Interference Screw Research Articles

Mechanical Evaluation of Bone-Patellar Tendon-Bone Graft Fixation to the Tibia in ACL Reconstruction: Bone Plug Tensioning and Fixation System versus Interference Screw.

This study aimed to evaluate the mechanical properties of bone plug fixation to the tibia with a novel device, the Bone plug Tensioning and Fixation (BTF) system.Forty bone-tendon-bone grafts consisting of the whole patella-patellar tendon-tibial bone plug of 10-mm width and tibiae from the porcine were prepared. After creating a 10-mm tibial tunnel, the tibial bone plug was fixed to the tibia with the BTF system or the interference screw (IFS) to prepare a test specimen of the patella-patellar tendon-tibial bone plug fixed to the tibia. For the graft tension controllability study, a predetermined initial tension of 9.8 or 19.6 N was applied and maintained for 5 minutes. Then the bone plug was fixed to the tibia with the BTF system or IFS in 10 specimens, monitoring the residual tension for an additional 5 minutes. Then, a cyclic loading test and a tension-to-failure test were performed.The mean difference between the residual tension and the predetermined tension was significantly smaller in BTF fixation (9.8 N → 10.6 ± 2.2 N; 19.6 N → 18.9 ± 2.1 N) than in IFS fixation (9.8 N → 23.4 ± 7.4 N; 19.6 N → 28.9 ± 11.5 N). The mean displacement of the bone plug after cyclic loading was significantly less in the BTF group (1.2 ± 0.6 mm) than in the IFS group (2.2 ± 1.0 mm; p < 0.01). Stiffness was significantly greater in the BTF group (504.6 ± 148.8 N/mm) than in the IFS group (294.7 ± 96.7 N/mm; p < 0.01), whereas the maximum failure loads in the two groups did not differ significantly (724.2 ± 180.3 N in the BTF and 634.8 ± 159.4 N in the IFS groups).BTF system better performed in graft tension controllability than IFS did. BTF fixation was superior to IFS fixation in the displacement of the bone plug during the cyclic loading test and in stiffness in the tension-to-failure test.

All-Suture Anchor Techniques for Biceps Tenodesis Are Noninferior in End-Cycle Stiffness to an Interference Screw Technique; However, Secondary Outcomes, Such as Ultimate Failure Load, Yield Load, Creep, and Load-to-Failure Stiffness, Are Inferior in an Ovine Model

PurposeThe purpose of this study was to assess the biomechanical performance of two simplified loop and tack biceps tenodesis techniques, all-suture anchor and all-suture anchor with a button, compared to the interference screw technique in an ovine model. MethodsTwenty-one biceps tenodesis procedures were executed on the humeri and flexor digitorum profundus tendons of skeletally mature, female sheep. Limbs were evenly randomized into two experimental groups (all-suture anchor with/without button) and one control group (interference screw). Cyclic loading followed by a load-to-failure test was conducted.The primary outcome metric was end-cycle stiffness, or stiffness measured at the end of cyclic loading, as it modeled the resistance of the construct to the lower-force activities of postoperative physical therapy. Secondary metrics included ultimate failure load (UFL), yield load, creep, and load-to-failure stiffness. End-cycle stiffness difference-of-means testing was conducted with a minimal clinically significant difference (MCID) threshold of -15N/mm (1.5kg/mm). Groups were compared using ANOVA for all recorded variables. ResultsBoth the all-suture anchor and all-suture anchor with button techniques were found to be noninferior in end-cycle stiffness compared to the interference screw technique (-5.2N/mm, 95% CI [-13.6, 3.3] and –3.8N/mm, 95% CI [-12.5, -4.9]) for -15N/mm MCID. The all-suture techniques showed significantly lower UFL, lower yield load, greater creep, and lower load-to-failure stiffness (P<0.001, P<0.001, P=0.002, P<0.001, respectively). Tendon dimensions did not vary significantly across groups. ConclusionsUnder subfailure loading conditions, the all-suture anchor with/without button techniques demonstrated end-cycle stiffness noninferiority with an interference screw technique, however, these techniques were inferior in all secondary outcomes, including significantly lower UFL, lower yield load, greater creep, and lower load-to-failure stiffness. Clinical RelevanceThe all-suture anchor with/without button approaches may retain the natural length-tension dynamics of the long head biceps tendon as fixation can occur before releasing the tendon origin. Additionally, it may offer a simpler and more cost-effective alternative to prevailing arthroscopic methods.

