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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1387-1391, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191695

RESUMO

Objective: To explore the necessity of repairing the deep layer of deltoid ligament in the treatment of mixed medial injury associated with ankle fractures. Methods: Between January 2016 and December 2018, 12 patients with mixed medial injury associated with ankle fractures were treated with the fixation of the lateral malleolus by bone plates, the fixation of the anterior colliculus of medial malleolus by cannulated screws, and the repair of the deltoid ligament by suture anchors. There were 8 males and 4 females, with an average age of 42 years (range, 18-56 years). According to the Lauge-Hansen classification criteria, there were 11 cases of supination-external rotation type and 1 case of pronation-external rotation type. According to the Weber classification criteria, all cases were type B. The time from injury to operation was 3-6 days, with an average of 4.7 days. In each patient, X-ray films of anteroposterior and lateral views and mortise view of ankle were taken postoperatively. The motion range of ankle joints was observed. The function of the ankle and the outcome of the treatment were evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system, Olerud-Molander scoring system, and the visual analogue scale (VAS) score. Results: All cases were followed up 12-42 months (mean, 28 months). The 12 patients returned to their pre-injury jobs. Five patients with sports injury completely recovered to their pre-injury motor function. No patient experienced persistent medial ankle pain or ankle instability. At last follow-up, the ankle range of motion in dorsiflexion was 9°-25° (mean, 17.96°), which was 0°-11° (mean, 4.02°) less than that in normal side; the range of motion in plantar flexion was 38°-50° (mean, 43.90°), which was 0°-7° (mean, 2.53°) less than that in normal side. The AOFAS score was 88-100 (mean, 96.7); the Olerud-Molander score was 90-100 (mean, 96.5); the VAS score was 0-3 (mean, 1.1). Conclusion: It is necessary to repair the deep layer of deltoid ligament in the mixed medial injuries associated with ankle fracture, which include anterior colliculus fracture and deep deltoid ligament injury. A better outcome can be achieved by employing the suture anchor repair method.


Assuntos
Fraturas do Tornozelo , Traumatismos do Tornozelo , Adolescente , Adulto , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Feminino , Fixação Interna de Fraturas , Humanos , Ligamentos , Masculino , Pessoa de Meia-Idade , Âncoras de Sutura , Resultado do Tratamento , Adulto Jovem
2.
J Surg Orthop Adv ; 29(3): 169-172, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33044159

RESUMO

Our aim was to compare the tensile strength of the native scapholunate ligament (SLL) with that of an all-suture anchor construct in a cadaveric model. The scaphoid and lunate were isolated, preserving all segments of the SLL. Using a servohydraulic testing machine, we increased the load until peak load-to-failure of the native SLL was reached in nine specimens (mean ± standard deviation, 273 ± 132 N). Using the same specimens, two JuggerKnot 1.4-mm suture anchors (Zimmer Biomet) were placed into the lunate and tensioned through transosseous tunnels in the scaphoid. Sutures were tied over the radial nonarticular aspect of the scaphoid. Load-to-failure testing was repeated. The mean peak load-to-failure for the all-suture anchor constructs was 172 ± 59 N versus 231 ± 117 N for the native group (p = 0.157). This represents approximately 75% of the native ligament strength. (Journal of Surgical Orthopaedic Advances 29(3):169-172, 2020).


Assuntos
Âncoras de Sutura , Técnicas de Sutura , Fenômenos Biomecânicos , Cadáver , Humanos , Ligamentos Articulares/cirurgia , Suturas , Resistência à Tração
3.
Arthroscopy ; 36(8): 2103-2105, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32747058

RESUMO

Suture anchor technologies are constantly being innovated in the quest for improved stability, biological integration and clinical outcomes. However, the decision about the choice of suture-anchor materials remain elusive. There are some factors, including reliability, effectiveness, simplicity, familiarity, and cost, that affect a surgeon's preference. The relative weights placed on different factors by different surgeons play decisive roles in individual choice. But decisions and choices are not arbitrary or merely subjective. Alternative options can be warranted or contested by rational argumentation. At the end, there may be losses and gains in the change of 1 suture anchor for another, but science does progress.


