Suture Anchor Technique Research Articles

Surgical Treatment of Pectoralis Major Muscle Ruptures: A Systematic Review and Meta-analysis

Background:Pectoralis major muscle (PMM) tendon ruptures are becoming more common. Multiple techniques for fixation of the avulsed tendon to its humeral insertion have been described. None of these techniques has been reviewed to compare outcomes in efforts to establish a first-line surgical technique.Purpose:To systematically review and analyze the data available in the literature to establish a clinically superior surgical technique and time frame in which surgery should occur.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic literature review was conducted. Only studies reporting the surgical techniques and outcomes of PMM repair were included. Data including patient age, injury mechanism, type and extent of the rupture, time from injury to surgery, surgical technique, outcome including complications, steroid use, location and year of publication, and activity level were extracted from the included studies. Statistical and descriptive analyses were conducted on the available literature.Results:Of 259 cases from studies that provided the timing of repair, 72.6% (n = 188) were repaired acutely, while the remaining were repaired more than 8 weeks after the injury. There was no statistical difference found in the outcomes of these repairs. There were 265 cases included in the statistical analysis comparing the outcomes of surgical techniques. The odds of an excellent/good outcome were significantly better for the transosseous suture (TOS) compared with the unicortical button (UCB) technique (odds ratio [OR], 6.28 [95% CI, 1.37-28.75]; P = .018) and also for the suture anchor (SA) compared with the UCB technique (OR, 3.40 [95% CI, 1.06-10.85]; P = .039). The odds of an excellent/good outcome were not significantly different when comparing the TOS, SA, and TOS with trough techniques to one another. The probability of complications was highest with the TOS with trough technique (12.0%), although the odds of having a complication were not statistically significant for any single technique compared with the others.Conclusion:The low quality of evidence available limited this review. There were no significant differences observed in the outcomes of PMM repair based on the timing of repair. The TOS and SA techniques had statistically significantly greater odds of resulting in an excellent/good outcome compared with the UCB technique, but 1 study that contributed to this analysis may have statistically skewed the results for the UCB technique. Therefore, all 3 surgical techniques are accepted options, and the best technique is that with which the surgeon is most proficient and comfortable. Comparative research with a greater level of evidence is needed to determine a definitive first-line surgical technique.

No influence of patellar fixation technique on clinical outcomes of double-bundle medial patellofemoral ligament reconstruction: a systematic review.

To compare clinical outcomes of double-bundle medial patellofemoral ligament (MPFL) reconstruction with different patellar fixation techniques including Kujala score, functional failure and complications. Pubmed, Embase, and Cochrane Library databases were searched for studies with clinical results of double-bundle MPFL reconstruction. The hamstring tendon autografts were used, and femoral fixation was performed with bone tunnel and an interference screw, and knee fixation angle was less than or equal to 45°. Patellar fixation methods were broadly categorized into 3 treatment groups: suture anchor (SA), bone tunnel (BT) and suture techniques (SU). Pooled means for Kujala score and pooled estimates for functional failure rate and complication rate were compared. 21 studies (23 groups) consisting of 691 knees met the inclusion criteria. 12 groups with 344 knees were in SA group, 5 groups of 161 knees were in BT group and 6 groups with 186 knees were in SU group. Statistically significant differences in Kujala score were found among three groups, 90.2 (95% CI 88.7-91.7) in SA group, 88.7 (95% CI 85.3-92.2) in BT group and 89.4 (95% CI 84.2-94.6) in SU group (all P < 0.001), but these differences were not clinically significant. No statistically significant differences were found in the positive apprehension sign rate, recurrent subluxation or dislocation rate, and major or minor complication rate among three groups. Patellar fixation with bone tunnel, suture anchor or suture techniques were all effective in the double-bundle MPFL reconstruction. The present systematic review failed to show that one technique was better than the others. More high-quality trials and randomized controlled trials are needed.

Proximal Adductor Avulsion Injuries: Outcomes of Surgical Reattachment in Athletes.

