Soft Anchor Research Articles

Biomechanical Performance of Transtibial Pull-Out Posterior Horn Medial Meniscus Root Repair Is Improved With Knotless Adjustable Suture Anchor-Based Fixation.

While posterior medial meniscus root (PMMR) techniques have evolved, there remains a need to both optimize repair strength and improve resistance to cyclic loading. Adjustable tensioning would lead to higher initial repair strength and reduce displacement with cyclic loading compared with previously described transtibial pull-out repair (TPOR) fixation techniques. Controlled laboratory study. A total of 56 porcine medial menisci were used. Eight intact specimens served as a control for the native meniscus. For the others, PMMR tears were created and repaired with 6 different TPOR techniques (8 in each group). Fixed PMMR repairs were executed using 4 different suture techniques (two No. 2 cinch sutures, two cinch tapes, two No. 2 simple sutures, and two No. 2 sutures in a Mason-Allen configuration) all tied over a cortical button. Adjustable PMMR repairs using Mason-Allen sutures were fixed with an adjustable soft tissue anchor fixation tensioned at either 80 N or 120 N. The initial force, stiffness, and relief displacement of the repairs were measured after fixation. Repair constructs were then cyclically loaded, with cyclic displacement and stiffness measured after 1000 cycles. Finally, the specimens were pulled to failure. The PMMR repaired with the 2 cinch sutures fixed technique afforded the lowest (P < .001) initial repair load, stiffness, and relief displacement. The adjustable PMMR repairs achieved a higher initial repair load (P < .001) and relief displacement (P < .001) than all fixed repairs. The 2 cinch sutures fixed technique showed an overall higher cyclic displacement (P < .028) and was completely loose compared with the native meniscus functional zone. Repairs with adjustable intratunnel fixation showed displacement with cyclic loading similar to the native meniscus. With cyclic loading, the Mason-Allen adjustable repair with 120 N of tension showed less displacement (P < .016) than all fixed repairs and a stiffness comparable to the fixed Mason-Allen repair. The fixed Mason-Allen technique demonstrated a higher ultimate load (P < .007) than the adjustable Mason-Allen techniques. All repairs were less stiff, with lower ultimate failure loads, than the native meniscus root attachment (P < .0001). Adjustable TPOR led to considerably higher initial repair load and relief displacement than other conventional fixed repairs and restricted cyclic displacement to match the native meniscus function. However, the ultimate failure load of the adjustable devices was lower than that of a Mason-Allen construct tied over a cortical button. All repair techniques had a significantly lower load to failure than the native meniscus root. Knotless adjustable PMMR repair based on soft anchor fixation results in higher tissue compression and less displacement, but the overall clinical significance on healing rates remains unclear.

All-Suture Anchor vs. Knotless Suture Anchor for the Treatment of Anterior Shoulder Instability-A Prospective Cohort Study.

All-suture or soft-anchors (SA) represent a new generation of suture anchor technology with a completely suture-based system. This study's objective was to assess Juggerknot® SA, for arthroscopic Bankart repair in recurrent shoulder instability (RSI), and to compare it to a commonly performed knotless anchor (KA) technique (Pushlock®). In a prospective cohort study, 30 consecutive patients scheduled for reconstruction of the capsulolabral complex without substantial glenoid bone loss were included and operated on using the SA technique. A historical control group was operated on using the KA technique for the same indication. Clinical examinations were performed preoperatively and 12 and 24 months postoperatively. RSI and WOSI at 24 months were the co-primary endpoints, evaluated with logistic and linear regression. A total of 5 out of 30 (16.7%) patients suffered from RSI in the SA group, one out of 31 (3.2%) in the KA group (adjusted odds ratio = 10.12, 95% CI: 0.89-115.35), and 13.3% in the SA group and 3.2% in the KAgroup had a revision. The median WOSI in the SA group was lower than in the KA group (81% vs. 95%) (adjusted regression coefficient = 10.12, 95% CI: 0.89-115.35). Arthroscopic capsulolabral repair for RSI using either the SA or KA technique led to satisfying clinical outcomes. However, there is a tendency for higher RSI and lower WOSI following the SA technique.