Loop technique for anterior cruciate ligament reconstruction combined with anterolateral structure reinforcement: technical description and clinical results

PurposeWe describe a surgical technique for ACL reconstruction combined with anterolateral structure reinforcement and report early clinical follow-up results.MethodsThe semitendinosus and gracilis tendons are braided into 5 strands and the ACL femoral tunnel and tibial tunnel are created. The graft is passed through the tunnel with the use of a traction suture and the tibial end is fixed with absorbable interference screws at 30° of knee flexion. The ACL graft traction suture is used as an anterolateral reconstruction structure to pass through the proximal exit of the ACL femoral tunnel and then through the depth of the iliotibial bundle to the anterior to Gerdy’s tubercle, a bony tunnel is created from the anterior to Gerdy’s tubercle to the goose foot, and the traction suture is passed through this bony tunnel to form a Loop structure at 20° of knee flexion. Between March 2021 and May 2022 IKDC score, Lysholm score, and Tegner score were performed preoperatively and 6–12 months postoperatively in 24 consecutive patients who met the indications for this procedure and underwent surgery. The patient’s maximum flexion angle, the circumference of the thigh, and the stress X-ray between the operated and healthy knee were measured.ResultsPatients showed significant improvement in IKDC score, Lysholm score and Tegner score at a mean follow-up of 7 months postoperatively compared to preoperatively. No significant increase in anterior tibial displacement was found between the patient’s operated side and the healthy side.ConclusionThe Loop technique ACLR combined with ALSA can be used in patients with an ACL tear combined with a high degree of positive pivot shift. The patient’s subjective perception was significantly improved from the preoperative period and knee stability was restored.Level of evidenceIV, therapeutic study.

Comparison of the Functional Outcomes of Arthroscopic Anterior Cruciate Ligament Reconstruction through the All-inside and Outside-in Techniques: A Double-Blinded Randomized Controlled Trial.

Objective To compare the functional outcomes of anterior cruciate ligament (ACL) reconstruction with hamstring autograft (HA) through the all-inside (AI) technique with adjustable-loop cortical Endobutton (Smith & Nephew, Watford, Hertfordshire, England) on the sides of the femur and tibia and through the outside-in (OI) technique using an interference screw on the tibial side and a cortical Endobutton on the femoral side. Materials and Methods The present is a double-blinded randomized controlled trial (RCT) of 44 patients undergoing arthroscopic ACL reconstruction from February 2019 to February 2022 in a tertiary care hospital. As per computer-based randomization, the patients were distributed into two groups: the AI and OI groups. Both groups were evaluated for 12 months using the Visual Analog Scale (VAS), the Lysholm Knee Scoring Scale, and part I (pain score) and part II (function score) of the Knee Society Score (KSS). Results On postoperative day 2, the VAS score was significantly higher in the OI group ( p = 0.0001), but insignificant ( p = 0.807) at 6 weeks. At 3, 6, and 12 months of follow-up, the score on the Lysholm Knee Scoring Scale was significantly higher ( p = 0.001) in the AI group. At 6 months, both parts of the KSS showed a significant difference, with the AI group presenting a better outcome ( p = 0.04). However, at 12 months, the AI group presented a better score on part I of the KSS, but no differences were observed regarding part II. Conclusion In a follow-up of 12 months, the patients submitted to the AI technique presented better outcome scores and pain relief than those submitted to the OI technique.