Assuntos
Cirurgiões , Âncoras de Sutura , Cadáver , Humanos , Reprodutibilidade dos Testes
4.
Medicine (Baltimore) ; 99(29): e21030, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702843

RESUMO

BACKGROUND: Single-row (SR) and double-row (DR) techniques are 2 kinds of widely used approaches for the arthroscopic repair of rotator cuff. This retrospective clinical trial was performed to address the question of whether a DR rotator cuff anchor repair gives results superior to a SR anchor repair in clinical outcome scores and complication rates. METHODS: This study was performed and reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. We retrospectively reviewed our database, which was collected prospectively. From 2014 to 2017, 264 patients underwent arthroscopic rotator cuff repair by an experienced single shoulder surgeon with the SR and DR techniques. This study was approved by the institutional review board in our hospital and was registered in the Research Registry. Outcome measures included Constant-Murley score, muscle strength, patient satisfaction, passive range of motion, and retear rates. RESULTS: The hypothesis was that the DR technique would achieve better functional scores and fewer complications as compared to the SR technique in treatment of rotator cuff tears.


Assuntos
Artroscopia/métodos , Lesões do Manguito Rotador/cirurgia , Âncoras de Sutura , Estudos de Coortes , Humanos , Força Muscular , Amplitude de Movimento Articular , Estudos Retrospectivos , Lesões do Manguito Rotador/reabilitação , Técnicas de Sutura
5.
Arthroscopy ; 36(6): 1533-1534, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32503769

RESUMO

The development of all-suture anchors has revolutionized the field of orthopaedic surgery. Biomechanically, these anchors have similar or better strength when compared with conventional solid anchors. All-suture anchors allow the suture to be placed in cortical bone tunnels, with a smaller diameter, thus limiting potential iatrogenic damage. To avoid the inconsistencies of knot tying and eliminate knot stacks, knotless all-suture anchors have been increasingly used in arthroscopic surgery. This may reduce the potential risk of knot abrasion, which can lead to soft-tissue or cartilage damage. Depending on the intraoperative situation and surgeon preference, surgeons must decide whether knotted or knotless anchor systems are indicated.


Assuntos
Lesões dos Tecidos Moles , Âncoras de Sutura , Artroscopia , Humanos , Técnicas de Sutura , Suturas
6.
Medicine (Baltimore) ; 99(21): e20312, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481315

RESUMO

The treatment of type 3 acromioclavicular joint injuries has still controversial issues. In this retrospective study, we aimed to compare the radiological and functional outcomes of the suture anchor and double-button fixation methods for the treatment of type 3 acromioclavicular joint injuries.This study included 20 patients who underwent suture anchor (9 patients) and double-button fixations (11 patients) for isolated type 3 acromioclavicular dislocation. Injuries were classified according to the Rockwood Classification System. Coracoclavicular(CC) distances and anterior translation have been measured pre-operatively and at the 12th month follow-up. Functional evaluation was performed using the DASH, and Constant-Murley scores of the patients were recorded at the12th-month follow-up.The mean age of the patients was 37 (22-50) years in Group 1(double-button group) and 39 (24-56) years in Group 2(suture anchor group). All of the patients were male. There was no statistically significant difference between the DASH and Constant-Murley scores of the 2 groups (P > .05). The mean DASH score of the patients evaluated at the postoperative 12th month was 6.65 (0-38.3) in Group 1 and 2.48 (0-4.2) in Group 2. The mean Constant-Murley score of the patients evaluated at the postoperative 12th month was 89,6 (50-98) in Group 1 and 93,6 (90-98) in Group 2. Comparison of the pre- and post-operative CC distances and pre- and post-operative anterior translation distances of both groups revealed that there was no statistically significant difference between groups regarding postoperative CC distances and anterior translation distances (P > .05).Suture anchor and double-button techniques are reliable treatment methods that are not superior to one another and can yield excellent functional outcomes.