Arthroscopic Modified Broström Repair with Suture-Tape Augmentation of the Calcaneofibular Ligament for Lateral Ankle Instability

Surgical repair of acute or chronic lateral instability of the ankle may be unsuccessful in the presence of associated anterior fibulotalar ligament (AFTL) and calcaneofibular ligament (CFL) injury. This Technical Note presents an arthroscopic double-row repair technique of the AFTL associated with suture tape augmentation of the CFL. The patient is in the supine position with the ankle hanging over the edge of the surgical table. The anteromedial portal is created inside the anterior tibial tendon, and the anterolateral portal is created under arthroscopic control. The ATFL is released from the capsule with a beaver blade. The calcaneal tunnel is created percutaneously at the footprint of the CFL. A soft anchor is impacted at the tip of the lateral malleolus with thread and tape. With the foot in the neutral position, the tape is then passed into the calcaneal tunnel and attached with an interference screw to strengthen the CFL. The ATFL is grasped with a Mini-Scorpion suture passer and pressed against the anchor with the foot in neutral position. A knotless anchor is impacted 5 mm above with the threads of the soft anchor, creating double-row fixation. This technique is indicated in proximal tears of the AFTL associated with a stretched CFL.

A Knotless Single-Row Suture Bridge Technique to Repair a Partial Articular Suproaspinatus Tendon Avulsion-Type Rotator Cuff Tear: Surgical Technique

With improving surgical and technological solutions for repairing rotator cuff tears, there has been increased interest in treatment of partial rotator cuff tears. The most prevalent type of partial tear is the PASTA (partial articular supraspinatus tendon avulsion) lesion. There is an ongoing debate on the best surgical technique to repair a PASTA lesion, which has led to the development of many different arthroscopic techniques. This Technical Note provides a cost-effective and reproducible technique of a transtendinous single-row bridge repair of PASTA lesions, using two 1.8 FiberTak Knotless Soft Anchors.

Biomechanical Comparison of Coracoclavicular Fixation Using Metallic Versus All-Suture Anchors.

A coracoclavicular (CC) fixation technique using an all-suture anchor with the assistance of fluoroscopy can prevent iatrogenic anterior deltoid detachment from the clavicle; however, soft anchor pullout has been reported as a complication. To compare the biomechanical properties of conventional metallic and all-suture anchors for CC suture fixation. Controlled laboratory study. A total of 24 fresh-frozen cadaveric specimens were divided into 2 groups: metal anchor group (group M) and all-suture anchor group (group A). In group M, 5.0-mm metallic suture anchors were used for CC fixation, whereas 2.8-mm all-suture anchors were used in group A. The prepared specimens were mounted on a materials testing machine. After preconditioning at 0 to 20 N for 10 cycles, the specimens were subjected to cyclic loading from 20 to 70 N for 1000 cycles. Finally, all the specimens were loaded to failure. Cyclic elongation, linear stiffness, ultimate load, and failure modes were recorded, and the Mann-Whitney U test was used to compare nonparametric parameters between the 2 groups. All of the specimens completed the cyclic loading test. The elongation after cyclic loading in group M (1.6 ± 0.6 mm) was significantly smaller compared with that in group A (2.5 ± 1.2 mm) (P = .02). No between-group differences were found in linear stiffness (42 ± 17 N/mm in group M and 41 ± 17 N/mm in group A). The ultimate failure load in group M (263 ± 66 N) was significantly greater than that in group A (177 ± 76 N) (P = .02). All specimens failed because of suture anchor pullout. The use of all-suture anchors in CC fixation resulted in significantly greater cyclic displacement and smaller ultimate failure load than that of metallic anchors. Understanding the most biomechanically sound suture anchor may assist in lowering the risk of clinical failure in CC fixation and repair.

Medial Patellofemoral Ligament Reconstruction Using Gracilis Tendon Graft and “All Suture” Knotless Anchors for Patellar Fixation

Patellar dislocation is a frequent sports-related knee injury. The primary restraint to lateral translation of patella is medial patellofemoral ligament. Several treatments for patella dislocation have been described in the literature. The purpose of this Technical Note is to describe the surgical technique for medial patellofemoral ligament reconstruction using gracilis tendon and 2 knotless soft anchors, avoiding patella tunneling.

