Suture Anchor System Research Articles

Treatment of Achilles insertional tendinopathy: our surgical procedure and medium-term results.

Achilles insertional tendinopathy (AIT) is a common injury and its pathogenesis is still not entirely clear. It manifests with worsening pain and functional limitations. When conservative treatment fails, surgical treatment is indicated. The purpose of our research is to evaluate the outcome after one year in patients affected by AIT (calcific and non-calcific AIT) who were treated at our centre. Between 2014 and 2021, 42 patients suffering from AIT - a total of 47 feet - underwent surgery at our centre. The patients filled in the VISA-A and AOFAS questionnaires at the pre-operative consultation and at the clinical check-up after one year of follow up. Of the 47 feet treated, 28 were calcific AITs treated by medial access and tendon reinsertion using a knotless double suture anchor system (Achilles Suture Bridge™) and 19 were non-calcific tendinopathies treated using a lateral paratendinous approach. The one-year clinical results show an increase in VISA-A scores of 48.6 and AOFAS scores of 44.1 and the absence of complications. Only one patient reported a recurrence of certain symptoms and none of the patients were hospitalized for recurrence. The literature is unable to establish a gold standard of treatment for AIT. The method we have used has shown excellent short- and medium-term results without any complications. Further studies are needed to prove its effectiveness in the long term.

Biomechanical properties of a suture anchor system from human allogenic mineralized cortical bone matrix for rotator cuff repair

BackgroundSuture anchors (SAs) made of human allogenic mineralized cortical bone matrix are among the newest developments in orthopaedic and trauma surgery. Biomechanical properties of an allogenic mineralized suture anchor (AMSA) are not investigated until now. The primary objective was the biomechanical investigation of AMSA and comparing it to a metallic suture anchor (MSA) and a bioabsorbable suture anchor (BSA) placed at the greater tuberosity of the humeral head of cadaver humeri. Additionally, we assessed the biomechanical properties of the SAs with bone microarchitecture parameters.MethodsFirst, bone microarchitecture of 12 fresh frozen human cadaver humeri from six donors was analyzed by high-resolution peripheral quantitative computed tomography. In total, 18 AMSAs, 9 MSAs, and 9 BSAs were implanted at a 60° angle. All three SA systems were systematically implanted alternating in three positions within the greater tuberosity (position 1: anterior, position 2: central, position 3: posterior) with a distance of 15 mm to each other. Biomechanical load to failure was measured in a uniaxial direction at 135°.ResultsMean age of all specimens was 53.6 ± 9.1 years. For all bone microarchitecture measurements, linear regression slope estimates were negative which implies decreasing values with increasing age of specimens. Positioning of all three SA systems at the greater tuberosity was equally distributed (p = 0.827). Mean load to failure rates were higher for AMSA compared to MSA and BSA without reaching statistical significance between the groups (p = 0.427). Anchor displacement was comparable for all three SA systems, while there were significant differences regarding failure mode between all three SA systems (p < 0.001). Maximum load to failure was reached in all cases for AMSA, in 44.4% for MSA, and in 55.6% for BSA. Suture tear was observed in 55.6% for MSA and in 22.2% for BSA. Anchor breakage was solely seen for BSA (22.2%). No correlations were observed between bone microarchitecture parameters and load to failure rates of all three suture anchor systems.ConclusionsThe AMSA showed promising biomechanical properties for initial fixation strength for RCR. Since reduced BMD is an important issue for patients with chronic rotator cuff lesions, the AMSA is an interesting alternative to MSA and BSA. Also, the AMSA could improve healing of the enthesis.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12891-022-05371-0.

Does Proximal Hamate Graft for Proximal Scaphoid Reconstruction Restore Native Wrist Kinematics?

