Suture Anchors Research Articles

Arthroscopic Fixation of Acute Large Bony Bankart with Suture-assisted Reduction and Screw Fixation - Surgical Technique.

Glenoid rim fractures with Bankart lesions are called bony Bankart lesions and are associated with persistent glenohumeral joint instability. Acute bony Bankart lesions can be treated by various arthroscopic techniques. Here, we present a technique of arthroscopic bony Bankart repair using suture-assisted reduction and screw fixation. The conventional suture anchor repair does not provide compression of the fractured fragment, and the bony piece may tilt because of the single-point fixation. This procedure can achieve firm compression between the bony fragments and prevent rotation of fragment during screw fixation to the glenoid. The capsular plication distributes the loads to the surrounding soft tissues. Hence, this procedure should be offered to all patients presenting acutely with a large bony Bankart of size >25% of glenoid width, as it is minimally invasive as well as provides excellent outcomes and anatomical union.

Arthroscopic Lateral Meniscus Root Repair With Reverse Suture Anchor Technique

The stability of the knee joint is crucially dependent on the integrity of the lateral meniscus posterior root, which is often accompanied by anterior cruciate ligament injury. Anchor suture repair for lateral meniscus posterior root injury not only achieves better biomechanical effects but also ensures favorable prognosis. However, the placement of anchors often requires the establishment of a posterior approach, and the insertion of an anchor is a technical challenge. In light of this, we have applied the technique of reverse anchor fixation for repairing the lateral meniscus posterior root, which not only simplifies the procedure but also effectively reduces the “bungee effect.”

Functional outcome of arthroscopic labral repair in adults for traumatic shoulder instability: a prospective study

Background: Anterior shoulder instability is often treated either by open procedure or arthroscopic method. present study to assess the functional outcome of the patients with recurrent dislocation of shoulder with Bankart lesion, treated with arthroscopic stabilization to evaluate shoulder function with labral tear and after repair of labral tear, to study epidemiology of labral tear and to study epidemiology of associated lesions. Methods: Prospective study in the 25 consented patients admitted in the orthopaedics department in new civil hospital Surat with different shoulder injury after IEC approval. Statistical analyses done in MS excel. Results: Mean age at time of first dislocation was 30 year and most (50%) were of 20-30 years. Most patients were males (92%). 84% of the cases, the dominant side is involved, right shoulder. Number of episodes of recurrent dislocation prior to surgery averaged 5 times. most common mechanism was Accidental fall (48%) followed by sports (32%), RTA (20%). Association of Hill-Sachs lesions was 80% with labral-tear secured with extra suture anchor. Preoperative parameters; number of dislocations, chronicity, reduction method do not have any significance on outcome. Rowe-score improved from 40.2% Preoperatively to 89.8% postoperatively at 12 weeks. 80% of patients is having excellent outcome. Conclusions: Arthroscopic Bankart’s repair is gold standard for labral tear due to recurrent shoulder dislocation which led to short surgery time, less intraoperative and postoperative complications, increased shoulder function among patients. Associated Hill Sach’s lesion should be repaired for better functional outcome.

Fixation strength of swelling copolymeric anchors in artificial bone.

Fixation with suture anchors and metallic hardware for osteosynthesis is common in orthopedic surgeries. Most metallic commercial bone anchors achieve their fixation to bone through shear of the bone located between the threads. They have several deficiencies, including stress-shielding due to mechanical properties mismatch, generation of acidic by-products, poor osteointegration, low mechanical strength and catastrophic failure often associated with large bone defects that may be difficult to repair. To overcome these deficiencies, a swelling porous copolymeric material, to be used as bone anchors with osteointegration potential, was introduced. The purpose of this study was to investigate the fixation strength of these porous, swelling copolymeric bone anchors in artificial bone of various densities. The pull-out and subsidence studies indicate an effective fixation mechanism based on friction including re-fixation capabilities, and minimization of damage following complete failure. The study suggests that this swelling porous structure may provide an effective alternative to conventional bone anchors, particularly in low-density bone.

