Validity of the Maturation Stage Method in the Individual Assessment of Midpalatal Suture Ossification Before Maxillary Expansion: A Systematic Review / Validez del Método de la Etapa de Maduración en la Evaluación Individual de la Osificación de la Sutura Palatina Mediana Previo a la Expansión Maxilar: Una Revisión Sistemática

In 2013, midpalatal suture maturation stage assessment was proposed for the evaluation of patients before performing maxillary expansion. In this study, we aimed to analyze the association between the midpalatal suture maturation stages assessed by CBCT, according to the method described by Angelieri et al., and other objective methods used to assess skeletal maturation or bone fusion. A computerized database search was conducted using PubMed, Cochrane Library, SciELO, LILACS, Web of Science, and Scopus, without language restriction. Unpublished literature was searched on ClinicalTrials.gov, the National Research Register, and Pro-Quest Dissertation Abstracts and Thesis database. Authors were contacted when necessary, and reference lists of the included studies were screened. Search terms included midpalatal suture, maturation, correlation, diagnostic performance, classification, evaluation, assessment, and relationship. Quality assessment was performed using the Observational Cohort and Cross-Sectional Studies tool developed by the National Heart, Lung, and Blood Institute. Eleven studies met the inclusion criteria. Of all the studies included, 81.9% had fair qualit y and 18.1% good quality, respectively. Eight out of eleven studies assessed the correlation between the midpalatal suture maturation method and the skeletal maturity evaluated by CVM method (Spearman's correlation coefficient: 0.244-0.908). Two out of eleven studies evaluated the correlation between midpalatal suture maturation method and the skeletal maturity assessed by HWM method (Spearman's correlation coefficient: 0.904-0.905) Even though midpalatal suture maturation stage assessment needs an exhaustive training and calibration process, it is a valid method to evaluate skeletal maturation or bone fusion. From a clinical perspective, for patients at CS4, CS5 and CS6, an assessment of the midpalatal suture on CBCT is indicated. A similar assessment should be done in patients at SMI 7-9.

En 2013, se propuso un nuevo método para la evaluación del estadio de maduración de la sutura palatina mediana para la evaluación de los pacientes antes de realizar la expansión maxilar. En este estudio, nuestro objetivo fue analizar la asociación entre las etapas de maduración de la sutura palatina mediana evaluada en CBCT, según el método descrito por Angelieri et al., y otros métodos objetivos utilizados para evaluar la maduración esquelética o la fusión ósea. Se realizó una búsqueda en las bases de datos PubMed, Cochrane Library, SciELO, LILACS, Web of Science y Scopus, sin restricción de idioma. Se buscó literatura no publicada en ClinicalTrials.gov, el Registro Nacional de Investigación y la base de datos Pro-Quest Dissertation Abstracts and Thesis. Se estableció contacto con los autores cuando fue necesario y se revisaron las listas de referencias de los estudios incluidos. Los términos de búsqueda incluyeron sutura palatina mediana, maduración, correlación, rendimiento diagnóstico, clasificación, evaluación, valoración y relación. La evaluación de la calidad se realizó mediante la herramienta de Estudios transversales y de cohortes observacionales desarrollada por el Instituto Nacional del Corazón, los Pulmones y la Sangre. Once estudios cumplieron con los criterios de inclusión. Del total de estudios incluidos, el 81.9% tuvo calidad regular y el 18.1% calidad buena, respectivamente. Ocho de once estudios evaluaron la correlación entre el método de maduración de la sutura palatina mediana y la madurez esquelética evaluada por el método CVM (coeficiente de correlación de Spearman: 0.244-0.908). Dos de once estudios evaluaron la correlación entre el método de maduración de la sutura palatina mediana y la madurez esquelética evaluada por el método HWM (coeficiente de correlación de Spearman: 0.904-0.905). Aunque la evaluación del estado de maduración de la sutura palatina mediana necesita un proceso exhaustivo de entrenamiento y calibración, es un método válido para evaluar la maduración esquelética o la fusión ósea. Desde una perspectiva clínica, para pacientes en CS4, CS5 y CS6, está indicada una evaluación de la sutura palatina mediana en CBCT. Se debe realizar una evaluación similar en pacientes con SMI 7-9.

Rotura aguda del tendón de Aquiles tratadas quirúrgicamente con Técnica de Mínimo Abordaje. Resultados clínicos y funcionales a un año de seguimiento / Acute rupture of the Achilles tendon surgically treated with the Minimal Approach Technique. Clinical and functional results at one year of follow-up

Se deben tener consideraciones especiales cuando se realizan reparaciones quirúrgicas del tendón de Aquiles. Su anatomía e irrigación particular plantean desafíos únicos para el manejo, y tener comprensión profunda de estas características es crucial para escoger el tratamiento adecuado y lograr resultados exitosos. El objetivo de este trabajo es analizar la eficiencia de la reparación quirúrgica de la rotura aguda del tendón de Aquiles con técnica de Dresden, entre el 2015 y el 2021. Se realizó un estudio de tipo analítico, observacional, longitudinal y prospectiva. El análisis del aspecto estadístico fue a través de estadística descriptiva y asociación de las variables. Se incluyeron 34 pacientes con un promedio de 42 años, la mayoría de sexo masculino. Al aplicar las escalas VISA-A se obtuvo un promedio de 12 puntos, 67,5 puntos a los 6 meses y 80,5 puntos a los 12 meses. En la encuesta SF-12 a los 6 meses se obtuvo un promedio de 68,5 puntos y 80 puntos a los 12 meses; un paciente presentó rechazo de la sutura y 6 afirmaron algún grado de edema residual aun al año de la cirugía. La reparación quirúrgica con técnica de Dresden mejora la funcionabilidad del tendón de malos resultados a regulares y buenos resultados al año de seguimiento. El 68% de la población estudiada afirmó que se encuentran satisfechos con la cirugía(AU)

