scholarly journals Biomechanical Comparison of Anterograde and Retrograde Lesser Trochanter Avulsion Repair

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989228
Author(s):  
Alexander Otto ◽  
Joshua B. Baldino ◽  
Alyssa M. DiCosmo ◽  
Katherine Coyner ◽  
Jeremiah D. Johnson ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Suture Anchors ◽  
Retrograde Approach ◽  
Avulsion Fractures ◽  
Iliopsoas Tendon ◽  
Lesser Trochanter ◽  
Cortical Button ◽  
Load To Failure ◽  
Biomechanical Comparison ◽  
Lesser Trochanter Avulsion

Background: Lesser trochanter avulsions are rare injuries in adolescents. Severe cases with relevant fragment displacement can be treated surgically. However, no standard approach is available in the literature. Operative techniques are presently limited to anterograde fixations. A new retrograde approach to reduce operative difficulty and postoperative morbidity has been proposed. So far, no biomechanical comparison of these techniques is available. Hypothesis: Retrograde repair of the lesser trochanter with a titanium cortical button will produce superior stability under load to failure and similar displacement under cyclic loading compared with anterograde fixation with titanium suture anchors. Study Design: Controlled laboratory study. Methods: Sixteen paired hemipelvic cadaveric specimens (mean age, 62.5 ± 10.7 years) were dissected to isolate the lesser trochanter and iliopsoas muscle. After repair of a simulated lesser trochanter avulsion, specimens were tested under cyclic loading between 10 and 125 N at 1 Hz for 1500 cycles before finally being loaded to failure at a rate of 120 mm/min in a material testing machine. Motion tracking was used to assess displacement at the superior and inferior aspects of the iliopsoas tendon under cyclic loading. Results: Load to failure was significantly greater for the retrograde repair compared with the anterograde repair (1075.24 ± 179.39 vs 321.85 ± 62.45 N; P = .012). Mean displacement at the superior repair aspect (retrograde vs anterograde: 3.29 ± 1.84 vs 4.39 ± 4.50 mm; P = .779) and mean displacement at the inferior aspect (3.54 ± 2.13 vs 4.22 ± 4.48 mm; P = .779) of the iliopsoas tendon did not significantly differ by the type of repair. Mode of failure was tendon tearing by the sutures for each retrograde repair and anchor pullout for each anterograde repair. Conclusion: Surgical repair of lesser trochanter avulsion fractures with retrograde fixation using a titanium cortical button demonstrated superior load to failure and similar displacement under cyclic loading compared with anterograde fixation using suture anchors. Clinical Relevance: The retrograde approach provides a biomechanically validated alternative to other surgical techniques for this injury.

scholarly journals Biomechanical Evaluation of Proximal Hamstring Repair: All-Suture Anchor Versus Titanium Suture Anchor

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989292 ◽  
Author(s):  
Alexander Otto ◽  
Alyssa M. DiCosmo ◽  
Joshua B. Baldino ◽  
Julian Mehl ◽  
Elifho Obopilwe ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Suture Anchor ◽  
Testing Machine ◽  
Optical Tracking ◽  
Rank Test ◽  
Suture Anchors ◽  
Posterior Aspect ◽  
Significant Difference ◽  
Load To Failure ◽  
Proximal Hamstring

Background: Proximal hamstring avulsions are severe tendon injuries and are commonly sports-related. Open and endoscopic techniques as well as different anchor configurations have already been described for proximal hamstring repair. Novel all-suture anchors have been developed to provide decreased bone loss during placement and reduced occupied bone volume when compared with titanium suture anchors. Hypothesis: Complete proximal hamstring avulsions repaired with all-suture anchors will demonstrate equal load to failure and comparable displacement under cyclic loading when compared with titanium suture anchors. Study Design: Controlled laboratory study. Methods: Complete proximal hamstring avulsions were created in 18 paired cadaveric specimens (mean ± SD age, 63.0 ± 10.4 years). Either all-suture anchors or titanium suture anchors were used for repair. Cyclic loading from 10 to 125 N at 1 Hz was performed for 1500 cycles with a material testing machine. Displacement was assessed along anterior and posterior aspects of the tendon repair with optical tracking. Specimens were loaded to failure at a rate of 120 mm/min. Displacement, load to failure, and repair construct stiffness were compared between matched pairs with the Wilcoxon signed-rank test. Correlations were determined by Spearman rho analysis. Results: The all-suture anchors showed significantly higher load-to-failure values when compared with the titanium anchor repairs (799.64 ± 257.1 vs 573.27 ± 89.9 N; P = .008). There was no significant difference in displacement between all-suture anchors and titanium suture anchors at the anterior aspect (6.60 ± 2.2 vs 5.49 ± 1.1 mm; P = .26) or posterior aspect (5.87 ± 2.08 vs 5.23 ± 1.37 mm; P = .678) of the repaired hamstring tendons. Conclusion: All-suture anchors demonstrated similar displacement and superior load to failure when compared with titanium suture anchors. Clinical Relevance: The results of this study suggest that all-suture anchors are an equivalent alternative to titanium suture anchors for proximal hamstring avulsion repair.

