Clinical Comparative Study on the Treatment of Inferior Pole Fractures of Patella by Double-row Anchor Suture Bridge Technique Combined with Kirschner Wire Tension Band Internal Fixation

Objective: To investigate the method, technique and clinical efficacy of double-row anchor suture bridge technique in the treatment of inferior pole fractures of patella, and to compare it with traditional Kirschner wire tension band internal fixation. Methods: General information A total of 62 patients were enrolled in this study, including 35 males and 27 females, aged 31-80 years old, with an average of (53.2±4) years old. All the patients were divided into two groups by a random double-blind method: Group A (double-row anchor suture bridge technique group) and Group B (Kirschner wire tension band internal fixation group), with 32 cases and 30 cases in each group, respectively. The two techniques were performed by the same group of doctors to fix the fracture respectively, and the intraoperative bleeding, operation time, incidence of postoperative complications, knee function score, etc., were compared between the two techniques. Results: Group A (double-row anchor suture bridge technique group): operation time 56-80min, with an average of (60±10) min; intraoperative blood loss 30-56ml, with an average of (43±10) ml. All incisions healed in one stage and stitches were removed after 2 weeks. No complications such as incision infection, flap necrosis and nerve injury occurred. The average healing time of the fracture was 12 weeks. At the last follow-up, the Bostman score was (28.5±3.3), and the excellent rate was 93.7%. Group B (Kirschner wire tension band internal fixation group): operation time 54-76min, with an average of (56±10) min; intraoperative blood loss 31-50ml, with an average of (43±80) ml. One patient developed delayed incision healing postoperatively. Four patients experienced Kirschner wire withdrawal, one of which was accompanied by infection. Two patients were found to have mild separation of distal fracture fragments, despite the fracture being fine. The average healing time of the fracture was 13 weeks. At the last follow-up, the Bostman score was (23.5±3.3), and the excellent rate was 86.7%. Conclusion: Double-row anchor suture bridge technique is applied to inferior pole fractures of patella by virtue of its various effects, such as the complete preservation of the inferior pole fragments during the operation, satisfactory fracture reduction, firm fixation, and meeting patients’ requirements for early postoperative ambulation. This technology is superior to traditional Kirschner wire tension band internal fixation owing to its advantages of no need to take out the internal fixation, firm fixation, no need to worry about Kirschner wire withdrawal and fewer complications, and its clinical efficacy satisfaction rate is also better than traditional surgical methods. In short, double-row anchor suture bridge technique is an ideal surgical procedure for the treatment of the inferior pole fracture of patella with safety, reliability and high satisfaction.

Clinical Outcomes and Repair Integrity after Arthroscopic Full-thickness Rotator Cuff Repair: Traditional Suture-bridge Versus Novel Modified Suture-bridge Technique

Background: This prospective study compared the clinical and radiologic outcomes of patients who underwent arthroscopic rotator cuff repairs by the traditional suture bridge technique and the modified suture bridge technique.Methods: From December 2018 to December 2019, 50 consecutive cases of full-thickness medium rotator cuff tear, 1 to 3 cm in the coronal plane, for which arthroscopic rotator cuff repair was performed, were included. The TSB technique was used in 24 consecutive shoulders; and the MSB technique, in 26 consecutive shoulders. Clinical outcomes at 3 months, 6 months and a minimum of 1 years (mean, 11.92±1.92months) were evaluated postoperatively using range of shoulder, the visual analog scale score; University of California Los Angeles Shoulder Scale score; Constant-Murley shoulder score and American Shoulder and Elbow Surgeons Subjective Shoulder Scale score. All patients underwent preoperative MRI and B-US to identify the rotator cuff tear, and postoperatively at final follow-up to evaluate tendon integrity. Results: At the final follow-up, the clinical outcomes improved in both groups. There were no significant differences in the results of the ROM between the two groups at 3 months, 6 months and the final follow-up. The average VAS score decreased from 6.12±0.95 to 1.04±0.45 in MSB Group and decreased from 6.29±0.91 to 1.33±0.48 at the final follow-up in TSB Group. The VAS score significantly differed between the two groups only at the final follow-up (P=0.03). The mean UCLA score increased from 12.23±3.47 to 30.96±2.54 in MSB Group and increased from 11.50±4.00 to 28.79±4.47 in TSB Group at the final follow-up; the mean Constant shoulder score increased from 40.54±5.61 to 92.08±7.21 in MSB Group and increased from 41.79±5.51 to 86.96±8.42 in TSB Group at the final follow-up. The average ASES score increased from 36.04±2.47 to 96.04±7.28 in MSB Group and increased from 35.04±3.10 to 91.50±7.33 in TSB Group at the final follow-up. The UCLA (P=0.044), Constant (P=0.025), ASES (P=0.033) score significantly differed between the two groups only at the final follow-up. At the final follow-up postoperatively, the MRI assessments showed no retear in MSB Group and two retears in TSB Group (8%)(Z=-1.538, P=0.124), B-US assessments showed no retear in MSB Group and one retear in TSB Group (4%)(Z=-1.169, P=0.242). No significant difference was found between the 2 groups regarding cuff integrity in accordance with MRI assessments and B-US assessmentsConclusion: For medium-sized RCTs, the patients who underwent MSB repair had shown better shoulder functional outcomes and a lower but not significant re-tear rate with those who underwent TSB repair. Therefore, the MSB repair technique can be considered an effective treatment for patients with medium-sized full-thickness RCTs.ClinicalTrials.gov Identifier: NCT04825249 Level of evidence: A prospective study, Level II.