Impact of BMI on the Surgical Management of Chronic Insertional Achilles Tendinopathy

Posterior heel pain secondary to insertional Achilles tendinopathy is a common condition that often times requires surgical management. Typically, this involves reflecting a portion of the Achilles tendon from its insertion to adequately debride devitalized or thickened tendon as well as any osseous prominence and then reattached into the calcaneus via suture anchors. Oftentimes, it is suggested that patients with an increased body mass index (BMI) have a higher risk of complications. However, there is no published evidence to support this claim. The present study is a retrospective review of 78 patients who underwent detachment/reattachment of the Achilles tendon for chronic insertional Achilles tendinopathy. Patients were separated into three groups based on BMI: normal, obese, and morbidly obese. The mean BMI of all patients included was 35.6 kg/m2 (range: 21.8-54.9, SD: 6.9). We compared complication rates between the groups and found no significant difference (p = .541). Patients in all groups also demonstrated statistically significant improvements in both American Orthopedic Foot and Ankle Society (AOFAS) hindfoot-ankle scores (Normal BMI: p = .002; Obese: p = <.001; Morbidly obese: p = <.001) and Patient-Recorded Outcomes Measurement Information System (PROMIS) scores (Normal BMI: p = .003; Obese: p = <.001; Morbidly obese: p = .001). In conclusion, the results of our study demonstrate that detachment/reattachment of the Achilles insertion in the management of insertional Achilles tendinopathy in obese and morbidly obese patients may be safe and effective without the risk of increased complications.

Open Medial Meniscotibial Ligament Repair With Concomitant Open Superficial Medial Collateral Ligament Repair With Internal Brace Augmentation

The medial collateral ligament (MCL) is the most commonly injured ligament in the knee. Historically, nonsurgical management for these injuries has been favored for a majority of grade I-III sprains, particularly femoral-based. However, when coupled with other injuries such as meniscotibial ligament tears or distal Stener type avulsion tears, early surgical management for these cases is recommended. This will allow for stabilization and protection of the meniscus in addition to preventing residual valgus laxity, especially related to more severe Stener-like avulsions of the superficial MCL that can be seen with meniscotibial ligament tears. Utilizing an open approach, meniscotibial repair with suture anchors with internal brace augmentation for the MCL repair can provide a strong final construct, and a safe and fast recovery.

Tommy John Ligament Repair with Ulnar Collateral Ligament Internal Brace

Ulnar collateral ligament (UCL) injuries commonly occur in overhead athletes as a result of excess valgus stress on the elbow and can be functionally debilitating, requiring surgical intervention. Since the advent of the first initial UCL reconstruction technique pioneered by Dr. Frank Jobe performed on professional baseball player Tommy John, UCL, or Tommy John Ligament reconstruction has successfully returned athletes to sport following injury and shown enhanced clinical outcomes with minimal complication rates. Tommy John surgery continues to evolve with the development of various techniques over recent years. This technical note describes a UCL repair with an internal brace using knotless suture anchors and aims to contribute to the current literature a technique that is efficacious and reproducible and offers satisfactory stability, functionality, and return to play.

Distal Radius Plates With Coracoid Suture Anchors for the Fixation of Displaced Lateral End Clavicle Fractures.

Introduction Management of displaced fractures of the lateral end clavicle has always challenged orthopaedic surgeons, due to a high non-union rate, and difficulty achieving stable fixation allowing early mobilisation. Different methods of fixation have been utilised to provide stability and improve healing and functional outcomes. In this series, we evaluate the results of internal fixation using dorsal distal radius locking plates and coracoid suture anchors. Patients and methods We retrospectively reviewed the clinical notes and radiographs of eight consecutive patients with fractures of the lateral end of the clavicle presented to our hospital between January 2016 and December 2017. Patients were treated by open reduction and internal fixation using dorsal distal radius locking plates and coracoid suture anchors. Results All patients achieved full range of motion of the shoulder at eight weeks postoperatively. There were no intra-operative complications. Evidence of bone healing was noted in all cases within eight weeks post-operatively. There were no cases of wound complications, metal work irritation or fixation failures. The pre-morbid level of function was restored following the rehab protocol and physiotherapy. Conclusion Dorsal distal radius plates with suture anchor fixation appear to be a valuable alternative for the treatment of fractures of the lateral end of the clavicle. Coracoclavicular fixation provided and maintained the reduction of the fracture. Good clinical results can be achieved with a low risk of complications and without the need for metalwork removal.