Biomechanical Comparison of Onlay Distal Biceps Tendon Repair: All-Suture Anchors Versus Titanium Suture Anchors

2019 ◽  
Vol 47 (10) ◽  
pp. 2478-2483 ◽  
Author(s):  
Alexander Otto ◽  
Julian Mehl ◽  
Elifho Obopilwe ◽  
Mark Cote ◽  
Lucca Lacheta ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Biceps Tendon ◽  
Peak Load ◽  
Tendon Repair ◽  
Suture Anchors ◽  
Mineral Density ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Load To Failure ◽  
Biceps Tendon Repair

Background: A rupture of the distal biceps tendon is the most common tendon rupture of the elbow and has received increased attention in the past few years. Newly developed all-suture anchors have the potential to minimize surgical trauma and the risk of adverse events because of the use of flexible drills and smaller drill diameters. Purpose/Hypothesis: The purpose was to biomechanically compare all-suture anchors and titanium suture anchors for distal biceps tendon repair in cadaveric specimens. The hypothesis was that all-suture anchors would show no differences in load to failure or displacement under cyclic loading compared with titanium suture anchors. Study Design: Controlled laboratory study. Methods: Sixteen unpaired, fresh-frozen human cadaveric elbows were randomized to 2 groups, which underwent onlay distal biceps tendon repair with 2 anchors. Bone mineral density at the radial tuberosity was evaluated in each specimen. In the first group, distal biceps tendon repair was performed using all-suture anchors. In the second group, titanium suture anchors were applied. After cyclic loading for 3000 cycles, the repair constructs were loaded to failure. The peak load to failure as well as repair construct stiffness and mode of failure were determined. Results: The mean (±SD) peak load was 293.53 ± 122.15 N for all-suture anchors and 280.02 ± 69.34 N for titanium suture anchors ( P = .834); mean stiffness was 19.78 ± 2.95 N/mm and 19.30 ± 4.98 N/mm, respectively ( P = .834). The mode of failure was anchor pullout for all specimens during load to failure. At the proximal position, all-suture anchors showed a displacement of 1.53 ± 0.80 mm, and titanium suture anchors showed a displacement of 0.81 ± 0.50 mm ( P = .021) under cyclic loading. At the distal position, a displacement of 1.86 ± 1.04 mm for all-suture anchors and 1.53 ± 1.15 mm for titanium suture anchors was measured ( P = .345). A positive correlation between bone mineral density and load to failure was observed ( r = 0.605; P = .013). Conclusion: All-suture anchors were biomechanically equivalent at time zero to titanium suture anchors for onlay distal biceps tendon repair. While the proximally placed all-suture anchors demonstrated greater displacement than titanium suture anchors, the comparable displacement at the distal position as well as the similar load and mechanism of failure make this difference unlikely to be clinically significant. Clinical Relevance: All-suture anchors performed similarly to titanium suture anchors for onlay distal biceps tendon repair at time zero and represent a reasonable alternative.

scholarly journals Preliminary Presentation of Metastatic Non-Small Cell Carcinoma of the Lung as Atraumatic Avulsion Fracture of the Lesser Trochanter

2020 ◽  
Vol 13 (1) ◽  
pp. 436-441
Author(s):  
Adam Creissen ◽  
Aysha Rajeev ◽  
Kumud Jain ◽  
Paul Banaszkiewicz
Keyword(s):  
Cell Carcinoma ◽  
Small Cell Carcinoma ◽  
Groin Pain ◽  
Avulsion Fracture ◽  
Small Cell ◽  
Avulsion Fractures ◽  
Lesser Trochanter ◽  
Tumour Biopsy ◽  
History Of ◽  
Lesser Trochanter Avulsion

Traumatic avulsion fractures of the lesser trochanter are usually seen along with fractures of the proximal femur and with young adolescents involved in high-intensity sporting injuries. Atraumatic isolated lesser trochanter avulsion in adults are most commonly associated with malignancy. We describe a case of a female in her sixties who was previously fit and healthy with no systemic illness and no history of trauma presenting with groin pain. The X-ray demonstrated an isolated lesser trochanter avulsion fracture. Further imaging including MRI and a staging CT scan of the neck, chest, abdomen and pelvis revealed a pulmonary tumour. Biopsy later confirmed this as a non-small cell carcinoma of the lung. At the time of publication, she had been started on palliative chemotherapy (afatinib) with encouraging results.