Special considerations must be made when performing surgical repairs of the Achilles tendon. Its particular anatomy and blood supply pose unique management challenges, and a thorough understanding of these characteristics is crucial to choosing the right treatment and achieving successful results. The objective of this work is to analyze the efficiency of the surgical repair of the acute rupture of the Achilles tendon with the Dresden technique, between 2015 and 2021. An analytical, observational, longitudinal and prospective study was carried out. The analysis of the statistical aspect was through descriptive statistics and association of the variables. 34 patients with an average age of 42 years were included, most of them male. When applying the VISA-A scales, an average of 12 points was obtained, 67,5 points at 6 months and 80,5 points at 12 months. In the SF-12 survey at 6 months an average of 68,5 points and 80 points at 12 months were obtained; One patient presented rejection of the suture and 6 reported some degree of residual edema even one year after surgery. Surgical repair with the Dresden technique improves the functionality of the tendon from poor to regular results and good results after a year of follow-up. 68% of the population studied stated that they are satisfied with the surgery(AU)

Sutura meniscal en deportistas: análisis de fallas y retorno al deporte / Meniscal suture in athletes: Failure analysis and return to Sport

Introducción: La sutura meniscal es una técnica cada vez más utilizada en pacientes con lesiones meniscales, con buenos resultados en la población general. Sin embargo, los estudios realizados en pacientes deportistas son escasos. Se analizaron las fallas de la sutura meniscal y el retorno al deporte en pacientes deportistas, y se identificaron posibles factores asociados. Materiales y Métodos: Se evaluaron retrospectivamente 61 suturas meniscales en deportistas (puntaje de Tegner ≥6) con un seguimiento mínimo de 12 meses. Cuarenta y nueve eran lesiones aisladas y 12 se asociaban con plástica del ligamento cruzado anterior. El seguimiento promedio fue de 61 meses y los pacientes fueron evaluados con los puntajes de Tegner y de Lysholm. Resultados: Se constató la falla de la sutura meniscal en 12 (19,67%) pacientes; la falla ocurrió, en promedio, 14 meses poscirugía. Nueve fallas se produjeron en suturas aisladas y 3 se asociaron con plástica del ligamento cruzado anterior (p <0,05). El menisco que más falló fue el interno. El 75% corresponde a pacientes que practicaban un deporte de contacto y pivote (p <0,05). Los pacientes que no sufrieron falla pudieron continuar con la misma actividad deportiva que antes de la lesión y el puntaje de Lysholm había mejorado significativamente (p <0,05). Conclusiones: Las fallas fueron significativamente más frecuentes en meniscos internos, suturas aisladas, lesiones en asa de balde, y deportes de contacto y pivote. Consideramos que la sutura meniscal es una excelente opción quirúrgica para pacientes deportistas, ya que un alto porcentaje de ellos retorna al deporte. Nivel de Evidencia: IV

Introduction: Meniscal suturing is a technique increasingly used in patients with meniscal lesions, with good outcomes in the general population. However, research on athletes is limited. Meniscal suture failures and return to sport in athletes were analy-zed, and possible contributing factors were identified. Materials and Methods: Sixty-one meniscal sutures in athletes (Tegner score ≥6) with a minimum follow-up of 12 months were retrospectively evaluated. Forty-nine were isolated lesions and 12 were associated with anterior cruciate ligament reconstruction. The average follow-up was 61 months and patients were evaluated with Tegner and Lysholm scores. Results: Meniscal suture failure was noted in 12 (19.67%) patients; failure occurred, on average, 14 months post-surgery. Nine failures occurred in isolated sutures and 3 were associated with anterior cruciate ligament recons-truction (p<0.05). The meniscus that failed the most was the internal meniscus. Seventy-five percent corresponded to patients who practiced pivot-contact sports (p<0.05). Patients who did not suffer failure were able to continue with the same sporting activity as before the injury and the Lysholm score had significantly improved (p<0.05). Conclusions: Failures were significantly more frequent in internal menisci, isolated sutures, bucket-handle injuries, and pivot-contact sports. We believe that meniscal suture is an excellent surgical option for athletic patients because a high percentage of them return to sports. Level of Evidence: IV

