Soft Tissue Suture Research Articles

A Suture Technique for Nasal Tip Support: 'Neo-interdomal Ligament Suture'.

The part that requires the most fine workmanship in rhinoplasty is tipplasty. In tipplasty, we demonstrated the benefits of the Neo-interdomal ligament suture, which is a soft tissue suture and is one of the important parts of the 'Polygon Tipplasty Concept', which is one of the most adopted concepts by surgeons. We believe that it contributes significantly to the protection of the projection as well as aligning the two dome points. This bicenter retrospective study, which included patients in whom this suturing technique was used, was performed on a total of 253 patients between January 2021 and March 2024. As a result, we consider that this suture technique is an easy-to-apply and useful technique in providing nasal tip support. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Alveolo-dental trauma: Epidemiological, clinical and therapeutic aspects at Centre Hospitalier Universitaire Yalgado Ouédraogo

: TAD constitutes one of the most frequent and urgent reasons in the stomatology and maxillofacial surgery (S/CMF) department. This study aimed to contribute to improving the management of alveolar-dental trauma at CHU-YO. This was a retrospective case series study, based on the clinical files of patients who underwent TAD and admitted to the S/CMF department of the CHU-YO during the period of study from July 1, 2022 to June 30, 2023. Data were collected from collection sheets and patient files during this period. 100 cases of TAD were collected in the S/CMF department of the CHU-YO. These TADs were relatively frequent. The age group of 15 to 30 years was the most affected (51%). Male predominance was clear (64%). ACRs were the greatest providers of alveolar-dental trauma (84%). Dislocations were predominant (51%) and the elective site was the upper jaw (61%). Medical treatment consisted mainly of antibiotics (100%), analgesics (97%), anti-inflammatories (71%) and topical uses of oral antiseptics (100%). The most commonly performed surgical treatment was soft tissue sutures. Restraints using Duclos arch ligatures were the subject of the majority of cases of orthopedic treatment (46%). Evolution was good in 84% of cases. Dental mobility (4%) and alveolitis (4%) dominated the table of complications.: Reducing ACR, which involves significant road prevention, would undoubtedly contribute to reducing the incidence of alveolar-dental trauma. Strengthening the technical platform and interdisciplinary collaboration of the department of odontostomatology and maxillofacial surgery could improve patient care at the CHU-YO.

Outcomes of an All-Soft Tissue Fixation Technique for Reconstruction of the Medial Patellofemoral Complex Using Double-Bundle Quadriceps Tendon Autograft for Recurrent Patellar Dislocation in Skeletally Immature Patients.

Patellar fracture, femoral physis injury, and recurrent instability are concerning complications in medial patellofemoral ligament (MPFL) reconstruction (MPFLR) techniques for recurrent patellar dislocation in children and adolescents. To evaluate the outcomes of an anatomic all-soft tissue fixation technique for reconstruction of the medial patellofemoral complex (MPFC) using a double-bundle quadriceps tendon (QT) autograft for recurrent patellar dislocation in skeletally immature patients. Case series; Level of evidence, 4. This retrospective study involved 24 skeletally immature patients (24 knees; 16 women and 8 men; age range, 9.5-15 years) with recurrent patellar dislocation who underwent MPFC reconstruction using a double-bundle QT autograft between September 2018 and January 2021. Only soft tissue suture fixation was used on the femoral and patellar sides of the 2 bundles of the QT. Radiographs, computed tomography, and magnetic resonance imaging were used to evaluate physeal status, lower limb alignment, patellar height and tilt, trochlear morphology, tibial tubercle-trochlear groove distance, and any associated knee pathology. Functional outcomes were assessed with the Kujala score, the visual analog scale (VAS) for pain, and the grading system of Insall et al.22. The mean follow-up time was 40 ± 9.6 months (range, 28-56 months). At the final follow-up, the Kujala and VAS pain scores showed a significant improvement versus preoperative scores (P < .001), and the passive lateral patellar glide showed a significant reduction (P < .001). All patients had negative apprehension and J signs. Of the 24 patients, 23 regained full range of motion, while 1 patient had a knee flexion deficit. The patellar tilt angle improved significantly at the final follow-up (P < .001). There was no patellar fracture, femoral physis injury, or recurrence of patellar dislocation. According to the grading system of Insall et al, the results were excellent in 15 knees (62.5%), good in 8 knees (33.3%), fair in 1 knee (4.2%), and no knees showed poor results. Reconstruction of the MPFC using a double-bundle QT autograft with an all-soft tissue fixation technique was an effective method for treating patellar instability in skeletally immature patients.

