Lateral Anchors Research Articles

The clinical outcome of three procedures for extraarticular stabilization of cranial cruciate ligament injuries in dogs

The objective of this study was to evaluate the long-term outcomes in dogs with cranial cruciate ligament injury in which the stifle was stabilized with lateral suture stabilization, lateral suture stabilization-modified, or Securos lateral bone anchor tibial suture and monofilament nylon sutures placed at quasi-isometric points of the stifle. It is a retrospective study comprising a sample population of 49 client-owned dogs. Medical records from 2014?2016 were reviewed to identify dogs that had a cranial cruciate ligament rupture in which the stifle was stabilized using one of the aforementioned methods. The overall complication rate was 16.3% and the documented complication rate requiring implant removal was 0%. Owners reported full or acceptable function in 96% of cases. There were no significant statistical differences between the 3 techniques. Stabilization of cranial cruciate ligament-deficient stifles in dogs with lateral suture stabilization, lateral suture stabilization-modified, or Securos lateral bone anchor tibial suture is reliable with acceptable complication rates. The 3 procedures tested may be appropriate in medium-sized nonathletic dogs whose owners have limited budgets.

Double-row repair of rotator cuff tears: Comparing tendon contact area between techniques.

BACKGROUNDIn rotator cuff repair surgery, the double-row technique is widely performed. Studies have shown that with increased contact area and pressure between tendon and bone interface, better healing is promoted.AIMTo assess the different suture configurations with the double-row technique and how this influences the contact area of the rotator cuff tendon to bone.METHODSThis was a controlled laboratory study where identical tears were created in 24 fresh porcine shoulders over a 1.5 cm × 2.5 cm infraspinatus insertion footprint. Double-row repair techniques, with 3 to 4-suture anchors in different configurations (2 medial, 2 lateral vs 2 medial, 1 lateral vs 1 medial, 2 lateral), were employed for three control groups. Each group consisted of eight shoulders with identical repair configurations. Footprint contact areas of the repaired tendon against the tuberosity were determined using pressure sensitive Fujifilm placed between the tendon and tuberosity.RESULTSThe mean contact area between tendon and insertion footprint from the imprinted Fujifilm was obtained using computer software. The contact area measured from a standard 4-suture anchor double row repair was 75.1 ± 9.3 mm2, whereas areas obtained for the 2 lateral - 1 medial and 2 medial - 1 lateral anchor configurations were 72.9 ± 5.2 mm2 and 75.0 ± 4.9 mm2 respectively. No statistical significance was noted between the three groups.CONCLUSIONIn the technique of double-row repair, using a 3-suture anchor configuration may offer a non-inferior alternative to the standard 4-anchor construct in terms of efficacy. This may also result in overall cost reduction and shorter surgical time.

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

Double Row–Equivalent PASTA Repair Technique

Articular surface partial rotator cuff tendon tears are a common source of shoulder pain and dysfunction, and there is no consensus regarding the optimal arthroscopic treatment. Commonly accepted techniques, such as transtendinous repair or tear takedown with primary repair, may violate healthy tendon tissue and increase the suture anchor density. In this note, we describe an outside-in double row–equivalent technique for repair of partial articular-sided rotator cuff tears. A medial row of inverted horizontal mattress stitches is placed percutaneously using spinal needles to shuttle partially absorbable braided sutures into the joint. The technique may incorporate a soft tissue biceps tenodesis into the rotator cuff with a second, oblique medial row mattress stitch. Suture limbs are retrieved and tied in the subacromial space and then secured to a lateral anchor. The result is a side-to-side double row–equivalent rotator cuff repair, anatomically reproducing the footprint of the rotator cuff without removing healthy tissue. We believe this is an efficient and reproducible technique that preserves intact bursal tissue, limits implant costs, and produces reliable healing in partial articular-sided tears of the rotator cuff.