The 2.5 mm PushLock suture anchor system versus a traditional suture anchor for ulnar collateral ligament injuries of the thumb: a biomechanical study

2009 ◽  
Vol 35 (2) ◽  
pp. 139-143 ◽  
Author(s):  
C. D. Jarrett ◽  
G. R. Mcgillivary ◽  
W. C. Hutton
Keyword(s):  
Cyclic Loading ◽  
Suture Anchor ◽  
Ulnar Collateral Ligament ◽  
Suture Anchors ◽  
Gap Formation ◽  
Ligament Injuries ◽  
Collateral Ligament ◽  
Average Force ◽  
Anchor System ◽  
Load To Failure

We compared the biomechanical strength of the 2.5 mm PushLock suture anchor with a traditional Bio-SutureTak suture anchor in repair of ulnar collateral ligament injuries. Iatrogenic ulnar collateral ligament injuries in 18 cadaveric thumbs were repaired and used to test for load to failure and cyclic loading. The average force required to generate a 2 mm gap was 7.7 N for the 2.5 mm PushLock and 6.3 N for the Bio-SutureTak ( p = 0.04). The ultimate load to failure was 28.0 N for the 2.5 mm PushLock and 18.8 N for the Bio-SutureTak ( p = 0.16). There were no statistical differences between the two suture anchors under cyclic loading. The 2.5 mm PushLock suture anchor provides significantly stronger resistance to 2 mm gap formation at the repair site and is less likely to fail at the suture–ligament interface. However, there was no difference in the load to failure between the two suture anchors.

scholarly journals Spontaneous Isolated Iliopsoas Tendon Tear in Elderly—Case Report and Review of Literature

2021 ◽  
Author(s):  
Ramanan Rajakulasingam ◽  
Christine Azzopardi ◽  
Peter Dutton ◽  
David Beale ◽  
Rajesh Botchu
Keyword(s):  
Case Report ◽  
Full Thickness ◽  
Review Of Literature ◽  
Tendon Tear ◽  
Avulsion Fractures ◽  
Iliopsoas Tendon ◽  
Lesser Trochanter ◽  
Tendon Tears

AbstractIliopsoas tendon tears are rare. These typically occur in young and can be associated with avulsion fractures of lesser trochanter. We report a case of full thickness rupture of iliopsoas tendon in 87-year-old male without avulsion of the lesser trochanter.

scholarly journals Sequential bilateral lesser trochanter avulsion fractures in an adolescent patient

2014 ◽  
Vol 2014 (nov24 1) ◽  
pp. bcr2014207911-bcr2014207911 ◽  
Author(s):  
N. J. Obi ◽  
C. Allman ◽  
E. Moore-Thompson ◽  
M. D. Latimer
Keyword(s):  
Adolescent Patient ◽  
Avulsion Fractures ◽  
Lesser Trochanter ◽  
Lesser Trochanter Avulsion

The Effect of Suture Anchor Insertion Angle on Calcaneus Pullout Strength: Challenging the Deadman’s Angle

2016 ◽  
Vol 10 (5) ◽  
pp. 411-414 ◽  
Author(s):  
William M. Weiss ◽  
Ramon P. Saucedo ◽  
John D. Robinson ◽  
Chung-Chieh Jason Lo ◽  
Randal P. Morris ◽  
...  
Keyword(s):  
Suture Anchor ◽  
Tensile Load ◽  
Achilles Tendinopathy ◽  
Fixation Strength ◽  
Suture Anchors ◽  
Insertion Angle ◽  
Load To Failure ◽  
Biomechanical Comparison ◽  
Anchor Fixation

Background. Refractory cases of Achilles tendinopathy amenable to surgery may include reattachment of the tendon using suture anchors. However, there is paucity of information describing the optimal insertion angle to maximize the tendon footprint and anchor stability in the calcaneus. The purpose of this investigation is to compare the fixation strength of suture anchors inserted at 90° and 45° (the Deadman’s angle) relative to the primary compressive trabeculae of the calcaneus. Methods. A total of 12 matched pairs of adult cadaveric calcanei were excised and potted to approximate their alignment in vivo. Each pair was implanted with 5.5-mm bioabsorbable suture anchors placed either perpendicular (90°) or oblique (45°) to the primary compressive trabeculae. A tensile load was applied until failure of anchor fixation. Differences in failure load and stiffness between anchor fixation angles were determined by paired t-tests. Results. No significant differences were detected between perpendicular and oblique suture anchor insertion relative to primary compressive trabeculae in terms of load to failure or stiffness. Conclusion. This investigation suggests that the fixation strength of suture anchors inserted perpendicular to the primary compression trabeculae and at the Deadman’s angle are possibly comparable. Levels of Evidence: Biomechanical comparison study

scholarly journals Suture-bridge technique for tibial avulsion fractures of the posterior cruciate ligament - a biomechanical comparison

