Functional outcomes of all-inside arthroscopic anterior talofibular ligament repair with loop suture versus free-edge suture.

BACKGROUND: Anatomic repair of anterior talofibular ligament (ATFL) is used to manage chronic lateral ankle instability (CLAI). However, the optimal suture configuration used to repair the ATFL is not yet determined. It remains unclear whether suture configuration affects clinical outcomes in such patients. PURPOSE: To compare the functional outcomes of all-inside arthroscopic ATFL repair using either a loop suture and or a free-edge suture configuration in CLAI patients. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This retrospective cohort study included 71 patients with CLAI who had undergone an all-inside arthroscopic ATFL repair procedure with either loop suture (n = 36) or free-edge suture (n = 35) from February 2016 to July 2018. Comparable pre-operatively, the Visual analogy score (VAS), American Orthopedic Foot and Ankle Society scoring system (AOFAS), Karlsson Ankle Functional Score (KAFS) scoring system, Anterior Talar Translation (ATT) and Active Joint Position Sense (AJPS) were used to evaluate postoperative ankle function. RESULTS: There were no postoperative wound complications, implant reactions, or neurological or vascular injuries. Postoperative hospitalization, VAS, AOFAS, KAFS, AJPS and the time of return to sport were similar between the loop suture group and free-edge suture group. Requiring a longer procedure time, patients with loop suture configuration achieved better ATT. CONCLUSION: All-inside arthroscopic ATFL repair procedure for CLAI treatment provides better ATT and comparable functional outcomes when a loop suture configuration is used instead of a free-edge suture configuration. A statistical difference in ATT was observed. Given the relatively short follow-up, it is questionable whether this will have any clinical relevance.

Functional Comparison of Horizontal Mattress Suture Versus Free-Edge Suture in the All-Inside Arthroscopic Broström-Gould Procedure for Chronic Lateral Ankle Instability.

OBJECTIVE: To compare the clinical outcomes of horizontal mattress suture vs free-edge suture in the all-inside arthroscopic Broström-Gould procedure. METHODS: This retrospective cohort study included 68 chronic lateral ankle instability (CLAI) patients who underwent either a horizontal mattress suture or a free-edge suture all-inside arthroscopic Broström-Gould procedure from January 2014 to January 2017. Patients were divided into two groups based on the suture fashion during the all-inside arthroscopic Broström-Gould procedure. In the horizontal mattress suture group (n = 31), anchor sutures were used to suture the ATFL, capsule, and inferior extensor retinaculum in horizontal mattress suture fashion. In the free-edge suture group (n = 37), anchor sutures were used to suture the ATFL, capsule, and inferior extensor retinaculum in free-edge suture fashion. The Visual Analogue Scale (VAS) score, the American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), Anterior Talar Translation (ATT), the rate of return to sports, and ankle proprioceptive recovery were compared in both groups. RESULTS: The operative times and duration of hospitalization between the two groups were comparable (all P > 0.05). The VAS, AOFAS, ATT, the rate of return to sports, and ankle proprioceptive recovery were comparable between the horizontal mattress suture and free-edge suture groups at 1 and 2 years after surgery. Patients of the free-edge suture group achieved better KAFS 1 and 2 years after the surgery compared with those of the horizontal mattress suture group. In both groups, incisions were healed by first intention, and complications such as infection, implant reactions, tendon injury, and nervous or vascular injuries were not observed. The ankle proprioceptive recovery in horizontal mattress suture and free-edge suture groups showed no significant differences at 1 and 2 years after surgery. The mean time of the return to full activity for patients in the horizontal mattress suture group was 10.38 ± 2.02 (range 8 to 12) weeks vs 8.63 ± 2.31 (range 8 to 12) weeks for those in the free-edge suture group (P = 0.001, power = 0.907). The exercise participation rates were comparable between groups (P > 0.05). At the 2-year follow-up, all patients regained normal activities and ankle stability, and no recurrence of CLAI or revision surgery was recorded. CONCLUSION: All-inside arthroscopic Broström-Gould surgery for the treatment of CLAI ensures a better functional effect (KAFS) and better recovery time when free-edge suture is used instead of horizontal mattress suture.

An investigation of the effects of suture patterns on mechanical strength of intestinal anastomosis: an experimental study.

How the distance of sutures from the edge of tissue and the horizontal distance between stitches affect the mechanical strength of anastomosis is investigated. In this study, 180 bovine intestines were used to investigate the optimum pattern in 18 groups by considering a 4, 6, and 8 mm horizontal distance between stitches, and a 3, 5, and 7 mm distance from the edge of tissue with 3-0 Silk and 3-0 PDS sutures to maximize the strength of anastomosis (10 specimens in each group). Also, 80 specimens were used to investigate the maximum effective distance of sutures from the edge of tissue in eight groups of: 3, 5, 7, and 10 mm distance from the edge, with the same type of sutures. Tensile tests with an elongation rate of 5 mm/min were performed for all the groups. Based on the results, the pattern of 7-6 (distance from the edge-distance between stitches) for both 3-0 Silk and 3-0 PDS, 5-6 and 7-4 for 3-0 Silk, and 5-6 and 7-4 for 3-0 PDS can be considered as the best options among 18 different combinations. It was also found that increasing the distance from the edge from 7 mm to 10 mm does not cause a significant difference in mechanical strength. Results can help surgeons to improve the intestinal anastomosis and employ it as an input for automatic suturing devices.

Does a Multimodal No-Compression Suture Technique of the Intercostal Space Reduce Chronic Postthoracotomy Pain? A Prospective Randomized Study.

INTRODUCTION: Chronic postthoracotomy pain is a significant adverse outcome of thoracic surgery. We evaluated with a prospective randomized trial the effect of a multimodal no-compression suture technique of the intercostal space on postoperative pain occurrence in patients undergoing minithoracotomy. METHODS: Patients undergoing a muscle-sparing lateral minithoracotomy for different thoracic diseases were randomly divided into two groups: 146 patients received intercostal muscle flap harvesting and pericostal no-compression "edge" suture (the IMF group), and 151 patients received a standard suture technique associated with an intrapleural intercostal nerve block (the IINB group). Pain scores and interference of pain with daily activities were assessed by using the Italian version of the Brief Pain Inventory on day 1, and at 1 to 6 months postoperatively. The results of pulmonary function tests (spirometry and the 6-minute walking test ) were evaluated preoperatively and at 1 and 6 months postoperatively. RESULTS: Postthoracotomy pain scores throughout the first postoperative day were significantly lower in the IMF group. After 1 and 6 months, patients in the IMF group had a significantly lower average pain score (p = 0.001). There were no significant differences in pain interference scores at each evaluation time point in either group. However, differences were shown in lung function test results at 1 and 6 months postoperatively (the forced expiratory volume in 1 second in the IINB group averaged 68.8 ± 17.4% of predicted value and 72.8 ± 10.5%, respectively, and in the IMF group it averaged 83.1 ± 7.4% and 86.4 ± 12.8%, respectively [p = 0.023 and 0.013, respectively]; the 6-minute walking test results in the IINB group averaged 311.1 ± 51.0 and 329.9 ± 54.8 m, respectively, and those in the IMF group averaged 371.2 ± 54.8 and 395.7 ± 56.4 m, respectively [p = 0.0001]). CONCLUSIONS: The multimodal no-compression suture technique is a rapid and feasible procedure that reduces the intensity of early and chronic postthoracotomy pain.