Arthroscopic Knotless Remplissage for the Treatment of Hill-Sachs Lesions Using the PASTA Bridge Configuration

Recurrent glenohumeral dislocations can produce Hill-Sachs lesions—bony defects on the humeral head resulting from the humerus hitting the glenoid during dislocations. Some of these lesions can engage on the glenoid during motion, producing instability and potentially affecting the success of a labral repair. The remplissage was developed to address these Hill-Sachs lesions and improve stability. French for “filling,” the goal of the remplissage is to fill the Hill-Sachs lesion with the infraspinatus tendon, preventing the margins of the lesion from engaging with the glenoid. Analogous to restoring the rotator cuff footprint during repair, a primary goal of the remplissage is to have the infraspinatus cover the Hill-Sachs lesion. The partial articular supraspinatus tendon avulsion (PASTA) bridge was originally developed for partial-thickness rotator cuff repair in situ, but additional uses have been found in other settings. The PASTA bridge uses a medial row horizontal mattress with a lateral anchor to create a linked construct to effectively distribute force and provide adequate coverage of the lesion. Knotless anchor technology used in this procedure prevents the need for arthroscopic knot tying and potentially damaging knot stacks. This Technical Note describes a remplissage technique using the PASTA bridge configuration to address Hill-Sachs lesions associated with recurrent glenohumeral instability.

All Soft-suture Anchor versus Suture Bridge Construct for Insertional Achilles

Category: Ankle Introduction/Purpose: New techniques and anchors have been developed for the surgical treatment of insertional Achilles tendinopathy and rupture to allow for earlier return to postoperative weight bearing and accelerated rehabilitation. Two recently introduced soft tissue-to-bone anchor technology have purported advantages for insertional Achilles repairs. Knotless suture anchors allow suture tension to be precisely controlled with a ratcheting mechanism. The other is a suture bridge construct fastened with biotenodesis screws, increasing the soft tissue footprint and reducing the risk of suture pullout through the tendon. However, neither technology has been studied in a biomechanical model of Achilles tendon repair. We hypothesized that there would be no difference in the biomechanical characteristics of a single-row all-suture anchor repair to a double-row repair with knotless anchors and suture tape. Methods: Six matched-pairs of fresh-frozen lower leg cadaveric specimens (12 total) were obtained. All tendons were completely detached from their calcaneal insertions and tendon thickness was measured. Calcaneal exostectomies were performed (e.g., Haglunds removal) above the Achilles insertion. Group 1 was repaired with a single-row construct with two all-soft anchors. Group 2 was repaired with a double-row suture bridge construct with two knotless anchors distally and two suture tape anchors proximally. The repaired specimens were cyclically loaded from 10N to 100N at 1 Hz for 2,000 cycles then to failure at 1mm/sec. A motion capture system measured Achilles-calcaneal displacement at the medial and lateral anchors. Paired t-tests and linear mixed models (LMMs) were used to analyze the following outcomes: clinical failure load, ultimate failure load, Achilles-calcaneal medial and lateral displacement, distance at ultimate failure load, tendon thickness, footprint, and mode of failure. A p-value of <0.05 was considered statistically significant. Results: Group 2 showed significantly less Achilles-calcaneal overall medial and lateral displacement, 19.5% and 36.9% respectively (Table 1). Group 2 showed a statistical trend toward greater clinical and ultimate failure load, 23.8% and 34.2%, respectively (Table1). LMM analyses showed that a suture bridge repair over all-soft anchor repair was independently associated with a 50.24N increase in the load to clinical failure (p=0.0011). Higher clinical failure loads were associated with higher BMI (p<0.0001), thinner tendons (p<0.0001), and smaller tendon footprints on the calcaneus (p=0.0013). Higher absolute failure loads were associated with older age (p<0.0001), higher BMI (p<0.0001), thinner tendons (p=0.0028), and larger footprints (p<0.0001). Conclusion: These data suggest a trend toward higher clinical and ultimate failure loads in a suture bridge construct compared to all-soft suture anchors for insertional Achilles repair. Loads to failure in both groups were higher than previously reported pull-out strengths for most suture anchors (150-300 N), but are lower than typical loads at the Achilles insertion during walking activities. The use of the suture bridge repair method may result in superior loads to failure compared to all-soft anchors. Patient age, BMI and tendon thickness impact failure loads. Adequate healing should be allowed followed repair of complete Achilles detachment.

