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Sidharthan S, Bhattacharya R. Technology Update in Management of Multi-Ligament Knee Injuries. Indian J Orthop 2024; 58:1537-1547. [PMID: 39539335 PMCID: PMC11555171 DOI: 10.1007/s43465-024-01281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 09/26/2024] [Indexed: 11/16/2024]
Abstract
Introduction Multi-ligament knee injuries present in various combinations of structures around the knee joint, with or without involvement of neurovascular structures, posing significant challenges to the treating physician and therapists. Accurate diagnosis with appropriate surgical intervention and comprehensive rehabilitation to restore function and stability is, therefore, paramount. This article looks at the recent advancements in technology that are aiding in the management of these injuries. Method An extensive search of literature was done in PubMed, SCOPUS, and Google Scholar on this topic and the necessary information was derived from the relevant articles for this review. The progress made in the field of diagnosis, surgical management, rehabilitation and patient education tools were explored. Discussion A wide variety of diagnostic tools exists that are providing a more accurate evaluation of multi-ligament knee injuries both pre-operatively and post operatively. Advances in technology and techniques have aided in transforming their surgical management to a more minimally invasive approach. Patient-specific instrumentation, computer navigation and robotic-assisted surgery are in various stages of development offering enhanced precision and accuracy during ligament reconstruction procedures along with developments in digital technology and artificial intelligence. Conclusion Advancements in technology have transformed the management of multi-ligament knee injuries, offering new tools and techniques that enhance diagnostic accuracy, surgical precision, and rehabilitation effectiveness. Artificial intelligence and its utility have widened the horizons, while at the same time bringing in the need for regulations necessary to monitor and develop these technologies.
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Affiliation(s)
- Sujith Sidharthan
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, The Bays, St Mary’s Hospital, South Wharf Road, London, W2 1NY UK
| | - Rajarshi Bhattacharya
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, The Bays, St Mary’s Hospital, South Wharf Road, London, W2 1NY UK
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Sezer HB, Bohu Y, Hardy A, Coughlan A, Lefevre N. Effect of Different Screw Materials on ACL Reconstruction With the Tape Locking Screw Technique: A Retrospective Study From the FAST Cohort. Orthop J Sports Med 2024; 12:23259671241258505. [PMID: 39157024 PMCID: PMC11329977 DOI: 10.1177/23259671241258505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/10/2023] [Indexed: 08/20/2024] Open
Abstract
Background Screws for graft fixation are available in 3 different materials for anterior cruciate ligament reconstruction (ACLR) with the Tape Locking Screw (TLS) technique: titanium, poly-l-lactic acid bioabsorbable, and polyetheretherketone (PEEK). Purpose To compare the effect of the 3 different fixation materials on graft and implant survival after ACLR with the TLS technique. Study Design Cohort study; Level of evidence, 3. Methods Included were 521 patients from the French Prospective ACL Study (FAST) cohort who underwent primary surgical ACLR with the TLS technique. Patients were divided into 3 groups depending on the type of screw material used: titanium (TLS-T group), poly-l-lactic acid bioabsorbable (TLS-B group), or PEEK (TLS-P group). The primary endpoint was a retear within 2 years after ACLR. The secondary endpoints were complication rate, return to sports rate, and functional scores. Objective and subjective functional scores-including the International Knee Documentation Committee, the Knee injury and Osteoarthritis Outcome Score (KOOS), and the Lysholm score-were evaluated preoperatively and at the 2-year follow-up. Pain was assessed with the KOOS-Pain subscore recorded pre- and postoperatively every 6 months up to 2 years. Patient satisfaction was recorded at the 2-year follow-up. Results No significant differences between the study groups were found in retear rates (4.4%, 4.5%, and 4.3% in the TLS-T, TLS-P, and TLS-B groups 2 years after surgery) or subjective and objective outcomes. The TLS-T group had the lowest rate of intraoperative implant-related complications (0.9%) compared with the TLS-P (4.3%) and TLS-B (7.7%) groups. Young age was a significant risk factor for retear in the TLS-T (P = .03) and TLS-B (P = .0001) groups, while a high level of sports was found to be a significant risk factor in the TLS-P (P = .04) group. All functional scores improved significantly at the 2-year follow-up (P < .0001), with no significant group difference. The KOOS-Pain subscore improved continuously with no significant group difference. The rate of return to preinjury sports was between 43.4% and 58.6%. The rate of highly satisfied patients at the final follow-up was between 86.2% and 91.8%. Conclusion There was no difference in retear rate or objective and subjective functional scores between implant materials for TLS ACLR in this study.