Soft Tissue Fixation Strategies of Human Quadriceps Tendon Grafts: A Biomechanical Study

To evaluate the effects of different stitching methods and suture diameters on the graft fixation of soft tissue human quadriceps tendon grafts for anterior cruciate ligament (ACL) reconstruction. The Krackow locking stitch (K), whipstitch (W), and baseball stitch (B) were combined with either a 2× no. 2 (#2) or a 1× no. 5 (#5) braided composite suture for graft fixation of 36 human quadriceps tendons in 6 groups. Biomechanical testing was performed using a cyclic protocol with loads between 0 and 100N. The maximum load until failure, cyclic elongation, and failure mode were recorded. The highest mean maximum load to failure was observed in the 2 Krackow stitch groups. The K#2 group had significantly higher load to failure values compared with those of the W#2 and B#2 groups (K#2, 553 ± 82N vs W#2, 392 ± 107N, P= .0349; K#2 vs B#2 366 ± 118N, P= .0129). The mean cyclic elongation was lowest in the Krackow groups (K#2, 10.59 ± 2.63mm; K#5, 13.66 ± 2.3mm). The regular failure mode was the rupture of the suture for the Krackow stitch (8 of 12) and suture pullout for the whipstitch (11 of 12) and baseball stitch groups (12 of 12). The double Krackow stitch with no. 2 braided composite suture exhibits a high maximum load to failure combined with a low amount of elongation in a biomechanical study for human quadriceps tendon soft tissue graft fixation. Unlike the whipstitch and the baseball stitch, it can solidly prevent suture pullout. A safe soft tissue graft fixation technique is especially important for quadriceps tendon grafts with their laminar anatomical structure and physiologically varying diameter. Unlike other grafts for ACL replacement, it fully relies on the soft tissue suture fixation to resist the pullout force.

Analysis of a poly(\u03b5-decalactone)/silver nanowire composite as an electrically conducting neural interface biomaterial

BackgroundAdvancement in polymer technologies, facilitated predominantly through chemical engineering approaches or through the identification and utilization of novel renewable resources, has been a steady focus of biomaterials research for the past 50 years. Aliphatic polyesters have been exploited in numerous biomedical applications including the formulation of soft-tissue sutures, bone fixation devices, cardiovascular stents etc. Biomimetic ‘soft’ polymer formulations are of interest in the design of biological interfaces and specifically, in the development of implantable neuroelectrode systems intended to interface with neural tissues. Critically, soft polymer formulations have been shown to address the challenges associated with the disregulation of mechanotransductive processes and micro-motion induced inflammation at the electrode/tissue interface. In this study, a polyester-based poly(ε-decalactone)/silver nanowire (EDL:Ag) composite was investigated as a novel electrically active biomaterial with neural applications.Neural interfaces were formulated through spin coating of a polymer/nanowire formulation onto the surface of a Pt electrode to form a biocompatible EDL matrix supported by a percolated network of silver nanowires. As-formed EDL:Ag composites were characterized by means of infrared spectroscopy, scanning electron microscopy and electrochemical methods, with their cytocompatibility assessed using primary cultures of a mixed neural population obtained from the ventral mesencephalon of Sprague-Dawley rat embryos.ResultsElectrochemical characterization of various EDL:Ag composites indicated EDL:Ag 10:1 as the most favourable formulation, exhibiting high charge storage capacity (8.7 ± 1.0 mC/cm2), charge injection capacity (84.3 ± 1.4 μC/cm2) and low impedance at 1 kHz (194 ± 28 Ω), outperforming both pristine EDL and bare Pt electrodes. The in vitro biological evaluation showed that EDL:Ag supported significant neuron viability in culture and to promote neurite outgrowth, which had the average length of 2300 ± 6 μm following 14 days in culture, 60% longer than pristine EDL and 120% longer than bare Pt control substrates.ConclusionsEDL:Ag nanocomposites are shown to serve as robust neural interface materials, possessing favourable electrochemical characteristics together with high neural cytocompatibility.

Recent Advances in Polyesters for Biomedical Imaging.

