Study of Typical Functional Failure and Mechanical Properties of Non-absorbable Suture Anchor / 中国医疗器械杂志

OBJECTIVE@#To study the mechanical properties related to the typical functional failure modes of non-absorbable suture anchor in clinical use, and to support product design, development and verification.@*METHODS@#By retrieving the database of relevant adverse events, the typical functional failure modes of non-absorbable suture anchor were summarized, and the influencing factors of functional failure were further analyzed by studying the mechanical properties related to functional failure. The publicly available test data was retrieved for verification and provided reference for the researchers.@*RESULTS@#The typical functional failure modes of non-absorbable suture anchor include anchor failure, suture failure, fix loosening, inserter failure, which are related to the mechanical properties of products, such as screw-in torque and break torque of screw-in anchors, insertion force of knock-in anchors, suture strength, pull-out force before and after system fatigue test and elongation of sutures after fatigue test.@*CONCLUSIONS@#Enterprises should pay attention to improving the mechanical performance level of products through material, structural design and the suture weaving process to ensure the safety and effectiveness of products.

Effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in treatment of patellar inferior pole fracture / 中国修复重建外科杂志

OBJECTIVE@#To investigate effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in the treatment of patellar inferior pole fractures.@*METHODS@#A clinical data of 37 patients with unilateral patellar inferior pole fracture who met the selection criteria between June 2017 and June 2021 was retrospectively analyzed. Among them, 17 cases were treated with the suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling (group A), and 20 cases were treated with the traditional Kirschner wire tension band technique (group B). There was no significant difference in terms of gender, age, body mass index, fracture side, combined medical disease, and preoperative hemoglobin between the two groups ( P>0.05). Operation time, intraoperative blood loss, postoperative complications, fracture healing time, knee range of motion, and knee function Bostman score (range of motion, pain, daily work, muscle atrophy, walking aids, knee effusion, soft leg, and stair climbing) and grading were recorded in both groups at last follow-up.@*RESULTS@#There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). All incisions healed by first intention. All patients were followed up 1-2 years, with an average of 1.7 years. X-ray films reexamination showed that all fractures in group A healed, while 2 cases in group B did not heal. There was no significant difference in bone healing time between the two groups ( P>0.05). At last follow-up, the knee range of motion, the range of motion score of Bostman score, total score and effectiveness grading in group A were significantly better than those in group B ( P<0.05). There was no significant difference in the other items of Bostman scores between the two groups ( P>0.05). During follow-up, 2 cases of internal fixation failure and 1 case of internal fixator irritation occurred in group B, and no complication related to internal fixation occurred in group A. The occurrence of complications was significantly lower in group A than in group B ( P<0.05).@*CONCLUSION@#Compared with the traditional Kirschner wire tension band technique, the suture anchor combined with Nice knot strapping via longitudinal patellar drilling for the patellar inferior pole fractures has the advantages of simple operation, reliable fixation, early flexion and extension activity, and better functional recovery of knee joint.

Comparison of suture anchor and simple suture for acute injury to lateral ankle ligament: mid-to long-term outcomes / 中华创伤骨科杂志

