Suture Anchor Repair Techniques Research Articles

Clinical and Structural Results Following Arthroscopic and Open Repair of Isolated Subscapularis Tears.

Objective: With advances in techniques, arthroscopic repair of isolated subscapularis tendon tears has become increasingly popular in recent years. The aim of this study was to analyze the clinical and structural results of arthroscopic repair versus the gold standard of open repair. It is a prospective cohort study with a control group; evidence level III. Methods: In a prospective study performed at two centers, 18 patients with an isolated subscapularis tear were treated with arthroscopic repair (ARG) and 16 patients with open repair (ORG) using a uniform single-row suture anchor repair technique in both groups. The subscapularis function was assessed using specific clinical tests (belly-press and lift-off tests), strength testing and shoulder function with the use of the Constant-Murley score (CMS). Standardized magnetic resonance imaging (MRI) was used to evaluate the postoperative subscapularis muscle-tendon status. Results: At a minimum follow-up of 48 months, the CMS increased from a mean of 54 points preoperatively to a mean of 86 points postoperatively in the ARG (p < 0.01) and from 50 points to 85 points postoperatively in the ORG (p < 0.01). Specific subscapularis tests (belly-press test and lift-off test) were significantly improved from the preoperative to the postoperative status in both repair groups (p < 0.05). Despite a subscapularis tendon healing rate of over 90% on MRI scans in both repair groups, the incomplete correction of specific muscle tests was a frequent postoperative finding. Conclusions: Arthroscopic repair of isolated subscapularis tears achieved equivalent clinical and structural results compared to the gold standard of open repair.

A comparison of distal triceps tendon repair outcomes by surgical technique

Distal triceps tendon ruptures are an uncommon injury with several reported repair techniques. Outcomes research between the repair techniques is complicated by the rarity of the injury as most published materials are based on small sample sizes and specific surgical techniques. This study compared surgical complications, reoperations, and range of motion between all suture transosseous tunnel only (TT), suture anchor only (SA), and transosseous tunnel plus suture anchor (TTSA) repair techniques. We retrospectively identified patients who underwent a distal triceps repair at our tertiary-care institution from 2011 to 2021. The electronic medical record was reviewed for patient demographics, triceps rupture characteristics, repair technique, and postoperative complications. This study includes 199 patients who underwent a repair by TT (82), SA (69), or TTSA (48) techniques. No differences were identified between groups with regards to demographics and medical comorbidities. Patients treated by SA technique were more likely to have a loss of elbow extension (SA: 14 [26.4%], TT: 6 [8.57%], TTSA: 4 [10.0%], P= .014) postoperatively with an average loss of 9° for the patients in all groups. However, no differences were identified between the groups with regards to postoperative complications (TT: 15.9%, SA: 17.4%, TTSA: 18.8%, P= .911), including triceps rerupture (TT: 6.10%, SA: 4.35%, TTSA: 12.5%, P= .260), and reoperation (TT: 11.0%, SA: 11.6%, TTSA: 14.6%, P= .822) rates. Regardless of repair technique, distal triceps tendon repair surgery has a relatively high complication and reoperation rate. However, given the similarities between the various methods of repair, surgeons can be confident in repairing this type of injury by whichever modality they deem appropriate.

Biomechanical Comparison of Four- versus Six-Strand Transosseous Suture Repair for Patellar Tendon Rupture.

Surgical repair is indicated for patellar tendon ruptures that result in loss of knee extensor mechanism function. However, biomechanical studies report conflicting results when comparing transosseous suture versus suture anchor repair techniques. This discrepancy may be due to inconsistencies in experimental design as these studies use various numbers of suture strands. Therefore, the main objective of this study is to compare the ultimate load of four- versus six-strand transosseous suture repair. Secondary objectives are to compare gap formation after cyclical loading and mode of failure. Six pairs of fresh-frozen cadaveric specimen were randomly allocated to either four- or six-strand transosseous suture repair. Specimen underwent preconditioning cyclical loading and then load to failure. The six-strand repair had a significantly higher maximum load to failure compared with the four-strand repair (mean difference = 319.3 N [57.9%], p = 0.03). There was no significant difference in gap length after cyclical loading or at max load. There were no significant differences in mode of failure. Utilizing a six-stand transosseous patella tendon repair construct with one additional suture increases overall construct strength by over 50% compared with a four-strand construct.