Effectiveness of arthroscopic binding fixation using suture through single bone tunnel for posterior cruciate ligament tibial insertion fracture in adults / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of arthroscopic binding fixation using suture through single bone tunnel for posterior cruciate ligament (PCL) tibial insertion fractures in adults.@*METHODS@#Between October 2019 and October 2021, 16 patients with PCL tibial insertion fractures were treated with arthroscopic binding fixation using suture through single bone tunnel. There were 11 males and 5 females with an average age of 41.1 years (range, 26-58 years). The fractures were caused by traffic accident in 12 cases and sports in 4 cases. The time from injury to operation ranged from 2 to 10 days with an average of 6.0 days. The fractures were classified as Meyers-McKeever type Ⅱ in 4 cases and type Ⅲ in 9 cases, and Zaricznyi type Ⅳ in 3 cases. There were 2 cases of grade Ⅰ, 7 cases of grade Ⅱ, and 7 cases of grade Ⅲ in the posterior drawer test. There were 3 cases combined with lateral collateral ligament injury and 2 cases with meniscus injury. The visual analogue scale (VAS) score, Lysholm score, International Knee Documentation Committee (IKDC) score, and knee range of motion were used to evaluate knee joint function. The posterior drawer test and knee stability tester (Kneelax 3) were used to evaluate knee joint stability. The X-ray films were used to evaluate fracture reduction and healing.@*RESULTS@#All incisions healed by first intention after operation. There was no incision infection, popliteal neurovascular injury, or deep venous thrombosis of lower limbs. All patients were followed up 6-12 months, with an average of 10 months. X-ray films at 6 months after operation showed the fractures obtained bone union. There were 11 cases of grade 0, 4 cases of gradeⅠ, and 1 case of grade Ⅱin posterior drawer test, showing significant difference when compared with preoperative results ( Z=23.167, P<0.001). The VAS score, Lysholm score, IKDC score, knee range of motion, and the results of Kneelax3 examination all significantly improved when compared with preoperative results ( P<0.05).@*CONCLUSION@#For adult patients with PCL tibial insertion fractures, the arthroscopic binding fixation using suture through single bone tunnel has the advantages of minimal trauma, good fracture reduction, reliable fixation, and fewer complications. The patient's knee joint function recovers well.

Effectiveness analysis of "tail compression fixation+suture bridge" technology under shoulder arthroscopy for treating primary tear in medial enthesis of rotator cuff / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility and effectiveness of "tail compression fixation+suture bridge" technology under shoulder arthroscopy for treating primary tear in medial enthesis of rotator cuff.@*METHODS@#The clinical data of 11 patients with primary tear in medial enthesis of rotator cuff who met the selection criteria between October 2020 and October 2022 were retrospectively analyzed, including 3 males and 8 females, aged 39-79 years, with an average of 61.0 years. Rotator cuff injury was caused by traumatic fall in 8 cases, and the time from injury to admission was 1-4 months, with an average of 2.0 months; the remaining 3 cases had no obvious inducement. The active range of motion of the affected shoulder was limited, with an active forward flexion range of motion of (64.1±10.9)°, abduction of (78.1±6.4)°, internal rotation of (48.2±6.6)°, and external rotation of (41.8±10.5)°; 5 cases had shoulder stiffness. The preoperative visual analogue scale (VAS) score was 7.8±0.8 and the American Society of Shoulder and Elbow Surgeons (ASES) score was 23.9±6.4. The patients were treated with "tail compression fixation+suture bridge" technology under shoulder arthroscopy, and the pain and functional recovery were evaluated by VAS score, ASES score, and active range of motion of shoulder joint at last follow-up; MRI was performed after operation, and the integrity of rotator cuff was evaluated by Sugaya classification system.@*RESULTS@#All the 11 patients were followed up 2-22 months, with an average of 13.5 months. All incisions healed by first intention, and there was no complication such as infection, rotator cuff re-tear, and anchor falling off. At last follow-up, the VAS score was 0.8±0.7 and the ASES score was 93.5±4.2, which significantly improved when compared with those before operation ( P<0.05). All 11 patients had no significant swelling in the shoulders, and the active range of motion was (165.1±8.8)° in flexion, (75.3±8.4)° in abduction, (56.6±5.5)° in internal rotation, and (51.8±4.0)° in external rotation, which significantly improved when compared with those before operation ( P<0.05). Shoulder MRI showed adequate tendon thickness and good continuity in 9 cases, including 4 cases with partial high signal area; and 2 cases with inadequate tendon thickness but high continuity and partial high signal area. According to Sugaya classification system, there were 4 cases of type 1 (36.4%), 5 cases of type 2 (45.5%), and 2 cases of type 3 (18.1%).@*CONCLUSION@#For the patients with primary tear in medial enthesis of rotator cuff, the "tail compression fixation+suture bridge" technology under shoulder arthroscopy is simple and effective.

Clinical application of Fastpass Scorpion suture passer for arthroscopic Bankart repair / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness and advantages of using Fastpass Scorpion suture passer to stitch the inferior capsulolabral complex in arthroscopic Bankart repair compared with traditional arthroscopic suture shuttle.@*METHODS@#The clinical data of 41 patients with Bankart lesion, who met the selection criteria and were admitted between August 2019 and October 2021, was retrospectively analyzed. Under arthroscopy, the inferior capsulolabral complex was stitched with Fastpass Scorpion suture passer in 27 patients (FS group) and with arthroscopic suture shuttle in 14 patients (ASS group). There was no significant difference between the two groups ( P>0.05) in gender, age, injured side, frequency of shoulder dislocation, time from first dislocation to operation, and preoperative Rowe score of shoulder. Taking successful suture and pull-tightening as the criteria for completion of repair, the number of patients that were repaired at 5∶00 to 6∶00 (<6:00) and 6∶00 to 7∶00 positions of the glenoid in the two groups was compared. The operation time, and the difference of Rowe shoulder score betwee pre- and post-operation, the occurrence of shoulder joint dislocation, the results of apprehension test, and the constituent ratio of recovery to the pre-injury movement level between the two groups at 1 year after operation.@*RESULTS@#Both groups completed the repair at 5∶00 to 6∶00 (<6∶00), and the constituent ratio of patients completed at 6∶00 to 7∶00 was significantly greater in the FS group than in the ASS group ( P<0.05). The operation time was significantly shorter in the FS group than in the ASS group ( P<0.05). All incisions in the two groups healed by first intention. All patients were followed up 12-36 months (mean, 19.1 months). No anchor displacement or neurovascular injury occurred during follow-up. Rowe score of shoulder in the two groups significantly improved at 1 year after operation than preoperative scores ( P<0.05), and there was no significant difference in the difference of Rowe shoulder score between pre- and post-operation between the two groups ( P>0.05). At 1 year after operation, no re-dislocation occurred, and there was no significant difference in the apprehension test and the constituent ratio of recovery to the pre-injury movement level between the two groups ( P>0.05).@*CONCLUSION@#Compared with the arthroscopic suture shuttle, using Fastpass Scorpion suture passer to stitch the inferior capsulolabral complex in arthroscopic Bankart repair is more convenient, saves operation time, and has good effectiveness.