Assuntos
Articulação Acromioclavicular/lesões , Procedimentos Ortopédicos/métodos , Lesões do Ombro/cirurgia , Âncoras de Sutura , Técnicas de Sutura/instrumentação , Articulação Acromioclavicular/diagnóstico por imagem , Articulação Acromioclavicular/cirurgia , Adulto , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Radiografia , Estudos Retrospectivos , Lesões do Ombro/diagnóstico , Resultado do Tratamento , Adulto Jovem
7.
Am J Sports Med ; 48(9): 2129-2136, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32551868

RESUMO

BACKGROUND: Some studies reporting clinical outcomes after transosseous-equivalent (TOE) repair have attributed type II rotator cuff failure to excessive bridging suture tension, as it can cause overloading on the medial row. In a previous biomechanical cadaveric study, increasing bridging suture tension over 90 N did not improve the contact area and ultimate failure load of the TOE construct, despite increasing the contact force and contact pressure. PURPOSE: To compare the clinical outcomes of different bridging suture tensions after TOE rotator cuff repair based on the results of a previous biomechanical study. STUDY DESIGN: Randomized controlled trial; Level of evidence, 2. METHODS: A total of 78 patients who underwent arthroscopic rotator cuff repair for medium- to large-sized tears were prospectively enrolled and randomly divided into 2 groups according to the applied bridging suture tension: optimum tension group (96.3 ± 4.9 N) and maximum tension group (199.0 ± 20.3 N). Bridging suture tension was measured with a customized tensiometer, as used in the previous biomechanical study. The functional outcome was measured at the final follow-up (27.4 ± 5.9 months [range, 24-45 months]) using the visual analog scale for pain, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and Constant score, and the anatomic outcome was evaluated using magnetic resonance imaging or ultrasonography at least 12 months after surgery. RESULTS: Overall, 64 patients (32 in each group) were analyzed. The functional outcomes improved significantly compared with preoperative values (all P < .05) but did not show significant differences between the 2 groups (all P > .05). Regarding the anatomic outcomes, the maximum tension group (n = 1; 3.1%) had a significantly lower healing failure rate than the optimum tension group (n = 9; 28.1%) (P = .013). One patient in the maximum tension group had a type II failure. CONCLUSION: Maximum bridging suture tension in TOE repair for medium- to large-sized rotator cuff tears provided better anatomic healing with less risk of medial rotator cuff failure, which differs from the results of a previous time-zero biomechanical study.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Técnicas de Sutura , Artroscopia , Humanos , Imagem por Ressonância Magnética , Estudos Prospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Âncoras de Sutura , Suturas , Resultado do Tratamento
8.
Jt Dis Relat Surg ; 31(2): 238-245, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584720

RESUMO

OBJECTIVES: This study aims to analyze and compare total deformations with tension band wiring (TBW), intramedullary screw (IS) and novel suture anchor (SA) fixation methods, and to investigate practicality of SA fixation in olecranon fractures using finite element analysis (FEA). MATERIALS AND METHODS: This finite element analysis study was conducted between May 2019 and October 2019. TBW, IS and SA fixation methods were compared in order to analyze fracture behavior in the ulna and humerus using FEA, which is among the mathematical methods of stress analysis. Boundary conditions were applied to the created model and total deformation amounts were compared among the methods in terms of displacement. RESULTS: The lowest amount of displacement was obtained with TBW method (1.2095 mm), while IS method (2.7703 mm) showed the highest amount of total displacement. Total displacement was lower with SA system (2.0397 mm) compared to IS fixation. In addition, no problem was observed with SA system in terms of failure occurrence. CONCLUSION: According to the results of FEA, although the lowest amount of displacement was obtained with TBW, it is concluded that anchor fixation method may be an alternative with practicality and mechanical properties. However, further studies are needed to obtain more precise data.