The objective of this study was to determine whether reconstruction of the proximal pole of the scaphoid with a proximal hamate graft restores native carpal kinematics. A cadaveric study was designed assessing wrist kinematic after proximal hamate graft for proximal pole of the scaphoid nonunion. Wireless sensors were mounted to the carpus using a custom pin and suture anchor system to 8 cadavers. A wrist simulator was used to move the wrist through a cyclical motion about the flexion/extension and radial/ulnar deviation axes. Each specimen was tested under a series of 3 conditions: (1) a native state, "Intact"; (2) fractured scaphoid proximal pole, "Fracture"; and (3) post-reconstruction of the proximal pole of the scaphoid using a proximal hamate graft, "Graft." The fracture condition resulted in a statistically significant change in scapholunate kinematics across the entire arc of motion relative to the intact condition. Reconstruction with proximal hamate grafts restored scapholunate kinematics close to the intact state in both flexion/extension and radial/ulnar deviation axes. The lunocapitate flexion during wrist flexion was significantly different after the hamate graft reconstruction. Proximal hamate to scaphoid transfer resulted in restoration of near normal carpal kinematics to the intact state.

The Safety and Efficacy of Biceps Tenodesis Performed using a Novel Suture Anchor

Introduction: Biceps tendon degeneration or tearing is a significant cause of shoulder discomfort and dysfunction. Biceps tenodesis is commonly performed to treat symptomatic biceps tendon pathology. A variety of fixation techniques can be used including screw fixation, endobutton, or suture anchor techniques. This study examines the patient outcomes when the FOOTPRINT™ Ultra suture anchor system is used for biceps tenodesis. Materials and Methods: Retrospective review of consecutive patients undergoing biceps tenodesis was conducted. All patients underwent biceps tenodesis using the FOOTPRINT™ Ultra suture anchor. The primary endpoint was any device-related complication during the intraoperative or postoperative period. Descriptive and inferential statistics were performed to assess patient characteristics and outcomes. Results: Twenty-nine patients were included in this study; 20 (69.0%) underwent arthroscopic biceps tenodesis and the remainder underwent open surgery. The mean follow-up time was 8.51 ± 5.28 months postoperatively. One patient experienced a postoperative infection within the first 30 days requiring a return to the operating room. Two patients experienced a complication within the first 6 months postoperatively. No patients experienced a device-related complication. No patients experienced a retear of their biceps tendon; two patients experienced a retear to their rotator cuff repair. The mean pain Numeric Rating Scale improved from 5.88 ± 2.58 on a scale of 0–10 preoperatively to 1.94 ± 2.32 postoperatively (P &lt; 0.001). Conclusion: The FOOTPRINT™ Ultra suture anchor appears to be safe for the use in patients undergoing arthroscopic or open biceps tenodesis.

Clinical Safety and Outcomes of a Novel Ultrasound Assisted Bioabsorbable Suture Anchor in Foot and Ankle Surgeries

Category:SportsIntroduction/Purpose:Bioabsorbable suture anchors have been popularized due to potential for osseous integration, less interference with diagnostic imaging, and ease of use. Recently, ultrasound assisted suture anchor systems have been introduced with the benefits of obtaining interdigitation with cancellous bone while maintaining a minimal footprint. In a cadaveric study, ultrasound assisted suture anchors demonstrated a similar pullout strength and less system displacement when compared to a benchmark bioabsorbable anchor system. However, the failure and complication rates of ultrasound assisted bioabsorbable anchors has never been demonstrated in a clinical setting. We studied the Stryker SonicAnchor by examining complication rates in foot and ankle procedures and secondarily determined the efficacy by evaluating clinical outcomes of surgeries using this anchor system.Methods:A retrospective analysis was performed on all patients treated by the primary investigator using the Stryker SutureAnchor between the dates of May 2016 and February 2018. We included all patients for which the anchor was used during surgery with at least 2 year followup including VAS and FAOS scores. We recorded baseline demographic information as well as the type of surgery patients underwent. We recorded all intraoperative and postoperative complications for these surgeries. In addition, we compared preoperative and postoperative clinical scores.Results:57 patients met inclusion criteria. On average, patients were 53 years old at the time of surgery. Mean followup was 32.8 months. Mean BMI was 30.36. Three patients reported current tobacco use (5.3%), four patients (7.0%) had type II diabetes mellitus at the time of their surgery, and only one patient (1.8%) had osteoporosis. Common procedures were Achilles repair including Haglund’s resection, peroneal surgery, and lateral ligament reconstruction. There were two deep infections requiring reoperation, one medial malleolus stress fracture following total ankle replacement, one metatarsal stress fracture not involving the surgery site, and one DVT. No reports of anchor pullout or soft tissue repair failure. VAS and FAOS scores improved from 6.2 to 1.2 and 54.3 to 93.9.Conclusion:In our review of 57 patients operated on with the SonicAnchor with at least two year followup, there were zero cases of complications stemming from the anchor including anchor pullout or soft tissue repair failure. Overall, patients improved tremendously in their clinical outcome scores across a wide range of different procedures. Previous studies have demonstrated the biomechanical strength of the SonicAnchor and our review supports its clinical safety and efficacy in long-term clinical followup.