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Affiliation(s)
| | - Yoann Bohu
- Chirurgie du Sport, Clinique du Sport Paris V, Paris, France
| | - Alexandre Hardy
- Chirurgie du Sport, Clinique du Sport Paris V, Paris, France
| | - Adam Coughlan
- Chirurgie du Sport, Clinique du Sport Paris V, Paris, France
| | - Nicolas Lefevre
- Chirurgie du Sport, Clinique du Sport Paris V, Paris, France
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Adkar N, Thareja S, Kerhalkar RA, Sadalagi P. A Single-Center, Observational Study Assessing Functional Outcomes After Arthroscopic Anterior Cruciate Ligament Reconstruction Using Suspensory Tibial Fixation With a Polyether Ether Ketone (PEEK) Button. Cureus 2024; 16:e64779. [PMID: 39156308 PMCID: PMC11329805 DOI: 10.7759/cureus.64779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2024] [Indexed: 08/20/2024] Open
Abstract
Background Anterior cruciate ligament reconstruction (ACLR) is a crucial procedure in orthopedic surgery. This study evaluates the efficacy and safety of ACLR employing suspensory tibial fixation with a polyether ether ketone (PEEK) button. Methodology This retrospective observational study conducted at Sai Shree Hospital, Pune, India, between November 2023 and December 2023 enrolled 47 subjects aged 18-60 years who underwent arthroscopic ACLR utilizing the T-Button-A Adjustable Loop Ultra-High-Molecular-Weight Polyethylene Suture PEEK button. The functional outcomes and patient-reported outcomes were assessed using the International Knee Documentation Committee (IKDC) score, the Modified Cincinnati Rating System Questionnaire (MCRS), the Single Assessment Numeric Evaluation (SANE) score, the Tegner Activity Level (TAL) Scale, and Knee Injury and Osteoarthritis Outcome Score (KOOS) quality of life subscale. Results Femoral fixation utilized 27 (57.4%) Proloop Ultra Adjustable Loop Button 60 mm, 19 (40.4%) Infiloop Fixed Loop Button 20 mm, and 1 (2.1%) Infiloop Fixed Loop Button 30 mm. Tibial fixation solely relied on T-Button A (PEEK Tibial Button With Adjustable Loop 90 mm). Postoperative evaluations revealed favorable IKDC (79.49 ± 12.67), MCRS (81.32 ± 11.57), SANE (77.83 ± 11.11), TAL Scale (3.87 ± 0.99) and KOOS quality of life subscale (83.81 ± 13.07) scores. Conclusions The findings affirm the efficacy and safety of arthroscopic ACLR utilizing suspensory tibial fixation with the PEEK button, supporting its use for improved patient outcomes.