Objective:To compare the mid-to long-term clinical outcomes between suture anchor and simple suture for acute injury to lateral ankle ligament (cauda equina tear near the insertion).Methods:This retrospective study included 146 patients (professional and semi-professional athletes) who had been treated for acute injury to lateral ankle ligament (cauda equina tear near the insertion) at Department of Sports Medicine, The Third Hospital Affiliated to Peking University from June 2007 to May 2017.They were 101 males and 45 females, with an age of (27.1±10.3) years (from 12 to 62 years). Depending on ligament repair techniques, the patients were divided into a suture anchor group of 81 cases subjected to reconstruction of the torn ligament with a 1.8 mm suture anchor, and a simple suture group of 65 cases subjected to direct suture of the torn ligament with a braided thread. The 2 groups were compared in terms of visual analog scale (VAS) pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and Tegner scores at preoperation and the last follow-up, time and level of postoperative motion recovery, proportion of limited joint motion, incidence of re-sprain and patient satisfaction.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P>0.05). The mean follow-up duration was (46.1±14.1) months (from 36 to 132 months). The VAS pain score, AOFAS ankle-hindfoot score and Tegner score at the last follow-up were significantly improved than those before operation in all the patients ( P<0.05). Postoperatively, there was no significant difference between the 2 groups in VAS pain score, AOFAS ankle-hindfoot score, Tegner score, incidence of re-sprain or proportion of limited joint motion ( P> 0.05). The suture anchor group was significantly better than the simple suture group in the level of postoperative motion recovery (92%±13% versus 89%±13%) and time of postoperative motion recovery [(4.2±1.1) months versus (4.6±1.0) months] ( P<0.05). Conclusions:Ligament repair, either by suture anchor or by simple suture, is a reliable procedure for patients with high sports demands after severe acute injury to the lateral ankle ligament. Compared with simple suture, suture anchor may accelerate postoperative motion recovery to the pre-injury level.

Mini suture anchor: An effective device for reduction and fixation of displaced temporomandibular joint disc with intracapsular condylar fracture / 中华创伤杂志(英文版)

PURPOSE@#The main aim is to provide clinical reference for the application of mini suture anchor in the reduction and fixation of displaced temporomandibular joint (TMJ) disc with intracapsular condylar fracture.@*METHODS@#From October 2018 to October 2019, 21 patients (31 sides) with intracapsular condylar fractures and articular disc displacement from West China Hospital of Stomatology, Sichuan University were included. The selection criteria were: (1) mandibular condylar fractures accompanied by displacement of the TMJ disc, confirmed by clinical examination, CT scan and other auxiliary examinations; (2) indication for surgical treatment; (3) no surgical contraindications; (4) no previous history of surgery in the operative area; (5) no facial nerve injury before the surgery; (6) informed consent to participate in the research program and (7) complete data. Patients without surgical treatment were excluded. The employed patients were followed up at 1, 3, 6 and 12 months after operation. Outcomes were assessed by success rate of operation, TMJ function and radiological examination results at 3 months after operation. Data were expressed as number and percent and analyzed using SPSS 19.0.@*RESULTS@#All the surgical procedures were completed successfully and all the articular discs were firmly attached to the condyles. The articular disc sufficiently covered the condylar head after the fixation. The fixation remained stable when the mandible was moved in each direction by the surgeons. No complications occurred. The functions of the TMJ were well-recovered postoperatively in most cases. CT scan revealed that the screws were completely embedded in the bone without loosening or displacement.@*CONCLUSION@#Mini suture anchor can provide satisfactory stabilization for the reduced articular disc and also promote the recovery of TMJ functions.

Stable ankle after modified brostrom technique using one anchor with double suture at Sanglah Hospital: a case report

Ankle sprains are commonly seen injuries among athletic and young population, and it is necessary to stabilize the patient ankle as soon as possible. Authors report the cost-effective option of using a modified Brostrom technique with one suture anchor in a limited resource setting. Case a 24- year-old male came to the orthopaedic clinic with chief complaint of left ankle pain for the past 2 weeks after jumping and landing in a twisted position. Patient also complained of unstable ankle after the fall. On physical examination, the ankle showed tenderness and instability when anterior drawer test was performed. The patient was diagnosed with lateral ankle instability. This case report describes a modification to the original Brostrom procedure using one suture anchor to anatomically reconstruct the lateral ankle ligaments in treating high demand patient who have lateral ankle instability. After six months follow up, the patient has shown significant improvement on his left ankle. Despite of all the modifications of Brostrom procedure, the use of more suture anchors or sophisticated technique such as arthroscopy might result in increasing cost. Reasonably good outcome can still be achieved with modified Brostrom procedure that utilizes minimal incision, simple steps, and single suture anchor. Due to its cost-effectiveness, authors believe that modified Brostrom technique with one suture anchor is an effective and practical treatment option for lateral ankle instability. Brostrom technique using suture anchors as shown here can provide similarly good outcomes compared with other more complex techniques.