An Antegrade Soft Anchor in a Retrograde Drilling for Medial Meniscus Root Repair with High Tibial Osteotomy: A Modified Approach to Avoid Tunnel Collision

An Antegrade Soft Anchor in a Retrograde Drilling for Medial Meniscus Root Repair with High Tibial Osteotomy: A Modified Approach to Avoid Tunnel Collision

ALL Repair and Reconstruction: Techniques From the SANTI Study Group

Background: Combining an anterior cruciate ligament (ACL) reconstruction with an anterolateral ligament (ALL) reconstruction results in significant advantages including reduced graft rupture rates, a lower risk of reoperation for secondary meniscectomy, improved knee stability, and higher rates of return to preinjury levels of sport. Indications: The previously reported indications for combined ACL and ALL reconstruction are as follows: ACL reconstruction revision; high-grade pivot shift test; long-term ACL rupture; young patients; pivoting activities; concomitant medial meniscus repair, and, specifically, regarding the ALL repair, it must be an acute surgery (within 15 days from injury). Technique Description: Several modern techniques have been described to repair and reconstruct the ALL. This technical note details a number of these techniques performed by the Scientific Anterior Cruciate Ligament Network International (SANTI) Study Group. Results: First, we describe a combined ACL reconstruction and double-bundle ALL reconstruction using hamstring autograft. Secondly, we describe a single-bundle ALL reconstruction using gracilis autograft. Thirdly, we describe an ALL reconstruction technique using a knotless soft anchor, which provides shallow fixation and prevents tunnel convergence. Finally, we describe a technique for ALL repair. Conclusion: Several techniques have been described to repair and reconstruct the ALL, all offering significant advantages over an isolated ACL reconstruction. 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.

Outcomes of Double-Row Rotator Cuff Repair Using a Novel All-Suture Soft Anchor Medial Row.

Few studies have examined the short-term clinical outcomes of rotator cuff repair (RCR) with all-suture anchors for medial row anchor fixation. To evaluate clinical outcomes of double-row suture bridge RCR using a novel all-suture medial row anchor. Case series; Level of evidence, 4. We enrolled 179 patients before double-row suture bridge RCR (mean age at surgery, 60.0 years; 63% male patients) at a single institution. All patients underwent RCR with all-suture anchor fixation for the medial row and solid anchor fixation for the lateral row. Preoperative (baseline) and follow-up (minimum follow-up time of 2 years; mean, 2.5 years) clinical outcomes were compared using the American Shoulder and Elbow Surgeons (ASES) score and a 10-point numeric pain rating scale (NPRS). We calculated the proportions of patients meeting previously published Patient Acceptable Symptom State (PASS) thresholds for the ASES (≥78.0) and NPRS (≤1.7). We further compared baseline and follow-up outcome scores and the proportions of patients meeting PASS thresholds using paired t tests and McNemar tests, respectively, and calculated effect size to quantify the magnitude of change from baseline to follow-up. Values significantly improved from baseline to follow-up for ASES (from 45.3 ± 19.8 to 87.3 ± 17.1) and NPRS (from 5.2 ± 2.5 to 1.4 ± 2.1). The proportion of patients meeting PASS thresholds also significantly improved for the ASES (from 6% to 77%) and the NPRS (from 7% to 72%). The magnitude of baseline to follow-up change for all measures was large (all effect sizes ≥1.5). Our study demonstrated excellent short-term clinical outcomes and substantial improvements for patients undergoing double-row suture bridge RCR with all-suture anchors for medial row fixation.

Arthroscopic Double-Row Repair for Acute Proximal Detachment of the Lateral Collateral Ligament in a Complex Ankle Sprain

Management of ankle sprains is still being discussed. For athletes, recent studies recommend surgical treatment for acute grade III rupture, because of better long-term ankle stability. The purpose of this technical note is to describe the arthroscopic acute double-row repair for proximal disinsertion of collateral lateral ligament ankle. With the patient in dorsal decubitus under spinal anesthesia, the foot and ankle are extended beyond the edge of the surgical table. The anteromedial portal is created inside the anterior tibial tendon in which the arthroscope is introduced. The anterolateral approach is simulated with a needle under arthroscopic control, in front and under the tip of the lateral malleolus. The anterior talofibular ligament (ATFL) is released from the capsule with a beaver blade. The tip of the lateral malleolus is sharpened, and a soft anchor is impacted there. ATFL is caught with a Mini-Scorpio plier, a Lasso loop is performed to improve tissue grasping. The ligament is pressed against the anchor, with the foot in maximum dorsiflexion and eversion. A knotless anchor is impacted 5 mm above and with the threads of the soft anchor, creating a double-row fixation. The arthroscopic acute double-row repair for proximal desinsertion of collatéral lateral ligament ankle can be done especially for athletes.