Effectiveness of fascial tissue flaps and skin flaps with layered sutures for repair of wounds after excision of sacrococcygeal pilonidal sinus / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility and effectiveness of fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus.@*METHODS@#Between March 2019 and August 2022, 9 patients with sacrococcygeal pilonidal sinus were admitted, including 7 males and 2 females with an average age of 29.4 years (range, 17-53 years). The disease duration ranged from 1 to 36 months, with a median of 6 months. There were 7 cases with obesity and dense hair, 3 cases with infection, and 2 cases with positive bacterial culture of sinus secretion. The wound area after excision ranged from 3 cm×3 cm to 8 cm×4 cm, with a depth of 3-5 cm, reaching the perianal or caudal bone; there were 2 cases with perianal abscess formation and 1 case with caudal bone inflammatory edema. Enlarged resection was performed during operation, and the fascial tissue flap and skin flap were designed and excised at both left and right sides of the buttock, ranging from 3.0 cm×1.5 cm to 8.0 cm×2.0 cm. A cross drainage tube was placed at the bottom of the wound, and the fascial tissue flap and skin flap were advanced and sutured in three layers, namely, 8-string sutures in the fascial layer, barbed wire reduction sutures in the dermis, and interrupted skin sutures.@*RESULTS@#All 9 patients were followed up 3-36 months, with an average of 12 months. All incisions healed by first intention, and no complication such as incisional dehiscence or infection in the operative area occurred. There was no recurrence of sinus tracts, the shape of gluteal sulcus was satisfactory, both sides of buttocks were symmetrical, local incision scar was concealed, and the shape disruption was minimal.@*CONCLUSION@#Fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus can effectively fill the cavity and reduce the incidence of poor incision healing, with the advantages of small trauma and simple operation.

Effectiveness of arthroscopic "hybrid" suture for delaminated rotator cuff tear: A prospective randomized controlled study / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of "hybrid" suture with en masse combined with double-layer repair under arthroscopy in repair of delaminated rotator cuff tear by comparison with en masse suture.@*METHODS@#Fifty-six patients with delaminated rotator cuff tears met selection criteria between June 2020 and January 2022 were included in the study. Patients were divided into two groups ( n=28) using a random number method. The patients in trial group underwent arthroscopic "hybrid" suture with the combination en masse and double-layer suture. The patients in control group underwent en masse suture under arthroscopy. There was no significant difference between the two groups ( P>0.05) in terms of gender, age, rotator cuff tear side, tear size, cause of injury, disease duration, and preoperative American Association of Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder scoring, visual analogue scale (VAS) score, and shoulder range of motion (forward flexion and lateral external rotation). The operation time, the difference of ASES score, UCLA score, VAS score, and shoulder range of motion (forward flexion and lateral external rotation) between pre- and post-operation were recorded and compared between the two groups ( P>0.05). The rotator cuff healing was examined by MRI and evaluated based on the classification criteria of rotator cuff healing proposed by Sugaya et al.@*RESULTS@#Three cases (1 case in the trial group and 2 cases in the control group) were excluded from the study due to loss of follow-up. Twenty-seven cases in the trial group and 26 cases in the control group were included in the final study analysis. All operations of the two groups were completed successfully. There was no significant difference in the operation time between groups ( P>0.05). The follow-up time was 10-12 months (mean, 10.9 months) in the trial group and 10-13 months (mean, 11.4 months) in the control group. All incisions healed by first intention. No surgery-related complications occurred. The UCLA score, ASES score, VAS score, and shoulder range of motion (forward flexion and lateral external rotation) of both groups at 9 months after operation were significantly superior to those before operation ( P<0.05). The difference of UCLA score, ASES score, and VAS score between before and after operation in the trial group were significantly better than those in the control group ( P<0.05). There was no significant differences between the two groups in the difference of shoulder range of motion (forward flexion and lateral lateral rotation) ( P>0.05). At 9 months after operation, according to the classification criteria of rotator cuff healing proposed by Sugaya et al, MRI showed that the rotator cuff healing of the trial group was significantly better than that of the control group ( P<0.05).@*CONCLUSION@#Compared with en masse suture, arthroscopic "hybrid" suture for the repair of delaminated rotator cuff tear has advantages in relieving pain and improving shoulder joint function, and the rotator cuff healing is better.

