Clinical Safety and Efficacy of a Novel Ultrasound-Assisted Bioabsorbable Suture Anchor in Foot and Ankle Surgeries

2020 ◽  
Vol 41 (9) ◽  
pp. 1073-1078
Author(s):  
Jie Chen ◽  
Akhil Sharma ◽  
Craig Chike Akoh ◽  
Rishin Kadakia ◽  
Selene G. Parekh
Keyword(s):  
Tissue Repair ◽  
Ligament Reconstruction ◽  
Suture Anchor ◽  
Varus Deformity ◽  
Lateral Ligament ◽  
Suture Anchors ◽  
Foot And Ankle ◽  
Soft Tissue Repair ◽  
Clinical Safety ◽  
Ultrasound Assisted

Background: Suture anchors have been used for soft tissue repair in orthopedic surgery for decades. Recently, bioabsorbable suture anchors have increased in popularity and have spurred the introduction of ultrasound-assisted systems. The purpose of our study was to determine the clinical safety and efficacy of a new ultrasound-assisted suture anchor system for foot and ankle procedures. Methods: We retrospectively reviewed 50 cases using the ultrasound-assisted suture anchor with at least 24 months of follow-up. We reviewed demographic data including comorbidities, type of procedure, adverse events, and clinical outcomes using the Foot and Ankle Outcome Score (FAOS) and visual analog scale (VAS) score. We divided complications into minor and major, with major complications requiring revision surgery or leading to long-term morbidity. Our primary outcome was complication rates and our secondary outcome was improvement in clinical scores. Results: The most frequent cases using the anchor included lateral ankle ligament reconstruction ( n = 19), insertional Achilles repair ( n = 15), lateral ligament reconstruction in conjunction with a total ankle arthroplasty ( n = 6), and plantar plate repair ( n = 3). There were 5 superficial wound infections that resolved with wound care and/or oral antibiotics. There were 3 major complications (6%): a deep wound infection that required an irrigation and debridement, a deep venous thrombosis, and a recurrence of varus deformity in a patient who underwent a total ankle arthroplasty with lateral ligament reconstruction. Only the varus deformity recurrence case could possibly be directly linked to the suture anchor (2% of all cases). VAS scores improved from 6.0 to 1.2 ( P < .001) and FAOS improved from 54.7 to 94.2 ( P < .001). Conclusion: This bioabsorbable anchor was a safe device with low failure rates, and it was used for soft tissue repair cases in the foot and ankle with successful clinical outcomes. Level of Evidence: Level IV, retrospective case series.

scholarly journals Clinical Safety and Outcomes of a Novel Ultrasound Assisted Bioabsorbable Suture Anchor in Foot and Ankle Surgeries

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0016
Author(s):  
Jie Chen ◽  
Akhil Sharma ◽  
Craig C. Akoh ◽  
Rishin J. Kadakia ◽  
Selene G. Parekh
Keyword(s):  
Soft Tissue ◽  
Tissue Repair ◽  
Suture Anchor ◽  
Complication Rates ◽  
Suture Anchors ◽  
Foot And Ankle ◽  
Soft Tissue Repair ◽  
Clinical Safety ◽  
Anchor System ◽  
Ultrasound Assisted

Category: Sports Introduction/Purpose: Bioabsorbable suture anchors have been popularized due to potential for osseous integration, less interference with diagnostic imaging, and ease of use. Recently, ultrasound assisted suture anchor systems have been introduced with the benefits of obtaining interdigitation with cancellous bone while maintaining a minimal footprint. In a cadaveric study, ultrasound assisted suture anchors demonstrated a similar pullout strength and less system displacement when compared to a benchmark bioabsorbable anchor system. However, the failure and complication rates of ultrasound assisted bioabsorbable anchors has never been demonstrated in a clinical setting. We studied the Stryker SonicAnchor by examining complication rates in foot and ankle procedures and secondarily determined the efficacy by evaluating clinical outcomes of surgeries using this anchor system. Methods: A retrospective analysis was performed on all patients treated by the primary investigator using the Stryker SutureAnchor between the dates of May 2016 and February 2018. We included all patients for which the anchor was used during surgery with at least 2 year followup including VAS and FAOS scores. We recorded baseline demographic information as well as the type of surgery patients underwent. We recorded all intraoperative and postoperative complications for these surgeries. In addition, we compared preoperative and postoperative clinical scores. Results: 57 patients met inclusion criteria. On average, patients were 53 years old at the time of surgery. Mean followup was 32.8 months. Mean BMI was 30.36. Three patients reported current tobacco use (5.3%), four patients (7.0%) had type II diabetes mellitus at the time of their surgery, and only one patient (1.8%) had osteoporosis. Common procedures were Achilles repair including Haglund’s resection, peroneal surgery, and lateral ligament reconstruction. There were two deep infections requiring reoperation, one medial malleolus stress fracture following total ankle replacement, one metatarsal stress fracture not involving the surgery site, and one DVT. No reports of anchor pullout or soft tissue repair failure. VAS and FAOS scores improved from 6.2 to 1.2 and 54.3 to 93.9. Conclusion: In our review of 57 patients operated on with the SonicAnchor with at least two year followup, there were zero cases of complications stemming from the anchor including anchor pullout or soft tissue repair failure. Overall, patients improved tremendously in their clinical outcome scores across a wide range of different procedures. Previous studies have demonstrated the biomechanical strength of the SonicAnchor and our review supports its clinical safety and efficacy in long-term clinical followup.