Several synthetic materials exhibiting contrast imaging properties have become vital to the field of biomedical imaging. Polymeric biomaterials and metals are commonly used imaging agents and can assist in the monitoring of therapy response, migration, degradation, changes in morphology, defects, and image-guided surgery. In comparison to metals, most bio and synthetic polymers lack inherent imaging properties. Polymeric biomaterials, specifically polyesters, have gained a considerable amount of attention due to their unique properties including biocompatibility, biodegradation, facile synthesis, and modification capability. Polyester implants and nanomaterials are available on the market or are in clinical trials for many applications including: dental implants, cranio-maxilofacial implants, soft tissue sutures and staples, abdominal wall repair, tendon and ligament reconstruction, fracture fixation devices, and coronary drug eluting stents. This review aims to provide a summary of the recent developments of polyesters with bioimaging contrast properties. The three main approaches to prepare bioimaging polyesters (coating, encapsulation, and functionalization) are discussed in depth. Furthermore, commonly used imaging modalities including X-ray computed tomography, magnetic resonance imaging, ultrasound, fluorescence, and radionucleotide polyester contrast agents are highlighted. In each section, examples of impactful bioimaging polyesters in the five major imaging modalities are evaluated.

Creating a Small Anchor to Eliminate Large Knots in Mesh and Tape Suture

Wide mesh or tape sutures are used to close high-tension wounds such as in hernia or tendon repair. However, wide sutures produce large knots that are susceptible to increased palpability, infection, and foreign body response. To prevent such adverse events, we developed a small suture anchor to replace wide suture knots. The suture anchor was iteratively developed using three-dimensional (3D) design software and produced via 3D printing. Anchor prototypes underwent monotonic, cyclic fatigue, and stress-life testing in a benchtop soft tissue suture model. Results were compared to a standard of care knot and alternative suture fixation devices. The final anchor design was selected based on minimal size and mechanical performance. The size of the final anchor (200 mm3) was 33% smaller than a tape suture knot and 68% smaller than a mesh suture knot. Monotonic testing of mesh and tape sutures revealed a significantly greater anchor failure load compared to knot and alternative fixations (p &lt; 0.05). Additionally, all anchors successfully completed cyclic fatigue testing without failure while other fixations, including knot, failed to complete cyclic fatigue testing multiple times. Stress-life testing demonstrated durable anchor fixation under varying tensile stresses. Failure mode analysis revealed anchor fracture and tissue failure as modes of anchor failure, each of which occurred at supraphysiologic forces. We created a small suture anchor that significantly outperforms knot and alternative suture fixations in benchtop testing and addresses concerns of increased palpability, infection, and foreign body response from large suture knots.

How Should We Secure Our Transplanted Meniscus? A Meta-analysis

Background: Meniscal allograft transplant (MAT) is a salvage procedure for young patients with symptomatic meniscal deficiency. Although many studies report good outcomes, MAT remains controversial, and an optimal fixation technique for the meniscus roots is debated. Purpose: To assess the overall outcome of MAT and compare the results of different meniscal root fixation techniques. Study Design: Meta-analysis. Methods: Following specific guidelines, we systematically evaluated all current literature for studies reporting on the outcomes of patients who underwent MAT. Using random effect models of proportions, we determined the tear and failure rates. Standardized mean differences (SMDs) were calculated to determine the improvement in clinical outcomes and pain level. Data were then stratified by root fixation method into 2 groups: fixation that preserved the graft’s root insertions on the allograft bone (bone fixation group) and suture fixation of the root soft tissue without the allograft bone (soft tissue suture group). Results: A total of 38 studies (1637 MATs, 81% men) involving subjects with a mean age of 34 years (range, 20-48 years) and a mean follow-up of 60 months (range, 25-168 months) met inclusion criteria. This overall cohort had significant improvements in Lysholm scores (from 57.8 to 81.4 points; SMD 1.5, P < .001) and pain level (visual analog scale [VAS], from 56 to 21 points; SMD 1.8, P < .001). The cohort had a tear rate of 9% and a failure rate of 12.6%. No significant differences were found between the soft tissue suture (485 MATs) and bone fixation (489 MATs) groups in terms of meniscal allograft tear rates (13.4% vs 14.9%), failure rates (17.6% vs 18.8%), Lysholm scores (from 52.3 to 82.4, SMD 2.0, and from 60.7 to 82.9, SMD 1.7; respectively), and VAS scores (from 65 points to 18 points, SMD 2.6, and from 63 points to 13 points, SMD 3.1; both P < .001). Meniscal extrusion was similar, with a weighted mean percentage of extrusion of 40.2% in the soft tissue suture group and 43.1% in the bone fixation group. Conclusion: This meta-analysis demonstrated significant improvements in clinical outcomes for MAT patients with low tear and failure rates. The data do not demonstrate a difference between soft tissue suture and bone fixation for MAT root fixation. This suggests that the technique of root fixation may not have an appreciable influence on clinical outcome, pain reduction, extrusion, or MAT longevity. Further prospective trials are needed.