Process Parameter Optimization of Material Extrusion-Based Additive Manufacturing of 3D Printed-Biocomposite Interference Screw for Anterior Cruciate Ligament Reconstruction

Process Parameter Optimization of Material Extrusion-Based Additive Manufacturing of 3D Printed-Biocomposite Interference Screw for Anterior Cruciate Ligament Reconstruction

Arthroereisis with interference screw in flexible flatfoot, a comparison with the conventional surgical technique

Objective: To evaluate functional results of subtalar arthroereisis with non-conventional implants, as well as their clinical, radiographic, and functional results, comparing them with those of the conventional technique. Methods: Documentary research consisting of the analysis and review of medical records of six patients, with application of the Orthopaedic Foot and Ankle Score (AOFAS) and Short Form Health Survey 36 (SF-36) questionnaires and evaluation of pre-and postoperative radiographic results. Results: Patients achieved satisfactory clinical and functional results, indicated by an improvement in the pitch, kite, Giannestras, and Meary angles analyzed and by comparing the pre-and postoperative periods. There was also an improvement in the AOFAS and SF-36 questionnaire scores postoperatively, suggesting an evolution in the quality of life of patients studied. Conclusion: Subtalar arthroereisis is a non-invasive surgical procedure that contributes to the clinical improvement of patients. The use of interference screw showed good results, with the advantage of it being a low-cost implant when compared to the conventional ones, which makes the procedure more accessible. Level of Evidence III; Therapeutic Studies; Case control study.

Clinical outcomes of primary anterior cruciate ligament reconstruction using six-strand hamstring autograft

Objectives: Quadrupled and five-strand hamstring tendon (HT) autografts are commonly used in anterior cruciate ligament reconstruction (ACLR), but there is significant variability in graft diameter. The six-strand HT autograft has been introduced to increase graft diameter in patients with undersized HT grafts and may achieve better clinical outcomes. None of the studies has reported clinical outcomes following this technique in Indian patients. We investigated clinical outcomes in patients who underwent primary ACLR using a six-strand HT autograft technique with a minimum six-month follow-up. Materials and Methods: Fifty-five patients who underwent primary ACLR using six-strand HT autografts with interference screw fixation were included in the study. These patients were followed up at three and six months for the evaluation of clinical outcomes. Subjective evaluations included the TegnerLysholm score, anterior cruciate ligament-quality-of-life (ACL-QOL) score, and International Knee Documentation Committee (IKDC) subjective score. Laxity assessments of the knees were performed using the Lachman test and the pivot-shift test. Functional evaluation of the patients was performed with an overall IKDC objective score. Results: The mean IKDC subjective score was significantly improved at three-month (63.42 ± 5.38) and six-month (82.82 ± 7.49) follow-up after surgery (P &lt; 0.05) when compared with pre-operative scores (50.55 ± 1.84). A similar finding was also noted with the Tegner-Lysholm score and ACL-QOL score in our study. All patients have achieved normal to near-normal functional outcomes at six months in our study without any major complications. The most commonly found complication was paresthesia (21.80%) in the present study. Conclusion: In the primary ACLR, six-strand hamstring autograft achieves similar clinical outcomes and complications as reported with four-strand or five-strand HT autografts. However, the percentages of patients who achieved normal to near-normal outcomes were higher in the present study (100%) as compared to earlier reported data using four-strand or five-strand HT autografts (~85%). The six-strand graft technique is a useful means of increasing graft diameter when faced with an undersized hamstring graft.

Biomechanical comparisons of all--suture suspensory button vs. interference screw for inlay subpectoral bicep tenodesis

All-suture buttons (ASBs) and interference screw (IS) are commonly utilized in the inlay subpectoral biceps tendon tenodesis. However, the biomechanical characteristics of these two methods have not been compared directly. The aim of present study was to compare the biomechanical properties of ASB vs. IS for inlay subpectoral biceps tendon tenodesis in a human cadaveric model. Sixteen fresh-frozen human cadaveric shoulders were randomly divided into two experimental inlay biceps tenodesis groups: ASB or IS. After tenodesis, every specimen was preloaded at 5N for 2minutes, followed with a cyclic loading test from 5 to 70N for 500 load cycles. Then the load-to-failure test was performed. Afterward, the humerus was placed in a cylinder tube and secured with anchoring cement. Lastly, a two-point bending test was performed to determine the strength of the humerus. Destructive axial force was applied, and the failure strength and displacement were recorded. No difference in stiffness was observed between the two groups (ASB=27.4±3.5N/mm vs. IS=29.7±3.0N/mm; P=.270). Cyclic displacement was significantly greater in the ASB group (6.8±2.6mm) than the IS group (3.8±1.1mm; P=.021). In terms of failure load, there were no statistical differences among the two groups (P=.234). The ASB group was able to withstand significantly greater displacement (11.9±1.6mm) before failure than the IS group (7.8±1.5mm; P=.001). During the humeral bending test, the ASB group exhibited significantly greater maximal load (2354.8±285.1N vs. 2086.4±296.1N; P=.046) and larger displacement (17.8±2.8mm vs. 14.1±2.8mm; P=.027) before fracture. In inlay subpectoral bicep tenodesis, ASB fixation appears to offer comparable stiffness and failure load to that of IS fixation. Additionally, the ASB group exhibited greater resistance to load and displacement before humeral fracture. However, the ASB group did demonstrate increased cyclic displacement compared to IS group.