Background:Sports-related groin injuries are common among athletes. However, traumatic proximal adductor avulsion injuries are relatively rare groin injuries in the athletic population, with limited case reports describing suture anchor repair.Purpose:To report on the outcomes of surgical reattachment of proximal adductor avulsion injuries in athletes utilizing a suture anchor repair technique.Study Design:Case series; Level of evidence, 4.Methods:Prospective data were collected on patients undergoing surgical reattachment of proximal adductor avulsion injuries from December 2012 to May 2015 by a single surgeon. Six athletes presented after a traumatic sports-related injury with disabling groin pain, adductor weakness, and magnetic resonance imaging confirmation of fibrocartilage avulsion of the proximal adductor with retraction. Patient-reported outcomes (Hip Outcome Score–Activities of Daily Living [HOS-ADL] and Hip Outcome Score–Sport Specific [SS] subscales, modified Harris Hip Score [mHHS], and visual analog scale [VAS] for pain) were collected preoperatively and at a minimum 2-year follow-up.Results:The latest follow-up of each patient averaged 33.4 months postoperatively (range, 25-42.5 months). All patients returned to sporting activities, with 1 minor wound complication that resolved. Paired-samples t tests indicated that the mean latest postoperative scores for all patients were significantly better than their mean preoperative scores (HOS-ADL: 99.0 vs 43.2, HOS-SS: 98.9 vs 8.3, and mHHS: 97.1 vs 44.6, respectively; P < .001 for all). Similarly, there was a significant improvement in mean postoperative VAS scores for all patients (from 89.2 to 2.2; P < .001).Conclusion:Patient-reported outcomes offer an objective measure of hip function and pain control. Surgical reattachment utilizing a multiple suture anchor technique is a successful procedure that allows for a safe return to athletic performance and a predictable return to sport.

Suture Anchor Repair for a Medial Meniscus Posterior Root Tear Combined With Arthroscopic Meniscal Centralization and Open Wedge High Tibial Osteotomy

Medial meniscus posterior root tear (MMPRT) is now attracting increased attention as a risk factor for the development of osteoarthritis. However, the healing rate after root repair by the suture anchor technique or the pull-out technique is still low. Here we report on a technique of MMPRT repair using suture anchor combined with arthroscopic meniscal centralization and open wedge high tibial osteotomy (OWHTO). The purposes of this technique are (1) to distribute the meniscal hoop tension between the root repair site and the centralization site and (2) to reduce the load on medial meniscus by OWHTO. The routine exposure for OWHTO with superficial medial collateral ligament release creates good visualization for arthroscopic root repair. The first anchor is inserted on the medial edge of the medial tibial plateau, and the second anchor is inserted on the root attachment through a posteromedial portal. After tying the knots, OWHTO could be performed without interference between the suture anchors and the screws of the plate for fixing the osteotomy. Although further follow-up is required, this technique could improve the outcomes after root repair, as well as have some technical advantages.

Patellar Redislocation Rates and Clinical Outcomes After Medial Patellofemoral Ligament Reconstruction: Suture Anchor Versus Double Transpatellar Tunnel Fixation

Background: Few studies to date have compared clinical outcomes in patients who have undergone medial patellofemoral ligament (MPFL) reconstruction using the suture anchor and double transpatellar tunnel fixation methods. This meta-analysis therefore compared the clinical results, including the patellar redislocation rate and improvement in functional scores, of suture anchor and double transpatellar tunnel fixation. Hypothesis: The recurrence rate and improvement in functional outcomes after surgery would be similar using the suture anchor and double transpatellar tunnel fixation methods. Study Design: Meta-analysis. Methods: Studies evaluating MPFL reconstruction using either the suture anchor or double transpatellar tunnel technique for patellar site fixation were included if they reported the patellar redislocation rate after surgery and/or validated patient-reported outcomes such as the Kujala and Lysholm scores. Results: Twenty-one studies were included in this meta-analysis. The mean patellar redislocation rates were similar using the suture anchor (3.2% [95% CI, 1.6%-6.2%]) and double transpatellar tunnel (3.4% [95% CI, 2.1%-5.4%]) techniques (P = .879). The mean improvement in the Kujala score from before to after MPFL reconstruction was greater using the suture anchor (37.2 [95% CI, 31.1-43.4]) method than the double transpatellar tunnel method (28.7 [95% CI, 21.2-36.1]) (P = .018). However, the mean improvement in the Lysholm score did not differ significantly using the 2 techniques. Conclusion: The patellar redislocation rate did not differ significantly in patients who underwent MPFL reconstruction using the suture anchor and double transpatellar tunnel fixation methods. The suture anchor fixation method, however, resulted in a greater degree of improvement in patient-reported outcomes.