Biomechanical Comparison of a First- and a Second-Generation All-Soft Suture Glenoid Anchor.

Background:All–soft tissue suture anchors provide advantages of decreased removal of bone and decreased glenoid volume occupied compared with traditional tap or screw-in suture anchors. Previous published data have led to biomechanical concerns with the use of first-generation all-soft suture anchors.Purpose/Hypothesis:The purpose of this study was to evaluate the load to 2-mm displacement and ultimate load to failure of a second-generation all-soft suture anchor, compared with a first-generation anchor and a traditional PEEK (polyether ether ketone) anchor. The null hypothesis was that the newer second-generation anchor will demonstrate no difference in loads to 2-mm displacement after cycling compared with first-generation all-soft suture anchors.Study Design:Controlled laboratory study.Methods:Twenty human cadaveric glenoids were utilized to create 97 total suture anchor sites, and 1 of 3 anchors were randomized and placed into each site: (1) first-generation all-soft suture anchor (Juggerknot; Biomet), (2) second-generation all-soft suture anchor (Suturefix; Smith & Nephew), and (3) a control PEEK anchor (Bioraptor; Smith & Nephew). After initial cyclic loading, load to 2 mm of displacement and ultimate load to failure were measured for each anchor.Results:After cyclic loading, the load to 2-mm displacement was significantly less in first-generation anchors compared with controls (P < .01). However, the load to 2-mm displacement was significantly greater in second-generation anchors compared with controls (P < .01). There was no difference in ultimate load to failure between the first- and second-generation all-soft suture anchors (P > .05).Conclusion:The newer generation all-soft suture anchors with a theoretically more rigid construct and deployment configuration demonstrate biomechanical characteristics (specifically, with load to 2-mm displacement after cyclic loading) that are improved over first-generation all-soft suture anchors and similar to a traditional solid tap-in anchor. The configuration of these newer generation all-soft suture anchors appears to mitigate the biomechanical concerns of decreased load to failure with first-generation all–soft tissue suture anchors.Clinical Relevance:The theoretical advantages of all-soft anchors may be particularly valuable in revision surgery or in cases where multiple anchors are being placed into a small anatomic area.

Biomechanical evaluation of the long head of the biceps brachii tendon fixed by three techniques: a sheep model

ObjectiveTo evaluate the biomechanical properties of the fixation of the long head of the biceps brachii into the humeral bone with suture anchors, interference screw, and soft tissue suture, comparing strength, highest traction load, and types of fixation failure. MethodsThirty fresh-frozen sheep shoulders were used, separated into three groups of ten for each technique. After fixation, the tendons were subjected to longitudinal continuous loading, obtaining load-to-failure (N) and displacement (mm). ResultsThe mean load-to-failure for suture anchors was 95±35.3N, 152.7±52.7N for interference screw, and 104.7±23.54N for soft tissue technique. There was a statistically significant difference (p<0.05), with interference screw demonstrating higher load-to-failure than suture anchor fixation (p=0.00307) and soft tissue (p=0.00473). The strength of interference screw was also superior when compared with the other two methods (p=0.0000127 and p=0.00000295, respectively). There were no differences between suture anchors and soft tissue technique regarding load-to-failure (p=0.9420) and strength (p=0.141). ConclusionTenodesis of the long head of the biceps brachii with interference screw was stronger than the suture anchors and soft tissue techniques. The other two techniques did not differ between themselves.

Avaliação biomecânica da fixação do tendão da cabeça longa do bíceps braquial por três técnicas: modelo em ovinos

ObjectiveTo evaluate the biomechanical properties of the fixation of the long head of the biceps brachii into the humeral bone with suture anchors, interference screw, and soft tissue suture, comparing strength, highest traction load, and types of fixation failure. MethodsThirty fresh‐frozen sheep shoulders were used, separated into three groups of ten for each technique. After fixation, the tendons were subjected to longitudinal continuous loading, obtaining load‐to‐failure (N) and displacement (mm). ResultsThe mean load‐to‐failure for suture anchors was 95±35.3N, 152.7±52.7N for interference screw, and 104.7±23.54N for soft tissue technique. There was a statistically significant difference (p<0.05), with interference screw demonstrating higher load‐to‐failure than suture anchor fixation (p=0.00307) and soft tissue (p=0.00473). The strength of interference screw was also superior when compared with the other two methods (p=0.0000127 and p=0.00000295, respectively). There were no differences between suture anchors and soft tissue technique regarding load–to‐failure (p=0.9420) and strength (p=0.141). ConclusionTenodesis of the long head of the biceps brachii with interference screw was stronger than the suture anchors and soft tissue techniques. The other two techniques did not differ between themselves.