Influences from Implant Angle of Suture Anchors on the Maximum Pullout Force / 医用生物力学

Objective To make biomechanical evaluation on ultimate pullout strength of the suture anchors based on the angle of suture anchor (SA) implanted into the humerus during arthroscopic rotator cuff repair (RCR) surgery. Methods Polyurethane materials with densities of 0.16 g/cm3 and 0.32 g/cm3 were used to simulate osteoporosis and normal cancellous bone, and polyurethane materials with densities of 0.64 g/cm3 and 3 mm thickness were used to simulate human cortical bone. The two kinds of cancellous bone models were respectively adhered together with cortical bone model to construct human humerus model. Titanium metal suture anchors were inserted into humerus models at 45°, 60°, 75° and 90° angle, then the continuous tensile experiments were performed, and 45° pulling direction between the humerus model surface and suture anchor was used to simulate the supraspinatus physiological traction direction, and each group was continuously tested 8 times, recording the pullout strength and failure modes. ResultsThe pullout force of high-density bone models was significantly higher than that of low-density bone models (P＜0.001), and at the same density, compared with 45°, 60° and 75°, the implant angle of 90° has a larger pullout force (P＜0.01). Conclusions In the model of humerus, the 90° implantation of suture anchor showed better biomechanical properties, and the vertical implantation of anchor in the repair of rotator cuff was beneficial to the knotting during operation and postoperative recovery of the supraspinatus.

Arthroscopic suture bridge technique with suture anchor in the treatment of acromioclavicular dislocation / 中国组织工程研究

BACKGROUND: There is no uniform standard for acromioclavicular dislocation. Clavicular hook plate fixation is a commonly used fixation method clinically, but minimally invasive ligament reconstruction technology and arthroscopic surgery have become a research hotspot. OBJECTIVE: To observe the application value of suture bridge with thread anchor under arthroscopy in the treatment of acromioclavicular dislocation. METHODS: Patients with Tossy type III acromioclavicular dislocation who were admitted to Department of Orthopedic Surgery of General Hospital of Jizhong Energy Xingtai Mining Group between January 2016 and April 2018 were selected as the subjects. The patients were randomly divided into two groups. The patients in the arthroscopy group were treated with arthroscopic suture bridge technique with suture anchor for reduction and fixation, while those in the clavicle hook plate group were treated with clavicular hook plate for internal fixation. The length of surgical incision, duration of surgery, hospitalization time and time to return to work of both groups were recorded. The shoulder function was evaluated according to the Lazzcano criterion of curative effect at 3, 6 and 12 months after surgery. The visual analogue scale score of shoulder pain, abduction and raising, forward bend and raising were compared between the two groups. All patients were followed up for 1 year to record the occurrence of complications. This study was approved by the Medical Ethics Committee of General Hospital of Jizhong Energy Xingtai Mining Group. All subjects signed the informed consent. RESULTS AND CONCLUSION: (1) There was no significant difference in the duration of surgery between the two groups (P > 0.05). The surgical incision, hospitalization time and time to return to work of the arthroscopy group were significantly better than those of the clavicle hook plate group (P 0.05). (3) Visual analogue scale scores of the two groups showed a decreasing trend at 3, 6 and 12 months after surgery (P < 0.01). The visual analogue scale score of arthroscopy group was significantly lower than that of the clavicle hook plate group at the same time point (P < 0.01). (4) Angles of abduction and raising, forward bend and raising of both groups showed an increasing trend at 3, 6 and 12 months after surgery (P < 0.01). The angles of abduction and raising, forward bend and raising of the arthroscopy group were larger than those of the clavicle hook plate group at the same time point (P < 0.01). (5) The 1-year follow-up results showed that the incidence of complications in the arthroscopy group (6%) was significantly lower than that in the clavicle hook plate group (63%) (P < 0.01). (6) Compared with clavicular hook plate fixation, the technique of suture anchors under arthroscopy has the advantages of small trauma, quick recovery, fewer complications and no need to remove endografts again. Meanwhile, the surgery can also clearly diagnose the concomitant lesions in the joints and treat them when necessary, so as to improve the treatment effect.