Outcomes of Liquifying PLDLLA Suture Anchor for Lateral Ligament Reconstruction of the Ankle

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Amalie A. Erwood ◽  
Jacob M. Wilson ◽  
Danielle Mignemi ◽  
Jason T. Bariteau
Keyword(s):  
Ligament Reconstruction ◽  
Suture Anchor ◽  
Lateral Ligament

A Radiographic Investigation to Determine the Safety of Suture Anchor Systems for Pediatric Modified Broström Ankle Ligament Reconstruction

2005 ◽  
Vol 33 (3) ◽  
pp. 435-438 ◽  
Author(s):  
Kaushik Hazratwala ◽  
Alistair Best ◽  
Matthew Kopplin ◽  
Eric Giza ◽  
Martin Sullivan
Keyword(s):  
Ligament Reconstruction ◽  
Suture Anchor ◽  
Clinical Success ◽  
Suture Anchors ◽  
Adult Group ◽  
Lateral Ankle ◽  
Adolescent Group ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
The Mean

Background The modified Broström ligament reconstruction using anchor sutures has been performed in adults with clinical success; however, the safety parameters for the use of suture anchors in adolescent lateral ankle ligament reconstruction have not been established. Purpose To perform a radiographic analysis comparing the depth of penetration of suture anchors in adult ankle ligament reconstruction with the average distance of the physis from the tip of the fibula in adolescents. Study Design Cross-sectional study, Level of evidence, 4. Methods Forty postoperative ankle radiographs of adult patients who had a modified Broström procedure were compared with 40 normal adolescent ankle radiographs. In the adult group, the distance of the suture anchor penetration from the distal tip of the fibula was measured; in the adolescent group, the distance of the physis from the distal tip of the fibula was measured. Results The mean depth of the suture anchors was 17 mm (range, 14-21 mm) from the tip of the fibula in the adult group, and the mean distance of the growth plate was 23 mm (range, 18-29 mm) in the adolescent group. Eight radiographs from the adolescent group (20%) had a physis measurement of <22 mm on the anteroposterior or mortise view. Conclusions Using careful preoperative planning and intraoperative technique, it is possible to safely perform lateral ankle ligament repair in the skeletally immature patient using suture anchors.

scholarly journals Short Oblique Patellar Tunnels for Patellar Fixation Do Not Increase Fracture Risk in MPFL Reconstruction: A Retrospective Cohort Study

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0050
Author(s):  
Milos Lesevic ◽  
Matthew Deasey ◽  
Zachary Burnett ◽  
David Diduch ◽  
Thomas Moran
Keyword(s):  
Ligament Reconstruction ◽  
Suture Anchor ◽  
Cost Savings ◽  
Mpfl Reconstruction ◽  
Drill Bit ◽  
Suture Anchors ◽  
Material Cost ◽  
Increase Fracture Risk ◽  
Significant Difference ◽  
Bone Tunnels

Objectives: The current standard of care for recurrent patellar instability is reconstruction of the medial patellofemoral ligament (MPFL), the primary soft tissue constraint to lateral subluxation of the patella. Historically, transpatellar bone tunnels have been associated with increased rates of patella fracture. To avoid this dreaded outcome, many surgeons now employ suture anchors to affix the MPFL graft to the patella. This study aims to evaluate the costs and outcomes associated with short oblique patella tunnels as compared to suture anchor fixation in MPFL reconstruction. Methods: A total of 467 knees in 419 patients undergoing MPFL reconstruction between 2011 and 2018 were included in the study. A single institution electronic medical record queried for all patients undergoing extra-articular ligament reconstruction using Current Procedural Technology codes 27422 and 27427. Chart review of operative reports was utilized to identify those who had undergone MPLF reconstruction. Patients undergoing revision MPFL reconstruction were excluded, as were patients for whom fully transpatellar bone tunnels were employed for patellar fixation. This left two groups: those for whom small, oblique tunnels (n = 277) and suture anchors (n = 190) for patellar fixation were compared. Implant pricing for the 3.2 mm drill bit, suture anchors, and allograft were obtained through publicly available databases and prior published research. Results: Short oblique tunnels showed no significant increase in risk of patellar fracture compared to suture anchors for patellar fixation (P = 1.00). Use of suture anchors was associated with an increased risk of subluxation or dislocation compared to small, oblique tunnels (OR = 3.34, P = 0.021). No significant difference in the need for revision MPFL reconstruction surgery was found (OR = 1.964, P = 0.45) [Table 1]. The cost difference between allo- and autograft in ligament reconstruction has been analyzed in multiple prior studies and found to be $1100. The 3.2mm drill bit used to create the tunnels cost $84 but is reusable, while the average cost of two suture anchors was $500, leading to a material cost savings of $1600 per case in which transpatellar tunnels were used for MPFL autograft fixation when compared to a suture anchor and allograft combination. Regardless of the graft choice, material cost savings exceeds $400 per case simply by conversion to short oblique tunnels rather than suture anchors. Conclusion: The use of small, oblique tunnels with hamstring autograft is a safe and cost effective method for patellar fixation in MPFL reconstruction. Value in healthcare is defined as quality divided by cost. As surgeons and institutions are increasingly judged not only by the quality of the care they provide, but also in its cost, employment of this high-value technique should be considered by surgeons performing MPFL reconstruction.