Retrospective evaluation of 211 patients with maxillofacial reconstruction using parietal bone graft for implants insertion.

For a century, autologous bone grafts have been used in maxillofacial reconstruction. The ideal bone harvest site and grafting procedure remains a point of contention in regards to obtaining optimal long-term results with sufficient bone quantity and density without serious complications. More recently, confronted with growing patient requests and biomaterials development, maxillofacial surgeons and dentists have been considering these issues as they relate to pre-implant surgery. This study sought to evaluate implant success rate and complications following pre-implant surgery with parietal bone grafting. A retrospective study was carried out on patients who underwent maxillofacial reconstruction of different sites (symphysis, mandibular corpus, maxillary sinus and premaxilla) for the purpose of implant insertion. 311 procedures in 211 patients were included. The implant osseointegration rate was around 95%. Clinical follow-up ranged from 10 months to 11 years. A secondary procedure was performed in 6.1% of cases and we noted no serious complications at the harvest site. With good revascularization and osseointegration of the graft, the use of parietal bone leads to an implant success rate similar to that seen in the literature. Moreover, the use of this material results in few infections and low bone resorption provided there is strict immobilization of the graft and no tension on the soft tissue sutures. Parietal bone grafts technique possess the required qualities for the success of implant surgery, offering results at least as interesting as others using autogenous bone and with no serious complications on donor site.

Recent advances in biodegradable metals for medical sutures: a critical review.

Sutures that biodegrade and dissolve over a period of several weeks are in great demand to stitch wounds and surgical incisions. These new materials are receiving increased acceptance across surgical procedures whenever permanent sutures and long-term care are not needed. Unfortunately, both inflammatory responses and adverse local tissue reactions in the close-to-stitching environment are often reported for biodegradable polymeric sutures currently used by the medical community. While bioabsorbable metals are predominantly investigated and tested for vascular stent or osteosynthesis applications, they also appear to possess adequate bio-compatibility, mechanical properties, and corrosion stability to replace biodegradable polymeric sutures. In this Review, biodegradable alloys made of iron, magnesium, and zinc are critically evaluated as potential materials for the manufacturing of soft and hard tissue sutures. In the case of soft tissue closing and stitching, these metals have to compete against currently available degradable polymers. In the case of hard tissue closing and stitching, biodegradable sternal wires could replace the permanent sutures made of stainless steel or titanium alloys. This Review discusses the specific materials and degradation properties required by all suture materials, summarizes current suture testing protocols and provides a well-grounded direction for the potential future development of biodegradable metal based sutures.

1390 PROSPECTIVE, RANDOMIZED USE OF THE VLOC VESICOURETHRAL ANASTAMOSIS DURING ROBOT ASSISTED RADICAL PROSTATECTOMY: LONG-TERM FOLLOWUP