Double-pulley combined with suture bridge technique for fixation of comminuted fractures of distal patella pole / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of double pulley combined with suture bridge in the treatment of comminuted fracture of the lower pole of the patella.@*METHODS@#From January 2018 to June 2020, 15 patients with comminuted fracture of the lower pole of the patella were treated with double pulley and suture bridge technology, including 9 males and 6 females, aged 28 to 68 years old with an average of (42.4±9.6) years old. All patients had obvious knee joint pain and limited movement after injury. All knee joints were examined by X-ray and CT, which confirmed that they were all comminuted fractures at the lower level of the patella. After operation, X-ray films of the knee joint were taken regularly to understand the fracture healing, the Insall Salvati index was measure, the range of motion of the joint was recorded, and the function of the knee joint was evaluateed by the Bostman scoring system.@*RESULTS@#All the 15 patients were followed up for 7 to 24 months with an average of (11.4±4.2) months, and there was no obvious anterior knee pain. At the last follow-up, the knee joint range of motion of the affected limb was 105° to 140° with an average of (128.5±12.8) °, and the Insall Salvati index was 0.79 to 1.12 with an average of (0.92±0.18). The X-ray film showed that the patella was bone healing, and no anchor fell off, broken, or displaced fracture block was found. Bostman patellar fracture function score was 27.85±2.06, 13 cases were excellent, 2 cases were good.@*CONCLUSION@#Double pulley technique combined with suture bridge technique is reliable for reduction and fixation of comminuted fracture of the lower pole of patella, and patients can start functional exercise early after operation.

Complications in repairing acute closed Achilles tendon rupture with micro-incision percutaneous Achilles tendon suture system / 中国骨伤

OBJECTIVE@#To analyze the causes, management and prevention of complications after micro-incision percutaneous repair of acute Achilles tendon rupture.@*METHODS@#A retrospective study indentyfied 279 patients with acute Achilles tendon rupture who underwent a mini-invasive procedure using the micro-incision percutaneous Achilles tendon suture system(MIPAS) from August 2008 to November 2019, including 269 males and 10 female;96 cases on the right side and 183 cases on the left side;aged from 18 to 64 years old with an average of (36.9±11.4 )years old. Surgery was performed 0.5 to 7 days with an average of(2.7±0.9 )days after injury. The incision-related complications, re-rupture, sural nerve injury, deep vein thrombosis, Achilles tendon adhesion, local pain, and ankle stiffness within 18 months after surgery were recorded, as well as the corresponding management and outcome, the causes and prevention measures were analyzed.@*RESULTS@#No superficial or deep infection was found in all patients, symptomatic Achilles tendon adhesion and ankle stiffness were not observed, delayed suture foreign-body reactions occurred in 2 cases (0.7%), re-rupture in 5 cases (1.8%), sural nerve injury in 3 cases (1.1%), 21 cases(7.5%) with skin invagination at puncture site, 2 cases (0.7%) with symptomatic vein thrombosis, and 45 cases (16.1%) of transient posterior medial malleolus pain. After individualized treatment, the function was good. American Orthopeadic Foot & Ankle Sciety(AOFAS) score was 93 to 100 with an average of(98.9±5.4) scores.@*CONCLUSION@#Despite the occurrence of unique complications with MIPAS, it shows low functionally-related complications rates, such as incision-related complications, re-rupture, sural nerve injury, deep vein thrombosis and ankle stiffness.

Early effectiveness of arthroscopic repair of supraspinatus tendon tears with douple-pulley suture-bridge / 中国修复重建外科杂志

OBJECTIVE@#To investigate the early effectiveness of arthroscopic repair of supraspinatus tendon tears with douple-pulley suture-bridge.@*METHODS@#The clinical data of 38 patients with supraspinatus tendon tears who met the selection criteria between September 2020 and July 2022 were retrospectively analyzed, and all of them were treated with arthroscopic double-pulley suture-bridge technique. There were 15 males and 23 females, aged from 43 to 77 years, with an average of 61.5 years. There were 15 cases of left shoulder and 23 cases of right shoulder. Seven cases had a history of trauma, and the other 31 cases had no obvious inducement. The main clinical symptoms of the patient were pain in lifting the shoulder joint and hug resistance test (+). The time from onset of symptoms to admission ranged from 6 to 19 months, with an average of 10.3 months. Flexion, abduction, and external rotation of the shoulder were recorded before operation and at 3 and 12 months after operation. Pain and function of the shoulder were evaluated by visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, and American Society of Shoulder and Elbow Surgeons (ASES) score before operation and at 12 months after operation. Tendon healing, tendon continuity, and tension were evaluated by MRI at 3-6 months after operation, and patient's satisfaction was evaluated at last follow-up.@*RESULTS@#All the incisions healed by first intention, and there was no complication such as incision infection or nerve injury. All patients were followed up 12-34 months, with an average of 23.3 months. VAS score, UCLA shoulder score, and ASES score at 12 months after operation were significantly better than those before operation ( P<0.05). The external rotation range of shoulder joint significantly improved at 3 and 12 months after operation ( P<0.05), and it further improved at 12 months after operation when compared with 3 months after operation ( P<0.05). There was no significant difference in the range of flexion and abduction at 3 months after operation when compared with those before operation ( P>0.05), but the range of flexion and abduction at 12 months after operation significantly improved when compared with those before operation and at 3 months after operation ( P<0.05). MRI reexamination was performed in 28 patients at 3-6 months after operation. Among them, 25 patients had intact supraspinatus tendon structure, good tension, and tendon healing, and 3 patients had type 1 retear. The remaining 10 patients refused to undergo MRI reexamination because of the satisfactory effectiveness. At last follow-up, 29 patients (76.3%) were very satisfied with the results, 6 (15.7%) were satisfied, and 3 (7.8%) were not satisfied.@*CONCLUSION@#Arthroscopic double-pulley suture-bridge technique can achieve the effect of suture bridge operation, reduce the cost of operation and the risk of type 2 retear, and the early effectiveness is satisfactory, but the shoulder joint movement is limited within 3 months after operation.