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Affiliation(s)
- Neeraj Adkar
- Department of Orthopedics, Saishree Hospital, Pune, IND
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Sakamoto T, Horii M, Watanabe S, Ito R, Akagi R, Hosokawa H, Kimura S, Yamaguchi S, Ohtori S, Sasho T. Clinical Outcomes of Modified Suture Buttons for Tibial Side Fixation in Anterior Cruciate Ligament Reconstruction: A Retrospective Comparative Study. Cureus 2024; 16:e64357. [PMID: 39130981 PMCID: PMC11316669 DOI: 10.7759/cureus.64357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction Restoring knee joint stability and resuming sports activities are important objectives of anterior cruciate ligament (ACL) reconstruction. The maintenance of anterior knee stability after ACL reconstruction is contingent on graft tension. Various devices and techniques have been used to achieve robust tibial graft tendon fixation, and their advantages and disadvantages are established. However, a gold standard has not been established. Therefore, we aimed to determine whether anterior knee joint stability and clinical outcomes of graft tendon fixation could be improved using a recently modified suture button (MSB) compared with using an adjustable suspensory fixator (ASF) at 1 year after double-bundle ACL reconstruction. Methods This study retrospectively analyzed postoperative data derived from 79 patients at a single center between January 2016 and December 2021. The patients were assigned to groups that underwent double-bundle ACL reconstruction with tibial fixation using an MSB (n = 30) that maintains tension while tying sutures, or an ASF (n = 49). We then compared complications, clinical outcomes and knee joint stability at 1 year postoperatively. Rates of postoperative infection, graft rupture, implant removal and residual anterior knee laxity (AKL) were compared between the groups using chi-square tests. Patient-reported outcome measures (PROM) based on Forgot Joint Score-12, Knee Injury and Osteoarthritis Outcome, and Lysholm Knee scores were compared using Mann-Whitney U tests. Results One patient in the MSB group developed postoperative infection. Rates of graft rupture and implant removal in the MSB and ASF groups were 3.3% and 4.1%, and 3.6% and 10.2%, respectively. None of the PROMs differed between the groups. The proportions of postoperative AKL were 3.6% and 14.9% in the MSB and ASF groups, respectively. A trend towards lower postoperative AKL in the MSB group did not reach statistical significance (p = 0.25). Conclusions The incidence of AKL at a year after ACL reconstruction using the MSB was 3%. Postoperative AKL and clinical outcomes were comparable between the MSB and ASF groups. A low AKL rate and positive postoperative outcomes indicated that MSB could be an option for tibial-side fixation in ACL reconstruction.
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Affiliation(s)
- Takuya Sakamoto
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
- Center for Preventive Medical Sciences, Chiba University, Chiba, JPN
| | - Manato Horii
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Shotaro Watanabe
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN, Chiba, JPN
| | - Ryu Ito
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
- Center for Preventive Medical Sciences, Chiba University, Chiba, JPN
| | - Ryuichiro Akagi
- Department of Orthopedic Surgery, Oyumino Central Hospital, Chiba, JPN
| | - Hiroaki Hosokawa
- Department of Orthopedic Surgery, Toho University Sakura Medical Center, Chiba, JPN
| | - Seiji Kimura
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, JPN
| | - Satoshi Yamaguchi
- Department of Orthopedic Surgery, Chiba University Graduate School of Global and Transdisciplinary Studies College of Liberal Arts and Sciences, Chiba, JPN
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Chiba University Hospital, Chiba, JPN
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | - Takahisa Sasho
- Center for Preventive Medical Sciences, Chiba University, Chiba, JPN
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Sacks G, Shah V, Yao L, Yan C, Shah D, Limeta L, DeStefano V. Polyaryletherketones: Properties and applications in modern medicine. BIOMEDICAL TECHNOLOGY 2024; 6:75-89. [DOI: 10.1016/j.bmt.2023.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2025]
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Butler JJ, Shukhmakher E, Hartman H, Kennedy JG. Talar and fibular histiocytic-driven massive expansile osteolysis following polyetheretherketone interference screw implantation: a case report. J ISAKOS 2024; 9:410-414. [PMID: 38266965 DOI: 10.1016/j.jisako.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/03/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
Numerous interference screws of different compositions exist including titanium screws, bioabsorbable screws, and polyetheretherketone (PEEK) screws. PEEK-based implants are frequently used in orthopaedic surgery due to their biocompatibility, similar elastic modulus to cortical bone, and purported negligible risk of osteolysis compared with bioabsorbable screws. In this case report, we present the case of a 48-year-old healthy female who experienced a massive osteolytic reaction in the talus and fibula after 11 weeks following implantation of PEEK-based interference screws during lateral ankle ligament reconstruction. The patient subsequently underwent removal of the PEEK screws and specimens were sent for microbiological and histopathological analysis. The specimens report demonstrated fibrotic tenosynovial soft tissue with patchy chronic inflammation, oedematous reactive changes, and histiocytic reaction, with no evidence of any significant acute inflammation. The patient recovered well and was asymptomatic at 6 months postoperatively. To our knowledge, this is the first case report of a massive osteolytic reaction to PEEK-based interference screws.