Arthroscopic augmentation with an absorbable synthetic scaffold in critical cuff repairs

Introduction Confronted with a failed rotator cuff (RC) repair or a massive tear with compromised tissue quality patch augmentation becomes a logical adjunct from a mechanical and biological point of view. We hypothesize that augmentation of the repair with a novel bioabsorbable scaffold might improve healing rates with few complications and reasonable added costs. Methods A consecutive series of 54 patients was prospectively included since 3/14. The case series includes 38 revision cases (typically medial failures) and 16 primary repairs in massive tears. The operation is technically demanding but reproducible and includes 12 steps (video). The cuff is repaired with a standard suture bridge construct using 1–2 medial and 2 lateral anchors; no additional anchors are needed for patch augmentation. The proposed scaffold (BioFiber, Tornier) consists of biosynthetic fibers woven into a lattice structure and fully absorbing in the Krebs cycle over 18 months. Results Until now 14 patients have completed 24 mo FU including constant score (CS), subjective shoulder value (SSV) and a native MRI. The CS rose from 46 to 85 points, the SSV from 43 to 89%. MR scans showed an intact repair in 12 cases, typically Sugaya type III (intact but thinnend cuff). 2 retears were observed (14%). In this series of 54, one shoulder was revised for infection, one shoulder received a reversed prosthesis and two more were sucessfully revised because of a symptomatic gap formation at the posterior edge of the patch. Reversal of pseudoparesis in massive tears was achieved in 10 cases. The added costs of patch augmention were about 600 Euros, added operation time after the learnig curve less than 30. Patch integration has been observed at repeat arthroscopy. Conclusion We report a learnable technique for patch augmentation in the revision setting and for massive RC tears. Implant costs are reasonable; the material has been succesfully used in abdominal wall hernias and cosmetic breast surgery. The scaffold is made from fully absorbable synthetic fibres degrading without known toxicity and containing no DNA residues. It has good mechanical and biological properties. The preliminary results suggest an improved outcome and higher healing rates in these critical situations.

Biomechanical Comparison of Transosseous Knotless Rotator Cuff Repair Versus Transosseous Equivalent Repair: Half The Anchors With Equivalent Biomechanics?

To compare the biomechanics of a transosseous equivalent (TOE) repair using medial and lateral anchors with tape to a transosseous knotless (TOK) tape repair with only laterally placed intraosseous anchors. One of 2 different repairs were performed on 8 paired specimens: (1) transosseous equivalent (TOE) tape repair or (2) transosseous knotless (TOK) tape repair. Specimens were mounted on a materials testing machine and loaded in uniaxial tension to measure cyclic construct gap formation, followed by failure testing. Paired t tests were used to compare gapping, ultimate stiffness, and failure loads. Fisher exact test was used to compare modes of failure (soft tissue failure vs construct failure). Peak cyclic gapping, failure stiffness, and ultimate failure loads did not differ between TOE and TOK repairs (P= .140 for gapping, P= .106 for stiffness, and P= .672 for peak failure loads). All TOK repairs failed via soft tissue failure medial to the medial suture line, with no construct failures. TOE repairs failed more often through construct failure (anchor migration or suture-bone interface cut through) than TOK repairs (P= .026). TOK repairs only failed through soft tissue whereas TOE repairs failed through both soft tissue and the repair construct. Despite 50% fewer suture anchors in the TOK repairs than the TOE repairs, cyclic gapping and ultimate stiffness and failure loads were not significantly different. The transosseous knotless construct presented is a 2-anchor construct that is equivalent in biomechanical function to a traditional 4-anchor construct, reducing anchor load in the tuberosity.

Holding capacity of dynamically installed anchors in normally consolidated clay under inclined loading

This paper describes a design framework for inclined tensile loading capacity (holding capacity) of dynamically installed anchors in soft clay. Centrifuge model test and numerical results indicate that, while ultimate inclined holding capacity increases with a loading angle smaller than 45° (to the vertical at anchor padeye), anchor failure is controlled predominantly by the ultimate vertical holding capacity, which can be predicted using the American Petroleum Institute method put forth in 2007 with interface friction ratio of 0.25–0.34 and 0.60–0.82 for short- and long-term conditions, respectively. For a loading angle larger than about 65°, anchor failure is controlled largely by the ultimate horizontal holding capacity. It is proposed herein that the ultimate lateral holding capacity can be estimated by generalizing Broms’ method put forth in 1964 for lateral anchor capacity to variable cross section; thereby allowing anchor geometry to be considered in a rational manner. Good agreement can be obtained between the estimated ultimate horizontal holding capacity and that computed using the finite element method by using a lateral resistance of 10.5su, where suis the undrained shear strength. For a loading angle between 45° and 65°, there is significant interaction between vertical and horizontal failure modes. This allows a normalized horizontal–vertical interaction curve to be defined by fitting data from this and previous studies.

Optimal Lateral Row Anchor Positioning in Posterior-Superior Transosseous Equivalent Rotator Cuff Repair: A Micro-Computed Tomography Study.