Suture anchor fixation may be an alternative to tension band wiring in olecranon fractures: Finite element analysis.

Objectives This study aims to analyze and compare total deformations with tension band wiring (TBW), intramedullary screw (IS) and novel suture anchor (SA) fixation methods, and to investigate practicality of SA fixation in olecranon fractures using finite element analysis (FEA).Materials and methods This finite element analysis study was conducted between May 2019 and October 2019. TBW, IS and SA fixation methods were compared in order to analyze fracture behavior in the ulna and humerus using FEA, which is among the mathematical methods of stress analysis. Boundary conditions were applied to the created model and total deformation amounts were compared among the methods in terms of displacement.Results The lowest amount of displacement was obtained with TBW method (1.2095 mm), while IS method (2.7703 mm) showed the highest amount of total displacement. Total displacement was lower with SA system (2.0397 mm) compared to IS fixation. In addition, no problem was observed with SA system in terms of failure occurrence.ConclusionAccording to the results of FEA, although the lowest amount of displacement was obtained with TBW, it is concluded that anchor fixation method may be an alternative with practicality and mechanical properties. However, further studies are needed to obtain more precise data.

Clinical Safety and Efficacy of a Novel Ultrasound-Assisted Bioabsorbable Suture Anchor in Foot and Ankle Surgeries.

Suture anchors have been used for soft tissue repair in orthopedic surgery for decades. Recently, bioabsorbable suture anchors have increased in popularity and have spurred the introduction of ultrasound-assisted systems. The purpose of our study was to determine the clinical safety and efficacy of a new ultrasound-assisted suture anchor system for foot and ankle procedures. We retrospectively reviewed 50 cases using the ultrasound-assisted suture anchor with at least 24 months of follow-up. We reviewed demographic data including comorbidities, type of procedure, adverse events, and clinical outcomes using the Foot and Ankle Outcome Score (FAOS) and visual analog scale (VAS) score. We divided complications into minor and major, with major complications requiring revision surgery or leading to long-term morbidity. Our primary outcome was complication rates and our secondary outcome was improvement in clinical scores. The most frequent cases using the anchor included lateral ankle ligament reconstruction (n = 19), insertional Achilles repair (n = 15), lateral ligament reconstruction in conjunction with a total ankle arthroplasty (n = 6), and plantar plate repair (n = 3). There were 5 superficial wound infections that resolved with wound care and/or oral antibiotics. There were 3 major complications (6%): a deep wound infection that required an irrigation and debridement, a deep venous thrombosis, and a recurrence of varus deformity in a patient who underwent a total ankle arthroplasty with lateral ligament reconstruction. Only the varus deformity recurrence case could possibly be directly linked to the suture anchor (2% of all cases). VAS scores improved from 6.0 to 1.2 (P < .001) and FAOS improved from 54.7 to 94.2 (P < .001). This bioabsorbable anchor was a safe device with low failure rates, and it was used for soft tissue repair cases in the foot and ankle with successful clinical outcomes. Level IV, retrospective case series.

A 2-year follow-up of isolated Medial Patellofemoral Ligament Reconstruction by using soft suture anchor and adjustable cortical fixation system

PurposeNumerous surgical techniques and fixation methods have been described in medial patellofemoral ligament (MPFL) reconstruction such as choice of graft, graft fixation method of patella/femur and initial tension. We describe short term clinical results of MPFL reconstruction by using soft suture anchor and adjustable cortical fixation system. MethodsTwenty-four patients who underwent isolated MPFL reconstruction by using soft suture anchor and adjustable cortical fixation system were included in this study. All patients were followed up for at least 2 years, and pre-operative and 2 years post-operative Kujala score, IKDC score and Knee Injury and Osteoarthritis Outcome Score were used to assess clinical outcome. Radiographic evaluation included the Q angle, congruence angle and patellar tilt angle. Pre- and post-operative changes were evaluated by Mann–Whitney U test. ResultsThere were no complications including re-dislocation, patella fracture, infection, and joint contracture. The apprehension test was positive in 4.2% post-operatively. A statistically significant improvement in clinical scores and radiographic evaluation were evident after surgery. ConclusionsIsolated MPFL Reconstruction using soft suture anchor and adjustable cortical fixation system led good restoration of patellar stability and significant improvement of knee function in short-term results. This surgical technique can reduce complications such as patella fractures, and can be done safely. Clinical relevanceThis technique may be a treatment option with little associated complications in the treatment for patellar instability. Level of EvidenceCase series, Level IV.