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Affiliation(s)
- James J Butler
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, 10002, USA
| | - Elan Shukhmakher
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, 10002, USA
| | - Hayden Hartman
- Lincoln Memorial University-DeBusk College of Osteopathic Medicine, TN, USA
| | - John G Kennedy
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York City, 10002, USA.
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Sakti M, Wawolumaja AFI, Saleh R, Usman MA, Arifin J, Johan MP. Modified Implant Fixation Technique Is an Alternative for Patients with an Anterior Cruciate Ligament Tear in Limited Resource Settings: A Comparison Functional Outcome Study with Polyether Ether Ketone and Bioabsorbable Screws. J Clin Med 2024; 13:2964. [PMID: 38792505 PMCID: PMC11121912 DOI: 10.3390/jcm13102964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Anterior cruciate ligament (ACL) injury is one of the most prevalent factors contributing to knee instability worldwide. This study aimed to evaluate modified metal fixation techniques for ACL reconstruction compared to factory-made implants, such as polyether ether ketone (PEEK) screws, bioabsorbable screws, and modified metal implants. Methods: A retrospective cohort analysis was conducted to assess the functional outcomes of ACL using various fixation methods. Patients who underwent arthroscopic ACL reconstruction at several healthcare facilities were included in the study. The functional outcomes were evaluated using the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) score questionnaire at 6- and 12 months post-surgery. Statistical analyses, including the Shapiro-Wilk test and analysis of variance, were performed to compare outcomes among the fixation groups. Results: Thirty-three patients who underwent ACL reconstruction surgery with varying distributions across the three fixation groups (modified metal implants, PEEK screws, and bioabsorbable screws) were included in the study. As measured by the Lysholm and IKDC scores at 6- and 12 months post-surgery, the PEEK group demonstrated the highest average scores. Nevertheless, these functional outcomes were not significantly different between the groups (p = 0.140, 0.770, 0.150, and 0.200). These findings align with those of meta-analyses comparing different fixation methods for ACL reconstruction. Conclusions: While acknowledging the small sample size as a limitation, this study suggests that modified metal implants represent viable options for ACL reconstruction. The selection of fixation methods should consider patient characteristics and preferences, emphasizing biomechanical stability and long-term outcomes. Further research is needed to validate these findings and explore their biomechanical properties and cost-effectiveness.
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Affiliation(s)
- Muhammad Sakti
- Department of Orthopedic & Traumatology, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia; (A.F.I.W.); (R.S.); (M.A.U.); (J.A.); (M.P.J.)
- Department of Orthopedic & Traumatology, Wahidin Sudirohusodo Hospital, Makassar 90245, Indonesia
| | - Arian Fardin Ignatius Wawolumaja
- Department of Orthopedic & Traumatology, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia; (A.F.I.W.); (R.S.); (M.A.U.); (J.A.); (M.P.J.)
| | - Ruksal Saleh
- Department of Orthopedic & Traumatology, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia; (A.F.I.W.); (R.S.); (M.A.U.); (J.A.); (M.P.J.)
- Department of Orthopedic & Traumatology, Wahidin Sudirohusodo Hospital, Makassar 90245, Indonesia
| | - Muhammad Andry Usman
- Department of Orthopedic & Traumatology, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia; (A.F.I.W.); (R.S.); (M.A.U.); (J.A.); (M.P.J.)
- Department of Orthopedic & Traumatology, Wahidin Sudirohusodo Hospital, Makassar 90245, Indonesia
| | - Jainal Arifin
- Department of Orthopedic & Traumatology, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia; (A.F.I.W.); (R.S.); (M.A.U.); (J.A.); (M.P.J.)