Background:The optimal placement of suture anchors in transosseous-equivalent (TOE) double-row rotator cuff repair remains controversial.Purpose:A 3-dimensional (3D) high-resolution micro–computed tomography (micro-CT) histomorphometric analysis of cadaveric proximal humeral greater tuberosities (GTs) was performed to guide optimal positioning of lateral row anchors in posterior-superior (infraspinatus and supraspinatus) TOE rotator cuff repair.Study Design:Descriptive laboratory study.Methods:Thirteen fresh-frozen human cadaveric proximal humeri underwent micro-CT analysis. The histomorphometric parameters analyzed in the standardized volumes of interest included cortical thickness, bone volume, and trabecular properties.Results:Analysis of the cortical thickness of the lateral rows demonstrated that the entire inferior-most lateral row, 15 to 21 mm from the summit of the GT, had the thickest cortical bone (mean, 0.79 mm; P = .0001), with the anterior-most part of the GT, 15 to 21 mm below its summit, having the greatest cortical thickness of 1.02 mm (P = .008). There was a significantly greater bone volume (BV; posterior, 74.5 ± 27.4 mm3; middle, 55.8 ± 24.9 mm3; anterior, 56.9 ± 20.7 mm3; P = .001) and BV as a percentage of total tissue volume (BV/TV; posterior, 7.3% ± 2.7%, middle, 5.5% ± 2.4%; anterior, 5.6% ± 2.0%; P = .001) in the posterior third of the GT than in intermediate or anterior thirds. In terms of both BV and BV/TV, the juxta-articular medial row had the greatest value (BV, 87.3 ± 25.1 mm3; BV/TV, 8.6% ± 2.5%; P = .0001 for both) followed by the inferior-most lateral row 15 to 21 mm from the summit of the GT (BV, 62.0 ± 22.7 mm3; BV/TV, 6.1% ± 2.2%; P = .0001 for both). The juxta-articular medial row had the greatest value for both trabecular number (0.3 ± 0.06 mm–1; P = .0001) and thickness (0.3 ± 0.08 μm; P = .0001) with the lowest degree of trabecular separation (1.3 ± 0.4 μm; P = .0001). The structure model index (SMI) has been shown to strongly correlate with bone strength, and this was greatest at the inferior-most lateral row 15 to 21 mm from the summit of the GT (2.9 ± 0.9; P = .0001).Conclusion:The inferior-most lateral row, 15 to 21 mm from the tip of the GT, has good bone stock, the greatest cortical thickness, and the best SMI for lateral row anchor placement. The anterior-most part of the GT 15 to 21 mm below its summit had the greatest cortical thickness of all zones. The posterior third of the GT also has good bone stock parameters, second only to the medial row. The best site for lateral row cortical anchor placement is 15 to 21 mm below the summit of the GT.Clinical Relevance:Optimal lateral anchor positioning is 15 to 21 mm below the summit of the greater tuberosity in TOE.

Suture spanning augmentation of single-row rotator cuff repair: a biomechanical analysis

This in vitro study evaluated the biomechanical benefit of adding spanning sutures to single-row rotator cuff repair. Mechanical testing was performed to evaluate 9 pairs of cadaveric shoulders with complete rotator cuff repairs, with a single-row technique used on one side and the suture spanning technique on the other. The spanning technique included sutures from 2 lateral anchors securing tendon near the musculotendinous junction, spanning the same anchor placement from single-row repair. The supraspinatus muscle was loaded to 100 N at 0.25 Hz for 100 cycles, followed by a ramp to failure. Markers and a video tracking system measured anterior and posterior gap formation across the repair at 25-cycle intervals. The force at which the stiffness decreased by 50% and 75% was determined. Data were compared using paired t-tests. One single-row repair failed at <25 cycles. Both anterior and posterior gap distances tended to be 1 to 2 mm larger for the single-row repairs than for the suture spanning technique. The difference was statistically significant at all cycles for the posterior gap formation (P ≤ .02). The trends were not significant for the anterior gap (P ≥ .13). The loads at which the stiffness decreased by 50% and 75% did not differ significantly between the 2 types of repair (P ≥ .10). The suture spanning technique primarily improved posterior gap formation. Decreased posterior gap formation could reduce failure rates for rotator cuff repair.