A suture anchor-based repair technique for type IV jersey finger injuries: a biomechanical investigation

The aim of this biomechanical investigation was to evaluate a repair technique for type IV FDP tendon avulsions using a suture anchor, addressing the bony and the tendinous aspect of this injury simultaneously. In 45 distal phalanges from human anatomical specimens the injury was simulated and repairs were performed with a suture anchor using an innovative technique, interosseous sutures and a combination of screws and an interosseous suture. Repetitive loading for 500 cycles simulated postoperative mobilization. Repairs were loaded to failure thereafter. Elongation of the tendon-suture complex, gap formation at the bone-bone contact line and at the bone-tendon insertion line, load at first noteworthy displacement (2 mm), load at failure and the mechanism of failure were assessed. The suture anchor technique was superior biomechanically considering load at failure (mean: 72.8 N), bony gap formation (mean: 0.1 mm) as well as tendinous gap formation (mean: 0.7 mm), implying a preferable stability of the repair. Overall, this study demonstrates good ex vivo mechanical stability for a proposed suture anchor repair technique for type IV FDP tendon avulsion injuries, which might enable early postoperative mobilization in patients. The technique's subcutaneous implant placement and low implant load are expected to reduce potential complications observed in other commonly used repair techniques. This approach warrants further evaluation in vivo.

Application of suture anchors for a clinically relevant rat model of rotator cuff tear.

Current rat model of rotator cuff (RC) tear could not mimic the suture anchor (SA) repair technique in the clinical practice. We designed a novel SA for RC repair of rats to establish a clinically relevant animal model. Small suture anchors that fit the rat shoulder were assembled. 60 rats were assigned to the transosseous (TO) repair group or SA repair group (n = 30/group). Micro‐computed tomography (Micro‐CT) scanning, biomechanical test and histological analysis were implemented at 2, 4, and 8‐week post‐repair. The failure load and stiffness in the SA group were significantly higher than those of TO group at 4‐week post‐repair. Micro‐computed tomography analysis showed the bone mineral density and trabecular thickness of the SA group were significantly lower than those of TO group. The SA group showed a better insertion continuity at 4‐week post‐repair compared to TO group. No significant difference in gait parameters was found between groups. Therefore, SA repair is applicable for the rat model of RC tears. The SA repair achieved superior RC tendon healing, but more extensive initial bone damage compared to TO repair, while the shoulder function was comparable. This model could replicate the current repair technique in the clinical situation and be considered for future preclinical studies on healing enhancement for RC tears. Statement of Clinical Significance: With high clinical relevance, this model may facilitate the translation from an animal study into clinical trials.

Concomitant Use of Single Suture Anchor and Transosseus Repair Provide Optimal Results in Simultaneous Bilateral Quadriceps Tendon Rupture: A Case Report

Introduction&#x0D; Bilateral quadriceps tendon rupture is a rare condition and often associated with underlying medical comorbidities such as chronic renal insufficiency. This case report is aimed to evaluate the surgical outcome using the combination of suture anchor and transosseus repair technique.&#x0D; &#x0D; Presentation of Case&#x0D; Presenting a 54-year-old male who sustained simultaneous bilateral quadriceps tendon rupture with history of right nephrectomy and chronic kidney disease requiring intermittent hemodialysis. He came with sudden bilateral knee pain, history of falling, and inability to walk since three weeks before admission to the hospital. Tenderness above the superior pole on both patella, accompanied with slight swelling and no active range of motion (ROM) of either knee joint was found on physical examination. Complete rupture of the quadriceps tendon of both knees at their osseus-tendon junction were revealed on magnetic resonance imaging (MRI).&#x0D; &#x0D; Discussion&#x0D; Recent literatures suggested that transosseus technique offers the safest and more stable tendon reattachment, while suture anchor provides biomechanical superiority. We tried to combine these advantages by incorporating both methods. Progressive active knee motion exercise was performed shortly after using the Kocher slab for 2 weeks.Subsequently, the patient can achieve painless, active extension and active 90°-120° knee flexion 1 month post-operatively.&#x0D; &#x0D; Conclusion&#x0D; The application of a single suture anchor with transosseus repair in quadriceps tendon rupture led to an optimal outcome, improved stability, and earlier rehabilitation.