Advantages and disadvantages of internal fixation with suture anchors and locking plate in the treatment of the greater tuberosity fracture / 中国组织工程研究

BACKGROUND: Open reduction and internal fixation with locking plate is wildly used in treatment of the greater tuberosity fracture, but certain disadvantages still existed. OBJECTIVE: To compare the effects of open reduction and internal fixation with suture anchors and locking plate in the treatment of the greater tuberosity fracture. METHODS: A retrospective review of 33 patients with greater tuberosity fracture treated with open reduction and internal fixation between January 2016 and December 2018 was conducted. According to internal fixation method, the patients were divided into anchor group (n=7) and plate group (n=26), which received open reduction + suture anchor fixation and open reduction + locking plate fixation. Operation time, incision length, intraoperative blood loss, postoperative displacement of fracture mass, and Constant-Murley score 1 and 3 months after surgery and in final follow-up were compared between the two groups. Adverse reactions were recorded in the two groups. RESULTS AND CONCLUSION: (1) Operation time was shorter in the anchor group (73.1±10.5 minutes) than in the plate group (98.2±11.9 minutes). Incision length was shorter in the anchor group (7.3±1.1 cm) than in the plate group (14.9±1.7 cm). Intraoperative blood loss was less in the anchor group (45.0±7.1 mL) than in the plate group (141.0±25.9 mL) (P 0.05). (4) All results suggest that compared with locking plate fixation, suture anchor fixation is easier to be operated with small trauma in the treatment of the greater tuberosity fracture.

Double-Pulley technique combined with 8-shaped tension band for fixation of comminuted fractures of distal patellar pole / 第二军医大学学报

Objective: To explore the feasibility and clinical effects of Double-Pulley technique combined with 8-shaped tension band in teatment of comminuted fractures of distal patellar pole. Methods: From Jan. 2017 to Apr. 2018, 10 patients (6 males and 4 females) were treated with Double-Pulley technique combined with 8-shaped tension band in our hospital. The ages of patients ranged from 28 to 58 years old, with an average of (36.4± 11.4) years old. The average time from injury to surgery was (2.8 ± 1.1) d, ranging from 1 to 5 d. The injury cause was traffic accident in 6 cases, falling iniury in 3 cases, and sport injury in 1 case. Bostman's patellar fracture function evaluation system was used to evaluate the postoperative knee joint function. The clinical evaluation indexes included the excellent and good rate of Bostman's patellar fracture function score, and X-ray examination results and knee mobility during follow-up. Results: All patients were followed up for 16 to 24 months. The incision of all patients healed well, and no anterior knee pain or complications were found. Six months after surgery, X-ray examination showed that the patellar fracture healing of 10 patients were all osteonal union. Six months after surgery, the flexion range of knee joint was 132.0°±12.3°, and Bostman's patellar fracture function score was 28.5±1.8, with the excellent and good rate being 100% (excellent in 9 cases and good in 1 case). Conclusion: Double-Pulley technique combined with 8-shaped tension band is effective and reliable in the treatment of comminuted fractures of distal patellar pole, and the patients can start functional exercise early after surgery.