Treatment of tibial insertion avulsion fracture of anterior cruciate ligament involving anterior root of lateral meniscus with multi-point fixation with anchor and suture / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of arthroscopic multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of anterior cruciate ligament (ACL) involving the anterior root of lateral meniscus (LM).@*METHODS@#A retrospective analysis was conducted on the clinical data of 28 patients with tibial insertion avulsion fracture of ACL involving the anterior root of LM who were treated with arthroscopic multi-point fixation with anchor and suture between October 2017 and January 2023. There were 12 males and 16 females with the mean age of 26 years (range, 13-57 years). There were 20 cases of sports injury and 8 cases of traffic accident injury. In 2 cases of old fracture, the time from injury to operation was 45 days and 90 days, respectively; in 26 cases of fresh fracture, the time from injury to operation was 3-20 days (mean, 6.7 days). According to the Meyers-McKeever classification, there were 4 cases of type Ⅱ, 11 cases of type Ⅲ, and 13 cases of type Ⅳ. The preoperative Lysholm knee function score was 42.1±9.0, the International Knee Documentation Committee (IKDC) score was 40.0±7.3, and the Tegner score was 0.7±0.7.@*RESULTS@#All operations were successfully completed, and the incisions healed by first intention. All the 28 patients were followed up 5-60 months (mean, 20.4 months). During the follow-up, there was nocomplication such as infection, vascular or nerve injury, loosening or breakage of internal fixator, or stiffness of knee joint. Postoperative X-ray films showed satisfactory fracture reduction and firm fixation. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 10.3 weeks). At last follow-up, Lachman test and anterior drawer test were negative. At last follow-up, Lysholm knee function score was 92.4±5.5, IKDC score was 91.6±4.4, and Tegner score was 5.2±1.1, which significantly improved when compared with preoperative scores ( t=-22.899, P<0.001; t=-29.870, P<0.001; t=-19.979, P<0.001).@*CONCLUSION@#Multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of ACL involving the anterior root of LM can not only fix the LM, but also effectively reduce and fix the avulsion fracture, which can obtain good effectiveness.

Clinical study on a novel minimally invasive Achilles tendon suture instrument for treating fresh closed Achilles tendon rupture / 中国修复重建外科杂志

OBJECTIVE@#To assess the effectiveness of a novel minimally invasive Achilles tendon suture instrument in the treatment of fresh closed Achilles tendon rupture.@*METHODS@#A retrospective study was conducted on 150 patients who underwent surgical intervention for fresh closed Achilles tendon rupture. Eighty patients were treated with the novel minimally invasive Achilles tendon suture instrument (minimally invasive group) and 70 patients with traditional open surgery (traditional group). The two groups were comparable in terms of gender, age, injured side, cause of injury, the interval between injury and operation, and the distance from the fracture end to the calcaneal tuberosity ( P>0.05). The operation time, intraoperative blood loss, incision length, hospital stays, hospitalization expenses, and complications were recorded and compared. At 1 year after operation, the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.@*RESULTS@#The minimally invasive group demonstrated significantly shorter operation time, smaller incision length, and lower intraoperative blood loss when compared with the traditional group ( P<0.05). However, there was no significant difference in terms of hospital stays and hospitalization expenses between the two groups ( P>0.05). All patients were followed up 12-24 months after operation (mean, 15.5 months). In the traditional group, 6 cases of incision necrosis and 7 cases of Achilles tendon adhesion occurred, while in the minimally invasive group, all incisions healed at first intention and no Achilles tendon adhesion occurred. The differences in the incidences of the two complications between the two groups were significant ( P<0.05). At 1 year after operation, the AOFAS ankle-hindfoot score in the minimally invasive group was superior to that of the traditional group ( P<0.05).@*CONCLUSION@#In comparison with traditional open surgery, the use of self-designed novel minimally invasive Achilles tendon suture instrument proves to be an ideal technique for treating fresh closed Achilles tendon ruptures. This approach offers the benefits of smaller incisions, fewer complications, and better postoperative functional recovery, without increasing hospital costs.

Risk Analysis and Study of Post-marketing Adverse Events for Absorbable Sutures / 中国医疗器械杂志

Objective To investigate, analyze, and evaluate the risk data associated with the clinical use of absorbable sutures by retrieving and summarizing information from the databases of the US FDA and CNKI, as well as the adverse event reports related to absorbable sutures from January 2019 to October 2022 within Zhejiang province. The adverse event reports are obtained from both incident locations and monitoring organizations affiliated with the registrant. The aim is to identify the main risk factors associated with the clinical use of absorbable sutures. The key risk factors are potential product quality defects, product design and material selection, clinical selection and application, and postoperative recovery care including patient's self-care. Risk control strategies are further proposed to reduce or minimize the risk of adverse events caused by this product.