Suture Anchor Repair of a Combined Tear of the Proximal Iliotibial Band and Tensor Fascia Lata

A combined tear of the proximal iliotibial band and tensor fascia lata is an uncommon injury, and currently, the body of literature on the topic is limited. The suture anchor repair technique described in this article allows anatomic restoration of the proximal iliotibial band and tensor fascia lata.

Does the immediate repair of Bankart lesion following first dislocation reduce the chances of recurrence after arthroscopic repair in soldiers?

The study attempted to compare the effects of immediate and delayed arthroscopic Bankart repair on the shoulder dislocation recurrence. In total, 465 soldiers with first-time anterior shoulder dislocation were included in the study. Of the total, 285 soldiers underwent a quick arthroscopic Bankart repair procedure, whether 180 soldiers underwent a delayed repair procedure. The initial dislocation was traumatic in both groups and operated using the standard arthroscopic suture anchor repair technique. Patient's age, repair time since the first dislocation, number of dislocations before surgery, number of suture anchors used during the repair, duration of surgical procedure, duration from surgery to return to work, and recurrence of dislocation after surgery were recorded. Rowe score, Constant score, and American Shoulder and Elbow Surgeons score were used for clinical assessment. The operating time and recurrence rate were higher in the group subjected to delayed repair procedure than in the group subjected to immediate repair procedure. Repair timing was found to be crucial for a successful outcome. The findings suggest that Bankart repair must be performed immediately to minimize recurrence and other degenerative changes, which may require an additional surgical procedure for satisfactory repair. More studies are required to reach a definitive conclusion. Level III.

H-Plasty Repair Technique Improved Tibiofemoral Contact Mechanics After Repair for Adjacent Radial Tears of Posterior Lateral Meniscus Root: A Biomechanical Study

To compare the time-zero tibiofemoral contact mechanics among the 4 different suturing repairs: transtibial pullout suture repair, suture anchor repair, side-to-side repair, and H-plasty repair. Twenty-four human cadaveric knees were included. Each lateral meniscus condition (intact, radial tear, and repair) was tested under a 1000-N axial compressive load at 0°, 30°, 60°, and 90° of flexion. Four different repair techniques, transtibial pullout, suture anchor, side-to-side, and H-plasty repair technique, were tested. Tibiofemoral mean and peak contact pressure and contact area in the lateral and medial compartments were measured by Tekscan sensors. Radial tears adjacent to the posterior lateral meniscus root produced significantly decreased contact area and increased mean and peak contact pressures in the lateral compartment across all angles (P < .05). All repair groups could improve the contact mechanics relative to the torn condition (P < .05), but only H-plasty repair showed no significant difference in the mean and peak contact pressure and contact area compared with that of the intact state at all flexion angles (P > .05). The results showed that the tibiofemoral contact mechanics after adjacent radial tears of the posterior lateral meniscal root were improved to the intact level by H-plasty repair at time-zero. The additional vertical mattress sutures act as "stabilizers" to provide a more stable environment in distributing vertical tibiofemoral pressure. The other 3 repair techniques also significantly improved lateral tibiofemoral contact mechanics relative to the corresponding tear conditions. The results of this study suggest that H-plasty repair can restore the biomechanical properties to the intact state. Since it was a time-zero cadaveric study, the results should be carefully used in clinical practices.

Proximal Adductor Avulsion: A Biomechanical Comparison of Suture Anchor Repair Techniques