Arthroscopic GraftLink technique reconstruction combined with suture anchor fixation for anterior cruciate ligament and medial collateral ligament injuries / 中国修复重建外科杂志

Objective: To investigate the effectiveness of arthroscopic GraftLink technique reconstruction combined with suture anchor fixation in treatment of anterior cruciate ligament (ACL) rupture and medial collateral ligament (MCL) grade Ⅲ injury. Methods: Between June 2015 and February 2018, 28 patients with ACL rupture and MCL grade Ⅲ injury were treated. Arthroscopic GraftLink technique was used to reconstruct ACL with autologous peroneus longus tendon (PLT), and suture anchor fixation was used to repair MCL. There were 22 males and 6 females, aged 21-47 years, with an average age of 30.4 years. The cause of injury included traffic accident in 18 cases, falling from height in 7 cases, and sports injury in 3 cases. The time from injury to admission was 1-2 weeks, with an average of 1.3 weeks. The preoperative Lysholm score of knee joint was 46.8±3.0 and the International Knee Documentation Commission (IKDC) score was 49.2±2.7. The American Orthopaedic Foot and Ankle Society (AOFAS) score of ankle joint was 98.29±0.72. Both Lachman test and valgus stress test were positive. There were 8 cases of meniscus injury and 2 cases of cartilage injury. Results: The operation time ranged from 55 to 90 minutes, with an average of 72.5 minutes. All incisions healed by first intention after operation, and no complications related to operation occurred. All patients were followed up 6-38 months, with an average of 20.7 months. At 3 months after operation, the range of motion of the knee joint was 116- 132°, with an average of 122°. Lachman test showed that the anterior translation more than 5 mm in 2 cases, and the others were negative; while the valgus stress test showed that all patients were positive. At 6 months after operation, the Lysholm score and IKDC score of knee joint were 90.2±1.8 and 93.5±2.3, respectively, which were significantly higher than preoperative scores ( t=31.60, P=0.00; t=29.91, P=0.01); AOFAS score of ankle joint was 97.86±0.68, with no significant difference compared with preoperative score ( t=2.89, P=0.08). KT-1000 test showed that the difference of anterior relaxation between bilateral knee joints was less than 2 mm in 25 cases and 3 to 5 mm in 3 cases. Conclusion: The method of ACL reconstruction via arthroscopic GraftLink technique with PLT and MCL repair via suture anchor fixation has the advantages of less knee injury and faster recovery, and there is no significant impact on ankle function after tendon removal.

Clinical Outcomes of Arthroscopic Rotator Cuff Repair Using Poly Lactic-co-glycolic Acid Plus β-tricalcium Phosphate Biocomposite Suture Anchors

BACKGROUND: This study is performed to evaluate anchor-related outcomes and complications after arthroscopic rotator cuff repair using 30% β-tricalcium phosphate (β-TCP) with 70% poly lactic-co-glycolic acid (PLGA) biocomposite suture anchors. METHODS: A total of 78 patients (mean age, 61.3 ± 6.9 years) who underwent arthroscopic medium-to-large full-thickness rotator cuff tear repair were enrolled. The technique employed 30% β-TCP with 70% PLGA biocomposite suture anchors at the medial row (38 patients, Healix BRTM anchor [Healix group]; 40 patients, Fixone anchor B [Fixone group]). The radiologic outcomes (including perianchor cyst formation or bone substitution) and anatomical outcomes of the healing failure rate were evaluated using magnetic resonance imaging at least 6 months after surgery, the pain visual analogue scale at 3, 6 months, and final follow-up visit, and American Shoulder and Elbow Surgeons scores at least 1 year postoperatively. Anchor-related complications were also evaluated. RESULTS: The perianchor cyst formation incidence was similar for both groups (60.5%, Healix group; 60.0%, Fixone group; p=0.967), although severe perianchor cyst incidence was slightly lower in the Fixone group (15.0%) than in the Healix group (21.1%). There was no occurrence of anchor absorption and bone substitution. No differences were observed in the healing failure rate (13.2%, Healix group; 15.0%, Fixone group; p=0.815) and functional outcome between groups (all p>0.05). Anchor breakage occurred in 5 patients (2 Healix anchors and 3 Fixone anchors); however, there were no major anchor-related complications in either group. CONCLUSIONS: No differences were observed in the clinical outcomes of the Healix and Fixone groups, neither were there any accompanying major anchor-related complications.