Assuntos
Fixação Interna de Fraturas , Luxações Articulares , Olécrano , Âncoras de Sutura , Fraturas da Ulna , Parafusos Ósseos , Análise de Elementos Finitos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Humanos , Úmero/cirurgia , Luxações Articulares/etiologia , Luxações Articulares/prevenção & controle , Olécrano/lesões , Olécrano/cirurgia , Técnicas de Sutura , Tenodese/instrumentação , Tenodese/métodos , Fraturas da Ulna/complicações , Fraturas da Ulna/cirurgia
9.
Clin Sports Med ; 39(3): 537-548, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32446573

RESUMO

"For more than 4 decades, reconstruction of the ulnar collateral ligament (UCL) using some type of autograft tissue has been the standard of care for UCL-injured athletes. This article reviews the history of UCL repair including the rationale for the revival of interest in primary repair of the UCL as an option for the treatment of select athletes as well as the early clinical results indicating the short-term successful outcomes of the procedure in properly selected athletes."


Assuntos
Traumatismos em Atletas/cirurgia , Ligamento Colateral Ulnar/lesões , Reconstrução do Ligamento Colateral Ulnar/métodos , Humanos , Fita Cirúrgica , Âncoras de Sutura , Técnicas de Sutura , Tendões/transplante , Transplante Autólogo
10.
Clin Sports Med ; 39(3): 661-672, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32446582

RESUMO

Distal biceps tendon injuries typically occur from forced eccentric contraction against a heavy load and are more common in males than females. Most patients who rupture their distal biceps tendon undergo operative repair to minimize strength loss and fatigue. Single-incision and two-incision techniques have been developed in recent decades and achieve satisfactory outcomes. Cortical button and bone tunnel fixation demonstrate superior strength relative to suture anchors and interference screws for acute repairs. Patients who present late or who undergo surgery greater than 4 to 6 weeks from their injury are deemed chronic ruptures and may require autograft or allograft reconstruction.


Assuntos
Músculo Esquelético/lesões , Músculo Esquelético/cirurgia , Procedimentos Ortopédicos/métodos , Traumatismos dos Tendões/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura/diagnóstico , Ruptura/cirurgia , Âncoras de Sutura , Traumatismos dos Tendões/diagnóstico , Tendões/transplante , Transplante Autólogo
11.
Foot Ankle Spec ; 13(4): 351-355, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32306750

RESUMO

The use of suture button (SB) devices in the treatment of syndesmotic ankle injuries is increasing. These constructs have demonstrated better syndesmotic reduction, improved clinical outcomes, and lower rates of hardware removal compared with screw fixation. However, placing a SB device without a fibular plate can be technically challenging. In this technique tip, we use an illustrative case to demonstrate a technique tip that minimizes the risk of anterior or posterior cortical breach of the fibula and helps facilitate more accurate placement of a SB device.Levels of Evidence: Level V: Expert opinion.


Assuntos
Traumatismos do Tornozelo/cirurgia , Fíbula , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Procedimentos Ortopédicos/métodos , Âncoras de Sutura/efeitos adversos , Técnicas de Sutura , Adulto , Feminino , Humanos , Procedimentos Ortopédicos/efeitos adversos , Técnicas de Sutura/efeitos adversos
12.
Arthroscopy ; 36(4): 1009-1010, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32247400

RESUMO

Biomechanical studies with reliable clinical applicability are challenging to carry out. The results can be heavily dependent on the materials being tested (condition and ages of specimens), environmental conditions (temperature, moisture), magnitude and direction of loading, loading characteristics (static, dynamic), loading cycles and frequency, and how one measures and defines failure. The interested reader gains more confidence in the results and recommendations of a biomechanics study if the methodology reasonably models real-world scenarios and multiple studies from different labs all come to the same general conclusion.


Assuntos
Fosfatos de Cálcio , Âncoras de Sutura , Fenômenos Biomecânicos
13.
Arthroscopy ; 36(4): 962-963, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32247427

RESUMO

Vented open-architecture suture anchors provide theoretical benefits over traditional screw-in solid anchors to include improved osseous ingrowth, elution of marrow elements to enhance biology at the repair site, and easier revision because of reduced anchor material. However, there is no evidence that open-architecture anchors result in improvements in patient-reported outcomes or early cytokine and marrow element release into the subacromial space compared with traditional screw-in solid anchors. Although innovation and evaluation of new technologies are paramount to surgical progress, decisions on implant use should be based on factors including cost, impact on revision, and surgeon familiarity because frequently, clinical differences based on patient-reported outcomes are not appreciated between anchor types or designs.