Arthroscopic Biceps Tenodesis With Interference Screw Fixation: A Technique Video

Background: Management of long head of the biceps tendon (LHBT) pathology is accomplished through a biceps tenotomy or tenodesis. While both modalities provide beneficial outcomes, a biceps tenodesis may confer improved cosmesis, functional outcomes, and decreased muscle cramping postoperatively. Many procedural considerations are undertaken prior to a tenodesis, such as the surgical approach and fixation device. While similar clinical outcomes are achieved between an open subpectoral and arthroscopic suprapectoral biceps tenodesis (ASPBT) with interference screw (IS) fixation, the latter technique offers a minimally invasive modality. Indications: The primary indications for an ASPBT include superior labrum anterior posterior (SLAP) tears, LHBT tears, biceps instability, bicipital tunnel disease, biceps pulley lesions, and biceps tenosynovitis. Contraindications to the arthroscopic approach include a distal lesion of the biceps tendon below the pectoralis major tendon (PMT). The IS may be used to create a biomechanically stiffer construct. Technique Description: With the arthroscope in the lateral portal, the distal aspect of the bicipital groove proximal to the superior border of the PMT is identified and opened. The LHBT is subsequently mobilized and released. An anterosuperolateral portal is localized with a spinal needle positioned perpendicular to the bicipital tunnel, 1.5 cm proximal to the superior border of the PMT. The biceps is then removed ex vivo and whip-stitches are sewn beginning 1 cm proximal to the myotendinous junction of the LHBT. After firmly associating the LHBT with the tip of the IS, a guidewire is placed 1.5 cm superior to the superior border of the PMT, perpendicular to the humerus, and a reamer is used to prepare a 6-, 7-, or 8-mm diameter socket. The tendon is inserted through the accessory portal into the tunnel, followed by screw fixation. Suture tails are tied with 5 alternating half hitches, each secured via an arthroscopic knot pusher. Results: ASPBT with IS fixation provides significant pain relief, improves range of motion (ROM), and enhances quality of life. Discussion: ASPBT with IS fixation provides significant improvements in patient-reported and functional outcomes and thus can be an acceptable treatment for LHBT pathology. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

The Periosteum–Patellar Tendon–Bone Autograft for Anatomic, Single-Bundle Anterior Cruciate Ligament Reconstruction With Press-Fit Tibial Fixation

Optimal graft choice and fixation technique are still ongoing topics of debate for primary and revision anterior cruciate ligament reconstruction. Interference screws are frequently used as graft fixation devices but can sometimes lead to tunnel widening, cyst formation, chronic inflammation, screw breakage, and persistent pain. Tibial tunnel widening is of special concern because it is often associated with graft failure. This technical note introduces a graft technique with a periosteum–patellar tendon–bone autograft and a press-fit tibial fixation approach that could be a viable option for secure anterior cruciate ligament reconstruction while offering the possibility of a quicker postoperative recovery, less pain, and a quicker return to everyday activities.