Suture Anchor Refixation of Meniscal Root Tears Without an Additional Portal

The biomechanical consequences of a tear of the posterior root of the medial meniscus are comparable to that of a complete meniscectomy. The integrity of the meniscal roots is crucial to enable the important function of load sharing and shock absorption. An untreated root tear leads to extrusion and loss of function of the meniscus causing early degenerative arthritis of the respective knee compartment. Meniscal root repair can be achieved by 2 main techniques: indirect fixation using pullout sutures through a transtibial tunnel with extracortical fixation and direct fixation using suture anchors. Pullout sutures are prone to elongation or abrasion of the suture material due to the length of the bone tunnel. Current suture anchor techniques are challenging as they require an additional posterior portal with higher risk of damage to neurovascular structures. Even with the use of specially designed curved passing devices, secure insertion of the anchor is difficult. We present a technique for suture anchor refixation of the posterior root of the medial meniscus without the need for an additional posterior portal.

Nonreconstruction Options for Treating Medial Ulnar Collateral Ligament Injuries of the Elbow in Overhead Athletes.

This review aims to describe the nonreconstructive options for treating ulnar collateral ligament (UCL) injuries ranging from nonoperative measures, including physical therapy and biologic injections, to ligament repair with and without augmentation. Nonoperative options for UCL injuries include guided physical therapy and biologic augmentation with platelet-rich plasma (PRP). In some patients, repair of the UCL has shown promising return to sport rates by using modern suture and suture anchor techniques. Proximal avulsion injuries have shown the best results after repair. Currently, there is growing interest in augmentation of UCL repair with an internal brace. The treatment of UCL injuries involves complex decision making. UCL reconstruction remains the gold standard for attritional injuries and complete tears, which occur commonly in professional athletes. However, nonreconstructive options have shown promising results for simple avulsion or partial thickness UCL injuries. Future research comparing reconstructive versus nonreconstructive options is necessary.

Arthroscopic Repair of the Lateral Ulnar Collateral Ligament of the Elbow Using a Knotless Suture Anchor

The lateral collateral ligament (LCL) complex of the elbow plays a crucial role in the stability of the elbow joint, especially to varus loads. Deficiency of particularly the lateral ulnar collateral component of the LCL can lead to chronic posterolateral rotatory instability, which can be functionally debilitating and can lead to a rapid onset of early degenerative arthritis. Commonly, in the setting of acute rupture of the LCL, the ligament is repaired using an open technique with suture anchor fixation to the lateral epicondyle insertion point. However, with advancing arthroscopic techniques, it has become possible to repair the LCL arthroscopically. We present a relatively simple method for an all-arthroscopic repair of the LCL to the humerus using a knotless suture anchor technique.

A Biomechanical Assessment of Biceps Femoris Repair Techniques.

Background:Knee injuries encountered in clinical practice can involve avulsions of the biceps femoris from the fibula and proximal tibia. Advances in tendon repair methods now allow for repairs with increased surface areas using modern suture anchor techniques. Despite descriptions of repair techniques, there are no biomechanical studies on the biceps femoris for comparison.Purpose/Hypothesis:The objective of this controlled laboratory study was to determine the failure load of the native biceps femoris distal insertion and to evaluate modern repair techniques. Our hypothesis was 2-fold: (1) Suture repairs to the tibia and fibula would perform better on tensile testing than repairs to the fibula alone, and (2) complex bridge repairs, similar to those frequently used in rotator cuff surgery, would perform better on tensile testing than simple repairs.Study Design:Controlled laboratory study.Methods:A total of 40 paired, fresh-frozen cadaveric specimens were dissected, identifying the biceps femoris and its insertion on the proximal tibia and fibula. The native biceps femoris footprint was left intact in 8 specimens and tested to failure on a uniaxial materials testing machine evaluating tensile properties, while in the other 32 specimens, the biceps femoris insertion was dissected using a No. 15 scalpel blade, underwent repair, and was then tested to failure on a uniaxial materials testing machine evaluating tensile properties. Four repair constructs were evaluated, with 8 specimens allocated for each: construct 1 involved a simple repair (ie, passing suture through tissue in a running Krackow fashion and tying at the anchor site) to the fibula with 2 suture anchors, construct 2 involved a simple repair to the fibula and tibia with 3 suture anchors, construct 3 was a fibular repair with a tibial suture bridge involving the fibula and tibia and 3 suture anchors, construct 4 involved a transosseous repair through the fibula and 1 suture anchor on the tibia. Analysis of variance was used to evaluate for significance of the mean failure load and stiffness between groups.Results:The mean (±95% CI) failure loads were the following: native biceps femoris, 1280 ± 247.0 N; simple fibular repair, 173 ± 84.6 N; simple fibular and tibial repair, 176 ± 48.1 N; fibular repair with tibial suture bridge, 191 ± 78.5 N; and transosseous repair, 327 ± 66.3 N. The mean stiffness values were the following: native, 46 ± 13.0 N/mm; simple fibular repair, 16 ± 5.1 N/mm; simple fibular and tibial repair, 14 ± 5.4 N/mm; fibular repair with tibial suture bridge, 13 ± 2.8 N/mm; and transosseous repair, 15 ± 2.5 N/mm. Interconstruct comparison of failure loads revealed no statistical difference between constructs utilizing anchors alone. The transosseous repair showed a significant difference for the failure load when compared with each anchor repair construct (P = .02, .02, and .04 for constructs 1, 2, and 3, respectively). Interconstruct comparison of stiffness revealed no statistical difference between all constructs (P > .86). None of the repair techniques re-created the failure load or stiffness of the native biceps femoris tendon (P = .02).Conclusion:In this biomechanical study, no difference was found between the mean failure loads of different biceps femoris repair constructs involving suture anchors alone and No. 2 braided polyester and ultra–high-molecular-weight polyethylene suture. A technique involving transosseous fibular tunnels and 2-mm suture tape illustrated a greater mean failure load than repairs relying on suture anchors for fixation.Clinical Relevance:Understanding the tensile performance of biceps femoris repair constructs aids clinicians with preoperative and intraoperative decisions. Current biceps femoris repair techniques do not approximate the native strength of the tendon. A transosseous style of repair offers the highest failure load.