Safety Profile of Synthetic Elastic Degradable Matrix for Soft Tissue Reconstruction in Foot & Ankle Surgery

2021 ◽  
pp. 193864002110676
Author(s):  
Michael J. Kelly ◽  
Daniel M. Dean ◽  
Syed H. Hussaini ◽  
Steven K. Neufeld ◽  
Daniel J. Cuttica
Keyword(s):  
Soft Tissue ◽  
Safety Profile ◽  
Tissue Repair ◽  
Case Series ◽  
Wound Complications ◽  
Soft Tissue Reconstruction ◽  
Complication Rates ◽  
Foot And Ankle ◽  
Soft Tissue Repair ◽  
Level Of Evidence

Background Augmentation of soft tissue repairs has been helpful in protecting surgically repaired tissues as they heal. FlexBand (Artelon, Marietta, Georgia) is a synthetic, degradable, polycaprolactone-based polyurethane urea (PUUR) matrix that has been investigated and used for soft tissue repair in a variety of settings. The purpose of this study was to evaluate the safety profile of a PUUR matrix in a large cohort of patients undergoing soft tissue repairs about the foot and ankle. Methods A retrospective chart review of consecutive patients who underwent surgery using FlexBand to augment a soft tissue repair was performed to evaluate for major and minor complications related to the PUUR matrix. Results. A total of 105 patients with an average >6 months follow-up were included. The most common procedures were spring ligament repair, Achilles tendon repair, and Brostrom. There were 12 complications. Four major complications occurred with only 1 requiring PUUR matrix removal. Patients with wound complications had a higher body mass index (BMI) and rate of smoking. Conclusion Complication rates involving PUUR matrix in soft tissue foot and ankle reconstruction procedures are low and comparable with historical complication rates. The PUUR matrix is safe for use in a variety of soft tissue procedures about the foot and ankle. Level of Evidence: Level 4, Retrospective case-series

Immediate Unrestricted Weightbearing With Simple Stirrup Brace Following Single Anchor Lateral Ankle Ligament Stabilization

2020 ◽  
pp. 193864002097282
Author(s):  
Gregory A. Lundeen ◽  
Christopher Diefenbach ◽  
Laura Hemker Moles ◽  
Larissa Lee White ◽  
Patrick Barousse
Keyword(s):  
Ligament Reconstruction ◽  
Short Form ◽  
Case Series ◽  
Lateral Ligament ◽  
Foot And Ankle ◽  
Balance Test ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament

Objective To report on a series of patients treated with immediate unrestricted weightbearing with limited protection following single anchor lateral ligament stabilization. Methods Patients with chronic lateral ankle ligament instability who underwent modified Broström-Gould lateral ligament reconstruction with a single double-loaded anchor were identified. Immediate unrestricted full weightbearing in a stirrup brace was allowed the first postoperative day and accelerated physical therapy was initiated from 2 weeks. Subsequent assessment was performed at a minimum of 1-year follow-up. Results Thirteen patients with a mean age at final follow-up of 49 years (range 21-70 years). Average follow-up was 21 months (16 to 26). American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and visual analogue scale (VAS) score improved significantly (P < .05) from preoperative to postoperative, respectively (57 to 91, 5.7 to 1.5). Average postoperative Foot and Ankle Outcome Score (FAOS) was 82 (range 52-100). Short Form–12 (SF-12) scores averaged 55 and 49 on mental component and physical components, respectively, consistent with US age-matched averages. No measurable differences in range of motion, ligamentous stability, or Star Excursion Balance Test in the anterior, posterolateral, or posteromedial planes compared to the contralateral side (P > .05) were observed. No recurrence was reported. Conclusion Immediate unrestricted weightbearing in a stirrup brace following single anchor lateral ligament reconstruction is a successful protocol for the treatment of chronic lateral ankle instability. Levels of Evidence Therapeutic, Level IV: Case series

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