ACL Reconstruction with Peroneus Longus Autograft Using Endobutton &amp; Bioabsorbable Interference Screw and Brace Free Rehabilitation

Objective: To assess the functional outcome of arthroscopic anterior cruciate ligament (ACL) reconstruction with Peroneus longus tendon autografts using endobutton and interference screw at one-year follow-up post- operatively and brace-free rehabilitation. Material and Methods: A prospective study included 53 patients with clinical and radiological ACL deficiency. Arthroscopic ACL reconstruction was performed using Peroneus Longus double bundle autografts with sub- sequent brace-free rehabilitation. Pre- and postoperative assessment at one-year follow-up utilized the International Knee Documentation Committee (IKDC) score. Graft length and diameter were measured perioperatively, and donor site morbidity was evaluated using The American Orthopedic Foot and Ankle Score (AOFAS). Results: The study included 51 (94.4%) males and 2 (3.7%) females, mean age 27.3±7.2 years. Majority were left-sided procedures (64.8%). Peroneus Longus graft mean length and diameter were 116.8±5.3mm and 8.2±0.2mm respectively. At one-year follow-up, ankle joint movement at the graft site was preserved (mean AOFAS 98±0.8). There was a significant improvement in IKDC score postoperatively (p &lt; 0.05). Conclusions: ACL reconstruction with Peroneus longus autograft offers knee stability and facilitates early rehabilitation. Utilizing endobutton and bioabsorbable interference screw fixation supports graft strength until sufficient graft-to-bone healing occurs. Patients regain pre-injury activity levels, including stair climbing, sitting cross-legged, and squatting without difficulty.

The Effect of Supplementary Staple Fixation on Biomechanical Properties of Soft Tissue Graft Tibial Fixation in Anterior Cruciate Ligament Reconstruction.

This study aimed to test and compare the biomechanical properties of three tibial fixation methods of anterior cruciate ligament (ACL) tendon grafts under cyclic load and load-to-failure testing in the bovine proximal tibiae, comprising (1) staple fixation alone, (2) interference screw fixation alone, and (3) interference screw fixation with a supplementary staple. Twenty-four bovine tibiae used in the study were divided into three groups (eight proximal tibiae in each group) based on tibial fixation methods of ACL tendon grafts: group A (a spiked ligament staple alone), group B (a cannulated interference screw alone), and group C (a cannulated interference screw with a supplementary staple). Each graft fixation was exposed to cyclic loading conditions. Significant differences were determined in failure load among the three groups (p = 0.008). The mean failure load was significantly higher in group B (717.04 ± 218.51 N) than in group A (308.03 ± 17.22 N) (p = 0.006). No significant differences were observed among the groups regarding axial stiffness (p = 0.442). Cyclic displacement differed significantly among the three groups (p = 0.005). In pairwise comparisons, the mean cyclic displacement was significantly higher in group A (8.22 ± 3.24 mm) compared with group C (1.49 ± 0.41 mm) (p = 0.005). Failure displacement varied considerably among the groups (p = 0.037). Although group B (15.53 ± 6.43 mm) exhibited a greater mean failure displacement than both group A (4.9 ± 0.75 mm) and group C (8.84 ± 4.65 mm), these differences did not reach statistical significance (p = 0.602 and p = 0.329, respectively). Interference screw fixation alone and supplementary staple fixation have biomechanically similar characteristics in terms of initial strength and stiffness of tibial ACL soft tissue graft fixation. Regardless of staple use, an interference screw with the same diameter as the tibial tunnel can ensure sufficient tensile strength in tibial ACL graft fixation.

Clinical Outcomes in Patients Undergoing Anterior Cruciate Ligament Reconstruction With Controlled Accelerated Rehabilitation.

Background An anterior cruciate ligament (ACL) tear is one of the most common sports injuries in the knee region. Currently, anatomical ACL reconstruction with quadrupled hamstring tendon autograft and controlled accelerated rehabilitation is a frequently used treatment approach. This study aims to add to the literature the early and mid-term clinical results of the controlled accelerated rehabilitation program we implemented in our clinic to enable patients to return to their daily activities faster after ACL reconstruction. Methodology In this retrospective study, 51 patients (50 males, 1 female) diagnosed with ACL tear and undergoing ACL reconstruction with quadrupled hamstring tendon graft were included in our study.In the femoral fixation of the graft, the transfix method was used in 22 patients and the Endobutton-CL method was used in 29 patients. A controlled accelerated rehabilitation program developed by Shelbourne was employed with some modifications to the patients. Clinical evaluation of patients was performed using Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee (IKDC) scoring systems. Results The mean postoperative follow-up period was 18.7 months (range = 6-36 months). During the physical examination, Lachman, anterior drawer, and pivot shift, 49 (96%) patients achieved excellent or good results, while only two (5%) patients experienced fair clinical outcomes. On clinical assessment using the Lysholm and IKDC scoring systems, 50 (98%) patients demonstrated excellent or good results, whereas only one (2%) patient showed fair results. Excellent and good outcomes were observed in all patients using the Cincinnati scoring system. We found a significant decrease in Tegner activity score pre-surgery, which significantly increased post-surgery. Conclusions The combination of Endobutton and cross-pin for femoral fixation and staples and interference screw for tibial fixation is thought to be safe in patients undergoing controlled accelerated rehabilitation after ACL reconstruction. The implementation of controlled accelerated rehabilitation enables patients to return to their social lives earlier without resulting in clinically poor outcomes in grafts and implants applied in the early and middle stages.