You have accessJournal of UrologyTechnology & Instruments: Robotics - Malignant Disease & Benign Disease II1 Apr 20121390 PROSPECTIVE, RANDOMIZED USE OF THE VLOC VESICOURETHRAL ANASTAMOSIS DURING ROBOT ASSISTED RADICAL PROSTATECTOMY: LONG-TERM FOLLOWUP Kevin Zorn, Quoc-Dien Trinh, Dan Liberman, and Assaad ElHakim Kevin ZornKevin Zorn Montreal, Canada More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh Montreal, Canada More articles by this author , Dan LibermanDan Liberman Montreal, Canada More articles by this author , and Assaad ElHakimAssaad ElHakim Montreal, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1839AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic vesicourethral anastomosis (VUA) using the Van Velthoven technique has significantly improved urinary reconstruction during RARP. Recent series suggest off-label use of barbed polyglyconate suture may facilitate VUA, however the long-term risk for stricture formation and impact on urinary continence is unknown. Compared to standard monofilament posterior reconstruction (PR) and VUA technique, we sought to evaluate the effectiveness of VLOC for urinary reconstruction with minimum 1 year followup. METHODS A prospective,randomized study was conducted in 120 consecutive RARP cases by a single-surgeon. Assurance of watertight closure was ensured with 300mL intraoperatively. Time to complete the suture setup, anastomosis time and need to adjust suture tension were recorded. Suture related complications, validated-questionnaire continence and a cost analysis were also analyzed. RESULTS Compared to our conventional reconstruction technique, there was a significant reduction in mean reconstruction time (14.1 vs 22.2 min; p < 0.01). Need to readjust suture tension or place additional LapraTy clips to establish a watertight closure was observed in 13 (22%) vs 5 (8%) of cases (p = 0.05). A cost reduction was also noted favouring the interlocked VLOC technique (48.05$ vs 70.25$CAN). Time to foley removal was comparable between groups(4.1 vs 4.2 days, p = 0.87). Need for catheter replacement was similar between groups (both 5%). With a mean followup of 18.2 months, no delayed clinical anastomotic leaks or bladder neck contractures were observed in either group. Padfree continence outcomes at 1 (64% vs 69%, p = 0.60), 3 (76% vs 81%, p = 0.54), 6 months (88% vs 92%, p = 0.67) and 12 months (90% vs 92%; p = 0.57), were also comparable. CONCLUSIONS Compared to standard monofilament suture, use of VLOC suture appears to provide a safe, more efficient and cost effective urinary reconstruction during RARP. Use of the interlocked-VLOC suture technique prevents slippage, precluding the need for assistance, knot tying, and constant reassessing of anastomosis integrity. More important, to the best of our knowledge, this is the longest followup with such soft-tissue suture material for urinary reconstruction. Despite initial concern for increased inflammation from delayed material absorption and suture barbs, no adverse outcomes are observed in long-term assessment. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e564 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Zorn Montreal, Canada More articles by this author Quoc-Dien Trinh Montreal, Canada More articles by this author Dan Liberman Montreal, Canada More articles by this author Assaad ElHakim Montreal, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

THE ROLE OF FIBRIN GLUE AND SUTURE ON THE FIXATION OF ULTRA FROZEN PRESERVED MENISCUS TRANSPLANTATION IN RABBITS

Objective: To evaluate the ability of fibrin adhesive in promoting the meniscus fixation within two, four and eight weeks compared to the conventional soft-tissue suture technique. Materials and Methods: 36 right medial menisci of rabbits preserved at negative 73° Celsius for 30 days were transplanted to animals of the same sample and fixed with soft-tissue suture or fibrin glue. After 2, 4 or 8 weeks, the appearance of the menisci and the quality of fixation were macroscopically checked and evaluated by a scoring system. The findings were subjected to the statistical study of variance analysis (p ≤ 0.05%). Results: The deep-frozen meniscus preservation maintained the integrity of the meniscus transplant, and, macroscopically, there was no significant reduction of the length of the meniscus in all post-transplant periods (p = 0.015). The menisci fixed with fibrin showed slight changes in color and surface roughness. There were no signs of rejection or infection in both groups. Suture fixation scoring was superior (p = 0.015) in all periods (80% of total fixation) as compared to the setting promoted by fibrin (20% of total fixation). Conclusion: The homologous transplantation of the meniscus of rabbits experienced various degrees of integration to the knee according to the fixation method; the surgical soft tissues suturing technique was shown to be superior in the evaluation of scores compared to the fixation with fibrin adhesive.

THE TREATMENT OF FRACTURE-SEPARATION OF THE CAPITULAR EPIPHYSIS

1. Seventeen children with fracture-separations of the capitular epiphysis are reviewed. 2. Soft-tissue suture was used in eleven and metallic fixation in six children. 3. There was one bad result because of faulty technique but all the other children obtained good results. 4. Soft-tissue suture was found to be a simple procedure with none of the complications of wire fixation.

Non-union of the epiphysis of the lateral condyle of the humerus.

1. Thirteen cases of non-union of the epiphysis of the lateral condyle of the humerus were studied. Ten followed minor lateral luxations of the epiphysis; three were sequelae of open reduction and soft-tissue suture of major displacements. 2. In three cases in which non-union developed while the patient was under observation, union was secured after bone grafting by a technique described.

Fracture-dislocation of the trochlea.

1. Two cases of fracture-dislocation of the trochlea are described. One case was complicated by complete ulnar nerve palsy. 2. The injury is caused by direct force applied to the point of the elbow, or it may be associated with posterior dislocation of the joint. 3. Open reduction is recommended, the fragment being held in position by soft-tissue sutures alone. 4. Four other cases mentioned in the literature are reviewed.