosis separation treated by surgical operation from October 2011 to October 2013 were analyzed retrospectively. According to internal fixation, 38 cases were divided into two groups involving group A (cortical screw fixation) and group B (Endobutton plate cable system fixation). In group A, there were 26 patients including 16 males and 10 females with an average age of (37.90±4.67) years old ranging from 19 to 63 years old; 14 cases were on the left and 12 on the right;involving 8 cases of Weber-Denis type B, 18 cases of Weber-Denis type C; according to Lauge-Hanson typing, 9 cases of supination external rotation (SER), 10 cases of pronation abduction (PAB), 7 cases of pronation external rotation (PER). In group B, there were 12 cases including 7 males and 5 females, with an average age of (38.70±6.03) years old ranging from 20 to 55 years old;6 cases were on the left and 6 cases on the right;involving 4 cases of Weber-Denis type B and 8 cases of Weber-Denis; involving 7 cases of PER, 3 cases of SER, 2 cases of PAB. The operative time, intraoperative blood loss, surgery cost, hospital stay time, the wound healing, pain score at 1 month after operation, and the load time were recorded and evaluated. According to reviewing of X rays regulary, the healing of fracture were assessed, the function outcomes of ankle was evaluated according to the Ankle Hind Foot Scale of American Orthopaedic Foot and Ankle Society. All patients were followed up for 8 to 18 months with an average of 13.5 months. There were no statistical significance in intraoperative blood loss, hospital stay time, average load time and postoperative pain score at 1 month after operation between two groups (P>0.05). Duration of operation, the operative time were significantly shorter in cortical screw group;however, the average cost of hospitalization was significantly higher in Endobutton group. No significant differences were found between two groups in outcome of radiographic measurement. The X rays of 36 patients showed well healing of fracture, normal mortise and no distal tibiofibular syndesmosis separation. AOFAS score at the final follow up in group A was (87.50±8.67) scores, 18 cases got excellent result, 4 cases were good, and 4 cases were fair. AOFAS score at the final follow up in group B was (86.23±7.42) scores, 7 cases obtained excellent result, 4 cases were good and 1 case was fair; AOFAS score between two groups were no significant difference (P>0.05). Endobutton plate cable system is a dynamic capital equipment in treating the tibiofibular syndesmosis separation, it has a similar outcome compared with the screw, but without screw fractured and do not regular remove after operation. The patients could take the functional exercises earlier.

Clinical outcomes of endobutton versus traditional screw fixation for distal tibiofibular syndesmosis in ankle fractures

Objective To compare the clinical outcomes for endobutton versus traditional screw fixation of distal tibiofibular syndesmosis in ankle fractures. Methods Sixty-nine cases of ankle fractures accompanied with distal tibiofibular syndesmosis injury hospitalized between November 2012 and November 2014 were reviewed retrospectively. Thirty-two cases (19 males and 13 females) aged (38.1±15.3) years (range, 22-62 years) underwent syndesmosis stabilization with endobutton system (endobutton group), and mechanism of injury was sprain injury in 20 cases, traffic injury in 7 and high fall injury in 5. Another 37 cases (20 males and 17 females) aged(33.9±11.1)years (range, 22-65 years) were managed with traditional screw fixation (tradition group), and mechanism of injury was sprain injury in 22 cases, traffic injury in 8 and high fall injury in 7. According to the Lauge-Hansen classification, all had pronation external rotation ankle fractures. Operation time, manipulation angle, tibiofibular clear space (TBCS), tibiofibular overlap distance (TBOL), complications and final follow-up evaluation of American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were recorded. Results Comparison of endobutton group to tradition group showed no significant differences in operation time [10 min(5-17 min) ∶9 min(4-15 min)], TBOL [(9.1±1.8)mm ∶(8.2±2.3)mm], TBCS [(3.7±0.6)mm ∶(3.6±0.9)mm], total complication rate [6.3% ∶13.5%] and AOFAS score [(89.1±18.5)points ∶(86.6±12.4) points] (P>0.05), but endobutton technique was associated with a larger manipulation angle [(45.8±16.7)° ∶(28.5±5.6)°] and earlier full weight bearing [(6.8±1.6)weeks ∶(10.9±2.7)weeks] than traditional screw fixation (P<0.05). Conclusion Endobutton technique has comparative effect with traditional screw fixation and has advantages such as low demand in fixation angle, early weight bearing and no need for removal of implant. Key words: Ankle injuries; Fracture fixation, internal; Distal tibiofibular syndesmosis

Clinical Outcomes of Three Different Modes of Femoral Hamstring Graft Fixation in Anterior Cruciate Ligament Reconstruction

Abstract Introduction. There are various methods of anterior cruciate ligament (ACL) reconstruction of which the two main choices in autograft reconstruction involve the use of the bone-patella tendon-bone or hamstring graft. Femoral fixation can be divided into three main types: cortical suspensory devices such as Endobutton (Smith &amp; Nephew, Arthrex), interference screws, and femoral transfixation devices such as Transfix (Arthrex) and Rigidfix (Depuy-Mitek). The aim of this study was to compare the clinical outcome between Rigidfix, Transfix and Endobutton devices for soft tissue femoral fixation in primary ACL reconstruction using the autogenous hamstring graft. Methods. We conducted our study in 48 patients admitted to our clinic, University Traumatology Clinic, Clinical Center "Mother Teresa", Skopje for ACL reconstruction from September 2009 to May 2013. The patients with ACL reconstruction were assigned as Rigidfix group (n=28), the second patients to Transfix group (n=13) and the third to Endobutton group (n=7). MRI of the knee joint was done prior to surgery. A data sheet, containing demographic data, examination findings and Tegner &amp; Lysholm score, was completed for each patient. Results. Tegner &amp; Lysholm the average scores before surgery were 2.52 and 34.75 (p&gt;0.05). Six month after arthroscopy, the average value of Tegner and Lysholm scores in patients with ACL reconstruction was 8.37 and 89.08. Comparison among them showed that the operative mode of Endobutton femoral fixation had the highest level of the Lysholm score. Conclusions. Endobutton (Tight rope-RT) yielded a better outcome compared to the other two modes of femoral fixation in terms of instant stability of the graft and the general results.

Mechanical properties of suspensory fixation devices for anterior cruciate ligament reconstruction: Comparison of the fixed-length loop device versus the adjustable-length loop device

BackgroundNo definite consensus has been reached regarding the optimal technique for graft fixation to the femur in an anterior cruciate ligament reconstruction. The purpose of this study was to evaluate the mechanical strength of two cortical suspension devices which were the TightRope (TR), a new adjustable-length loop device, and the EndoButton (EB), a well-established fixed-length loop device. MethodsThe devices were tested under cyclic and pull-to-failure loading conditions in both an isolated device setup and a specimen setup using porcine femora and bovine flexor tendons. In particular, we examined the influence of tendon and device lengths, whereby the total length of the bone tunnel was fixed to 35mm and an effective length of tendon in the bone tunnel was adjusted. ResultsIn the isolated device testing, the EB showed significantly higher ultimate tensile strength than the TR. The displacement after preloading for the EB was statistically lower than that for the TR, and retained a significant difference after the cyclic load. In contrast, specimen testing showed no statistical difference in the displacement among the EB group and TR groups. ConclusionThis study indicated that the EB provides greater mechanical strength than the TR. An important new finding was the measurement of initial displacement from the initiation of fixation until loading began using 50N of tension. In isolated device testing, the TR induced significantly more displacement than the EB during preloading, which could reflect the TR loop's stretching capacity until a certain amount of tension is applied.