Comparaison des différentes ancres dans les réinsertions transosseuses de tendons fléchisseurs profonds en zone I

Transosseous reinsertion has been used to complement the Bunnell pull-out technique in the repair of zone I deep flexor tendon injuries. The aim of this study is to compare the different devices on the market in terms of complication, functional recovery and ease of use. This is a single-center study including all patients who underwent transosseous anchor reinsertion from 2010 to 2021 with a minimum of 6 months of follow-up. Twenty-seven patients were included. The anchors used were of different types: Microfix® Quickanchor plus® and Miniquick anchor® from DePuy Mitek; Juggerknot® Soft Anchor 1.0mm from Zimmer-Biomet; or Kerifix® 4.0 from KeriMedical. We analyzed intraoperative data, complications and functional recovery by quickDASH score. The average age was 38.6 years (±16.1), the demographic characteristics were identical in the different groups. There was a significant difference in the number of anchors used intraoperatively before definitive placement (P=0.02), to the disadvantage of the Juggerknot® anchors. There was no significant difference in terms of complications and functional recovery evaluated by the quickDASH. Our study did not find significant differences between the different anchors in terms of complications and functional recovery. Some anchors seem to have a better grip during placement than others.

Augmentation of a Nonanatomical Repair of a Medial Meniscus Posterior Root Tear With Centralization Using Three Knotless Anchors May Be Associated With Less Meniscal Extrusion and Better Compressive Load Distribution in Mid-Flexion Compared With Non-Anatomical Root Repair Alone in a Porcine Knee Model

To investigate the biomechanics of the centralization augmentation using knotless soft anchors to a nonanatomicaltranstibial pull-out root repair in a porcine medial meniscus posterior root tear (MMPRT) model. Porcine knee joints (N= 10) were used to perform one of the following procedures: (1) intact; (2) MMPRT; (3) nonanatomical root repair; (4) nonanatomical root repair with centralization using 2 anchors: anchors were inserted at the posterior medial collateral ligament (MCL) border and 10 mm anterior to the posterior MCL border; and (5) nonanatomical root repair with centralization using 3 anchors: another anchor was placed 10 mm posterior to the posterior MCL border. Contact area on the medial meniscus (MM), contact pressure in the MM and tibial cartilage, and MM extrusion were evaluated at 30°, 45°, 60°, and 90° knee flexions under 200 N compressive force. MM extrusion at the posterior MCL border was significantly reduced after root repair with centralization using 3 anchors than after root repair alone at 30° (-0.063 mm vs 1.5 mm, P= .017), 45° (0.21 mm vs 1.7 mm, P= .018), and 60° (0.78 mm vs 2.3 mm, P= .019). There were no significant differences in MM extrusion between the root repair alone and root repair with centralization using 2 anchors at all flexion angles. The contact area in the middle and posterior MM was significantly greater after centralization with 3 anchors than after root repair alone at all flexion angles (except the posterior MM at 90°). The mean contact pressure in the tibial cartilage was significantly lower after centralization with 3 anchors than after root repair at all angles. Augmentation of a nonanatomical repair of a medial meniscus posterior root tear with centralization using three knotless anchors may be associated with less meniscal extrusion and better compressive load distribution between 30° and 60° flexion compared with nonanatomical root repair alone in a porcine model. This biomechanical study at time zero suggests that the addition of centralization using 3 knotless anchors may reduce MM extrusion and restore the load-distributing function of the MM.