Concerns of Technical Evaluation on Registration of All-inside Meniscus Suture System / 中国医疗器械杂志

OBJECTIVE@#To summarize the product registration declaration ideas and registration technical review of the all-inside meniscal suture system, and to systematically think about of the technical review concerns of the all-inside meniscal suture system products to provide technical guidance for improving the quality of registration and application and regulatory efficiency.@*METHODS@#Consult the public information of such products at home and abroad, and summarize the experience of registration review of such products.@*RESULTS@#The technical review of the all-inside meniscus suture system registration mainly focuses on product basic information, pre-clinical research, clinical evaluation and product technical requirements.@*CONCLUSIONS@#The difficulty of product registration and declaration of the all-inside meniscus suture system lies in the provision of pre-clinical research data of the product, and the applicant needs to strengthen the basic research ability, formulate scientific technical indicators and test methods to ensure the safety and effectiveness of the product, and also provide sufficient supporting data for the registration declaration.

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.

Fios de sutura: um mapeamento da propriedade intelectual / Suture threads: a mapping of intellectual property / Hilos de sutura: un mapeo de la propiedad intelectual

Objetivo: Determinar a situação atual das patentes de produtos e processos tecnológicos relacionados a fios de sutura depositados no Instituto Nacional de Propriedade Industrial do Brasil. Metodologia: Foi realizado um levantamento dos depósitos na base de dados do instituto durante o mês de agosto de 2020. Resultados: Verificaram-se 72 patentes, tendo o Brasil como o maior depositante. As patentes depositadas foram categorizadas em 13 classificações internacionais de patentes, sendo a mais frequente a A61B, cujo objetivo é abranger instrumentos, implementos e processos para fins de diagnóstico e cirurgia. O setor tecnológico de equipamentos e dispositivos médico-cirúrgicos relacionados a fios de sutura apresentam amplas aplicações em diferentes tecidos orgânicos. As invenções inovam a forma de armazenamento e a resistência, reduzem o tempo de procedimento, aumentam o controle da tensão e transporte de medicamentos. Conclusões: Os produtos e processos patenteados e depositados no Brasil possibilitam maior eficiência no procedimento, proporcionando uma melhor e mais segura recuperação no período pós-operatório... (AU)

Objevtive: determine the current status of patents on products and technological processes related to suture threads deposited at the National Institute of Industrial Property in Brazil. Methodology: A survey of deposits was carried out in the Institute's database during the month of August 2020. Results: 72 patents were verified, with Brazil as the largest depositor. The patents filed were categorized into 13 International Patent Classifications, the most frequent being A61B, whose objective is to cover instruments, implements and processes for the purposes of diagnosis and surgery. The technological sector of medical-surgical equipment and devices related to suture threads wide applications in different organic tissues. The selected inventions bring benefits to storage, to the resistance of materials, to the reduction of the procedure time, to the tension control, to the vehicle of medicinal drugs, to antimicrobials, to stem cells. Conclusions: The products and processes patented and deposited in Brazil enable greater efficiency in the procedure and recovery, providing a better and safer recovery of the postoperative period... (AU)

Objetivo: Determinar la situación actual de las patentes de productos y procesos tecnológicos relacionados a hilos de sutura depositados en el Instituto Nacional de Propiedad Industrial de Brasil. Metodologia: Fue realizado un levantamento de los depósitos en la base de datos del instituto durante el mes de agosto de 2020. Resultado: Se verificaron 72 patentes, teniendo a Brasil como el mayor depositante. Las patentes depositadas fueron categorizadas en 13 clasificaciones internacionales de patentes, siendo la más frecuente la A61B, cujo objetivo es cubrir instrumentos,implementos y procesos com fines diagnósticos y cirugia. El sector de equipamentos tecnológicos y dispositivos médico-quirúrgicos relacionados a hilos de sutura presentan amplias aplicaciones en diferentes tejidos orgánicos.. Las intervenciones innovan las formas de almacenamiento y la resisténcia, reducen el tiempo de procedimiento, aumentan el control de la tensión y transporte de medicamentos. Conclusiones: Los productos y procesos patenteados y depositados en Brasil posibilitan mayor eficiência en el procedimiento, proporcionando uma mejor y más segura recuperación en el período póst operatório... (AU)

Tratamiento artroscópico de las fracturas de la eminencia intercondílea / Arthroscopic treatment of intercondylar eminence fractures

Introducción: las fracturas de la eminencia intercondílea son fracturas por avulsión del ligamento cruzado anterior (LCA). Las opciones terapéuticas en las fracturas desplazadas consisten en un abordaje artroscópico y fijación de las fracturas. Actualmente se debate sobre la técnica quirúrgica y el material de fijación. El objetivo de nuestra revisión bibliográfica es analizar los diferentes métodos de fijación artroscópica disponibles en la actualidad para el tratamiento de las fracturas de la eminencia intercondílea. Materiales y métodos: se realizó una revisión sistemática de la bibliografía con el formato PRISMA. Se incluyeron fracturas de la eminencia intercondílea en adultos tratados mediante artroscopía. Resultados: se analizaron dieciséis artículos, con un total de quinientas cincuenta y una fracturas. El método de fijación más utilizado fue la sutura (31%), cerclaje (25%), anclas (22%), fijación con Kw (8%), Endobutton® (6.3%), tornillos (4.5%) y alambre (3%). Conclusión: ningún método de fijación demostró superioridad en cuanto a porcentajes de estabilidad, consolidación y tiempo de inmovilización. Nivel de Evidencia: II