Management of Patellar Tendinopathy

Patellar tendinopathy is a common pathology typically seen in athletes involved in repetitive explosive jumping and running activities. Also known as jumpers’ knee, it is commonly seen in high-level basketball players. Typically, athletes continue to play with symptoms, which can be aggravated and progress to partial patellar tendon tears. When partial patellar tendon tears occur, prolonged recovery and decreased performance is commonly seen. The pathology and treatment can be frustrating for both the athlete and medical provider. Patellar tendinopathy typically does not involve inflammation but rather microinjury to the tendon fibers, which leads to mucoid degeneration, necrosis, and loss of transitional fibrocartilage. When partial tendon tears do occur, the typical location is posteromedially adjacent to the patella. Treatment involves a stepwise approach starting with nonoperative means, including activity modification, nonsteroidal anti-inflammatories, and physical therapy focused on eccentrics. Extracorporeal shock wave treatments and injections with platelet-rich plasma or bone marrow aspirate concentrate should be considered, with evolving literature to support their use. Ultrasound percutaneous tendon scrapping with a needle supplemented with the aforementioned injections is an emerging treatment option that the authors have found to be helpful, although further studies are required. Surgical intervention is considered after failure of nonoperative treatments, and typically occurs in tears greater than 50% of the tendon thickness and in tendons with increased thickness (>8.8 mm). Open or arthroscopic debridement can be considered, with no studies showing superior outcomes with either technique; however, no high-quality comparison studies exist. The authors prefer an open technique where, much like a bone–patellar tendon–bone harvest, the unhealthy proximal tendon and bone are excised with then closure of the healthy tendon with absorbable sutures. Suture anchor repair may also be used when necessary. In a recent systematic review, surgical management of patellar tendinopathy has been shown to result in improved patient-reported outcomes with return to sport at high levels.1 Treatment for the difficult and sometimes frustrating pathology of patellar tendinopathy continues to evolve, with biologic and less-invasive ultrasound-based treatments showing promise, and surgical intervention providing reliable outcomes.

Single Working Portal Technique with 70-Degree Arthroscope for Arthroscopic Bankart Repair

The Bankart lesion is a common injury to the labrum in the shoulder joint, usually resulting from anterior shoulder dislocation. Arthroscopic Bankart repair is a surgical technique used to treat recurrent dislocations by reattaching the labrum to the glenoid rim using suture anchors. Typically, 3 portals are created: 1 for visualization and 2 for instrumentation. However, this Technical Note proposes a single working portal approach using a 70° arthroscope from the posterior portal. This technique enhances visualization and prevents portal jamming, particularly in cases with a small rotator interval.

Combined Deltoid and Spring Ligament Reconstruction Using the Quadrangular Construct: Our Experience and Review of the Literature.

Background A combined reconstruction of chronic deltoid and spring ligament insufficiency is uncommon. Our study aims to share our experience in treating post-traumatic, chronic deltoid, and spring ligament insufficiency using the "quadrangular construct" technique. Material and methods Five patients who had post-traumatic combined deltoid and spring ligament insufficiency were included in the study. All patients reported a "giving-way" sensation.Preoperatively, each patient underwent weight-bearing radiographs of the ankle and foot. The talo-first metatarsal angle and hindfoot alignment angle were noted. The superficial deltoid ligament was repaired using a suture anchor augmented with Internal BraceTM (Arthrex, Naples, USA) FiberTape® to form a quadrangular construct that anatomically mimics various components of the deltoid-spring ligament complex. Due to the associated excessive heel valgus, three patients also underwent medial displacement calcaneum osteotomy. Additionally, one patient required lateral ligament repair, and another patient required syndesmotic stabilization. TheAmerican Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was used to evaluate preoperative and postoperative ankle function. Results All five patients were followed up for a mean of 20 months (range: 12-24 months). The mean preoperative talo-first metatarsal angle improved from 8.46 degrees to 4.84 degrees. The preoperative mean hindfoot alignment angle was reduced from 10.9 to 5.76 degrees postoperatively. One patient had irritation due to the anchor, which needed removal after one year. Postoperatively, no patients re-experienced the feeling of "giving way". The AOFAS scores postoperatively showed two patients as excellent, two as good, and one as fair. All the patients returned to their pre-injury work. Conclusion We have developed a technique for combined deltoid and spring ligament reconstruction using a quadrangular construct. This technique helps to restore anatomical stability, is safe, easily reproducible, and has shown positive short-term results in follow-up. The level of evidence is one of the methods used to categorize the quality and reliability of research, and our study falls under the category of level IV evidence.

The Zipknot Technique: A Modified Tension Band Repair Technique for Isolated Supraspinatus Tears

Tension band repair frequently is used for small rotator cuff tears. This Technical Note describes a variation using a single knotless suture anchor but with a specific lark’s head knot technique to pass the sutures through the tendon that improves bone–tendon contact and tendon healing while preventing a dog-ear deformity.