Novel ultrasound assisted suture anchor system using the BoneWelding® technology yields a comparable primary stability in osteopenic and healthy human humeri as a benchmark anchor

IntroductionThe aim of this biomechanical study was to evaluate the primary stability of the SportWelding® Sombrero 3.6 mm suture anchor system in osteopenic and healthy cadaveric humeri. MethodsThe Sombrero® and BioCorkscrew® anchors were deployed in 8 osteopenic and 4 healthy cadaver humeri after the bone mineral density (BMD) measurements of the 32 specimens. Both anchors were loaded with a USP Nr. 2 FiberWire® suture. An established cyclic testing protocol was performed. The maximum failure load (Fmax), the system displacement and the modes of failure were recorded. ResultsThe Fmax and system displacement of the Sombrero® in osteopenic and healthy humeri was equivalent to the Bio-Corkscrew® benchmark anchor; there were no significant differences in the maximum failure loads and system displacement values. Only anchor and suture dislocations were observed; suture ruptures did not occur. ConclusionThis study shows that the Sombrero® yields similar maximum failure loads and system displacement values as the established Bio-Corkscrew® benchmark anchor. The primary stability of the Sombrero® and Bio-Corkscrew® seems to be independent of the bone mineral quality. This relatively small-sized polymer anchor is independent of the BMD and may be an alternative to established suture anchors in rotator cuff repair.

Arthroscopic soft tissue stabilization of posttraumatic anterior shoulder instability : Techniques, limitations and long-term results

Arthroscopic soft tissue stabilization is awell-established and broadly accepted procedure to treat posttraumatic shoulder instability. Advantages in comparison to open stabilization procedures include improved visualization of the structural damage and aless invasive approach. Technical developments in recent years have led to further improvement of the arthroscopic technique for shoulder instability. This article presents adescription of principles and new developments as it contains basic techniques including patient positioning, access portals, preparation of the glenoid bone, soft tissue handling and shuttle techniques. Modern suture anchor systems to achieve arthroscopic stabilization with the corresponding advantages and disadvantages are also presented. Furthermore, the limitations and long-term results of arthroscopic soft tissue stabilization are discussed.

Development of Biocomposite Based Anchor Screw System for Osteoporosis

With the recent advancements in arthroscopic surgery, the use of suture anchor has increased in the surgical treatment of rotator cuff tears. In the present study, we developed a suture anchor system for ligament reconstruction that can be applied to patients with osteoporosis or with low bone density. The anchor screws are made of biocomposites containing poly-L-lactic-co-glycolic acid (PLGA) and beta-tricalcium phosphate (β-TCP) in a 70:30 ratio. The suture anchor system consisted of medial and lateral screw. The lateral screw was designed in a hemicylindrical structure to prevent bone damage. The performance of the developed anchor screw was found to be greater than 402.5 N in a pull-out test.