Introduction: fractures of the intercondylar eminence are avulsion fractures of the anterior cruciate ligament (ACL). Treatment options for displaced fractures consist of an arthroscopic approach and fracture fixation. There is currently debate about the surgical technique and the fixation material. The aim of our literature review is to analyze the different methods of arthroscopic fixation currently available in the treatment of fractures of the intercondylar eminence.Materials and methods: a systematic review of the bibliography was carried out using the PRISMA format. The inclusion criteria were fractures of the intercondylar eminence in adults treated by arthroscopy.Results: sixteen articles were analyzed, with a total of 551 fractures. The most affected knee was the right with 66% of cases. The most used fixation method was suture (31%), cerclage (25%), anchors (22%), Kw fixation (8%), Endobutton® (6.3%), screws (4.5%) and wire (3%).Conclusions: no fixation method showed the superiority in terms of percentages of stability, consolidation, and immobilization time. Level of Evidence: III

Comparación entre suturas para cierre profundo y superficial en reemplazo total de rodilla: seguimiento a un año / A comparison of sutures for deep and superficial wound closure in total knee arthroplasty: One-year follow-up

Introducción Aunque diferentes materiales y técnicas se han desarrollado para el cierre superficial y profundo en reemplazo total de rodilla (RTR), no hay evidencia que permita dar recomendaciones respecto a una técnica especifica que disminuya complicaciones postoperatorias de la herida. El propósito de este estudio es comparar el uso de dos técnicas de cierre profundo (Sutura barbada vs. Sutura absorbible trenzada) y superficial (grapas vs. sutura de polipropileno) en RTR. Materiales y métodos Estudio observacional retrospectivo en 240 pacientes. Se excluyeron pacientes con antecedente de cirugía abierta previa de rodilla, RTR previo por lesiones tumorales o artrofibrosis. Seguimiento mínimo de 1 año. Resultados Se usaron grapas en 176 pacientes y Prolene® en 64 pacientes. El cierre profundo se realizó con Stratafix® en 164 pacientes y con Vicryl® en 75 pacientes. Encontramos complicaciones relacionadas con la herida y la funcionalidad al año de seguimiento. La infección superficial para el cierre con prolene presento un HR de 2.6 con un intervalo de confianza (IC) de 95%=1.1-6.2; p=0.029 y en el cierre profundo encontramos un HR a favor del Vicryl® de 0.22, IC 95%=0.96-5.8; p=0.05. Conclusiones Este estudio demostró un incremento significativo de la incidencia de infección superficial después de un RTR cuando el cierre profundo se realiza con suturas barbadas y el cierre superficial se realiza con sutura de polipropileno. Sin embargo, no se presentaron diferencias significativas en otras complicaciones relacionadas con la herida y en la funcionalidad postoperatoria con las diferentes técnicas de cierre superficial y profundo evaluadas.

Introduction Different materials and techniques have been developed for superficial and deep closure in total knee replacement (TKR), but there is no solid evidence that allows to recommend a specific technique that decreases the surgical post-operative complications. The purpose of this study is to compare the use of two deep closure techniques (barbed suture vs. braided absorbable suture) and superficial (staples vs. polypropylene suture) in TKR. Materials and methods An observational retrospective study was carried out in 240 patients. Those individuals were excluded with previous open knee surgery, arthrofibrosis, patients who underwent TKR due to tumor lesions or a follow up for less than one year. Results The skin was closed in 176 patients with staples and in 64 patients with Prolene®. Deep closure was performed with Stratafix® in 164 patients and with Vicryl® in 75 patients. Also, complications related to the wound and functionality were recorded in the first postoperative year. Superficial infection for closure with prolene presented an HR in favor of 2.6 with a confidence interval (CI) of 95%=1.1­6.2; p=0.029 and in deep closure a HR in favor of Vicryl® of 0.22, 95% CI=0.96­5.8; p=0.05 Conclusions This study demonstrated a significant increase in the incidence of superficial infection after TKR when deep closure is performed with barbed sutures and superficial closure with polypropylene suture. However, there were no significant differences in other complications related with the wound neither postoperative functionality with the different superficial and deep closure techniques that were evaluated.

An innovative technique of chest wall stabilization and reconstruction in traumatic flail chest: The figure-of-eight suture with polypropylene mesh and musculofascial flap / 中华创伤杂志(英文版)

Surgical stabilization of the flail chest is challenging and has no established guidelines. Chest wall integrity and stability are the main factors that ensure the protection of intrathoracic organs and an adequate respiratory function. Here, we report a novel chest wall reconstruction technique in a 45-year-old man with a traumatic left flail chest and open pneumothorax diagnosed both clinically and radiographically. Rib approximation and chest wall reconstruction was done using intercostal figure-of-eight suture and polypropylene mesh with vascularized musculofascial flap. The patient improved gradually and was discharged after three weeks of total hospital stay. He returned to regular working after a month with no evidence of respiratory distress or paradoxical chest movement. Follow-up visit at one year revealed no lung hernia or paradoxical chest movement. This is a novel, feasible and cost-effective modification of chest wall reconstruction that can be adopted for thoracic wall repair in case of open flail chest, which needs emergency surgical interventions even in resource constraint settings.