- Department of Orthopedic & Traumatology, Wahidin Sudirohusodo Hospital, Makassar 90245, Indonesia
| | - Muhammad Phetrus Johan
- Department of Orthopedic & Traumatology, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia; (A.F.I.W.); (R.S.); (M.A.U.); (J.A.); (M.P.J.)
- Department of Orthopedic & Traumatology, Wahidin Sudirohusodo Hospital, Makassar 90245, Indonesia
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Patel J, Kadkoy Y, Helbig T, Rupani M, Cuppari N, Cortes R, Wetterstrand C, Lu MT, Paglia DN, Galdi B, Beiro C. Interference Screw versus Cement Fixation in Anterior Cruciate Ligament Soft Tissue Grafts: A Biomechanical Study. J Knee Surg 2024; 37:326-332. [PMID: 37192659 DOI: 10.1055/a-2094-5586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Shortcomings of fixation have been reported as a source of graft failure in anterior cruciate ligament (ACL) reconstruction. While interference screws have long been used as fixation devices for ACL reconstruction, they are not without complications. Previous studies have highlighted the use of bone void filler as a fixation method; however, no biomechanical comparisons using soft tissue grafts with interference screws exist to our knowledge. The purpose of this study is to evaluate the fixation strength of a calcium phosphate cement bone void filler compared with screw fixation in an ACL reconstruction bone replica model with human soft tissue grafts. In total, 10 ACL grafts were constructed using semitendinosus and gracilis tendons harvested from 10 donors. Grafts were affixed with either an 8-10 mm × 23 mm polyether ether ketone interference screw (n = 5) or with approximately 8 mL of calcium phosphate cement (n = 5) into open cell polyurethane blocks. Graft constructs were tested to failure in cyclic loading under displacement control at a rate of 1 mm per second. When compared with screw construct, the cement construct showed a 978% higher load at yield, 228% higher load at failure, 181% higher displacement at yield, 233% higher work at failure, and a 545% higher stiffness. Normalized data for the screw constructs relative to the cement constructs from the same donor showed 14 ± 11% load at yield, 54 ± 38% load at failure, and 172 ± 14% graft elongation. The results of this study indicate that cement fixation of ACL grafts may result in a stronger construct compared with the current standard of fixation with interference screws. This method could potentially reduce the incidence of complications associated with interface screw placement such as bone tunnel widening, screw migration, and screw breakage.
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Affiliation(s)
- Jay Patel
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Yazan Kadkoy
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Thomas Helbig
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Mohammed Rupani
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Nicholas Cuppari
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ricardo Cortes
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Michael T Lu
- Department of Sports Medicine & Arthroscopic Surgery, University Orthopaedic Associates, Somerset, New Jersey
| | - David N Paglia
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Balazs Galdi
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Cristobal Beiro
- Department of Sports Medicine & Arthroscopic Surgery, University Orthopaedic Associates, Somerset, New Jersey
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McDermott ER, Aman ZS, Dekker TJ. Anterior Cruciate Ligament Reconstruction: Fixation Techniques. Arthroscopy 2024; 40:201-203. [PMID: 38296430 DOI: 10.1016/j.arthro.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 11/09/2023] [Indexed: 02/08/2024]
Abstract
Anterior cruciate ligament reconstruction (ACLR) is among the most common procedures performed by orthopaedic sports medicine surgeons and has inherent challenges due to the complex anatomy and biomechanical properties required to reproduce the function and stability of the native ACL. Awareness of the anatomic and biomechanical factors, including graft selection and tunnel placement, along with graft tensioning and fixation techniques, is vital in achieving a successful clinical outcome. Common techniques for ACLR graft fixation include intratunnel fixation with interference screws, suspensory fixation, or hybrid fixation strategies, along with several supplemental fixation techniques. Interference screw fixation may decrease graft-tunnel motion, tunnel widening, and graft creep and may be performed with metallic, PEEK (polyether ether ketone), or bioabsorbable screws. Suspensory fixation techniques primarily include suture-buttons, anchors, staples, and screws/washers. Suspensory fixation allows adequate biomechanical strength, although some techniques have been linked to increased graft-tunnel motion and potential tunnel widening. Supplemental fixation techniques may be performed in the setting of concerns for adequacy of primary fixation and includes the use of suture anchors, staples, and screw/washer devices. Regardless of the implant chosen for fixation, secure fixation is paramount to avoid displacement of the graft and allow for integration into the bone tunnel and facilitates early postoperative rehabilitation. It is important for orthopaedic sports medicine surgeons performing primary and revision ACLR to be familiar with multiple fixation techniques.