Subscapularis Tears in Our Younger Athlete

1. Abstract <span style=font-size:10.0pt; font-family: times= new= roman,serif=>Background: Subscapularis tendon tears are rare in the pediatric population due to the presence of the growing physis. Historically, the use of arthroscopic subscapularis repair has only been described in the adult population. Hypothesis: The use of arthroscopy in the repair of subscapularis tendon tears in the skeletally immature population is a promising alternative to open repair. Study design: Case report. Methods: Two pediatric, skeletally immature patients were identified with complete subscapularis tendon tears resulting from athletic participation. Extent of rotator cuff pathology was evaluated through physical examination, X-rays, Magnetic Resonance Imaging (MRI), and diagnostic arthroscopy. Two different suture anchor systems were utilized for repair of the tendon tear in Case 1 and Case 2:Mitek Helix BR (DePuyMitek, Raynham, MA) and Peek Bio-Corkscrew (Arthrex, Naples, FL), respectively. Immediate adequacy of repair was confirmed through intraoperative range of motion evaluation. Postoperative recovery included relative immobilization and graded physical therapy exercises. Surgical outcome was gauged at three months postoperative with active range of motion evaluation and thorough clinical evaluation; followed by evaluation of return to sport after 1 year postoperatively. Results: The patient in Case 1 presented with an isolated one-centimeter retraction of the entire subscapularis tendon from the insertion. Pertinent positives on clinical exam were anterior shoulder pain, positive belly-press test, positive lift-off test, and internal rotation to vertebra T10. At ten weeks following repair, the patient denied pain and limitation; and, clinical evaluation revealed negative lift-off and belly-press test with internal rotation to vertebra T7. The patient in Case 2presented with a subscapularis tendon tear with an associated non-displaced avulsion fracture of the proximal humerus. The subscapularis tendon tear retracted approximately two-centimeters from the avulsed fragment. At twelve weeks following arthroscopic repair, the patient denied pain and limitation; and, clinical evaluation revealed no instability, negative belly-press test and internal rotation to vertebra T12. Both patients returned to a pre-injury level of athletic performance following arthroscopic repair. Conclusion: We present the cases for two reasons: first, because subscapularis tendon tears are rare in the pediatric population, and second, to describe the technique and outcome of arthroscopic repair of subscapularis tears in this specific population. In this report, we successfully described two arthroscopic surgical techniques to repair a rare pediatric injury and the postoperative outcomes that allowed early return to play. 2. Keywords: Arthroscopy; Pediatric; Rotator Cuff; Subscapularis

A new technique for arthroscopic reduction and fixation of displaced tibial intercondylar eminence fractures, using suture anchor and EndoButton system.

The study aims to describe a less invasive technique for displaced tibial intercondylar eminence fractures, using only one bone tunnel with suture anchor and EndoButton system. Seventeen patients were followed up after arthroscopic fixation for tibial eminence fractures using suture anchor and EndoButton. The patients were followed with clinical examinations such as Lysholm, Tegner, and International Knee Documentation Committee (IKDC) rating scales. Radiographic assessments were also performed during the follow-up for evaluating the healing of the fracture. There were 14 male patients and 3 female patients with 10 right knees, and 7 left knees included. All the fractures healed anatomically at final follow-up. Also, no clinical signs of anterior cruciate ligament deficiency were detected. The mean Lysholm score improved significantly from 74.72 ± 3.24 (range from 70 to 79) to 96.2 ± 2.54 (range from 89 to 98) ( p < 0.001). The IKDC category was abnormal or severely abnormal preoperatively and all the patients improved to normal or nearly normal at final follow-up. The Tegner score also improved significantly postoperatively from 3.45 ± 1.02 to 6.34 ± 1.22 ( p < 0.001). The study demonstrated that the procedure is safe and effective, which can be another option for tibial intercondylar eminence fractures.

Reconstruction of a quadriceps tendon tear using Polyvinylidene fluoride sutures and patellar screw fixation: A biomechanical study

BackgroundAcute quadriceps tendon tears are infrequent injuries requiring surgical treatment. Improved stability after surgical repair may allow for earlier weight-bearing and range of motion. Therefore, a new implant was tested and compared with the “gold standard”, using transosseous sutures. MethodsQuadriceps tendon tears were constructed using a cadaveric model of 12 fresh matched-pair specimens (aged 61–97; mean age: 82years). The biomechanical testing compared non-absorbable suture anchors (Polyvinylidene fluoride) versus transosseous absorbable sutures (Polydioxanon). Following anatomic reconstruction, the repaired specimens were loaded until they failed (testing machine: Hounsfield H10KM, Redhill, United Kingdom; maximum force: 1000N; load speed: 25mm/min; maximum test length: 150mm; pre-load: 5N). Values for load until tear displacement, maximum load until complete failure of the construct (pullout or breakage of the sutures or anchors) and stiffness of the reconstruction were recorded. ResultsThe stiffness found in the Polyvinylidene fluoride reconstruction (mean 9.83N/mm) (standard deviation (SD) 7.75) showed a significant increase compared to the Polydioxanon reconstruction (mean 6.66N/mm (SD 3.32); P=0.045). Transosseous fixation showed comparable results to the suture anchor system. There was no significant difference found in the maximum load to tear displacement (PVDF: 290.88N (SD 106.01) vs. PDS: 266.75N (SD 82.61); P=0.358). ConclusionsUsing the Polyvinylidene fluoride thread showed comparable results to the established method in reconstruction of ruptured quadriceps tendon. Stiffness of the Polyvinylidene fluoride thread reconstruction was even greater than Polydioxanon thread. Clinical relevanceImproved stiffness may facilitate healing and is suggested as clinical relevance in reconstruction.