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0022
Author(s):  
Lukas Willinger ◽  
Lucca Lacheta ◽  
Constantin von Deimmling ◽  
Jan Lang ◽  
Andreas Imhoff ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Cruciate Ligament ◽  
Initial Stiffness ◽  
Avulsion Fractures ◽  
Suture Bridge ◽  
Load To Failure ◽  
Group A ◽  
Group B ◽  
Pcl Avulsion ◽  
Suture Bridge Technique

Aims and Objectives: Tibial posterior cruciate ligament (PCL) avulsion fractures require surgical fixation in order to provide primary stability and adequate bone healing. Small fragments are common and comprise the risk to fracturing during screw fixation. Therefore, a suture-bridge configuration was developed to fixate small and multifragment fractures without the need of fragment drilling. The purpose of this study was to analyze the biomechanical properties of the suture-bridge technique compared to a well-established transtibial cortical suspension technique concerning cyclic elongation, stiffness and ultimate failure load. It was hypothesized that the suture bridge technique shows lower cyclic elongation and higher load to failure force compared to a cortical suspension button fixation. Materials and Methods: Nine fresh-frozen human cadaveric knees were biomechanically tested using an industrial testing machine (Zwick/Roell Amsler HC 10, Ulm). A standardized bony avulsion fracture (15 x 10 x 4 mm) of the tibial PCL insertion was generated. Two different techniques were used for fixation: A) 4x suture-bridge configuration (3 SwiveLock anchors, FiberTape, Arthrex Inc.) and B) 5x transtibial cortical suspension button fixation (FiberTape, Arthrex Inc). Cyclic loading was applied in 90° of flexion 500 times (10 to 100 N) to determine elongation, initial stiffness and load to failure. Students t-test for unpaired samples were used to calculate the difference of means (SPSS statistics software version 21). Statistical significance was set at a p value of < 0.05. Results: Suture-bridge technique resulted in a significant lower elongation (4.5 ± 2.9 mm) than transtibial cortical suspension button technique (11.9 ± 3.1 mm, p<0.01). Load of failure testing exhibited 319.8 ± 79.7 N in Group A and 232.6 ± 108.2 N in Group B (p=0.21). The initial stiffness at the beginning of cyclic loading was 45.0 ± 7.7 N/mm in Group A und 40.9 ± 10.0 N/mm in Group B (p=0.52). Conclusion: The novel PCL suture-bridge technique provides a significant lower construct elongation during cyclic loading and a trend towards higher load to failure in comparison to cortical suspension button fixation. As a clinical consequence, suture-bridge technique should be considered to fix small PCL avulsion fractures at the tibial insertion site.

Distal Biceps Brachii Tendon Repair

1998 ◽  
Vol 26 (3) ◽  
pp. 428-432 ◽  
Author(s):  
Gregory C. Berlet ◽  
James A. Johnson ◽  
Andrew D. Milne ◽  
Stuart D. Patterson ◽  
Graham J. W. King
Keyword(s):  
Cyclic Loading ◽  
Suture Anchor ◽  
Biceps Brachii ◽  
Biceps Tendon ◽  
Tendon Repair ◽  
Medullary Canal ◽  
Suture Anchors ◽  
Distal Biceps ◽  
Significant Difference ◽  
Load To Failure

Clinical reports suggest that suture anchors can simplify repair of distal biceps tendon avulsions. In this study, fixation strengths of Mitek and Statak suture anchors were compared with strength of reattachment using transosseous suture tunnels in eight cadaveric radii. Cyclic loading and load-to-failure testing were performed: No specimen failed during testing to 50 N for 3600 cycles; however, four of the Mitek anchors and one of the Statak anchors protruded out of the medullary canal. The mean load to failure of the Mitek suture anchor complexes was 220 54 N, that of the Statak suture anchor complexes was 187 64 N, and that of the transosseous sutures was 307 142 N. There was no significant difference in the failure load or mechanism of failure between the Statak and Mitek anchors. Transosseous sutures failed at significantly greater loads on static testing than the suture anchors. Cyclic loading results suggest that the bony fixation achieved using these three techniques should be sufficient to allow immediate passive mobilization of the elbow after surgery. Protrusion of the suture anchors out of the tuberosity during cyclic loading is a concern because of potential development of a gap at the repair site and interference with forearm rotation.

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