Midterm outcomes of suture anchor fixation for displaced olecranon fractures.

Displaced olecranon fractures constitute a challenging problem for elbow surgeons. The purpose of this study is to evaluate the role of suture anchor fixation for treating patients with displaced olecranon fractures. A retrospective review was performed for all consecutive patients with displaced olecranon fractures treated with suture anchor fixation with at least 2 years of clinical follow-up. Surgical repair was performed acutely in all cases with nonmetallic suture anchors in a double-row configuration utilizing suture augmentation via the triceps tendon. Osseous union and perioperative complications were uniformly assessed. Suture anchor fixation was performed on 17 patients with displaced olecranon fractures. Functional outcome scores were collected from 12 patients (70.6%). The mean age at the time of surgery was 65.6 years, and the mean follow-up was 5.6 years. Sixteen of 17 patients (94%) achieved osseous union in an acceptable position. No hardware-related complications or fixation failure occurred. Mean postoperative shortened disabilities of the arm, shoulder, and hand (QuickDASH) score was 3.8±6.9, and mean Oxford Elbow Score was 47.5±1.0, with nine patients (75%) achieving a perfect score. Suture anchor fixation of displaced olecranon fractures resulted in excellent midterm functional outcomes. Additionally, this technique resulted in high rates of osseous union without any hardware-related complications or fixation failures. Level of evidence: IV.

Arthroscopic Double-Pulley Suture-Bridge Repair of Supraspinatus Tendon Tear

At present, the suture bridge is a widely used surgical pattern in the treatment of supraspinatus tendon tear, but the shortcomings of a suture bridge, including expensive lateral-row anchor and increased type 2 retear rate, is obvious. The double-pulley suture-bridge described in this Technical Note uses a double-loaded suture anchor (medial-row anchor) as lateral-row anchor instead of traditional lateral-row anchor, combined with double-pulley technology forming suture-bridge in treatment of supraspinatus tendon tears. The surgical technique is described in pearls, pitfalls, advantages, and disadvantages.

IBC-Oxford University2023_BJSOral_17The Endoscopic Sleeve Megaplication (ESM): Preliminary Results of a Modification of a Standard Procedure to Reduce the Cost with Maintaining the Effectiveness. A six-month follow-up.

Abstract Aims The cost of POSE 2.0 is very high, being one of the limitations of the accessibility of this procedure. The Endoscopic Sleeve Megaplication (ESM) procedure involves a novel pattern of full-thickness gastric body plications to shorten and narrow the stomach using the IOP platform (USGI Medical, San Clemente, CA) and durable suture anchor pairs g-Cath and two g-Lix simultaneously to achieve larger folds, reducing the number of sutures per procedure. Our prospective trial examined the safety and durability of ESM in adults with obesity grade I and II. Methods Adults suffering obesity underwent ESM in our centre. A single line of double plications in the greater curvature from incisura till 3-4 cm from gastro-oesophageal junction, single plications were placed in distal body anterior and posterior walls to close the diameter of the distal body under 10 mm. Primary outcomes were safety, durability of plications at 3-, 6-, 12- and 24-month follow-up and the cost effectiveness of the technique. Safety will be determined by the incidence of any serious adverse events reported either by the subject or observed by the investigator, relating to the procedure either peri-procedurally or in the follow-up period. All adverse events will be documented. Secondary outcomes were total body weight loss (%TBWL), proportion of patients achieving &amp;gt; 5% TBWL at 12 months and reduction of the cost of the procedure compared to standard POSE 2.0 technique, based on the average number of plications placed. Results 13 patients (7F, age 45 ± 9.9 years) underwent ESM between February 2022 to September 2022. Baseline BMI was 37.2 ± 3.1 kg/m2. Technical success was 100%. An average of 10 ± 2 suture anchor pairs were placed in each case. At six months, patients (n=13) achieved a 16.1 ± 3.9 % total weight loss (%TWL), with 84,61 % achieving more than 10 % TWL. Blood test results, state that insulin resistance and liver enzymes improved. No serious adverse events were reported. The reduction of an average of 8 plications compared to the standard POSE 2.0 pattern brings a significant reduction of the cost of the procedure. Conclusions ESM procedure happens to be effective for treating obesity and its related comorbidities. It is a safe, durable and a cost-effective procedure however, it is necessary to complete a long-term follow-up and carry out studies with larger samples to proclaim those benefits.