Knotless All-Suture, Soft Anchor Bankart Repair Results in Excellent Patient-Reported Outcomes, High Patient Satisfaction, and Acceptable Recurrent Instability Rates at Minimum 2-Year Follow-Up

To evaluate minimum 2-year outcomes after arthroscopic knotless all-suture soft anchor Bankart repair in patients with anterior shoulder instability. This was a retrospective case series of patients who underwent Bankart repair using soft, all-suture, knotless anchors (FiberTak anchors) from 10/2017 to 06/2019. Exclusion criteria were concomitant bony Bankart lesion, shoulder pathology other than that involving the superior labrum or long head biceps tendon, or previous shoulder surgery. Scores collected preoperatively and postoperatively included SF-12 PCS, ASES, SANE, QuickDASH, and patient satisfaction with various sports participation questions. Surgical failure was defined as revision instability surgery or redislocation requiring reduction. A total of 31 active patients, 8 females and 23 males, with a mean age of 29 (range: 16-55) years were included. At a mean of 2.6 years (range: 2.0-4.0), patient-reported outcomes significantly improved over preoperative levels. ASES score improved from 69.9 to 93.3 (P < .001), SANE improved from 56.3 to 93.8 (P < .001), QuickDASH improved from 32.1 to 6.3 (P < .001) and SF-12 PCS improved from 45.6 to 55.7 (P < .001). Median patient postoperative satisfaction was 10/10 (range: 4-10). Patients reported a significant improvement sports participation (P < .001), pain with competition (P= .001), ability to compete in sports (P < .001), painless use of arm for overhead activities (P= .001), and shoulder function during recreational sporting activity (P < .001). Postoperative shoulder redislocations were reported in 4 cases (12.9%)-all after major trauma-with 2 patients progressing to Latarjet (6.45%) at 2 and 3 years postoperatively. There were no cases of postoperative instability without major trauma. Knotless all-suture, soft anchor Bankart repair resulted in excellent patient-reported outcomes, high patient satisfaction, and acceptable recurrent instability rates, in this series of active patients. Redislocation after arthroscopic Bankart repair with a soft, all-suture anchor only occurred after return to competitive sports with new high-level trauma. Level IV, retrospective cohort study.

Arthroscopic Superior Capsular Reconstruction (ASCR): All Soft Anchors Technique

Rotator cuff tears are among the most common orthopaedic injuries. If not treated, they can result in a massive irreparable tear because of tendon retraction and muscle atrophy. Mihata et al. in 2012 described the technique of superior capsular reconstruction (SCR) using fascia lata autograft. This has been considered an acceptable and effective method for treating irreparable massive rotator cuff tears. We describe an arthroscopically assisted superior capsular reconstruction (ASCR) technique using all soft anchors to preserve the bone stock and reduce possible hardware complications. Moreover, knotless anchors for the lateral fixation make the technique easier to reproduce.

Dermal Tuberoplasty for Irreparable Supraspinatus Tears Using Self-Punching, Knotless Fixation

Superior capsular reconstruction has become an accepted treatment option for the irreparable rotator cuff tear in the nonarthritic shoulder. Widespread adoption of this technique has been limited, however, because of the technical difficulty of performing this procedure. Recently, allograft interpositional grafting of the greater tuberosity has gained popularity as a simpler alternative to superior capsular reconstruction and provides similar joint preservation advantages. We describe a technique for allograft interpositional tuberoplasty that simplifies graft delivery, graft fixation, and suture management by using a graft inserter and self-punching, knotless soft anchors.

Primary Fixation and Cyclic Performance of Single-Stitch All-Inside and Inside-Out Meniscal Devices for Repairing Vertical Longitudinal Meniscal Tears

