UNASSIGNED: Two types of suture anchor insertion pathways (anterolateral portal vs lateral accessory portal) are used in arthroscopic anterior talofibular ligament (ATFL) repair. However, it is not clear which one is the better choice. This study aims to compare the clinical outcomes of these 2 suture anchor insertion pathways when performing arthroscopic ATFL lasso-loop repair for the treatment of chronic lateral ankle instability (CLAI).
UNASSIGNED: From 2019 to 2021, patients with CLAI who underwent arthroscopic ATFL lasso-loop repair were retrospectively reviewed and divided into the anterolateral portal (ALP) group and the lateral accessory portal (LAP) group. A 1:1 propensity score matching was used to control confounding factors based on age, sex, body mass index, follow-up duration, preoperative visual analog scale (VAS) score, and Tegner score (ALP group, n = 26; LAP group, n = 26). Karlsson score, VAS score, Tegner score, operation time, anterior drawer test results, patient symptoms, and magnetic resonance (MR) evaluation of ATFL quality were used to describe the outcomes.
UNASSIGNED: The patient characteristics and follow-up durations were similar between the 2 groups. After a mean follow-up duration of 28.8 ± 2.3 months, the ALP group had significantly better Karlsson score, VAS score, and Tegner score improvement than the LAP group, with fewer symptoms. Seven patients in the LAP group still had a feeling of ankle instability, and 3 of them exhibited ankle laxity.
UNASSIGNED: In this study, we found that inserting the suture anchor through the anterolateral portal was associated with better outcomes compared to that through the lateral accessory portal when performing arthroscopic ATFL lasso-loop repair for CLAI patients. The improvement was greater for pain relief and function and was associated with a lower frequency of subjective ankle instability.

UNASSIGNED: The ligamentous and osseous structures of the elbow joint are the major contributors to its inherent stability and damage to any of these structures can result in elbow instability. The aim of this study is to present objective and subjective outcomes following ligament repairs and/or reconstructions for acute elbow instability and chronic elbow instability.
UNASSIGNED: This study included patients who underwent an elbow ligament repair and/or reconstruction for acute or chronic elbow instability. We performed a comprehensive retrospective data analysis of the patient\'s files, followed by a clinical examination and X-ray of these patients.
UNASSIGNED: We identified 12 acute stabilizations and 22 stabilizations for chronic instability. Patients who underwent stabilization for chronic instability had statistically significant improvements in their preoperative flexion and extension; 14.8 ± 6.4° and 5.9 ± 2.5°. Patients with chronic instability achieved better extension-flexion and pronation-supination arcs compared with their acute instability counterparts and this reached statistical significance. When the elbow pain and function scores were compared, we found stabilizations in the acute setting had better outcomes. There were two cases of postoperative instability, one in the acute instability group and one in the chronic instability group.
UNASSIGNED: This study provides evidence for elbow ligament repairs and reconstructions in both acute and chronic settings. It is an effective way of stabilizing the elbow joint in chronic instability patients, and results in an improvement in their overall range of motion. These patients achieved a greater range of motions compared with their acute instability counterparts.

BACKGROUND: The inclusion of a connecting path in a porous implant can promote nutrient diffusion to cells and enhance bone ingrowth. Consequently, this study aimed to evaluate the biomechanical, radiographic, and histopathological performance of a novel 3D-printed porous suture anchor in a rabbit femur model.
METHODS: Three test groups were formed based on the type of suture anchor (SA): Commercial SA (CSA, Group A, n = 20), custom solid SA (CSSA, Group B, n = 20), and custom porous SA (CPSA, Group C, n = 20). The SAs were implanted in the lateral femoral condyle of the right leg in each rabbit. The rabbits (New Zealand white rabbits, male, mean body weight of 2.8 ± 0.5 kg, age 8 months) underwent identical treatment and were randomized into experimental and control groups via computer-generated randomization. Five rabbits (10 femoral condyles) were euthanized at 0, 4, 8, and 12 weeks post-implantation for micro-CT, histological analysis, and biomechanical testing.
RESULTS: At 12 weeks, the CPSA showed a higher BV/TV (median 0.7301, IQR 0.7276-0.7315) than the CSSA and CSA. The histological analysis showed mineralized osteocytes near the SA. At 4 weeks, new bone was observed around the CPSA and had penetrated its porous structure. By 12 weeks, there was no significant difference in ultimate failure load between the CSA and CPSA.
CONCLUSIONS: We demonstrated that the innovative 3D-printed porous suture anchor exhibited comparable pullout strength to conventional threaded suture anchors at the 12-week postoperative time-point period. Furthermore, our porous anchor design enhanced new bone formation and facilitated bone growth into the implant structure, resulting in improved biomechanical stability.