Biomechanical and Biological Properties of Stereolithography-Based 3D-Printed Zirconia Interference Screws for Anterior Cruciate Ligament Reconstruction

For effective anterior cruciate ligament (ACL) reconstruction, an interference screw (IFS) is employed to force transplantation of the ligament into the bone tunnel. In this study, IFSs were successfully designed and prepared, and the top tooth width, thread depth, and drive structure were parameterized with a forming accuracy of 80.0 ± 21.1 µm using SLA–3D printing technology. To improve the initial stability of ACL reconstruction, a biomechanical model was established, and the results were optimized through insertion torque and tensile testing. Consequently, the IFS with the top tooth width of 0.4 mm, thread depth of 0.8 mm, and hexagon drive, matching with the Φ8 mm bone tunnel, exhibits the best mechanical properties (maximum insertion torque of 1.064 ± 0.117 N m, ultimate load of 446.126 ± 37.632 N, stiffness of 66.33 ± 27.48 N/mm). Additionally, the ZrO2/PDA/RGD/Zn2+ bioactive coating was found to significantly improve the surface bioactivity of zirconia IFS. In conclusion, this study has significant implications for ACL reconstruction.

Bilateral simultaneous distal biceps tendon rupture repair with both cortical button and interference screw

Bilateral simultaneous distal biceps tendon rupture repair with both cortical button and interference screw

Flexor hallucis longus tendon transfer for Tendo Achillis reconstruction

Background: Tendo Achilles injuries are common in orthopaedic practice. Degenerative, Chronic and failed repaires requires some form of soft tissue sleeve augmentation like Flexor Hallucis longs (FHL), Peroneus Brevis (PB), Plantaris etc.. are used along with proximal Tendo Achilles advancement procedures lie V-Y plasty, musculo tendinous Recession or Turn Down Procedures. These advancement procedure leads to weakening of already compromised Tendon. So, wanted to evaluate functional outcome of FHL tendon Trans Tendinous Transfer without any Advancement procedures. Methods: 20 patients satisfying inclusion criteria underwent FHL Trans tendinous Transfer to Tendo Achilles which is secured with Interference screw into the prepared bone bed of calcaneum. Initially anterior slab in planter flexion was applied later converted to cast in neutral position which is removed at the end of 6 weeks and joint mobilization started. Results: Out of 20 patients,11 were male patients and 9 were females. Average age ranged from 22 to 65 years. 9 were chronic Tears,9 were Degenerative Tears and 2 were failed Repairs. Wound healing complications were seen in 4 cases, 1 with chronic tear, 1 with Degenerative Tear and Both Filed repairs, all of them healed eventually. ALL patients were assessed for AOFAS at 6th and 12thmonth. The mean AOFAS of each subgroup improved significantly from months 3 to 12 (Table). At the one-year follow-up, all patients achieved good functional outcome in terms of the AOFAS scoring system. Conclusions: Tendo Achilles is the common tendon injured in ankle region due to repetitive stress and degeneration. Degenerative, Chronic and failed repair injuries of Tendo Achilles requires some form of soft tissue augmentation for healing. Trans-Tendinous FHL tendon transfer for Tendo Achilles Reconstruction shows good results with minimal complications in these scenarios in non-Athletic Population.