An additively manufactured titanium tilting suture anchor: a biomechanical assessment on human and ovine bone specimens.

A novel titanium tilting suture anchor was designed and fabricated using additive manufacturing. The anchor enjoyed a nonsymmetrical structure to facilitate its insertion procedure through a weight-induced tilt, a saw-teeth penetrating edge to provide a strong initial fixation into cancellous bones of various densities, and an appropriate surface texture to enhance the longterm fixation strength through bone ingrowth. Biomechanical tests were performed on 10 ovine and 10 human cadaveric humeri to examine the insertion procedure and assess the initial fixation strength of the anchor, in comparison with a standard screw-type anchor as control. This study indicated a simple yet reliable insertion procedure for the tilting anchor. All anchors survived after 400 cycles of cyclic loadings and failed in the load-to-failure step. There were no significant differences between the displacements and fixation stiffnesses of the anchors in either group. The ultimate failure load was significantly smaller (p<0.05) for tilting anchors in ovine group (273.7 ± 129.72 N vs. 375.6 ± 106.36 N), but not different in human group (311.8 ± 82.55 N vs. 281.9 ± 88.35). Also, a larger number of tilting anchors were pulled out in ovine group (6 vs. 3) but a smaller number in human group (4 vs. 6). It was concluded that the biomechanical performance of the designed tilting anchor is comparable with that of the standard screw-type anchors.

Comparing the biomechanical properties of conventional suture and all-suture anchors using patient-specific and realistic osteoporotic and non-osteoporotic phantom using 3D printing

Conventional suture anchors (CAs) and all-suture anchors (ASAs) are used for rotator cuff repair. Pull-out strength (POS) is an important factor that affects surgical outcomes. While the fixation mechanism differs between the anchor types and relies on the quality, few studies have compared biomechanical properties of anchors based on bone quality. This study aimed to compare the biomechanical properties of anchors using osteoporotic bone (OB) and non-osteoporotic bone (NOB) simulators. Humerus simulators were fabricated using fused deposition modeling of 3D printing and acrylonitrile butadiene styrene adjusting the thickness of cortical bone and density of cancellous bone based on CT images. Cyclic loading from 10 to 50 N, 10 to 100 N, and 10 to 150 N for 10 cycles was clinically determined at each anchor because the supraspinatus generates a force of 67–125 N in daily activities of normal control. After cyclic loading, the anchor was extruded at a load of 5 mm/min. Displacement, POS, and stiffness were measured. In OB simulators, CAs revealed bigger gap displacement than ASAs with cyclic loading of 10–150 N. ASA showed higher values for POS and stiffness. In NOB simulators, ASAs revealed bigger gap displacement than CAs with cyclic loading of 10–150 N. ASA showed higher values for POS and CA showed higher values for stiffness. POS of anchors depends on anchors ‘displacement and bone stiffness. In conclusion, ASA demonstrated better biomechanical performance than CA in terms of stability under cyclic loading and stiffness with similar POS in OB.

Biomechanical Comparison of Proximal Hamstring Reconstruction Using Distal Hamstring Graft Versus Fascia Lata Graft for Treatment of Chronic Hamstring Injury