Clinical effect of anchorage of saphenous nerve on repairing medial collateral ligament injury of knee joint / 中国医师进修杂志

Objective To evaluate the clinical effect of protecting the saphenous nerve with the suture anchor on repairing the medial collateral ligament injury of the knee joint. Methods From June 2014 to June 2016, 48 cases of medial collateral ligament injuries of the knee joint were repaired with suture anchors of the saphenous nerve in the 107th Hospital of PLA. Results All patients were followed up for 12-18 months, with an average of 14.6 months. All the patients were followed up with good stability of the knee joint. The 30 degree flexion stress test of the knee joint showed that 2 cases were positive forⅠdegree, and the stress test of the extension position was negative. The X-ray examination showed that the internal and external articular space of the knee joint was symmetrical and good, and the anchors did not loose or move in the bone. The average knee flexion before operation was (43.19 ± 2.60)°, and 1 year after operation was (135.62 ± 3.68) °. And the flexion of knee 1 year after operation was higher than that before operation (t=5.37, P<0.01). The Lysholm score was (43.19 ± 2.60) points before operation, and 1 year after operation was (93.69 ± 5.39) points, and the postoperative score was higher than that before operation (t=4.85, P<0.01). The grade of efficacy was excellent in 42 cases, good in 4 cases, fair in 2 cases, and the excellent and good rate was 95.8％(46/48). Conclusions The repair of medial collateral ligament injury with suture anchors under the protection of the hidden nerve can effectively prevent the symptoms of numbness in the medial area of the knee joint. It is simple, fixed and can be repaired under direct vision. It is reliable to restore the strength of the ligament and maintain the stability of the medial knee joint. It is worthy of clinical push and wide application.

Curative effect of adolescent tibial intercondylar eminence fracture:fixed with suture anchor or hollow screw or wire / 实用医学杂志

Objective To compare the curative effect of fixation of adolescent tibial intercondylar emi-nence fracture among suture anchor,hollow screw and wire. Methods Forty-six adolescent cases of the tibial intercondylar eminence fracture treated with surgical treatment were selected from January 2010 to June 2016 and divided into three groups refer to intra-operative fixation suture anchor group(Group A),hollow screw group (Group B)and wire group(Group C).Duration of treatment,total operation time,hospital stay and surgery times were recorded. All patient condition was assessed with the Lysholm,Tegner,IKDC and VAS score. Results All patients received an average of 13(11~14)months follow-up visit. No blood-vessel,nerve and osteoepiphysis injured,infection and fracture displacement occurred.Before receiving treatment,difference in Lysholm,Tegner, IKDC and VAS score of group A,B and C showed no statistical difference.When it comes to hospitalization condi-tion,data were as follows.Group A/B/C:operation time(80.67 ± 16.68/114.00 ± 20.28/111.88 ± 20.07)min, hospital stay(8.40 ± 1.12/ 15.47 ± 1.25/ 15.19 ± 1.17)d,surgery times(1/2/2)times. Moreover,compared with those before operation and after operation in both of groups,the Lysholm,Tegner,IKDC and VAS score were improved(P < 0.05). Besides,the Lysholm,Tegner,IKDC and VAS score of group A,B and C did not have statistically significant difference yet after post treatment(P>0.05).Conclusions The curative effect of fixation of adolescent tibial intercondylar eminence fracture among suture anchor,hollow screw and wire was similar. By contrast,the fixation of fracture by use of suture anchor can decrease operation time and hospital stay to some extent. It had advantage of need not to have a second operation to remove the internal fixation and can be used in preference.

Medial Meniscal Root Repair Using Curved Guide and Soft Suture Anchor

Medial meniscal root tears have been repaired using various methods. Arthroscopic all-inside repair using a suture anchor is one of the popular methods. However, insertion of the suture anchor into the proper position at the posterior root of the medial meniscus is technically difficult. Some methods have been reported to facilitate suture anchor insertion through a high posteromedial portal, a posterior trans-septal portal, or a medial quadriceptal portal. Nevertheless, many surgeons still have difficulty during anchor insertion. We introduce a technical tip for easy suture anchor insertion using a 25° curved guide and a soft suture anchor through a routine posteromedial portal.