Assuntos
Parafusos Ósseos , Âncoras de Sutura , Humanos
14.
J Shoulder Elbow Surg ; 29(6): e229-e237, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32307239

RESUMO

BACKGROUND: Given the similar outcomes of various fixation constructs for single-incision distal biceps repair, a critical evaluation of the factors that drive the cost of the procedure is the key to optimizing treatment value. The purpose of this study was to quantify variation in costs for surgical treatment of complete distal biceps ruptures, as well as identify factors affecting costs. METHODS: We retrospectively identified adult patients consecutively treated surgically for complete distal biceps ruptures between July 2011 and January 2018 at a single academic medical center. Using our institution's information technology value tool, we recorded the surgical encounter total direct costs (SETDCs) for each patient. Univariate and multivariate gamma regression models were used to determine factors affecting SETDCs. RESULTS: Of 121 included patients, 102 (86%), 7 (6%), and 12 (10%) underwent primary repair, revision, and reconstruction. SETDCs varied widely, with a standard deviation of 40% and a range of 58% to 276% of the average SETDC. The main contributors to SETDCs were facility utilization costs (53%) and implant costs (29%). Implant costs also varied, with a standard deviation of 16%, ranging up to 121% of the mean SETDC. Multivariate analysis demonstrated that reconstructions were 72% more costly than primary repairs (P < .001). No significant cost differences were found between cortical button and dual-suture anchor fixation (P = .058). American Society of Anesthesiologists class, body mass index, revision surgery, time to surgery, location, administration of postoperative block, and surgeon performing the procedure did not significantly affect the SETDC. CONCLUSION: Surgical encounter and implant costs vary widely for distal biceps rupture treatment. However, no significant difference in SETDC was identified between repair with a cortical button vs. dual-suture anchor repair. The greater costs associated with reconstruction surgery should be taken into consideration.


Assuntos
Custos Diretos de Serviços , Músculo Esquelético/lesões , Traumatismos dos Tendões/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Ruptura/cirurgia , Âncoras de Sutura/economia , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/economia , Resultado do Tratamento , Cicatrização
15.
Acta Orthop Traumatol Turc ; 54(1): 97-103, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32175903

RESUMO

OBJECTIVE: Due to the biomechanical importance of the meniscal root ligament, several surgical techniques have been defined in order to treat meniscal root tear. Different application techniques have different levels of difficulty. We aimed to find a stronger and simpler repair technique. METHODS: Sixteen bovine knee joints were prepared. The posterior root of the medial meniscus was dissected and repaired with one of two different techniques. The knees in group 1 ("knotted group") were repaired with the knotted suture anchor technique, and the knees in group 2 ("knotless group") were repaired using the knotless suture anchor technique. The strength of the repairs was tested biomechanically. RESULTS: Cyclic loading tests were done. On the 0-20 N one-cycle test, the knotted anchor group's equivalent stiffness average was 5.28 N/mm, and the knotless anchor group's equivalent stiffness average was 5.48 N/mm. The 5-20 N two-cycle test results were 8.29 N/mm for the knotted group and 8.66 N/mm for the knotless group. On the 5-20 N 100-cycle test, the equivalent stiffness averages were 8.59 N/mm for the knotted group and 10.18 N/mm for the knotless group. Elongation was 5.83 mm for the knotted group and 4.86 mm for the knotless group. After performing load-to-failure tests, the failure forces were recorded as 237.83 N for the knotted group and 204.90 N for the knotless group. The failure test elongation values were 26.83 mm for the knotted group and 18.70 mm for the knotless group. The failure energies were 3.87 J for the knotted group and 1.83 J for the knotless group. Except for elongation until failure (p=0.009), there were no significant differences between the two groups tested (p>0.05). The average elongation was significantly less in group 2, showing that the knotless anchor had an advantage, with less meniscal excursion compared to the sutured anchor. CONCLUSION: Knotless anchors have a mechanical advantage over knotted anchors for preventing meniscal excursion. When thought together with technical simplicity during arthroscopic surgery, knotless anchors could be used safely for the fixation of the meniscal root ligament.


