Suture Anchor Fixation Has Less Gap Formation and No Difference in Complications or Revisions for Patellar Tendon Repair: A Systematic Review.

PURPOSE: To evaluate the literature on suture anchor (SA) usage for patellar tendon repair, summarize the overall biomechanical and clinical outcomes, and assess whether the cumulative research supports the adoption of this technique compared with transosseous (TO) repair. METHODS: A systematic literature review using the Preferred Reporting Items for Systematic and Meta-Analyses guidelines was performed. Multiple electronic databases were searched to identify studies focusing on surgical outcomes of patellar tendon repair with suture anchor usage. Cadaver and animal biomechanical studies, technical studies, and clinical studies were included. RESULTS: A total of 29 studies met the inclusion criteria: 6 cadaver, 3 animal, 9 technical, and 11 clinical reports. Four of the 6 cadaver studies and 1 of the 2 animal studies found significantly less gap formation from SA than from TO repair. Average gap formation in human studies ranged from 0.9 to 4.1 mm in the SA group compared with 2.9 to 10.3 mm in TO groups. Load to failure was significantly stronger in 1 of 5 cadaver studies and 2 of 3 animal studies, with human studies SA load to failure ranging from 258 to 868 N and TO load to failure ranging from 287 to 763 N. There were 11 clinical studies that included 133 knees repaired using SA. Nine studies showed no difference between complication rate or risk for reoperation, where one study reported a significantly lower re-rupture rate after SA repair compared with TO repair. CONCLUSIONS: SA repair is a viable option for patellar tendon repair and could have several advantages over TO repair. Multiple studies indicate that SA repair has less gap formation during biomechanical testing compared with TO repair in human cadaver and animal models. No differences in complications or revisions were found in the majority of clinical studies. CLINICAL RELEVANCE: Both animal and human models suggest SA fixation has potential biomechanical benefits when compared with TO tunnels for patellar tendon repair, whereas clinical studies show no difference in complications and revisions postoperatively.

Arthroscopic Shoulder Simulation Studies Reveal Improvements in Performance Metrics Without Proven Transferability to the Operating Room: A Systematic Review.

PURPOSE: To evaluate the use of shoulder arthroscopic simulation in orthopaedic surgery trainees. METHODS: A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Medline (Ovid), and EMBASE library databases. Inclusion criteria were experimental studies reporting pre- and post-test results of shoulder arthroscopic simulation in orthopaedic trainees (studies reporting results of comparison between groups not within the groups were excluded). Participant demographics, type of simulator training, simulator tasks assessed, and performance outcome measures were systematically reviewed. Each performance outcome measure was graphically represented in a Forest plot with point estimates of the incidence of performance outcomes with corresponding 95% confidence intervals and I2. RESULTS: Fifteen studies met inclusion criteria with a total of 353 participants. The most common procedures simulated were diagnostic shoulder arthroscopy (n = 9 [60%]), arthroscopic Bankart repairs (n = 3 [20%]), and rotator cuff repairs (n = 2 [13%]). Simulations primarily used virtual reality (60%) and benchtop models (40%). The primary outcomes measured were time to task completion and Arthroscopic Surgical Skill Evaluation Tool scores. Time to task completion improved significantly with training (range 13-439 seconds pretest to 8-253.29 seconds post-test), with substantial heterogeneity across studies (I2 = 87%). ASSET scores improved in 60% of the studies (ranging from 14-20.9 pretest to 17.9-28.5 post-test), with low heterogeneity (I2 = 20%). In addition, both camera and probe distances decreased after simulation use, whereas the 14-point anatomic checklist showed no pre- to post-test differences. CONCLUSIONS: Arthroscopic simulation training benefits technical skills in shoulder arthroscopy, but the quality, assessment, and validity of these protocols vary. The translation of simulation training into the operating room has yet to be conclusively demonstrated. LEVEL OF EVIDENCE: Level IV, systematic review of Level I-IV studies.