The application of suture anchor in the treatment of ankle fractures with deltoid ligament rupture

Objective To discuss the clinical efficacy of suture anchor associated with open reduction and internal fixation (ORIF) in the treatment of ankle fractures with deltoid ligament rupture. Methods To retrospectively analyze 32 patients’ information admitted to Dalian Central Hospital from January 2010 to December 2015 treated by suture anchor associated with ORIF, there were 25 male, 7 female, and the average age was 46.6 years old (ranged from 28 to 66 years old). 14 cases left side and 18 cases right side. All cases were closed fractures with no combined fractures elsewhere. The timing from injury to therapy was 2 to 8 days, 4.8d on average. According to Lange-Hansen classification system, 6 cases were supination-external rotation (SER), 18 were pronation-external rotation (PER) and 8 cases were pronation-abduction (PA). All of 32 cases were treated by suture anchor technique, then evaluated its clinical efficacy on suture anchor technique by judging improvements on clinical syndromes and signs, and radiological examination. All patients were not provided with gypsum external fixation after operation, ankle functioning practice was allowed at early-stage and partially weight-bearing was permitted during the first 6 weeks of post-operation, and full weight-bearing on 12 weeks. The ankle foot function score was evaluated by American Orthopedic Foot and Ankle Society (AOFAS). Results All 32 cases were followed from 6 to 18 months, 12 months on average. Fracture union time was 8 to 12 weeks, 10 weeks on average. No infection, delayed union, nerve injury, screw loosening or osteomyelitis after surgery. 1 case of wound partially split and part of titanium plate screws exposed, and it was recovered through debridement for 3 weeks. 2 cases of traumatic arthritis with walking pain, 1 of which was treated by joint fusion and recovered then and the other was lost in follow-up, because of medical expense. AOFAS evaluation: 16 cases were excellent, 11 cases were good, 3 cases were fair and 2 cases were poor. The excellent and good rate reached 84.4% (27/32). X-ray measurement showed the medial malleolus space of pre-operation was (5.32±0.38) mm on the affected side, and (2.67±0.26) mm of post-operation, the difference was statistically significance. X-ray measurement showed the medial malleolus space was (2.78±0.23) mm on the affected side 8 months after operation, compared to the space (2.56±0.26) mm on unaffected side which indicated no statistically significance. Conclusion It shows promising clinical efficacy through suture anchor technique associated with ORIF in the treatment of ankle fractures with deltoid ligament rupture. Key words: Ankle joint; Ankle injuries; Ligaments; Reconstructive surgical procedures

Arthroscopic Anterior Shoulder Stabilization With Incorporation of a Comminuted Bony Bankart Lesion

Bony Bankart lesions are a common finding in patients with anterior glenohumeral dislocation. Although there are no defined guidelines, small bony Bankart fractures are typically treated arthroscopically with suture anchors. The 2 main techniques used are double- and single-row suture anchor stabilization, with debate over superiority. Biomechanical studies have shown improved reduction and stabilization with the double-row over the single-row suture anchor technique; however, this has not been reported for small or comminuted bony fragments. Both techniques have shown promising preliminary clinical outcomes. In this Technical Note, we describe our preferred technique for arthroscopic instability repair using a single-row all-suture anchor method with the incorporation of a comminuted bony Bankart fragment in the lateral decubitus position.