Tratamiento mediante hilera única versus transóseo doble hilera en las roturas del manguito de los rotadores de tamaño pequeño y medio. Estudio prospectivo y aleatorizado

IntroductionThe best technique for arthroscopic repair of rotator cuff tears is still not clear. Several studies point to an improvement, in biomechanical terms, of repairs in double row. However, few studies have demonstrated clinical superiority of repair in double row, and these have been mainly on large ruptures. ObjectiveThe objective of this study was to evaluate the clinical differences using the Constant score between two arthroscopic techniques for small and medium-sized tears of the supraspinatus, and to assess the costs and benefits of both techniques. Material and methodsProspective, randomised, study involving 114 patients with tears of up to 3cm of the supraspinatus tendon, diagnosed by magnetic resonance imaging, with failure of up to three months conservative treatment. Patients were randomised into two different surgical techniques: Classic single row technique with one or two anchors in 5.5mm PEEK, with 3-wire and transosseous-equivalent (TOE) with two anchors 5.5mm PEEK, 3-wire, medial, and two knotless lateral anchors. All patients were operated on by the same surgeon. All patients underwent the same rehabilitation program.Patients were evaluated before and at 12 months after the operation by an independent evaluator and using the Constant score. ResultsResults were obtained on 108 patients, after excluding three post-operative complications unrelated to the surgical technique, and loss of follow up of three other patients. The characteristics of both groups, in terms of demographics, rupture dimension and pre-surgical Constant score were analysed, with no significant differences being found. The mean post-surgical Constant score for the single row group was 79, and the TOE group of 78, not having a statistically significant difference. As regards the difference between the pre and post-surgery scores, the mean difference in the single row group was 50, and in the TOE group it was 55, also without significant statistical difference. In patients with abnormally low results (4 cases), a post-operative MRI was performed, with two cases of re-rupture identified for each technique. ConclusionIn our sample, with the techniques described, no differences in clinical outcome between the two techniques were identified. No differences were observed in the rate of re-rupture between the two techniques. Based on our results, the cost benefit ratio is unfavourable for the TOE technique.

A Rare Complication of Sacrocolpopexy

Pelvic organ prolapse is a prevalent condition with up to 12% of women requiring surgery in their lifetime. Various apical procedures have been performed vaginally, abdominally, and laparoscopically and include uterosacral, sacrospinous, and Sacrocolpopexy. There is little evidence of ureteral injury/kinking with placement of stitches to secure the vaginal graft at time of laparoscopic sacrocolpopexy. This video highlights information on sacrocolpopexy and associated complications. This is followed by a case presentation of a 65-year-old para 2 that underwent a laparoscopic sacrocolpopexy for stage 3 POP on POPQ exam and presented post-operatively with a hydronephrosis. Ultimately, caution should be taken when placing lateral anchor sutures so as to avoid the ureter and prevent kinking and obstruction.

Arthroscopic Rotator Cuff Repair With Absorbable Sutures in the Medial-Row Anchors

To report the retear rate and retear pattern after double-row arthroscopic rotator cuff repair (DR-ARCR) with the use of absorbable sutures as medial anchor sutures and to address the advantage of the use of absorbable sutures in medial-row anchors. Fifty-seven shoulders (22 male and 35 female patients; mean age, 66.1 years) with complete rotator cuff tears treated with DR-ARCR using absorbable mattress sutures as medial-row anchor sutures were included in the study. They included 35 medium, 17 large, and 5 massive tears. For the medial row, medial anchor sutures were replaced with absorbable mattress sutures. High-strength simple sutures were used for the lateral anchors. We evaluated retear patterns by magnetic resonance imaging examinations performed at 1 month, 3months, 6 months, and 1 year postoperatively. The clinical conditions of all patients preoperatively and 2 years postoperatively were assessed by the University of California, Los Angeles rating scale and the American Shoulder and Elbow Surgeons shoulder index. A complete retear of the tendon at the footprint was observed in 5 shoulders. Complete discontinuity at the middle of the tendon around the medial-row anchors with a footprint remnant was observed in 1 shoulder. A thinned repaired rotator cuff was observed in 2 shoulders because of a partial retear of the deep layer. The overall retear rate was 14%. From before to after surgery, the University of California, Los Angeles score significantly improved from 18.4 to 32.9 (P < .0001) and the American Shoulder and Elbow Surgeons index improved from 55.1 to 87.7 (P < .0001). No complications were observed. The retear rates after DR-ARCR with absorbable sutures as medial-row anchors were 8.8% for complete retears of the tendon at the footprint and 1.7% for complete discontinuity of tendon around the medial-row anchors. This procedure provided a low retear rate around the medial-row anchors. Level IV, therapeutic case series.