Assuntos
Artroscopia , Traumatismos do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Âncoras de Sutura , Animais , Artroscopia/instrumentação , Artroscopia/métodos , Bovinos , Humanos , Modelos Anatômicos , Técnicas de Sutura
16.
Orthop Surg ; 12(2): 679-685, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32162472

RESUMO

Osteochondral fracture of the lateral femoral condyle is a rare intra-articular injury with or without patellar dislocation. This kind of disease is commonly seen in the knee joint sprain during strenuous activity. At present, open reduction is often used to treat osteochondral fractures. In recent years, with the development of arthroscopy, we have been able to complete the reduction and internal fixation of fractures under arthroscopy. In this paper, three cases of osteochondral fracture of lateral femoral condyle were treated with arthroscopic TWINFIX Ti suture anchor internal fixation, and good results were obtained. After operation, the fracture of femoral condyle healed well and the function of knee joint recovered gradually. Suture anchor system is mostly used to repair rotator cuff and patellar tendon. This is the first case to apply the suture anchor system to the reduction and fixation of fracture.


Assuntos
Artroscopia/métodos , Fêmur/lesões , Fraturas Intra-Articulares/cirurgia , Traumatismos do Joelho/cirurgia , Âncoras de Sutura , Adolescente , Feminino , Humanos , Masculino , Adulto Jovem
17.
Acta Chir Orthop Traumatol Cech ; 87(1): 24-27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32131967

RESUMO

PURPOSE OF THE STUDY The purpose of this study is to evaluate the results of chronic tendinous mallet finger repair with all soft suture anchors. MATERIAL AND METHODS In this retrospective study we evaluated 14 patients. Data included age, side of surgery, the degree of extensor lag, the ratio of the damaged articular surface, postoperative recovery period and time to return to work. We recorded extensor lag and Crawford scores of all patients at the last follow-up. RESULTS Mean follow-up period was 22.07 months. The preoperative and postoperative extensor lags were 27.2 (15-35) and 3 (0-19), respectively. Crawford scores of patients were moderate in 1 patient, fair in 2 patients and excellent in 10 patients. We observed only one skin complication in the postoperative period. CONCLUSIONS All-soft suture anchors have high patient satisfaction rates and functional results. Thus, they could be used in the treatment of patients with chronic tendinous mallet finger. The low complication rate is a major advantage. Key words: tendinous mallet finger, hand surgery, all-soft anchor. Level of evidence: Level-4, Retrospective case-control study.


Assuntos
Deformidades Adquiridas da Mão , Âncoras de Sutura , Estudos de Casos e Controles , Deformidades Adquiridas da Mão/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
18.
Vet Surg ; 49(4): 736-740, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32073178

RESUMO

OBJECTIVE: To determine the mechanical pull-out properties of a 2.5-mm bone anchor implanted in ex vivo femurs of toy breed dogs and to determine whether there is a difference between knotted and knotless configurations. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Eight paired harvested femurs. METHODS: Femurs were assigned to knotted or knotless configuration. Equal numbers of right and left femurs were tested. The caudolateral femoral condyle at the distal pole of the lateral fabella (F2 site) was drilled. The assigned configuration with braided suture combined with the bone anchor was implanted into the F2 site. Each configuration was positioned into a mechanical testing machine to measure yield load, load at 3-mm displacement, ultimate load, stiffness, and mode of failure at the beginning of the canine standing phase angle (150°). RESULTS: Mean ultimate load was 100.14 and 88.69 N (P = .798), mean yield load was 59.72 and 55.85 N (P = .708), load at 3-mm displacement was 46.72 and 43.33 N (P = .656), and stiffness was calculated to be 43.06 and 47.09 N/mm (P = .548) for knotted and knotless configurations, respectively. Mode of failure occurred primarily by anchor pull-out. CONCLUSION: The bone anchor withstood deformation at the estimated forces applied on the native cranial cruciate ligament (CCL) of toy breed dogs in both configurations. CLINICAL SIGNIFICANCE: This bone anchor may constitute a useful alternative for stabilization of the CCL deficient stifle in toy breed dogs. However, before it can be recommended for widespread use in dogs, closely monitored clinical trials must be conducted to assess outcome and complications associated with this implant.