Suture Slippage After Arthroscopic Cuff Repair: Medial Displacement of Suture Knots on Follow-up Ultrasonography

Background: Compared with the single-row technique, the double-row rotator cuff repair technique is known to have a higher load to failure and a lower frequency of gap formation, leading to a lower retear rate. There are some patients with poor clinical outcomes or poor muscle strength without radiologic retear. Purpose/Hypothesis: To assess the postoperative position of suture knots via serial ultrasonography in patients who had undergone arthroscopic rotator cuff repair with the suture-bridge technique. Our hypothesis was that the suture would pull out of the lateral anchor (suture slippage), changing the positions of the medial suture knots during healing. Study Design: Case series; Level of evidence, 4. Methods: This study included 53 patients (55 shoulders) who underwent arthroscopic suture-bridge repair and were evaluated for a minimum of 24 months. On serial ultrasonography, a straight line was drawn between the top of the greater tuberosity and the medial cortex of the anchor hole. The distances between the knots of the medial rows and the perpendicular line through the center of the anchor hole were measured in longitudinal plane images of the supraspinatus. Follow-up ultrasonography was performed at 2, 3, and 6 months postoperatively as well as at the final visit. The visual analog scale, the American Shoulder and Elbow Surgeons score, the Constant score, and the University of California, Los Angeles shoulder score were recorded preoperatively and on the final follow-up. Results: Of the 55 shoulders, 6 developed retears at repaired sites. The mean follow-up duration was 37.5 months (range, 24-65 months). Slippage distance increased significantly over time ( P < .001). The slippage at the final visit did not differ between patients with retear and no retear (13.4 mm for retear group; 10.6 mm for no retear group [ P = .096]). Conclusion: Suture knots of the medial row migrated medially via a suture pullout from the lateral row anchor of suture-bridge technique. Suture slippage distance did not differ significantly between retear and no retear groups.

Os acetabuli—a new arthroscopic treatment option for the acetabular rim fracture

Os acetabuli (Os) or acetabular rimfractures are often seen in femoroacetabular impingement patients and can result in groin pain. When seen in symptomatic patients, the question is whether to remove them or to fixate the loose fragment to the acetabular rim. This depends on acetabular coverage and the extent of the Os. If removal of the Os might lead to hip dysplasia and instability, fixation of the Os should be the goal. This technical article describes the author's technique in fixating the Os with a suture-bridge technique.

Surgical Repair Using Suture Bridge Technique for Triceps Tendon Avulsion

Triceps tendon avulsion is a rarely occurring tendinous injury. Various surgical procedures, such as repair using sutures through the transosseous tunnel or suture anchors, have been reported for treating triceps tendon avulsion. However, standard surgical treatment has not yet been established. Here, we present a case of triceps tendon avulsion treated using the suture bridge technique. A 58-year-old man who fell on his left elbow from standing height presented to our hospital. Plain radiography revealed an avulsion fracture of the left olecranon process, suggesting triceps tendon avulsion. We performed surgical repair of the avulsed bone fragments and ruptured triceps tendon. We inserted suture anchors into the ulna, proximal to the fracture site, and passed the sutures through the full thickness of the triceps. Subsequently, fracture fragments were reduced and fixed by pulling them together with the triceps. We inserted knotless anchors into the ulna distal to the fracture site and fixed the avulsed bone fragments and triceps tendon using the suture bridge technique. The patient recovered well in five months and reported no elbow pain or limited range of motion. This suture bridge technique is advantageous as it prevents iatrogenic fracture and knot irritation, and it would be indicated in cases with poor bone quality or thin skin soft tissue of the olecranon.