Objectives:Acute avulsion of the proximal fibrocartilaginous origin of the adductor longus (AL) is an injury mostly occurring in individuals that perform cutting and rapid lateral movements such as in hockey, soccer, and rugby. Especially in competitive athletes, recent trends have advocated for surgical repair of these acute injuries. However, while multiple repair configurations have been proposed, the current literature lacks biomechanical data to guide surgical technique. Therefore, the purpose of this study was to determine load-to-failure values for two proximal adductor repair techniques and to compare their strength to that of a native, uninjured proximal adductor tendon.Methods:Seventeen cadaveric fresh frozen pelvic specimens were dissected to preserve the proximal adductor tendon and the fibrocartilage attachment to the pubis. The specimens were then divided into three groups: an intact AL tendon(baseline control), and ‘torn’ tendons repaired with either a 2-suture anchor or 4-suture anchor technique. Once repaired, specimens were cyclically loaded on a custom jig to simulate a maximal effort soccer-style kick. Testing endpoints included suture anchor pull-out, loss of clamp fixation, or catastrophic tendon failure. To control for individual differences, values were reported both in terms of gross force and as load-to-displacement ratios. Following collection, data from each of the three groups were recorded and analyzed via Kruskal-Wallis and multiple comparison tests.Results:The mean load to failure for the 4-anchor group was 83.74±19.28 N, which was significantly greater than for either the intact (25.43±3.46 N, p <0.05) or 2-anchor repair (20.58±1.33 N, p <0.001) conditions. All intact and 4-anchor repair specimens failed via disruption distal to the adductor’s musculotendinous junction, with no failure at the bone-anchor interface noted in either of these groups. In contrast, 80% of 2-anchor repairs failed at the bone to anchor interface. In this group, following initial pullout, failure of a secondary anchor occurred with 41.4% less force than for the index failure (p < 0.001).Conclusion:This study provides biomechanical data which identifies a 4-anchor repair as being much more resistant to surgical-site failure than a 2-anchor construct. Further, the 4-anchor group failed at the same anatomic location as the intact adductor group, suggesting that a 4-anchor construct results in a repair that acts similar to an uninjured control. Based on this finding, a 4-anchor repair construct should be preferentially used in proximal adductor repair whenever clinically feasible.Figure:Images of Adductor Dissection. A) Complete view of pubic symphysis with instrument at midline. B) Red line demonstrating transection of midline to demonstrate bilateral AL insertions. C) Detachment of the proximal adductor longus (yellow star) from its origin along the pubic body.Figure:Adductor Longus Experimental Design prior loading test A) Loaded adductor specimen in materials testing apparatus. B) Close up of two anchor adductor repair within potting medium

Gait analysis and body composition after treatment of quadriceps tendon ruptures showed equal results independent of suture anchor or transosseus repair technique used: a pilot study

Purpose: Suture anchor repair is a fairly new surgical technique for quadriceps tendon ruptures. It is supposed to be superior to the standard transosseus sutures because of biomechanical superiority and – due to a less invasive surgery – earlier rehabilitation onset. This study focused on analyzing functionality of the quadriceps muscle during gait as well as body composition between a suture anchor and a transosseus suture repair group and is the first study that undertook systematic gait analyses in this patient population. Materials and methods: Seventeen patients who underwent either suture anchor (9 subjects) or transosseus suture repair surgery (8 subjects) at two different trauma surgery centers between 2010 and 2015 were included. Gait analysis was performed with a three dimensional motion capture system (Vicon) and body composition was assessed with bioelectrical impedance analysis (Nutribox). Parametrical statistical analyses were conducted using independent t-tests. Results: No statistically significant differences were found in any outcome parameter of gait analysis or body composition measurement. Conclusion: Suture anchor repair shows equal results to transosseus suture repair technique regarding gait quality and body composition. Implications for rehabilitation In a long term follow-up suture anchor repair shows similar results to the transosseus suture technique regarding body composition and musculus quadriceps function in gait. Without the implementation of an appropriate rehabilitation protocol incorporating the earlier load-carrying capacity, early biomechanical advantages of suture anchor technique over transosseus sutures might vanish over time. The decision which surgery technique might be best for the individual patient, should not be based on the expectation that suture anchor repair alone without considering appropriate rehabilitation would lead to long term functional advantages over transosseus suture technique.

Distal Biceps Tendon Repair: Suture Anchor Technique

In active patients, acute ruptures of the distal biceps tendon are best treated by primary repair due to a loss of strength with conservative management. Various techniques have been reported with good clinical outcomes. The single-incision suture anchor repair technique demonstrates clinical results comparable with other fixation methods and low complication rates. The surgical technique is described in detail in this chapter.