Background: Primary device fixation and the resistance against gap formation during repetitive loading influence the quality of meniscal repair. There are limited biomechanical data comparing primary tensioning and cyclic behavior of all-inside versus inside-out repair. Hypothesis: All-inside devices provide higher initial load on the meniscal repair than inside-out fixation, and stiffer constructs show higher resistance against gap formation during cyclic loading. Study Design: Controlled laboratory study. Methods: In total, 60 longitudinal bucket-handle tears in human cadaveric menisci were created and repaired with a single stitch and randomly assigned to 4 all-inside groups (TrueSpan, FastFix 360, Stryker AIR, FiberStich) and 2 inside-out groups (suture repair [IO-S], suture tape [IO-ST]). Residual load after repair tensioning (50 N) and relief displacement were measured. Constructs underwent cyclic loading between 2 and 20 N over 500 cycles (0.75 Hz) with cyclic stiffness, gap formation, and final peak elongation measured. Ultimate load and stiffness were analyzed during pull to failure (3.15 mm/s). Results: All-inside repair demonstrated significantly higher primary fixation strength than inside-out repair. The significantly highest load (mean ± SD; 20.1 ± 0.9 N; P < .037) and relief displacement (–2.40 ± 0.32 mm; P < .03) were for the knotless soft anchoring FiberStich group. The lowest initial load (9.0 ± 1.5 N; P < .001) and relief displacement (–1.39 ± 0.26 mm; P < .045) were for the IO-S repair group. The final gap formation (500th cycle) of FiberStich (0.75 ± 0.37 mm; P < .02) was significantly smaller than others and that of the IO-S (1.47 ± 0.33 mm; P < .045) significantly larger. The construct stiffness of the FiberStich and IO-ST groups was significantly greater at the end of cyclic testing (16.7 ± 0.80 and 15.5 ± 1.42 N/mm; P < .042, respectively) and ultimate failure testing (23.4 ± 3.6 and 20.6 ± 2.3 N/mm; P < .005). The FastFix 360 (86.4 ± 4.8 N) and Stryker AIR (84.4 ± 4.6 N) groups failed at a significantly lower load than the IO-S group (P < .02) with loss of anchor support. The FiberStich (146.8 ± 23.4 N), TrueSpan (142.0 ± 17.8 N), and IO-ST (139.4 ± 7.3 N) groups failed at significantly higher loads (P < .02) due to suture tearing. Conclusion: Overall, primary fixation strength of inside-out meniscal repair was significantly lower than all-inside repair in this cadaveric tissue model. Although absolute differences among groups were small, meniscal repairs with higher construct stiffness (IO-ST, FiberStich) demonstrated increased resistance against gap formation and failure load. Clinical Relevance: Knotless single-stitch all-inside meniscal repair with a soft anchor resulted in less gapping, but the overall clinical significance on healing rates remains unclear.

Tenodesis with bone marrow venting under local anesthesia for recalcitrant lateral epicondylitis: results of 2 years of follow-up.

HypothesisWe hypothesized that the treatment of recalcitrant lateral epicondylitis requires accurate identification of the painful area to promote remodeling of the degenerated extensor insertion and to stabilize the tendon origin during tendon healing. Thus, we performed tenodesis with bone marrow venting under local anesthesia for recalcitrant lateral epicondylitis.MethodsTwenty patients (21 elbows) were treated with bone marrow venting at the painful area of the lateral epicondyle of the elbow and tenodesis using 2 soft anchors lateral to the capitellum (immediately distal to the painful area) and were followed up for ≥2 years. Patients were assessed using the numerical rating scale for pain and the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, and objective evaluation included active range of motion.ResultsThe mean preoperative and postoperative pain scores were 7.5 and 0.5, respectively, indicating significant pain relief (P < .001). The mean preoperative and postoperative Quick Disabilities of the Arm, Shoulder, and Hand questionnaire scores were 44.2 and 1.0, respectively (P < .001). Two elbows had a slightly positive Thomsen test at the final visit. No recurrence of intra-articular symptoms induced by synovial fringe impingement was observed. Patients experienced more pain at the bone-tendon junction of extensors than at the tendon parenchyma.ConclusionTenodesis with bone marrow venting under local anesthesia was effective for subjective patient satisfaction and positive clinical outcomes at ≥2 years of follow-up in patients with recalcitrant lateral epicondylitis. Intra-articular symptoms can be improved by stabilization of the lateral soft tissue without treatment for intra-articular lesions.