Treatment of patellofemoral instability in adolescent by anatomical double-bundle medial patellofemoral ligament reconstruction with double suture anchor technique / 中南大学学报(医学版)

Objective: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.

Curative effects of suture anchor tenodesis in repairing acute closed distal achilles tendon injuries / 天津医药

Objective To evaluate the effectiveness of the suture anchor in the treatment of acute closed distal achilles tendon rupture. Methods A retrospective review of clinical data in 25 patients with acute achilles tendon rupture was performed in the department of orthopedic trauma of Tianjin Hospital between October 2012 to January 2014. The operation was performed by standard approach, with the suture anchors to reconstruct the achilles tendon insertion, and the Krachow technique was used to suture the achilles tendon. All patients were followed up for 19~35 months. The situation of the wound healing, heel pain, and achilles tendon re-rupture were observed and analyzed. According to the passive range of motion of the bilateral ankle joint, the achilles tendon total rupture score (ATRS), the American orthopaedic foot and ankle society (AOFAS) score and functional recovery were assessed one year after operation. Results The operation was successfully completed in this group. The operation time was 25-35 min, the average time was (30.4 ± 4.8) min. No major vascular and nerve injury occurred in the operation. All patients were followed up. The wound healed well. No infection and skin necrosis, no heel pain and achilles tendon re-rupture were found during follow-up. There was no significant difference in mean passive plantar flexion between injured ankles and uninjured ankles one year after operation (44.36° ± 3.33° vs. 46.40°±4.53°, P>0.05). But mean passive dorsiflexion was lower in injured ankles than that of uninjured ankles (16.88°± 4.10° vs. 20.12°±3.21°,P<0.05). The mean ATRS score was 88.7±6.1 (range 79-97), and the mean AOFAS score was 92.4± 5.6 (range 76-100) at first postoperative year. According to the AOFAS scale, the results were excellent in 20 cases and good in 5 cases. Conclusion It was successful to repair the acute closed distal achilles tendon injuries with the suture anchors.

Treatment of Avulsion Fracture of Proximal Rectus Femoris with Suture Anchor / 대한스포츠의학회지

Avulsion injuries of the anterior inferior iliac spine, which is the origin of the rectus femoris muscle, are sometimes reported in children and adolescents, but acute avulsion injuries with complete rupture of the rectus femoris are very rare in adults. We treated a case of avulsion fracture of the anterior inferior iliac spine with suture anchors in an adult and achieved a favorable outcome. Thus, we report the case with a review of literature.

Curative analysis of suture anchors in repairing delayed Achilles tendon rupture / 中华创伤杂志

Objective To summarize the clinical efficacy of suture anchors in repairing the delayed Achilles tendon rupture.Methods From January 2010 to December 2013,23 patients with delayed Achilles tendon rupture were treated using the suture anchors.There were 19 males and 4 females,at mean age of 43 years (range,35-53 years).Injury on the left side occurred in 5 patients and right side in 18 patients.Mean time from injury to operation was 26.3 days (range,21-40 days).Ten patients were diaguosed by ultrasound and the other by MRI.All patients underwent suture anchor fixation without external support.Functional training started at the early stage.Incision complications were detected.Ankle flextiou-extension range,American Orthopedic Foot and Ankle Society (AOFAS) score,maximum bilateral leg circumference,tendon rerupture and walking posture were recorded at postoperative 6,12,18 and 24 months.Achilles tendon muscular strength was measured with the Lunsford-Perry heelrise test.Results Follow-up was 24 months.All incisions healed by first intention without sural nerve injury,adherence with skin and deep infection.Six months after operation,the ankle range of motion was dorsiflexion 10.8° (range,9-15°) and plantar flexion 43.8° (range,40-48°),with no significant difference in comparison to the health side (P ＞ 0.05).AOFAS score differed significantly before and after operation (P ＜ 0.01).Maximal leg circumference was 38.2 cm in the health side versus 35.8 cm in the injury side (P ＜ 0.05),but the difference was no more than 3 cm.All patients completed 25 times heel raising without difficulty.Four patients walked with a slight limp and recovered from the limp 12 months after operation.No Achilles tendon ruptured again during the follow-up time.Conclusions Repairing the old Achilles tendon rupture with suture anchors can supply strongly strain between broken ends of the tendon,and the outer cast is not needed after operation.Complications are less and functional practice can be commenced in the early postoperative period for better function restoration.