Assuntos
Lesões do Ligamento Cruzado Anterior/veterinária , Ligamento Cruzado Anterior/cirurgia , Âncoras de Sutura/veterinária , Animais , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Cadáver , Cães , Joelho de Quadrúpedes/cirurgia
19.
Arthroscopy ; 36(2): 397-399, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32014172

RESUMO

The advent of modern suture anchor technology has not only revolutionized arthroscopic treatment options for management of complex shoulder pathology, but also engendered a materials science quest to identify the ultimate composition and design. What began as an open procedure with transosseous suture fixation has evolved dramatically with the widespread adoption of an arthroscopic, anchor-based technique for rotator cuff repair. Currently, a litany of commercially available "hard" and "soft" anchors are flooding the market, with limited qualitative comparisons to suggest superiority of one type. Ideally, suture anchor design should permit preservation of native glenohumeral bone stock with gradual osseointegration, limit disruption of local tissue homeostasis, and maintain time-zero mechanical strength until soft-tissue healing has occurred. At present, a vented, open-anchor architecture may facilitate better biologic incorporation with increased bony ingrowth through access to marrow elements, although these radiographic advantages have not conferred any clinically meaningful differences for our rotator cuff repair patients. For anchor composition, the jury is still out, and we need to continue to critically evaluate for perianchor cyst formation and longer term remodeling. In fact, the true merits of increased bony ingrowth and limited osteolysis may only be realized at the time of revision rotator cuff repair, during which prior implant position or secondary cystic change may further dictate suture anchor design, size, and placement.


Assuntos
Lesões do Manguito Rotador , Âncoras de Sutura , Artroscopia , Humanos , Cetonas , Polietilenoglicóis , Estudos Prospectivos , Manguito Rotador
20.
Bone Joint J ; 102-B(2): 212-219, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009435

RESUMO

AIMS: In a randomized controlled trial with two-year follow-up, patients treated with suture button (SB) for acute syndesmotic injury had better outcomes than patients treated with syndesmotic screw (SS). The aim of this study was to compare clinical and radiological outcomes for these treatment groups after five years. METHODS: A total of 97 patients with acute syndesmotic injury were randomized to SS or SB. The five-year follow-up rate was 81 patients (84%). The primary outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale. Secondary outcome measures included Olerud-Molander Ankle (OMA) score, visual analogue scale (VAS), EuroQol five-dimension questionnaire (EQ-5D), range of movement, complications, reoperations, and radiological results. CT scans of both ankles were obtained after surgery, and after one, two, and five years. RESULTS: The SB group had higher median AOFAS score (100 (interquartile range (IQR) 92 to 100) vs 90 (IQR 85 to 100); p = 0.006) and higher median OMA score (100 (IQR 95 to 100) vs 95 (IQR 75 to 100); p = 0.006). The SS group had a higher incidence of ankle osteoarthritis (OA) (24 (65%) vs 14 (35%), odds ratio (OR) 3.4 (95% confidence interval (CI) 1.3 to 8.8); p = 0.009). On axial CT we measured a significantly smaller mean difference in the anterior tibiofibular distance between injured and non-injured ankles in the SB group (-0.1 mm vs 1.2 mm; p = 0.016). CONCLUSION: Five years after syndesmotic injury treated with either SB or SS, we found better AOFAS and OMA scores, and lower incidence of ankle OA, in the SB group. These long-term results favour the use of SB when treating an acute syndesmotic injury. Cite this article: Bone Joint J 2020;102-B(2):212-219.


Assuntos
Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/cirurgia , Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Âncoras de Sutura , Fraturas do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/diagnóstico por imagem , Seguimentos , Humanos , Resultado do Tratamento
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