Clinical and sonographic evaluation of subpectoral biceps tenodesis with a dual suture anchor technique demonstrates improved outcomes and a low failure rate at a minimum 2-year follow-up.

The purpose of this study was to evaluate the clinical outcomes and integrity of an open subpectoral biceps tenodesis using a dual suture anchor construct. Patients with at least 2years of follow-up were retrospectively evaluated for simple shoulder test (SST), American Shoulder and Elbow Surgeons (ASES) score, and visual analog scales (VAS) for pain, function and satisfaction. A physical exam assessed shoulder range of motion and elbow strength. Ultrasonography visualized construct integrity. Of 43 eligible patients, 36 completed questionnaire evaluation and 22 completed an additional physical examination. Indications included superior labral anterior-posterior (SLAP) lesions (4), partial thickness tears (6), instability (6), and tenosynovitis of the biceps tendon (20). Eighteen patients (50%) had an associated rotator cuff tear. Patient-reported outcomes improved pre- vs postoperatively: ASES score (45.4 vs 78.6, P<0.001), SST (5.1 vs 9.6, P<0.001), pain-VAS (4.8 vs 2.0, P<0.001), and function-VAS (4.9 vs 2.3, P<0.001). Satisfaction-VAS was 8.3 postoperatively. Patient-reported outcomes did not differ for patients with an associated rotator cuff tear compared to those without (P≥0.427). None of the physical exam measures were lower on the operative side compared to the healthy side (P≥0.516). Sonographic evaluation revealed preserved integrity of the tenodesis construct in all cases. No complications were noted. Subpectoral biceps tenodesis utilizing a dual suture anchor technique is a treatment option for SLAP lesions, partial thickness tears, subluxation, and tenosynovitis of the long head of the biceps with high rates of postoperative patient satisfaction, a low failure rate, and improved outcome scores. The presence of a concomitant rotator cuff tear did not influence clinical outcomes.

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.

All-Endoscopic Distal Biceps Repair: Cadaveric Portal Safety Analysis and Technical Feasibility Using 2 Fixation Techniques

The 2-part cadaveric study evaluated portal placement sites for distal biceps endoscopic repair. Technical feasibility and safety of an all-endoscopic repair using 2 fixation techniques (4 devices) was assessed. The study demonstrates the cadaveric anatomy-at-risk and presents guidelines for safe endoscopy in the cubital fossa and upper forearm region. Distal biceps tendon (DBT) injuries often require surgical intervention. Current treatment strategies use open surgical approaches to debride and repair the tendon. Endoscopic techniques have been suggested, however, the safety and feasibility of performing an endoscopic procedure in the upper forearm has not been evaluated. The purpose of this study was (1) to determine safe portal placement sites for endoscopy in the upper forearm, and (2) to analyze the feasibility and safety of performing an all-endoscopic repair of the ruptured distal biceps tendon using 2 fixation techniques (Button, suture anchors). The hypothesis of this study was that all-endoscopic DBT repair was possible without injury to neurovascular structures. 35 fresh frozen cadavers were used in 2 groups. In the first part of the study, 10 fresh frozen cadavers were used to analyze 5 possible portal sites (Parabiceps portal, two distal anterior portals [DAP 1 and DAP 2], tuberosity portal, and distal posterior portal) for distal biceps endoscopy. Nine neurovascular structures (cephalic vein; lateral cutaneous nerve; leash of vessels; radial nerve; superficial radial nerve; posterior interosseous nerve; radial artery; brachial artery; median nerve) were dissected, and their distances from portal sites were measured. In the second part, 25 fresh frozen cadaveric elbows were used. An endoscopic technique was used to explore the normal distal biceps and cubital fossa. The DBT was sectioned at the radial tuberosity. The tendon was then endoscopically reattached to the tuberosity using (1) button technique, with and without interference screw (15 cadaveric elbows), and (2) dual suture-anchor technique with 2 anchor types (10 cadaveric elbows). At the end of the procedure, each cadaver was dissected and nine neurovascular structures were assessed for injury. In addition, analysis of footprint of repaired DBT was performed, and placement site of fixation devices was evaluated. Compartmental pressures were obtained before and after procedure. In the first part (10 cadavers): parabiceps and distal posterior portals were safe. Radial artery was significantly ‘‘at risk’’ of injury from tuberosity portal. Similarly, superficial radial nerve (SRN) was ‘‘at risk’’ from the distal anterior portal 2, and the posterior interosseous nerve (PIN) was ‘‘at risk’’ from distal anterior portal (DAP 1). Overall, RA, SRN, and PIN were found to be significantly'' at risk'' (p<0.05). In the second part (25 cadavers): The normal and sectioned tendons, and the anterior and medial aspects of the tuberosity were clearly visualized via the parabiceps portal. Endoscopic repair was possible using all fixation devices. Neurovascular structures were at low risk for injury. A small rise in compartment pressures was noted before and after the procedure. Gapping and contact area varied between the different fixation devices. Endoscopic reattachment of the sectioned DBT was safe and feasible using all fixation devices. Parabiceps and distal posterior portals were safe, However, other 3 anterior portals were significantly closer to neurovascular structures, and open dissection is recommended if these portals are used. RA, SRN, and PIN were significantly ‘‘at risk’’ as compared to other structures amongst the portals studied.