Targeted suture anchor repair technique for deltoid ligament rupture

Objective To summarize the characteristics of deltoid ligament rupture and explore the feasibility and short-term clinical outcomes of targeted suture anchor repair technique according to the rupture site. Methods From May 2011 to October 2014, 19 cases of complete deltoid ligament rupture (17 males and 2 females) were recruited in this study, with an average age of 34.15±1.23 years (ranged from 15 to 60 years). According to Lauge-Hansen classification, there were 7 cases of pronation external rotation grade IV injury, including 3 cases of Maisonnuve fracture; 1 case of pronation abduction type III degree injury, 1 case of pronation abduction grade IV injury; and 10 cases of supination external rotation grade IV injury. According to AO/OTA classification, there were 9 cases of 43B type injury and 10 cases of 43C type injury. According to the rupture site of deltoid ligament, the targeted suture anchor repair surgery was operated respectively. Early mobilization with the help of hinged ankle brace was encouraged. The evaluation at last follow-up was based on the American Orthopedic and Ankle Association (AOFAS) criteria of ankle and hindfoot, and the visual analogue scale (VAS) scoring system. Results Nineteen patients were all followed up for 24 to 48 months, with an average of 30.42±5.11 months. Fourteen cases (73.7%, 14/19) with talus end avulsion were treated by double suture anchor in the talus, with continuous locking suture of the avulsed end. Four cases (21.1%, 4/19) with middle part rupture were treated by double suture anchor in the talus, with the sutures crossing three bone tunnels at the medial malleolus. One case (5.3%, 1/19) with medial malleolus end avulsion was treated by single suture anchor at the medial malleolus, with continuous locking suture of the avulsed end. At the last follow-up, the AOFAS score was ranged from 70 points to 96 points, with an average of 90.53 points, and excellent in 16 cases, good in 2 cases, fair in 1 case, excellent and good rate was 94.7%. The VAS score was ranged from 0 to 2 points, with an average of 0.42 point. No wide medical clear space was detected. But traumatic arthritis was happened in 2 patients. Conclusion The targeted suture anchor repair technique according to the rupture site was a save technique in treating deltoid ligament rupture, which is conducive to early postoperative functional exercise, with excellent short-term clinical outcomes and few complications. Key words: Ligaments; Ankle joint; Wounds and injuries; Suture anchors

Arthroscopic Intramuscular Side-to-Side Repair of an Isolated Infraspinatus Tear

Intramuscular, full-thickness rotator cuff tears are uncommon and present a challenging clinical scenario for repair because traditional suture anchor or transosseous repair techniques are less feasible. The goal of repair is to achieve a tension-free reduction of both ends of the muscle to allow for adequate healing over time. Intramuscular tears of the infraspinatus specifically have rarely been reported. The clinical presentation of these patients can be challenging to interpret, and other causes of rotator cuff dysfunction, including compression to the suprascapular nerve, must be ruled out. In this Technical Note, we describe our technique for arthroscopic side-to-side suture repair of an isolated intramuscular infraspinatus tear.

Pectoralis Major Repair With Unicortical Button Fixation And Suture Tape

Although injuries of the pectoralis major muscle are generally uncommon, ruptures of the pectoralis major are occasionally seen in younger, more active patients who participate in weightlifting activities. These injuries usually occur during maximal contraction of the muscle, while in extension and external rotation. In the case of a rupture, operative treatment is advocated especially in young, active patients regardless of the chronicity of the injury. Various surgical techniques for reattachment of the avulsed tendon have been described, but bone tunnel and suture anchor repair techniques are most widely used. In this Technical Note, we present our preferred technique for acute pectoralis major rupture repair involving use of cortical buttons for tendon stump-to-bone fixation.

