Biomechanical Comparison of Transosseous Versus Suture Anchor Repair of the Subscapularis Tendon

There has been interest in improving arthroscopic subscapularis repairs due to their popularity and efficacy when compared to open subscapularis repairs. However, previous biomechanical analyses of rotator cuff repairs have typically focused on the supraspinatus tendon [1–5]. Testing repair techniques in the subscapularis tendon requires the modification of previously established biomechanical testing methods. Most rotator cuff tendon tests have utilized axial loading on supraspinatus and infraspinatus tendons [1–4]. Most subscapularis tendons are torn with forced external rotation of the shoulder. Axial loading of the subscapularis tendon would not be representative of the injury mechanism. Additionally, past rotator cuff studies have employed a variety of techniques for clamping tendons, including freezing clamps and soft tissue grips. Such methods offer insufficient fixation for tendons that have high muscle content, such as the subscapularis. Several studies have focused on the repair’s ability to restore the appropriate healing environment at insertion footprint. These investigations have used either digitizers or pressure-sensitive film to measure contact area [5–7]. However, there are questions concerning the repeatability and accuracy of the results provided by these techniques. The objective of this study was to compare the biomechanical performance of open, transosseous fixation with that of the arthroscopic, suture anchor technique for subscapularis repair, while making three specific improvements to current testing methods. It sought to: 1) apply physiologically accurate loads to the subscapularis using cyclic, external rotation, 2) identify an effective method of clamping tendons with high muscle content, such as the subscapularis, and 3) introduce a novel, tactile pressure measurement system that measures contact pressure and area in real-time.

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Anatomic Knot Suture Anchor Versus Knotless Suture Anchor Technique for Anterior Talofibular Ligament Repair: A Biomechanical Comparison

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119898125 ◽

2020 ◽

Vol 8 (1) ◽

pp. 232596711989812

Author(s):

Hong Li ◽

Hanlin Xu ◽

Yinghui Hua ◽

Wenbo Chen ◽

Hongyun Li ◽

...

Keyword(s):

Suture Anchor ◽

Anterior Talofibular Ligament ◽

Significant Difference ◽

Load To Failure ◽

Group A ◽

The Mean ◽

Group B ◽

Biomechanical Comparison ◽

Group D ◽

Suture Anchor Repair

Background: To date, there are few biomechanical studies comparing the strength between knot repair and knotless repair procedures for anterior talofibular ligament (ATFL) injury. Purpose: To perform a biomechanical comparison of the strength of the arthroscopic ATFL repair technique with knot or knotless suture anchors in a cadaveric model with partial or complete ATFL injuries. Study Design: Controlled laboratory study. Methods: A total of 24 fresh-frozen cadaveric ankles were used. Arthroscopy was used to identify, section, and repair the ATFL on the fibular insertion site. The specimens were then randomly placed into 1 of 4 groups: group A received complete ATFL section and 1–suture anchor repair with knot, group B received complete ATFL section and 1-anchor knotless repair, group C received partial ATFL section and 1–suture anchor repair with knot, and group D received partial ATFL section and 1-anchor knotless repair. After repair, the ATFL tension was measured first with a digitalized tensiometer. Specimens were then mounted on a materials testing system to determine the ultimate load to failure and stiffness. Results: The mean ± SD ligament tension measured during the arthroscopic procedure was 8.6 ± 0.6 N for group A, 9.2 ± 0.5 N for group B, 9.4 ± 1.1 N for group C, and 9.6 ± 0.9 N for group D. No significant difference in tension was detected among groups. In load-to-failure testing, the mean ultimate failure load was 27.9 ± 4.1 N for group A, 26.2 ± 9.3 N for group B, 81.9 ± 26.5 N for group C, and 88.1 ± 41.6 N for group D. The mean ultimate failure loads of the partial repair groups were significantly higher than those of the complete repair groups (C vs A, P = .008; D vs B, P = .002), while there was no significant difference between groups A and B ( P > .05) or between groups C and D ( P > .05). Conclusion: The results of the present study showed that there was no significant difference in biomechanical properties between knot repair and knotless repair techniques. Clinical Relevance: Biomechanically, the results showed that knot suture anchor and knotless suture repair provide similar biomechanical strength for ATFL injury. Unfortunately, these methods in the complete ATFL section models provided less than half the strength and stiffness in the partial ATFL section models at time zero after surgery. As a result, 1–suture anchor repair is not suitable for complete ATFL injury regardless of the repair method.

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Suture Anchor Repair of Quadriceps and Patellar Tendon Injuries

Journal of Long-Term Effects of Medical Implants ◽

10.1615/jlongtermeffmedimplants.2020034908 ◽

2020 ◽

Vol 30 (1) ◽

pp. 57-60

Author(s):

Sean P. McGowan ◽

Benjamin C. Taylor ◽

Devon M. Myers ◽

Braden J. Passias

Keyword(s):

Patellar Tendon ◽

Suture Anchor ◽

Tendon Injuries ◽

Suture Anchor Repair

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Navigation-assisted suture anchor insertion for arthroscopic rotator cuff repair

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-3021-2 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Ivan Micic ◽

Erica Kholinne ◽

Hanpyo Hong ◽

Hyunseok Choi ◽

Jae-Man Kwak ◽

...

Keyword(s):

Suture Anchor ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Rank Test ◽

Subscapularis Tendon ◽

Signed Rank ◽

Original Target ◽

Signed Rank Test ◽

Arthroscopic Rotator Cuff ◽

Anchor Fixation

Abstract Background Suture anchor placement for subscapularis repair is challenging. Determining the exact location and optimum angle relative to the subscapularis tendon direction is difficult because of the mismatch between a distorted arthroscopic view and the actual anatomy of the footprint. This study aimed to compare the reliability and reproducibility of the navigation-assisted anchoring technique with conventional arthroscopic anchor fixation. Methods Arthroscopic shoulder models were tested by five surgeons. The conventional and navigation-assisted methods of suture anchoring in the subscapularis footprint on the humeral head were tested by each surgeon seven times. Angular results and anchor locations were measured and compared using the Wilcoxon signed rank test. Interobserver intraclass correlation coefficients (ICCs) were analyzed among the surgeons. Results The mean angular errors of the targeted anchor fixation guide without and with navigation were 17° and 2° (p < 0.05), respectively, and the translational errors were 15 and 3 mm (p < 0.05), respectively. All participants showed a narrow range of anchor fixation angular and translational errors from the original target. Among the surgeons, the interobserver reliabilities of angular errors for ICCs of the navigation-assisted and conventional methods were 0.897 and 0.586, respectively, and the interobserver ICC reliabilities for translational error were 0.938 and 0.619, respectively. Conclusions The navigation system may help surgeons be more aware of the surrounding anatomy and location, providing better guidance for anchor orientation, including footprint location and anchor angle.

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