Conservative management equally effective to new suture anchor technique for acute mallet finger deformity: A prospective randomized clinical trial

Study DesignProspective randomized controlled trial. Purpose of the StudyThis study was designed to compare our new suture anchor technique with conservative management in acute Wehbe-Schneider type I A-B and II A-B mallet fingers. MethodsTwenty nine patients who presented to our clinic between 2013 and 2015 were randomized for surgical or conservative treatment. Wehbe-Schneider subtype C fractures were excluded. Fourteen were treated with surgery, and 15 were treated with conservative treatment. Primary outcomes were visual analog scale score, active distal interphalangeal (DIP) joint flexion, return to work, extension deficit and DIP joint degeneration. Follow-up time was 12 months. ResultsThe mean visual analog scale was 2.0, and return to work was on average in 63.2 days in the surgical group and 1.47 and 53.7 days in the conservative group. Extension deficit was 8.1° in the surgical group and 6.1° in the conservative group. The mean DIP flexion at final follow-up was 54.5° (40-65) in the surgery group and 58.3° (45-70) in the conservative group. DIP joint degeneration was observed with X-rays in 4 patients in surgical group, and none of the patients in the conservative group had DIP degeneration at 1 year after treatment. ConclusionsThe therapeutic effectiveness of suture anchor technique was not statistically different from conservative treatment. Subluxation seen after fixation treatment with suture anchors may be due to inadequate anchor fixation. DIP joint degeneration was seen significantly more in the surgical group. Our study suggests that the new suture anchor technique is not superior to conservative treatment. Level of EvidenceIb.

Comparison of bone tunnel and suture anchor techniques in the modified Broström procedure for chronic lateral ankle stability

Comparison of bone tunnel and suture anchor techniques in the modified Broström procedure for chronic lateral ankle stability

Treatment of patellofemoral instability in adolescent by anatomical double-bundle medial patellofemoral ligament reconstruction with double suture anchor technique

To explore the clinical outcomes of anatomical double-bundle medial patellofemoral ligament (MPFL) reconstruction with double suture anchor technique in treating patellofemoral instability in adolescent. Methods: Twenty-five young people with patellofemoral instability (25 knees) in our department from January 2013 to December 2014 were enrolled for this study. All patients were performed anatomical double-bundle MPFL reconstruction with arthroscopic-assisted suture anchors technique in the patella, and fixed in the femoral socket with absorbable interference screw. All patients are evaluated by different methods, including patient's satisfaction, patellar apprehension test, recurrent subluxation/dislocation, CT assessment of bone tunnel and patellar tilt angle. Lysholm scores, Tegner scores and Kujala scores were recorded at the final follow-up. Results: The mean follow-up was 24 (range 20-40) months. All cases were observed in negative patellar apprehension test. Infection, recurrent subluxation/dislocation and patellar fracture were not found at the last follow-up. CT results demonstrated that the tunnel position were good. The patellar tilt angle was decreased from 21.6°±2.3° to 10.5°±1.6° (P<0.05); the Lysholm scores was increased from 51.7±5.3 to 93.8±6.5 (P<0.05). Tegner scores was increased from 4.1±1.1 to 5.5±0.6 (P<0.05). Kujala scores was increased from 53.5±6.4 to 94.6±4.3 (P<0.05). Conclusion: Arthroscopic-assisted anatomical double-bundle MPFL reconstruction with the suture anchors technique is a safe, minimal invasive and effective surgical option for treating patellofemoral instability in adolescent.