Minimal Medial-row Tie with Suture-bridge Technique for Medium to Large Rotator Cuff Tears

BACKGROUND: The purpose of this study was to evaluate the postoperative magnetic resonance imaging (MRI) results of minimal-tying (one medial-row tie among 4 medial-row sutures) on the medial-row in double-row suture-bridge configuration (2x2 anchor with 4x4 suture stands). METHODS: From 2011 March to 2012 July, 79 patients underwent arthroscopic rotator cuff repair using 2x2 anchor double-row configuration. The mean age was 61.3 years (range, 31-81 years). Two double-loaded suture anchors were used for medial-row. Four medialrow stitches were made with only one medial-row knot-tying (the most anterior suture). Lateral-row was secured using the conventional suture-bridge anchor technique; all 4 strands were used for each anchor. Repair integrity was evaluated with MRI at mean 6.2 months postoperatively. Retear and the pattern of retear, change of fatty infiltration, and muscle atrophy of supraspinatus were evaluated using pre- and postoperative MRI. RESULTS: Repaired tendon integrity was 38 for type I, 30 for type II, 6 for type III, 4 for type IV, and 1 for type V, according to Sugaya classification. Considering type IV/V as retear, the rate was 6.3% (5 out of 79 patients). Medial cuff failure was observed in 4 patients. Fatty atrophy of supraspinatus was significantly improved postoperatively according to Goutallier grading (p=0.01). The level of muscle atrophy of supraspinatus was not changed significantly after surgery. CONCLUSIONS: Minimal tying technique with suture configuration of four-by-four strand double-row suture-bridge yielded a lower retear rate (6.3%) in medium to large rotator cuff tears.

Operative Treatment of Medial Epicondylitis: A Comparative Analysis of the Clinical Outcomes between the Suture Anchor Group and the Non-suture Anchor Group

BACKGROUND: The purpose of this study was to make a comparative analysis of the clinical outcomes after the operative treatment of refractory medial epicondylitis between the suture anchor group and the non-suture anchor group. METHODS: We enrolled 20 patients (7 men and 13 women) with recalcitrant medial epicondylitis who were able to receive operative treatment in a minimum of an 18-month follow-up. The mean age was 48.6 years (range, 36-59 years). The patients were allocated into either the suture anchor group (7 patients) or the non-suture anchor group (13 patients). We evaluated clinical outcomes using the visual analog scale (VAS), the pain grading system of Nirschl and Pettrone, and postoperative grip strength. RESULTS: The VAS score decreased from 8.8 to 2.0 for the suture anchor group and from 8.6 to 1.3 for the non-suture anchor group (p=0.16). The postoperative grip strength was 95%, 93% of the non-treated arm in both groups (p=0.32). The postoperative satisfaction level was good in 5 patients and fair in 2 for the suture anchor group and excellent in 5 patients, good, in 4, and fair, in 4 for the nonsuture anchor group (p=0.43). The clinical outcomes did not show a statistically significant difference between the two groups. CONCLUSIONS: We found that patients with recalcitrant medial epicondylitis were treated reliably with satisfactory clinical outcomes whether or not suture anchors were used. We believe the use of suture anchors when more than 50% of the tendon origin is affected provides an effective and favorable treatment modality.