No clinical difference in outcomes between inlay and onlay arthroscopic biceps tenodesis techniques during rotator cuff repair

BackgroundBoth inlay and onlay arthroscopic biceps tenodesis (ABT) are common procedures performed during rotator cuff repair. The inlay method involves creating a bone socket in the bicipital groove to secure the long head of the biceps tendon (LHBT) using an interference screw. The onlay method utilizes a suture anchor to secure the LHBT on the surface of the bicipital groove. Little is known on the long-term differences in patient reported outcomes (PROs) between these two techniques. The primary purpose of this study was to compare PROs of inlay versus onlay ABT with a minimum follow-up of two years. Secondary aims were to evaluate the impact of rotator cuff tear size on outcomes and compare rates of complications between the two techniques. MethodsA retrospective chart review was performed to identify patients who had an ABT during a full-thickness rotator cuff repair. Any symptom specific to the biceps were noted, including pain and cramping, Popeye deformity, or revision surgery. Complication rates were compared between groups. The VAS pain score, ASES, SANE, and VR-12 scores were compared at two years. The impact of rotator cuff tear size was analyzed by categorizing into small/medium or large/massive based on operative reports and arthroscopic images. ResultsThere were 165 patients identified (106 in the inlay group and 59 in the onlay group). No revision surgeries were performed secondary to the biceps tendon in either group. Eleven patients (10%) in the inlay group complained of biceps pain or cramping compared to 2 patients (3%) in the onlay group (p = .11). One Popeye deformity was noted in each group (p = .67). No significant differences were found between groups for VAS (p=.41), ASES functional (p = .61), ASES Index (p = .91), SANE (p = .09), VR-12 PCS (p = .77), or VR-12 MCS (p = .09). Rotator cuff tear size within the groups also did not demonstrate statistical significance. ConclusionNo clinical differences or complications were found at minimum two-year follow-up between inlay and onlay arthroscopic biceps tenodesis in patients undergoing rotator cuff repair when controlling for tear size. The clinical relevance suggests either technique is effective and can be based on surgeon preference.

Comparison of the Clinical Outcomes between All-inside and Standard Technique in Anterior Cruciate Ligament Reconstruction with 6-strand Hamstring Tendon Autograft.

All-inside and standard techniques with 4-strand hamstrings graft have been widely used in anterior cruciate ligament (ACL) reconstruction. However, the graft diameter of less than 8 mm will significantly increase the rate of surgical failure, and the 6-strand graft can solve this problem. The purpose of this study is to compare all-inside ACL reconstruction using suspensory cortical button fixation on both tibia and femur with standard ACL reconstruction using suspensory femoral fixation and a bioabsorbable tibial interference screw with a 6-strand hamstring tendon autograft in postoperative clinical outcomes. From January 2020 to December 2020, 48 patients performed ACL reconstruction were divided into the all-side group and the standard group according to the different surgical techniques. Magnetic resonance imaging (MRI) and subjective function scores was used to assess clinical outcomes at least 24 months following ACL reconstruction. MRI was used to measure the value of bone tunnel widening in articular and middle portions. Subjective function scores included the Lysholm knee score, the International Knee Documentation Committee (IKDC) score, the Knee Society Score (KSS) for pain and function, and KT-1000. The t-test was used assuming the distribution of the patients which follows the normal distribution and we used non-parametric tests if these two conditions were not satisfied. At the final follow-up, there were 22 patients in the all-inside group and 24 patients in the standard group. No significant differences were found with respect to femoral tunnel widening and subjective function scores. However, a significant increase in tibial tunnel widening was found in the middle portion of the standard group (2.25 ± 0.74) compared to the all-inside group (0.76 ± 0.24) (p < 0.01) and also in the articular portion of the standard group (2.07 ± 0.77) compared to the all-inside group (1.52 ± 0.54) (p = 0.02). In addition, the value of the KT-1000 was 1.81 ± 0.45 for the all-inside group and 2.12 ± 0.44 in the standard group (p = 0.016). The objective stability of the knee was relatively better in the all-inside group than in the standard group. And tunnel widening after ACL reconstruction was significantly greater in the standard technique when compared to the all-inside technique on the tibia side.

No Difference in Bone Tunnel Enlargement and Clinical Outcome between Cortical Suspension and Hybrid Femoral Fixation in Hamstring Anterior Cruciate Ligament Reconstruction.