Circumferential Rotator Cuff Repair With the N+4 Portal, Subclavian Portal, and High Posteromedial Portal

Passing suture during a rotator cuff repair requires proper orientation and purchase of the rotator cuff tendon. Our technique uses a new portal to improve access to the supraspinatus and infraspinatus and uses additional portals for a circumferential repair of the tear, thereby restoring the footprint. Using a penetrating suture passer through the anterior, posterior, and superomedial portals allows 270° of coverage. The lateral anchors complete the circumferential repair. Sutures from the medial anchors are passed in a retrograde fashion using 3 small incisions with no cannula. A spinal needle is used to localize the orientation of each portal. The N+4 portal is the workhorse portal, allowing access to the supraspinatus and infraspinatus. The suture retriever enters the trapezius 5 cm from the medial border of the acromion and 1 cm anterior to the spine of the scapula. It enters the subacromial space on top of the supraspinatus. This provides protection to the suprascapular nerve in the supraspinatus fossa. The cuff is lifted with a grasper to allow perpendicular passage of suture. The suture is retrieved for tying. The tissue purchase and location of suture placement help restore the footprint of the supraspinatus and infraspinatus. Additional sutures are passed anteriorly through the subclavian portal and posteriorly through the high posteromedial portal. The repair is completed with lateral-row anchors as needed.

Analysis Procedure of the Cyclic Bearing Capacity for Suction Anchors in Soft Clays

This article presents a procedure to calculate the bearing capacity of suction anchors subjected to inclined average and cyclic loads at the optimal load attachment point using the undrained cyclic shear strength of soft clays based on the failure model of anchors proposed by Andersen et al. The constant average shear stress of each failure zone around an anchor is assumed and determined based on the static equilibrium condition for the procedure. The cyclic shear strength of each failure zone is determined based on the average shear stress. The cyclic bearing capacity is finally determined by limiting equilibrium analyses. Thirty-six model tests of suction anchors subjected to inclined average and cyclic loads were conducted, which include vertical and lateral failure modes. Model test results were predicted using the procedure to verify its feasibility. The average relative error between predicted and test results is 1.7%, which shows that the procedure can be used to calculate the cyclic bearing capacity of anchors with optimal loading. Test results also showed that the anchor was still in vertical failure mode under combined average and cyclic loads if an anchor was in vertical failure mode under static loads. The anchor failure would depend on the vertical resistance degradation under cyclic loads if an anchor was in lateral failure mode under static loads. Cyclic bearing capacities associated with the number of load cycles to failure of 1000 were about 75% and 80% of the static bearing capacity for vertical failure anchors and lateral failure anchors, respectively.

Arthroscopic Single-Row Versus Double-Row Repair for Full-Thickness Posterosuperior Rotator Cuff Tears: A Critical Analysis Review.

Over the past two decades, arthroscopic rotator cuff repair has become one of the most popular orthopaedic surgical procedures because of its proven ability to diminish pain and improve function in patients with symptomatic rotator cuff tears. As a result of this increasing demand, arthroscopic techniques have evolved rapidly in an effort to improve structural integrity, biomechanical function, and, ultimately, clinical outcomes. With the increasing number of techniques available for the repair of full-thickness rotator cuff tears, debate has arisen regarding the clinical superiority of any one of these methods over the others. Specifically, this debate has centered on traditional single-row versus traditional double-row repair constructs (Fig. 1). Therefore, the purpose of this article is to present a critical review of the most relevant evidence and to provide clinical care recommendations regarding arthroscopic single-row versus double-row rotator cuff repair constructs. Fig. 1 Traditional single-row suture configuration utilizes two lateral anchors tied in a simple stitch pattern ( Fig. 1 , A ). Traditional double-row suture configuration utilizes an additional medial row of anchors with mattress stitches ( Fig. 1 , B ). The rotator cuff represents a confluence of four tendons that envelop the humeral …

Osteochondral Autograft Plug Transfer for Treatment of Osteochondritis Dissecans of the Capitellum in Adolescent Athletes