Knotless Suture Anchor With Suture Tape Quadriceps Tendon Repair Is Biomechanically Superior to Transosseous and Traditional Suture Anchor–Based Repairs in a Cadaveric Model

To compare the biomechanical properties of a knotless suture anchor with suture tape quadriceps tendon repair technique with transosseous and suture anchor repair techniques. Twenty matched pairs of cadaveric knees underwent a quadriceps tendon avulsion followed by repair via the use of transosseous tunnels with #2 high-strength sutures, 5.5-mm biocomposite fully threaded suture anchors with #2 high-strength sutures, or 4.75-mm biocomposite knotless suture anchors with suture tape. Ten knees were repaired via transosseous repair and 10 via fully threaded suture anchor repair, and their matched specimens were repaired with suture tape and knotless anchors. Biomechanical analysis included displacement during cyclic loading over 250 cycles, construct stiffness, ultimate load to failure, and failure mode analysis. Compared with transosseous repairs, quadriceps tendons repaired with knotless suture tape demonstrated significantly less displacement during cyclic loading (cycles 1-20 3.6 ± 1.3 vs 6.3 ± 1.9mm, P= .003; cycles 20-250 2.0 ± 0.4 vs 3.1 ± 0.9mm, P= .011), improved construct stiffness (67 ± 25 vs 26 ± 12N/mm, P= .001), and greater ultimate load to failure (616 ± 149 vs 413 ± 107N, P= .004). Our repair technique also demonstrated improved biomechanical parameters compared with fully threaded suture anchor repair in initial displacement during cyclic loading (cycles 1-20 3.0 ± 0.8 vs 5.1 ± 0.9mm, P < .001), construct stiffness (62 ± 20 vs 28 ± 10N/mm, P= .001) and ultimate load to failure (579 ± 129 vs 399 ± 87N, P= .006). Repair of quadriceps tendon ruptures with this knotless suture anchor with suture tape repair technique is biomechanically superior in cyclic displacement, construct stiffness, and ultimate load to failure compared with transosseous and fully threaded suture anchor techniques in cadaveric specimens. The demonstration that our repair technique is biomechanically superior to previously described techniques in a cadaveric setting suggests that consideration should be given to this technique.

Biomechanical evaluation of different surgical techniques for treating patellar tendon ruptures

The aim of this study was to biomechanically assess patellar tendon repair techniques with additional cable wire or polydioxanone suture (PDS) cord augmentation in comparison with a suture-anchor repair technique. Patellar tendon repair was performed in 60 specimens using a porcine bone model. Yield load, maximum load, stiffness and elongation of patellar tendon reconstructions with (1) cable wire augmentation, (2) PDS cord augmentation or (3) suture anchor repair were evaluated using a cyclic loading and load-to-failure test setup. In comparison with suture anchor repair, augmentation of the reconstruction with either cable wires or PDS cords provides significantly higher maximum loads (527 and 460N vs. 301N; p < 0.01 and p = 0,012, respectively) under load-to-failure testing and less elongation (8.81mm ± 1.55mm and 10.56mm ± 3.1mm vs. 18.38mm ± 7.51mm; p = 0.037 and p = 0.033, respectively) under cyclic loading conditions. Augmentation of a patellar tendon repair with either a cable wire or a PDS cord provides higher primary stability than suture anchor repair in patellar tendon ruptures. The study supports the use of additional augmentation of a tendon repair in the clinical setting in order to prevent loss of reduction and allow for early post-operative mobilisation.

Three‐point suture anchor repair of traumatic sternoclavicular joint dislocation

Traumatic dislocation of the sternoclavicular joint (SCJ) is a rare injury. Previous techniques are associated with hardware migration, loss of reduction and infectious complications. We aim to describe our preferred surgical technique and summarize our experience with three-point suture technique of acute SCJ dislocation (SCJD). The objective of this study was to describe and assess the safety of three-point suture anchor repair technique in acute traumatic dislocation in the SCJ. A 7-year retrospective study in a university affiliated level 1 trauma centre. Operative cases and the trauma registry was reviewed to identify all potential cases of SCJD between 2005 and 2011. Inclusion criteria for this study were computed tomography (CT) identification of Allman III SCJD, intra-operative confirmation of the CT findings, acute fixation defined as <7 days and surgical management with three-point suture anchor technique. Chronic cases, suspected SCJDs without CT confirmation, physeal injuries and other surgical techniques were excluded. Eight patients met inclusion criteria. The patients were aged 16-46 years (mean age 24 years). Two primary surgeons were involved and time to surgery ranging from day of presentation to day 6 post injury. No loss to follow-up with clinical examinations and imaging being attended at 2 and 6 weeks, and 3 months. Average follow-up was 10.75 ± 5.30 months (3-18 months). All patients had uncomplicated post-operative course, with no evidence of respiratory compromise, swallowing difficulties during admission. In outpatient documentation there was no failure of hardware and no issues documented with regards to chronic pain or range of movement limitations secondary to pain. There have been no representations because of complications out to 6 years. This series supports the safety of the three-point suture anchor technique in the acute stabilization of SCJD. The technique is demonstrated as a safe, effective and reproducible method of SCJ fixation.