Preliminary clinical outcomes of the double-row anchor suture-bridge technique for the fixation of tibial intercondylar eminence fractures in adults: a 12-months minimal follow-up

Background Tibial intercondylar eminence avulsion fractures occur primarily in adolescents and young adults. However, the incidence of such fractures is increasing in adults, concurrent with an increase in sports injuries and traffic accidents. This study describes the fixation-based double-row anchor suture-bridge technique, a novel technique for treating tibial intercondylar eminence fractures in adults; and evaluates its preliminary clinical outcomes. Methods A retrospective evaluation of adult patients with tibial intercondylar eminence fractures treated at our institution from June 2016 to June 2018 was conducted. Seven such patients, treated with the anchor suture-bridge technique, were included. All patients were assessed for knee joint range of motion (ROM), Lysholm knee score, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form score, Tegner activity score pre-surgery, and the healing of the fracture at 3, 6 and 12 months minimal post-surgery follow-up. Results Patients were followed for a mean of 12.43 months (range 9-15 months). By the final follow-up, all fractures had fully healed. The mean Lysholm score improved from 27.86 (range, 2 to 54) pre-surgery to 88.14 (range, 81 to 100) 3 months post-surgery (p < 0.05). Similarly, the mean IKDC score improved from 48.86 (range, 43 to 55) to 84.29 (range, 75 to 90) (P < 0.05); and the mean Tegner activity score improved from 1.71 (range, 0 to 4) to 3.29 (range, 2 to 4) (p < 0.05). Furthermore, knee joint ROM, Lysholm scores, IKDC scores, and Tegner activity scores displayed excellent outcomes at the 6 and 12 months minimal follow-up. Conclusion The arthroscopic anchor suture-bridge technique is a valid and secure method for achieving effective fixation of tibial intercondylar eminence fractures in adults.

Repair of avulsion fracture of the anterior superior iliac spine by knotless suture bridge: Surgical technique and a review of 5 cases

Background: Avulsion fracture of the anterior superior iliac spine (ASIS) is a rare form of apophyseal avulsion fracture of the pelvis, and there is a lack of evidence-based guidelines for the selection of treatment options. There are various surgical procedures, but there is the risk of secondary removal of internal fixator and growth disturbance caused by epiphyseal fixation. Methods: We treated 5 patients with avulsion fracture of the anterior superior iliac spine by knotless suture bridge technique who visited our hospital from 2015 to 2020.The surgical treatment results were retrospectively analyzed. Results: 5 patients with fractures were healed after the surgery, no associated complications, the mean postoperative follow-up was 29.2 months (6-60months), all patients were not reported pain symptoms (visual analogue score of 0), they don’t have the limitation of daily activities, and the hip joint function recovered well, and very pleased with the results (Harris score 100 points) at the final follow-up. Conclusion: Knotless suture bridge technique is simple and effective in the repair of the avulsion fracture of anterior superior iliac spine. For such patients, this surgical technique can provide stable and reliable fixation, allow early recovery, and provide a feasible scheme for clinical practice.

An assessment of the functional outcomes of patients undergoing early exercise physiotherapy following arthroscopic rotator cuff repair using the double-row suture bridge technique

<ol><li><p><strong>Background:</strong> The methods of repairing rotator cuff tear are single-row technique, traditional double-row technique and suture-bridge technique. Studies have shown that the arthroscopic suture-bridge technique improved the pressurized contact area between the tendon and footprint. Controversy exists regarding the influence of early versus delayed motion on stiffness and healing rate after cuff repair. Early motion rehabilitation increases range of motion after cuff repair, although risk of re-tear is higher compared to immobilization. This study evaluated the functional outcomes in patients who underwent arthroscopic rotator cuff repair using the suture-bridge technique followed by an early exercise physiotherapy regime.</p><p><strong>Methods:</strong> The study was a prospective and retrospective analysis of patients treated arthroscopically for rotator cuff tears in Hosmat hospital, Bangalore. 30 patients who had only a supraspinatus/infraspinatus tear were included in the study. The functional outcome was assessed by two scoring systems, UCLA and ASES scores. Post operatively, patients were immobilized for 3 weeks only. They were followed up at 3 weeks, 6 weeks, 12 weeks and at 6 months.</p><p><strong>Results:</strong> Our study had 20 patients reporting a good outcome, whereas 9 patients had a fair outcome. Only 1 patient reported a poor outcome. The mean ASES scores improved from 20.43 to 77.87 whereas the UCLA score improved from 10.03 to 27.93. None had re-tears.</p><strong>Conclusions:</strong> The arthroscopic suture-bridge technique resulted in acceptable patient satisfaction and functional outcome as 67% of our patients had a “good” outcome. Early ROM exercise accelerated recovery from postoperative stiffness for patients after arthroscopic rotator cuff repair. </li></ol>