Pull-out stability of anchors for rotator cuff repair is also increased by bio-absorbable augmentation: a cadaver study.

INTRODUCTION: Osteoporosis is a highly focused issue in current scientific research and clinical treatment. Especially in rotator cuff repair, the low bone quality of patients suffering from osteoporosis is an important issue. In this context, non-biological solutions using PMMA for anchor augmentation have been developed in the recent past. The aim of this study was to evaluate whether augmentation of suture anchors using bio-absorbable osteoconductive fiber-reinforced calcium phosphate results in improved failure load of suture anchors as well. MATERIALS AND METHODS: Altogether 24 suture anchors (Corkscrew FT 1 Suture Anchors, Arthrex, Naples, FL, USA) were evaluated by applying traction until pullout in 12 paired fresh frozen human cadaver humeri using a servo-hydraulic testing machine. Inclusion criteria were an age of more than 64 years, a macroscopically intact RC and an intact bone. The anchors were evaluated at the anterolateral and posteromedial aspect of the greater tuberosity. 12 suture anchors were augmented and 12 suture anchors were conventionally inserted. RESULTS: The failure load was significantly enhanced by 66.8 % by the augmentation method. The fiber-reinforced calcium phosphate could be easily injected and applied. CONCLUSION: The bio-absorbable cement in this study could be a promising augmentation material for RC reconstructions, but further research is necessary-the material has to be evaluated in vivo.

Development of a new suturing technique for tendon graft preparation: an animal cadaver study.

BACKGROUND: This study should analyze ten different suturing techniques for tendon graft preparation to allow the development of an entirely new suturing technique. METHODS: Extensor tendon grafts of fattening bulls' forelegs were sutured with Ethibond Excel size three (six metric) fibers (Ethicon, Somerville, New York, USA). The tendon/suture complexes were biomechanically tested with a hydraulic testing machine applying traction according to a standardized protocol. The testing was observed to find out why the failure at the maximum traction load occurred. The mean values for the maximum tension and extension stiffness were recorded for each suturing technique. FINDINGS: An entirely new suturing technique was developed based on the observations and biomechanical results. The newly developed suture was also tested and provided a higher traction stability than the other ten techniques that had been evaluated. Compared to the other ten techniques the new technique was ranked 3rd in terms of extension stiffness and reached 10.3 N/mm. INTERPRETATION: The new technique evolved in the course of this study provided promising results. Therefore this study provides initial evidence that this technique could be useful in clinical routine.

Footprint reconstruction in a rotator cuff tear associated cyst of the greater tuberosity: augmented anchorage.

Tears of the rotator cuff (RC) complicated by bone cysts at the footprint might represent a challenge for the shoulder surgeon. This might be additionally aggravated in elderly patients with inferior bone quality due to osteopenia or osteoporosis. In this report we present a technique for open repair of RC tears by augmenting the cystic lesion at the greater tuberosity using bone void filler in combination with a double row anchor reconstruction technique. Despite disadvantageous position and size of the cyst, using this technique the footprint can be restored by obtaining an anatomical position of the supraspinatus tendon. The application range of this technique is not limited to defined bony defects and presents a promising novel surgical approach. Level of evidence V.

[Footprint and augmented anchorage]. / Footprint und Zementaugmentation.

OBJECTIVE: One-stage procedure for gaining adequate bone stock and rotator cuff repair. INDICATIONS: Tears of the rotator cuff in combination with bony cysts or reduced bone quality at the footprint. CONTRAINDICATIONS: Allergies to contents of the bone void filler, fatty infiltration of infraspinatus and subscapularis of stage 3 and 4, narrowing of the subacromial space (< 7 mm). SURGICAL TECHNIQUE: We report a one-stage technique for footprint reconstruction in a rotator cuff tear-associated greater tuberosity cyst by augmenting the cystic lesion with an injectable, absorbable, biocompatible, fiber reinforced bone void filler in combination with a double row rotator cuff reconstruction technique. POSTOPERATIVE MANAGEMENT: The arm is placed in a shoulder-immobilizing abduction pillow to achieve 30° abduction for a period of 4-6 weeks. The physical therapy program includes passive mobilization of the affected shoulder to 60-90° flexion/abduction within the first 3 weeks. During the next 3 weeks, the passive mobilization is changed to active mobilization, starting with assisted exercises. Active exercises without limitation in range of motion are not allowed until the 7th week after surgery and moderate sports not until the third month post-surgery. RESULTS: Six patients have been treated using the presented technique. However, long term results are still missing.

[Antibiotic prophylaxis in primary and revision hip arthroplasty: what is the evidence?]. / Antibiotische Infektionsprophylaxe in der Primär- und Revisionsendoprothetik der Hüfte: Was ist erwiesen?

Advances in the perioperative and postoperative management of total joint replacement have led to a steady decrease in the infection rate, which in the case of total hip replacement presently lies between 0.25 and 1%. Unfortunately there is disparity in current practice nationally and internationally, regarding duration, time of application and choice of antibiotics. Currently there are only Level 1a recommendations for primary hip arthroplasty, whereas, due to the heterogeneity and complexity of most revision cases as well as a lack of randomized controlled trials, antibiotic prophylaxis for hip revision arthroplasty is mostly based on the surgeon's preference. In this article the current literature is reviewed and scientifically sound data and recommendations are summarized.