BACKGROUND: In the general population, pectoralis major tendon ruptures are uncommon; however, it is a common injury in the military population. The military service members have greater physical demands than the general population. The purpose of this study is to critically assess the postoperative outcomes of pectoralis major tendon ruptures in military service members following a repair using intramedullary suture anchors.
METHODS: A retrospective chart review was performed between 2014 and 2022, identifying patients who underwent a pectoralis major rupture repair performed by the senior surgeon using intramedullary suture anchors. Records were reviewed for age, gender, mechanism of injury, chronicity, visual analog scale, and Single Assessment Numeric Evaluation (SANE) scores. Patients who had less than 1 year of follow-up were excluded from the study. During the study period, 18 patients underwent surgical repair of their torn pectoralis major, and 15 patients were followed up >1 year postoperatively. Twelve of these 15 patients (80%) were successfully contacted, and patient-reported outcomes were collected.
RESULTS: A total of 12 patients (12 male, 0 female) with a mean age of 34.5 years were identified. Average time from injury to surgery was 471.4 days. Average duration of follow-up was 3.7 years. There was a decrease in the preoperative average single repetition maximum (1RM) barbell bench press of 125.7 kg (277 lbs) to a postoperative average 1RM bench press of 101.8 kg (225 lbs) (P = .03). Mean change in average 1RM barbell bench press is a 19.04% decrease postoperatively. Postoperative SANE score was 80.8 and an American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score of 86.9. Seven patients (58.3%) stated they were afraid to bench press at their previous weight because of fear of reinjury. None of the patients were medically discharged from the military owing to limitations from their repaired shoulder. Ten patients (83%) reported they were extremely satisfied with their shoulder function postoperatively.
CONCLUSIONS: Repair of the pectoralis major tendon ruptures using intramedullary suture anchors has high rates of return to duty, patient satisfaction, and patient-reported outcomes. More than half of the patients reported they were afraid to bench press at their preinjury weight because of concerns of reinjury; the decrease in postoperative strength may be a result of the patients\' fear of reinjury rather than physiologic limitations.

UNASSIGNED: Suture anchor failures can lead to revision surgeries which are costly and burdensome for patients. The durability of musculoskeletal reconstructions is therefore partly affected by the design of the suture anchors.
UNASSIGNED: The purpose of the study was to quantify the strength of different suture anchors whose sizes are suitable for attaching artificial Achilles and tibialis cranialis tendons in a rabbit model, as well as determine the effect of cyclic loading on the anchoring strength.
UNASSIGNED: Four anchors (two with embedded eyelet and two with raised eyelet, n=5 per group) were tested with cyclical loading (1000 cycles and 4.5 mm/sec) and without cycling, to inform the failure loads and mode of failure of the suture anchors. An eyebolt screw with smooth eyelet was used as a control for the test groups.
UNASSIGNED: All samples in all groups completed 1000 cycles and failed via suture breakage in both test conditions. All anchors had failure loads exceeding the peak Achilles tendon force in rabbits during hopping gait. The data analysis showed an effect of anchor type on the maximum tensile force at failure (F max ) in all suture categories but not an effect of loading condition. Also, the Anika anchor had a significantly less adverse effect on suture strength compared to Arthrex anchor (p=0.015), IMEX anchor (p=0.004) and Jorvet anchor (p<0.001). We observed a greater percentage of failure at the mid-section for the anchors with the raised eyelets compared to the anchors with embedded eyelets, which all failed at the knot.
UNASSIGNED: Anchors with embedded eyelets had clinically preferred mode of failure with less adverse effects on suture and, may be more reliable than anchors with raised eyelets for attaching artificial Achilles and tibialis cranialis tendons in rabbits.