Objectives:Osteochondritis dissecans (OCD) of the capitellum is a condition most commonly seen in adolescents involved in repetitive over-head sports and can profoundly affect both ability to return to play and long-term elbow function. Large, unstable defects, defined as those greater than 1 cm in size, have unproven or poor long term outcomes with surgical interventions such as fragment excision, microfracture or attempted fixation. Treatment of similarly sized OCD lesions in the knee with osteochondral autograft plug transfer has proven both effective and safe. While interest has developed for expansion of its use to the elbow, it has yet to be adequately studied. The goal of this study is to evaluate clinical outcomes and return to play in adolescent athletes treated with osteochondral autograft plug transfer from the knee for large, unstable OCD defects of the capitellum.Methods:Inclusion Criteria: 1) Inability to participate in competitive sports 2) OCD defect of the capitellum that was either unstable on MRI or in patients who had failed 6 months of conservative treatment 3) Defect measuring at least 1 cm in area on diagnostic arthroscopy 4)Reconstruction of capitellar OCD with osteochondral autograft plug transfer 5) Minimum of 6 months post-operative follow-up. Data collection included chart review, determination of return to play, elbow range of motion, and DASH outcomes. The surgical technique was the same for all patients. It included initial diagnostic elbow arthroscopy, including loose body removal, followed by posterolateral approach to the elbow with lateral collateral ligament takedown from lateral epicondyle and eventual suture anchor repair, preparation of the capitellar osteochondral defect and appropriate plug transfer from the lateral trochlear ridge of the ipsilateral knee through a lateral approach. All patients followed the same post operative protocol, consisting of splint immobilization for 2 weeks, conversion to a hinged elbow brace for 4 weeks with progressive range of motion, and resumption of throwing and strengthening exercises at 3 months.Results:A cohort of 11 patients with a minimum of 6 months post procedure was identified. All patients were available for evaluation at an average 22.7 months follow up (range 6-49 months). Average age at the time of surgery was 14.5 years (range 13-17 years). The group consisted of 10 males and 1 female, all of which were involved in competitive athletics. Average return to play was 4.4 months (range 3-7 months). All athletes returned to at least their same level of play as pre-operatively. 3 have received Division 1 college scholarships (gymnastics, lacrosse and baseball pitcher). Of the 5 pitchers, 4 returned to pitching. The average DASH score was 1.36 (95% CI 0.59-2.12) and the average Sport Specific DASH score was 1.7 (95% CI -1.78-5.17). There were statistically significant improvements in elbow flexion from 125.45 degrees to 141.36 degrees (p=0.009) and extension from 20.45 degrees to 4.55 degrees (p=0.006). There was one adverse event. This consisted of a superficial wound infection, which resolved with surgical debridement and antibiotics and did not adversely affect eventual return to play. There were no complications or donor site morbidity related to graft harvest.Conclusion:Treatment of large, unstable osteochondritis dissecans lesions of the capitellum in adolescent athletes allows reliable return to high level of sports, is safe and has excellent long-term clinical outcomes.

Fracture of Proximal Humerus in the Lateral Anchor Site after Suture Bridge Repair: A Case Report

To report the fracture of proximal humerus in the lateral anchor site after suture bridge repair. A 57-year-old female patient with shoulder pain on the right-side was admitted through the emergency room following a car accident. Seven weeks before the accident, the patient had undergone surgery at a different hospital for the repair of supraspinatus tendon rupture on the right-side via suture bridge technique. Humerus surgical neck fracture was confirmed by X-ray, and proximal humerus fracture at the anchor site was confirmed by magnetic resonance imaging. Following 7 months of conservative treatment resulted in satisfactory bone union and motion of the shoulder joint. We report the need of close observation during and after the arthroscopic repair of the rotator cuff in patients with osteoporosis.

Synthesis and photovoltaic performance of dihydrodibenzoazepine-based sensitizers with additional lateral anchor

Three novel metal-free organic dyes with dihydro-5H-dibenzo[b,f]azepine as a donor and cyanoacrylic acid as an anchoring unit were designed as an innovative linear skeleton of D–D–π–A type of organic dyes. The conversion efficiency of the derived dye-sensitized solar cells is moderate. Among them, the dye with a hydroxy group as an additional anchoring moiety exhibited the highest UV–Vis absorption with a maximum molar extinction coefficient of 24,136 M−1 cm−1 at λmax = 458 nm and the best photovoltaic performance with an overall power conversion efficiency of 4.88%, while the dye with a carboxy group as an additional anchoring moiety exhibited the lowest conversion efficiency (4.52%). The results show that the dye loading on the film and photovoltaic performance of the dyes were influenced by the additional anchoring units.