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Affiliation(s)
- Emily R McDermott
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, Texas, U.S.A
| | - Zachary S Aman
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Travis J Dekker
- Department of Orthopaedic Surgery, 10th Medical Group, U.S. Air Force Academy, Colorado, U.S.A..
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Coppola C, Krost S, Runer A, Raas C, Glodny B, Mayr R. PEEK Interference Screws Show Significant Tunnel Enlargement After ACL Reconstruction and is Comparable to Adjustable-Length Loop Cortical Button Fixation. Indian J Orthop 2024; 58:40-47. [PMID: 38161404 PMCID: PMC10754774 DOI: 10.1007/s43465-023-01029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/19/2023] [Indexed: 01/03/2024]
Abstract
Background It is unclear whether the use of polyetheretherketone (PEEK) interference screws for anterior cruciate ligament (ACL) reconstruction leads to postoperative tunnel enlargement. Femoral tunnel enlargement was further compared with adjustable-length loop cortical fixation. Methods Eighteen patients with ACL reconstruction using hamstring grafts were retrospectively divided into two groups. Eleven patients were treated with the ACL reconstruction technique using a PEEK interference screw for femoral graft fixation. Seven patients received adjustable-length loop cortical buttons for femoral fixation. Tibial ACL graft fixation was performed using PEEK interference screws. Tunnel volume changes were assessed using computed tomography (CT) scans performed after surgery (100%) and after 1 year. The maximal tunnel diameter was measured. Results The group with femoral screw fixation showed a mean tunnel volume change of 108.15 ± 13.7% on the tibial side and 124.07 ± 25.38% on the femoral side. The group with femoral button fixation showed a tunnel volume change of 111.12 ± 12.72% on the tibial side and 130.96 ± 21.71% on the femoral side. The differences in femoral tunnel volume changes were not significant (P = 0.562). Femoral tunnels with PEEK screw fixation showed significantly larger diameter after 12 months in comparison with button fixation (13.02 ± 1.43 mm vs. 10.46 ± 1.29 mm, P < 0.001). Conclusions PEEK interference screws were associated with significant tibial and femoral tunnel enlargement. Femoral tunnel enlargement was comparable between PEEK interference screws and button fixation. Final femoral tunnel diameter was significantly larger with PEEK screw fixation in comparison to button fixation.