Long-term outcome after all-inside meniscal repair using the RapidLoc system.

The purpose of the present study was to evaluate the outcome at a minimum of 7years following meniscal repair using the RapidLoc (suture anchor) system. It was hypothesized that most patients would have an intact meniscus, as has been reported in several short- and medium-term studies. In the time period from 2002 to 2007, all patients with a vertical longitudinal tear of the meniscus that was judged to be repairable were treated with rasping of the tear area and nearby parameniscal synovium and fixation of the torn part with the use of RapidLoc implants. Using a surgeon-administered form, baseline information about the arthroscopic findings and procedures performed was recorded (at the time of surgery). A median 10-year (range 7-12years) follow-up was conducted in 2014-2015, and surgical procedures to the knee following the (index) meniscal repair were registered. Treatment failure was defined as a new surgical procedure to the same meniscus. At the time of follow-up, 39 out of 82 patients (48%) had undergone further surgery to the repaired meniscus (failures). Nine of these occurred within the first 6months after surgery, 21 within the first 12months and 26 within the first 24months. Thus, the failure rate was 11% at 6months, 23% at 12months and 28% at 2years. One-third (N=13) of the failures occurred 2years or later after the (index) meniscal repair. Long-term results of meniscal repair using the RapidLoc implants were found to be poor with a high failure rate. In a large proportion of the cases, re-rupture appeared several years after the index surgery, and a commonly used follow-up period of 2years would therefore fail to detect them. In the day-by-day clinical work, of interest to orthopaedic surgeons is that meniscal repair using an all-inside technique similar to the one used by the authors may not solve the problem in the long run. IV.

Influence of Temperature on the Biomechanical Stability of Titanium, PEEK, Poly-L-Lactic Acid, and β–Tricalcium Phosphate Poly-L-Lactic Acid Suture Anchors Tested on Human Humeri In Vitro in a Wet Environment

The purpose of this study was to analyze the biomechanical integrity of suture anchors of different materials (titanium, PEEK [polyether ether ketone], poly-L-lactic acid [PLLA], and β-tricalcium phosphate PLLA) and almost identical design for rotator cuff repair in human humeri positioned in a water bath at room and body temperature undergoing cyclic loading rather than single-pull or static tests. Four different anchor models (n= 6) were tested using healthy human cadaveric humeri in a water bath thermostatically regulated at 20°C and 37°C. A cyclic testing protocol was used. The maximum failure load, the system displacement, and the respective mode of failure were recorded. There were no significant differences regarding the maximum failure load values between the 20°C groups and 37°C groups for the 4 different anchor materials. The displacement values for the 20°C groups and 37°C groups also were not statistically significant. Anchor and suture dislocations were the predominant modes of failure; suture ruptures were observed in few cases. This study shows that there are no significantly relevant differences regarding the maximum failure loads and the displacement values of the tested suture anchor systems in a wet environment at 20°C or 37°C. The temperature differences do not seem to affect the modes of failure either. Titanium, PEEK, PLLA, and β-tricalcium phosphate PLLA suture anchors for rotator cuff repair can be expected-on the basis of this investigation comparing laboratory temperature with body temperature and a wet environment-to perform invivo similar to invitro testing.

Modified Open-Door Laminoplasty Using a Ceramic Spacer and Suture Fixation for Cervical Myelopathy.