Background: Surgical reconstruction using autografts is often required in treating chronic proximal hamstring injuries where the hamstring has retracted >5 cm. There is a paucity of evidence that evaluates reconstructive procedures using the 2 most popular autografts, distal hamstring and fascia lata. Purpose: To (1) compare failure load and elongation at failure between the proximal hamstring tendon reconstruction with distal hamstring and fascia lata grafts and (2) compare the stiffness between these reconstructions and the native state. Study design: Controlled laboratory study. Methods: Seven pairs of human cadaveric hemipelvises (mean age, 60.4 ± 5.0 years; 6 male, 1 female) with no evidence of previous injury or abnormality were dissected to the proximal hamstring origin. Through use of a dynamic tensile testing system, each specimen underwent preconditioning followed by a distraction test to determine the native specimen stiffness. Each pair of specimens was assigned to undergo proximal hamstring reconstruction with distal hamstring and reconstruction with fascia lata. Each specimen then underwent preconditioning followed by pull to failure. The failure load, elongation at failure, mode of failure, and stiffness were determined for each repair. Results: The distal hamstring group exhibited a greater failure load (mean, 334 ± 108 N; P = .031) and higher stiffness (mean, 47.6 ± 16.0 N/mm; P = .009) compared with the fascia lata group (mean, 179 ± 78 N and 23.0 ± 11.2 N/mm, respectively). Although the stiffness of the repair state in the distal hamstring group (mean, 61.4 ± 13.4 N/mm) was not significantly different from that of the native state (mean, 47.6 ± 16.0 N/mm), the stiffness of the repair state in the fascia lata group (mean, 23.0 ± 11.2 N/mm) was significantly lower than that of the native state (mean, 60.1 ± 17.7 N/mm) (P < .0001). The elongation at failure of the distal hamstring graft group (mean, 33.0 ± 6.6 mm) was not significantly different from that of the fascia lata graft group (mean, 29.2 ± 14.9 mm) (P = .58). The most common modes of failure for the distal hamstring group (29% each) were at the repair site, at the graft-muscle interface, and at the muscle, while the most common modes of failure for the fascia lata graft were at the tendon-graft interface. Conclusion: The distal hamstring group achieved higher failure load and stiffness than the fascia lata group, and stiffness of the distal hamstring group was not significantly different from that of the native tendon. Elongation at failure was not different between repair techniques. Although distal hamstring graft failure predominantly occurred in 3 distinct locations, failure of the fascia lata repair occurred predominantly at the tendon-graft interface. These cadaveric results suggest that it may be more clinically appropriate to use distal hamstring versus fascia lata for proximal hamstring reconstruction. Clinical Relevance: Our time-zero study suggests that the proximal hamstring reconstruction with distal hamstring could be the preferred surgical treatment for chronic hamstring injury over reconstruction with fascia lata. The failure load of reconstruction with distal hamstring was inferior to that of primary suture anchor, suggesting that rehabilitation after reconstruction should not be more aggressive than the standard postoperative rehabilitation protocol for acute repair.

Effectiveness of Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor in treatment of Cho type ⅡC distal clavicle fractures

To evaluate the effectiveness of Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor in the treatment of Cho type ⅡC distal clavicle fractures. The data of 17 patients with Cho type ⅡC distal clavicular fractures, who were treated with Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor between June 2019 and June 2021, was retrospectively analyzed. There were 11 males and 6 females with an average age of 38.7 years (range, 19-72 years). The fractures were caused by falling in 12 cases and traffic accident in 5 cases. All patients had fresh closed fractures. The interval from injury to operation was 1-5 days (mean, 2.6 days). The preoperative injury severity score (ISS) was 6-27 (mean, 10.2). The operation time, intraoperative blood loss, hospital stay, fracture healing, and postoperative complications were analyzed. The shoulder joint function was evaluated by disabilities of the arm, shoulder, and hand (DASH) score and Constant score at last follow-up. All operations were completed successfully. The operation time was 20-50 minutes (mean, 31.6 minutes). The intraoperative blood loss was 30-100 mL (mean, 50.6 mL). The hospital stay was 4-9 days (mean, 5.3 days). All incisions healed by first intention. All patients were followed up 12-16 months (mean, 13 months). All clavicle fractures healed, and the healing time was 8-15 weeks (mean, 11 weeks). No complications such as fracture displacement or nonunion caused by internal fixation failure occurred. During the follow-up, skin irritation caused by the Kirschner wire withdrawal occurred in 3 cases. The Kirschner wires were removed after fracture healing in 17 patients. At last follow-up, the Constant score of shoulder joint was 90-100 (mean, 98.2). The DASH score was 0-10 (mean, 1.5). Kirschner wire fixation combined with coracoclavicular ligament reconstruction with suture anchor in the treatment of Cho type ⅡC distal clavicle fractures has less postoperative complications and slight complications. It is convenient to remove the internal fixator. The Kirschner wire does not fix the distal clavicle fracture through the acromion, which has little effect on shoulder joint function and can obtain good effectiveness.

Patellar Sleeve Avulsion Fracture Repair: Suture Anchor Technique With Suture Cerclage Augmentation

Patella sleeve fractures are rare injuries that occur in pediatric patients. For minimally displaced fractures, nonoperative treatment with immobilization is possible. When fractures are displaced, surgical repair is indicated. Previously described operative techniques include transosseous sutures and tension band wiring. We describe a surgical technique to repair distal pole and patella sleeve avulsion fractures in pediatric patients using intraosseous suture anchors with suture cerclage augmentation.