The best method for femoral fixation in anterior cruciate ligament reconstruction (ACLR) remains controversial. The study assesses the bone tunnel enlargement and clinical outcome in hamstring ACLR using cortical suspension or hybrid (cortical suspension and compression) femoral fixation. From January 2010 to December 2021, 102 patients who underwent quadruple hamstring ACLR using cortical suspension (39 patients) or hybrid (63 patients) fixation on the femoral side were retrospectively analyzed. Clinical evaluation was conducted using the international knee documentation committee score, the Lysholm score, the Tegner activity level scale, the knee injury and osteoarthritis outcome score (quality of life score), the Lachman test, and the side-to-side difference by the KT-1000 arthrometer. The complications after the surgery were also evaluated. These data were compared at baseline and last follow-up. The diameters of the femoral tunnel were calculated at three sites: the width of the entrance of the femoral tunnel, 1 cm proximal to the entrance of the femoral tunnel and the largest diameter of the femoral tunnel on magnetic resonance imaging (MRI) coronal images. Bone tunnel widening data were contrasted between MRI images conducted at least 2 years and within 2 weeks after surgery. The morphology of bone tunnel enlargement was also observed and recorded. The categorical parameters were analyzed using the χ2-test and Fisher's exact test. The continuous variables conforming to a normal distribution were analyzed using Student's t-test, and the Mann-Whitney U-test was undertaken between the two groups without normal distribution. Both cortical suspension and hybrid femoral fixation in quadruple hamstring ACLR achieved significantly improved patient-reported outcome scores and knee stability compared to preoperative data. However, no significant differences were found between these two methods in clinical evaluations, postoperative complications, and patient-reported outcome scores. Although the mean diameter of the enlarged bone tunnel was lowered by an additional bioabsorbable interference screw fixation near the joint line, a statistically insignificant difference was found between the hybrid and cortical suspension fixation on the femoral side. There was no statistical difference in the distribution of enlarged bone tunnel morphology between groups. No significant difference was found in the bone tunnel enlargement and clinical outcome between cortical suspension and hybrid femoral fixation in ACLR using hamstring autograft.

All-Inside ACL Reconstruction: Short Femoral and Tibial Socket Technique

Background: Recently, there has been an increase in interest in all-inside anterior cruciate ligament (ACL) reconstruction (ACLR). Regarding graft maturity, graft contact with the bone tunnel is important. All-inside ACLR with short femoral and tibial sockets might allow to increase the contact between the graft and the socket (ie, no interference screw and contact between the graft and bottom of the socket) and can improve graft maturing. Indications: All-inside ACLR with short sockets technique is indicated in patients with primary ACL rupture or ACL graft re-rupture. Technique Description: The patient was placed in supine position. Following examination under anesthesia, diagnostic arthroscopy was performed to assess for meniscus injuries and chondral defects. The surgical technique required 6 steps: (1) graft preparation (4-strand semitendinosus tendon, graft length was about 45 mm, grafts larger than 8 mm), (2) creating femoral socket (5-10 mm), (3) creating tibial tunnel socket (10-15 mm), (4) passing the graft, (5) tensioning the graft, and (6) graft fixation and skin closure. Patients were partial weightbearing with crutches for 3 weeks and used a hinged knee brace for 6 weeks after surgery. Return to activities was based on functional strength recovery, with a return to running targeted at 4 to 5 months after surgery. Results: All-inside ACLR with short sockets technique provides a better chance of return to preinjury level of activity with accompanied patient satisfaction as compared with anteromedial portal technique at 2 years of follow-up. This technique has favorable functional and clinical outcomes with improvement of graft maturing. Discussion/Conclusion: In conclusion, we propose that ACLR with short tibial and femoral socket technique is simple and safe with favorable clinical outcomes. This is an advantageous ACLR technique that can preserve the gracilis muscle and reduce muscle strength loss of affected limbs. In addition, the all-inside technique is circumferential filling of the socket with the graft, which might increase bone to graft contact compared with interference screws. Further study is needed to show the better clinical outcome and the earlier graft maturation compared with ordinary ACLR. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.