UNASSIGNED: Both knotted all suture anchors and metal anchors are used for arthroscopic Bankart repair. We retrospectively evaluated and compared clinical and functional outcomes after arthroscopic Bankart repair using the knotted all-suture anchors and knotted metal anchors.
UNASSIGNED: In a retrospective cohort analysis, patients who underwent arthroscopic Bankart repair without any concomitant additional lesion repair using either all-suture anchors or metal anchors, between January 2015 and May 2018 were identified. Their pre- and post-operative functional and clinical outcomes were compared using Rowe and WOSI scores. The recurrence rate in the two groups was also compared.
UNASSIGNED: A total of 41 patients in all suture anchors group and 47 in the metal anchors group were identified as per inclusion and exclusion criteria. The demographic profile of both groups was comparable. There was no significant difference in clinical and functional outcome between the two suture anchor groups as per Rowe (pre-operative 40.13+6.51 vs 38.09+6.24 and post-operative 2 years 93.28+7.09 vs 92.55+9.2) and WOSI (pre-operative 943.05+216.64 vs 977.55+165.46 and post-operative 2 years 278.21+227.56 vs 270.94+186.25) scores. There was a significant improvement in both the groups between preoperative and post-operative ROWE and WOSI scores at 6 months and 2 years follow-up as compared to pre-operative scores (p<0.001). Re-dislocation rates were also comparable (4.8% vs 6.3%).
UNASSIGNED: All-suture anchors showed comparable clinical and functional results as the metal anchors for arthroscopic Bankart repair at two-year follow-up.

Tibial tubercle avulsion fractures are relatively uncommon fractures commonly seen in adolescent males. The treatment goal is to restore the extensor mechanism and to repair the articular surface. Although previous surgical techniques have been mainly screws or tension band wiring, there is a certain consensus on this. However, the choice of these surgical techniques largely depends on the surgeon. In our case, we utilized a suture anchor distal to the cannulated screw. This enabled us to use a smaller screw and cover the screw head completely with the patellar tendon. Therefore, this can be an advantage in lowering the incidence of device irritation. Given the successful outcome of our technique, we may consider applying suture anchors more frequently in tibial tubercle avulsion fractures in the future.

BACKGROUND: Shoulder disorders, particularly rotator cuff tears, are prevalent musculoskeletal conditions related to aging. Although the widely used suture anchor technique provides strong mechanical support to the tendon, it is associated with a risk of postoperative tendon retearing. The conventionally used titanium alloys can affect the interpretation of magnetic resonance imaging. Degradable magnesium alloys possess excellent biocompatibility, similar mechanical property to the bone, and stimulating bone formation ability from Mg2+. The purpose of this experiment was to develop innovative magnesium-based suture anchors to enhance rotator cuff repair by improving fixation materials, and to evaluate their feasibility in a goat model.
METHODS: We developed fluoridized ZK60 suture anchors as the implantation material for two goats, who underwent rotator cuff repair surgery on both shoulders. Computed tomography (CT) and histological analysis were performed at 12 weeks postoperatively, and the results were compared between the magnesium and titanium alloy groups. Additionally, a hematological examination was conducted, which included assessments of red blood cells, white blood cells, platelets, coagulation function, liver function, kidney function, and magnesium ion concentration.
RESULTS: The 12-week postoperative CT images showed intact MgF2 ZK60 suture anchors, effectively reconnecting the infraspinatus tendon to the humeral head. The anchors became less visible on CT scans, indicating absorption by surrounding tissues. New bone formation in the MgF2 group surpassed that in the Ti group, demonstrating superior osseointegration. The similarity between cortical bone and magnesium reduced stress-shielding and promoted bone regeneration. Histological analysis revealed successful tendon healing with MgF2 anchors, while the Ti group showed discontinuous interfaces and reduced collagen secretion. Hematological examination showed stable liver, renal function, and magnesium ion levels.
CONCLUSIONS: The findings indicate that MgF2-coated suture anchors are feasible for rotator cuff repair and potentially other orthopedic applications. We hope that magnesium alloy anchors can become the solution for rotator cuff tendon repair surgery.

UNASSIGNED: Patella fracture can occur due to direct injury to the knee or indirect eccentric contraction of the quadriceps tendon. These injuries can present in different configurations which require acceptable reduction and good fixation. Patients are at risk of not only losing their knee extensor mechanism but also having a defective patellofemoral articulation. Hence, the main aim in treating such fractures is to restore the knee extensor mechanism. Surgical options for treating patella fracture include tension band wiring, wiring through cannulated screws, fixation with plate, and suture anchor (SA) fixation.
UNASSIGNED: We demonstrate a new fixation technique for patella fracture with SAs in two of our patients. They presented with patella fracture following a fall and sustained closed injury with intact distal neurovascular status. The authors describe their technique using double-loaded SAs to obtain anatomical reduction and solid fixation. With three SAs, each inserted in a third portion of a distal fragment.
UNASSIGNED: There are several modalities and techniques available for fixation of patella fracture. However, authors recommend that their described novel technique can provide more strength and satisfactory outcome. Furthermore, this technique uses a smaller incision compared to conventional suture tunnel repair as in this technique only the fracture that needs to be exposed distally.

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