PurposeTo introduce a new simple technique using suture anchors and ceramic spacers to stabilize the elevated laminae in open-door cervical laminoplasty. Although ceramic spacers were placed in the opened laminae and fixed with nylon threads in this series, it was occasionally difficult to fix the nylon threads to the lateral mass.Materials and MethodsStudy 1: A preliminary study was conducted using a suture anchor system. Sixteen consecutive patients who underwent surgery for cervical myelopathy were prospectively examined. Study 2: The second study was performed prospectively to evaluate the feasibility of this new technique based on the result of the preliminary study. Clinical outcomes were examined in 45 consecutive patients [cervical spondylotic myelopathy (CSM)] and 43 consecutive patients (OPLL). The Japanese Orthopedic Association scoring system (JOA score), axial neck pain, and radiological findings were analyzed.Results1) In one case, re-operation was necessary due to dislodgement of the ceramic spacer following rupture of the thread. 2) In all patients, postoperative CT scans showed that the anchors were securely inserted into the bone. In the CSM group, the average JOA score improved from 9.5 points preoperatively to 13.3 at follow-up (recovery 51%). In the OPLL group, the average JOA score improved from 10.1 (5-14) points preoperatively to 14.4 (11-16) at follow-up (recovery 62%). There were no serious complications.ConclusionThe use of the suture anchor system made it unnecessary to create a hole in the lateral mass and enabled reliable and faster fixation of the HA spacers in open-door laminoplasty.

Lateral Canthoplasty Using the Mitek Anchor System

Lower-eyelid shape and position have important aesthetic and functional implications. While primary canthoplasty is generally a straightforward procedure, secondary canthoplasty can be considerably challenging. This is especially true in the setting of poor periorbital tissues and the resultant lack of a stable platform from which to suspend the canthus. We report the first use of the Mitek device in secondary lateral canthal procedures to remedy this common problem. Twelve patients underwent a total of 19 revision lateral canthoplasties using the mini Mitek suture anchor system. All of the patients had had prior cosmetic and/or reconstructive surgery in the lateral canthal area with resultant canthal malpositioning. To correct this, suture anchors were placed into a 2-mm area of intact bone on the lateral orbital wall, and the lateral canthal tendon was resuspended into proper position. In this series, there were no postoperative infections or patient reports of persistent discomfort at the anchor sites. All suture anchors remained in proper position postoperatively, and patients reported satisfaction with eyelid shape and function. Most of the patients reported resolution of their preoperative symptoms. Mean follow-up time was 24.2months. The Mitek suture anchor is an excellent tool for lateral canthoplasty in patients with significant periorbital scarring or suboptimal canthal positioning after multiple cosmetic surgery procedures. It is also a good option for patients with significant soft tissue damage owing to prior surgery, radiation, or trauma in the periorbital field. This technique can be performed quickly through small incisions and requires only a small amount of stable bone for tendon fixation. Results are excellent and the procedure has proven to be safe and effective in our series of patients.

Paper # 122: Functional Outcome Following Surgically Treated Distal Biceps Tendon Rupture at the Elbow using a Suture Anchor System in Single-Incision Technique

Surgically treated distal biceps tendon rupture (n=49) at the elbow using suture anchors in a single-incision technique reveals overall good to excellent subjective and objective results with high patient satisfaction in the short/mid-term follow-up (mean 42 months); however, complete restoration of isometric muscle strength (supination, flexion) and full range of supination were not achieved.

Arthroscopic treatment of post-traumatic shoulder instability in children and adolescents

Traumatic dislocation of the shoulder in childhood is rare, accounting for only 0.01% of all injuries in this age class. However, the literature does contain indications that post-traumatic instabilities and redislocations occur with more than average frequency in children and adolescents. This study describes the technique and results of arthroscopic stabilization of the shoulder joint before the completion of growth. Over a period of 4 years, seven patients were treated prior to reaching skeletal maturity. Five patients were treated by means of arthroscopically assisted labral refixation using suture anchor systems. Clinical follow-up was undertaken after between 6 and 48 months using a modified Constant-Murley score. Instabilities, re-dislocations and postoperative impairment of mobility did not occur after arthroscopic treatment, with a score of 92 points. Arthroscopic labral refixation is a reliable, surgical treatment procedure for post-traumatic shoulder instability in adults. This study showed that it can be used successfully in children and young people prior to skeletal maturity. No alteration of the surgical procedure of Bankart repair in adults is necessary. Considerable experience in adult shoulder reconstruction promises excellent results in children and adolescents, too. There is no evidence of growth disturbance or biodegradation associated problems in this group of children and adolescents. Delay of labral refixation until adulthood is therefore not indicated.