Medial Meniscus Posterior Root Repair Using a Transtibial Technique

The meniscal roots are critical in maintaining the normal shock absorbing function of the meniscus. If a meniscal root tear is left untreated, meniscal extrusion can occur rendering the meniscus nonfunctional resulting in degenerative arthritis. Two main repair techniques are described: (1) suture anchors (direct fixation) and (2) sutures pulled through a tibial tunnel (indirect fixation). Meniscal root repair using a suture anchor technique is technically challenging requiring a posterior portal and a curved suture passing device that can be difficult to manipulate within the knee. We present a technique for posterior medial meniscus root repair using 3 sutures (1 leader, 2 cinch), standard arthroscopy portals, and transtibial fixation. Overall, this technique simplifies a challenging procedure and allows for familiarity and efficiency.

Evaluation of a New Knotless Suture Anchor Repair in Acute Achilles Tendon Ruptures: A Biomechanical Comparison of Three Techniques

Acute ruptures of the Achilles tendon are a common injury, and debate has continued in published studies on how best to treat these injuries. Specifically, controversy exists regarding the surgical approaches for Achilles tendon repair when one considers percutaneous versus open repair. The present study investigated the biomechanical strength of 3 different techniques for Achilles tendon repair in a cadaveric model. A total of 36 specimens were divided into 3 groups, each of which received a different construct. The first group received a traditional Krackow suture repair, the second group was repaired using a jig-assisted percutaneous suture, and the third group received a repair using a jig-assisted percutaneous repair modified with suture anchors placed into the calcaneus. The specimens were tested with cyclical loading and to ultimate failure. Cyclical loading showed a trend toward a stronger repair with the use of suture anchors after 10 cycles (p = .295), 500 cycles (p = .120), and 1000 cycles (p = .040). The ultimate load to failure was greatest in the group repaired with the modified knotless technique using the suture anchors (p = .098). The results of the present study show a clear trend toward a stronger construct in Achilles repair using a knotless suture anchor technique, which might translate to a faster return to activity and be more resistant to an early and aggressive rehabilitation protocol. Further clinical studies are warranted to evaluate this technique in a patient population.

Flank Hernia Repair with Suture Anchor Mesh Fixation to the Iliac Crest

Traumatic or postsurgical flank hernias are complex and prone to recurrence, particularly at the border of the iliac crest. We reviewed our experience using suture anchors drilled into the iliac crest to fixate the mesh to bone. Our study of 10 repairs in eight patients was Institutional Review Board exempt. We obtained demographics, body mass index, diabetes, methicillin-resistant Staphylococcus aureus (MRSA) history, smoking status, steroid use, number of prior repairs, defect size, mesh size, number of anchors, and recurrence and infection at follow-up. We performed Kaplan-Meier analysis using a composite of recurrence or infection. Three of eight (interquartile range, 37.5%) patients were male. Median age and body mass index were 47.5 years (31.0, 54.7) and 32.2 (29.0, 36.0), respectively. Three patients had prior repairs, one each with two, three, and five prior attempts at fixation. One of eight patients (12.5%) had a history of MRSA infection. One of eight patients (12.5%) had a history of intermittent steroid use for sarcoidosis. Defect size was 90 cm2 (62.2, 165) and mesh size was 155 cm2 (150, 232) with four anchors (4, 5.5). Procedural complications included 2/10 (20%) with recurrence and 1/10 (10%) with postoperative MRSA infection. Follow-up was 12 months (3.0, 25.0). Mean freedom from recurrence and mesh infection (Kaplan-Meier) was 43.5 months (95%confidence interval = 24.2, 62.8). In conclusion, our series is one of the largest in the literature involving the suture anchor technique. Despite a high-risk patient population due to trauma, obesity, and prior smoking and MRSA history, we achieved an acceptable recurrence rate. Further study may benefit from a randomized trial design.