An anchor-free object detector based on soften optimized bi-directional FPN

We propose an anchor-free object detector that combines a weighted bi-directional Feature Pyramid Network (BiFPN) and Soft Anchor Point Detector to address the object detection problem in a pixel-wise paradigm. The current mainstream object detection methods are anchor-based, which require to set hyper parameters such as scale and aspect ratio. This requires strong prior knowledge and can be difficult to design. Therefore, we propose an anchor-free detector that completely avoids the complex calculations and all the hyper parameters related to the anchor box by eliminating the predefined set of anchor boxes in an anchor-free way. Anchor-free detectors are essentially dense prediction methods. Although the huge solution space can yield high recall, simple anchor-free methods tend to return too many false positives, which leads to the problem of semantic ambiguity caused by the high overlap of object centers. Therefore, we propose BiFPN to alleviate the impact of high overlap which also effectively addresses the problems related to multi-scale features. Moreover, in order to utilize the power of feature pyramid better, we tackle the issues with a novel training strategy that involves two soften optimization techniques, i.e., soft-weighted anchor points and soft-selected pyramid levels. This training strategy further re-weights the quality of the detection results to make our detection results more stable.

Perianchor Cyst Formation Is Similar Between All-Suture and Conventional Suture Anchors Used for Arthroscopic Rotator Cuff Repair in the Same Shoulder

PurposeThe purpose of this study was to compare perianchor cyst formation between soft and hard suture anchors placed in the same patient 1 year after arthroscopic rotator cuff repair (ARCR).MethodsThis study reviewed patients who underwent primary ARCR using a “hybrid” technique using at least one soft anchor (FiberTak, Arthrex, Naples, FL) and one hard anchor (SwiveLock) placed in the same shoulder between January 1, 2018 and December 31, 2018. Magnetic resonance imaging was obtained at minimum 1-year postoperative to assess cyst formation (perianchor fluid signal) and rotator cuff healing. Range of motion (ROM) and patient-reported outcome measures (PROMs) were evaluated at baseline and 1-year follow up. PROMs included visual analog scale pain score, Simple Shoulder Test score, American Shoulder and Elbow Surgeon (ASES) score.ResultsNineteen patients with a combined 45 hard and 26 soft suture anchors were available for follow-up at a mean of 20 months postoperatively. There was a higher proportion of grade 1 fluid signal changes in the hard anchor group compared to the soft group (62.2% to 7.7; P < .001); however, there was no difference in the incidence of cyst formation (grade 2 or 3 changes) between groups (13.3% vs 3.8%; P = .251). There was also no difference in the rate of cyst formation between biocomposite and polyether-ether-ketone-type hard anchors (18.2% vs 0%; P = .113) or between anchors placed at the greater and lesser tuberosities (10.2% vs 5.3%, P = .519).ConclusionHard suture anchors showed increased fluid signal compared to soft suture anchors at short-term follow-up after ARCR, but there was no difference in cyst formation between anchor types.

Modified arthroscopic Broström procedure using a soft anchor for chronic lateral ankle instability: Short-term follow-up results.

Objectives This study aims to examine the clinical outcomes and complications of lateral ligament reconstruction performed using soft anchors according to the arthroscopic modified Broström technique (MBT) for the treatment of chronic ankle instability (CAI) and to evaluate the frequency of return to sports.Patients and methods A total of 14 patients with CAI (9 males, 5 females; mean age: 30.1±4.6 years; range, 22 to 38 years) who underwent the MBT with soft anchors between January 2015 and December 2019 were retrospectively analyzed. Ankle function was evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale and Karlsson Ankle Function Score (Karlsson/Peterson, K/D score), while pain was evaluated using the Visual Analog Scale (VAS) after a minimum follow-up of 12 months.Results The mean follow-up was 23.6±7.7 months. The mean overall AOFAS score was 74.0±2.6 preoperatively, which improved to 96.2±1.9 in the postoperative period (p=0.001). The mean pre- and postoperative K/P scores were 72.4±3.1 (range, 68 to 78) and 95.3±2.2 (range, 92 to 98), respectively (p=0.001). The mean preoperative VAS score was 2.4±0.9 (range, 1 to 4) and showed a significant improvement to 0.6±0.5 (range, 0 to 1) in the postoperative period (p=0.001). Nine (64.3%) patients returned to sports activities after surgery at a mean period of 9±2.1 months.Conclusion In the treatment of CAI, arthroscopic MBT performed with soft anchors provides successful outcomes in short-term follow-up. In addition to being a minimally invasive technique, MBT is a reliable and safe approach with low complication rates and significant functional improvement. However, the low ratio of return to sports should be considered as a failure of this technique.