Biomechanical Comparison Between Suture Anchor and Transtibial Pull-out Repair for Posterior Medial Meniscus Root Tears

Background: Posterior medial meniscus root (PMMR) tears have a serious effect on knee joint biomechanics. Currently used techniques for refixation of the PMMR include the transtibial pull-out repair (TP) and suture anchor repair (SA). These techniques have not been compared biomechanically. Hypothesis: The SA technique provides superior biomechanical properties compared with the TP technique. Study Design: Controlled laboratory study. Methods: A total of 24 fresh-frozen porcine tibiae with attached intact medial menisci were used. The specimens were randomly assigned to 3 groups (8 specimens each). A standardized PMMR tear was created in 16 specimens. Refixation of the PMMR was performed by either the TP or SA technique. The native PMMR was left intact in 8 specimens. All specimens were subjected to cyclic loading followed by load-to-failure testing. Displacement after 100, 500, and 1000 cycles; maximum load to failure; stiffness; and displacement at failure were recorded. Results: Both repair techniques showed a significantly higher displacement during cyclic loading and a significantly lower maximum load and stiffness during load-to-failure testing compared with the native PMMR (P < .05). The SA technique showed a significantly lower displacement after 100, 500, and 1000 cycles (P < .001) and a significantly higher stiffness (P = .016) compared with the TP technique. Maximum load did not differ significantly between the SA and TP techniques (P = .027, Bonferroni adjustment). No significant difference between the 3 groups was observed for displacement at failure (P > .05). Conclusion: The SA technique provided superior biomechanical properties compared with the TP technique. Both repair techniques did not reach the strength of the native PMMR. Clinical Relevance: The favorable biomechanical properties of the SA technique might be beneficial for healing of the repaired PMMR and restoration of meniscus function. Because of inferior time zero stability compared with the native PMMR, slow rehabilitation is recommended after meniscus root repair.

Comparison of an All-Inside Suture Technique With Traditional Pull-Out Suture and Suture Anchor Repair Techniques for Flexor Digitorum Profundus Attachment to Bone

One goal in repairing zone 1 flexor digitorum profundus (FDP) injuries is to create a tendon-bone construct strong enough to allow early rehabilitation while minimizing morbidity. This study compares an all-inside suture repair technique biomechanically with pull-out suture and double-suture anchor repairs. Repairs were performed on 30 cadaver fingers. In all-inside suture repairs (n = 8), the FDP tendon was attached to bone with two 3-0 Ethibond sutures and tied over the dorsal aspect of distal phalanx. Pull-out suture repairs (n = 8) were performed with 2-0 Prolene suture and tied over a dorsal button. There were 2 suture anchor repair groups: Arthrex Micro Corkscrew anchors preloaded with 2-0 FiberWire suture (n = 7) and Depuy Micro Mitek anchors preloaded with 3-0 Orthocord suture (n = 7). Repair constructs were tested using a servohydraulic materials testing system and loaded until the repair lost 75% of its strength. There were no statistically significant differences in tensile stiffness, ultimate load, or work to failure between the repairs. Failure mode was suture stretch and gap formation greater than 2 mm at the repair site for all pull-out suture repairs and for 7 of 8 all-inside suture repairs. Two of the Arthrex Micro Corkscrew repairs and 5 of the Depuy Micro Mitek repairs failed by anchor pull-out. This cadaveric biomechanical study showed no difference in tensile stiffness, ultimate load, and work to failures between an all-inside suture repair technique for zone 1 FDP repairs and previously described pull-out suture and suture anchor repair techniques. The all-inside suture technique also has the advantages of avoiding an external button and the cost of anchors. Therefore, it should be considered as an alternative to other techniques. This study introduces a new FDP reattachment technique that avoids some of the shortcomings of current techniques.