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Affiliation(s)
- Christian Coppola
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Krost
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Armin Runer
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Christoph Raas
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Glodny
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Raul Mayr
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
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Dash SK, Mishra D, Sahu H, Moharana AK, Angrish S, Ts D. Functional Outcomes Following Arthroscopic Anterior Cruciate Ligament (ACL) Reconstruction Using the Sironix Titanium Button and the Polyetheretherketone (PEEK) Button: A Retrospective Observational Study. Cureus 2023; 15:e46186. [PMID: 37908964 PMCID: PMC10613784 DOI: 10.7759/cureus.46186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) injury is most common among athletes compared to the general population. ACL reconstruction is a clinical standard for restoring joint mechanical stability and enabling sports return. The purpose of the study is to evaluate the safety and functional outcomes after arthroscopic ACL reconstruction using the Sironix titanium button and the polyetheretherketone (PEEK) button. Methods A total of 31 subjects who have undergone arthroscopic ACL reconstruction using the Sironix titanium button and PEEK button between August 2022 and January 2023 were included in the study. Demographic data, surgery details, and other baseline characteristics of the subjects were collected from the hospital records. The primary objective of the study was to assess the functional outcome using the International Knee Documentation Committee (IKDC) questionnaire. The secondary objectives were to determine the pre- and post-surgery activity levels using the Tegner Activity Score (TAS) and Lysholm score. Quality of life evaluation was done by using the Quality of Life (QoL) subscale from the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Single Assessment Numerical Evaluation (SANE). Device-related adverse effect information was recorded. Results The mean (SD) of the total IKDC score of 31 subjects at baseline and post-surgery was 51.4 (2.84) and 91.8 (2.59) out of 100, respectively. The mean (SD) of TAS pre-injury and post-surgery was 5.3 (1.47) and 5.4 (1.38) out of 10, respectively. The total mean (SD) value of the total Lysholm Score at baseline and post-surgery was 53.9 (3.72) and 91.4 (3.61) out of 100, respectively. The mean (SD) value of the quality of life subscale of the KOOS score was 91.2 (3.91) out of 100. The total mean (SD) value of the SANE score that had affected joint/region of interest today was 97.4 (1.78), while for the opposite side today, it was 99.5 (0.85) out of 100. There were no adverse device effects reported in this study. Conclusion Based on the score assessment, it was observed that the performance of Sironix knee implant devices, Proloop-Titanium adjustable loop button, T-Button A® Closed PEEK button, and Surestitch® All Inside Meniscal Repair Implant (Healthium Medtech Limited, Bengaluru, Karnataka, India) was effective and safe with no adverse effects. Therefore, Sironix knee implants are considered safe and effective in ACL reconstruction and meniscus repair surgery.
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Affiliation(s)
| | | | | | | | - Sachin Angrish
- Clinical Affairs, Healthium Medtech Limited, Bengaluru, IND
| | - Deepak Ts
- Clinical Affairs, Healthium Medtech Limited, Bengaluru, IND
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12
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Scholes C, Ektas N, Harrison-Brown M, Jegatheesan M, Rajesh A, Kirwan G, Bell C. Persistent knee extension deficits are common after anterior cruciate ligament reconstruction: a systematic review and meta-analysis of randomised controlled trials. Knee Surg Sports Traumatol Arthrosc 2023; 31:3172-3185. [PMID: 36705690 DOI: 10.1007/s00167-022-07299-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/20/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Knee extension deficits complicate recovery from ACL injury and reconstruction; however, the incidence of knee extension loss is not well defined. The aim of this review was to identify the incidence of loss of extension (LOE) following ACL rupture and reconstruction, explore the definitions of knee extension deficits reported and identify prognostic factors affecting LOE incidence. METHODS A systematic search was conducted in Medline, Cochrane Library and PEDro for studies in publication up to November 2021, with no restrictions on publication year. References were screened and assessed for inclusion using predetermined eligibility criteria. Randomised controlled trials (RCTs) that quantified knee angle, loss of extension or incidence of extension deficit were included for quality assessment and data extraction. Statistical summaries were generated and meta-analyses performed in two parts to examine: (i) the probability of a datapoint being zero incidence compared to a nonzero incidence and (ii) the relationship between the predictors and nonzero LOE incidence. RESULTS A sample of 15,494 studies were retrieved using the search criteria, with 53 studies meeting eligibility criteria. The pooled results from 4991 participants were included for analysis, with 4891 participants who had undergone ACLR. The proportion of included studies judged at an overall low risk of bias was small (7.8%). The observed group and study were the most important predictors for whether a datapoint reported an incidence of extension deficit. Time to follow-up (P < 0.001) and graft type (P = 0.02) were found to have a significant influence on nonzero LOE incidence (%). Covariate adjusted estimates of average LOE indicated 1 in 3 patients presenting with LOE at 12 month follow-up, reducing to 1 in 4 at 2 years. CONCLUSIONS This review examined the definitions for the measurement and interpretation of postoperative knee extension and established the trajectory of knee extension deficit after ACL injury and reconstruction. While factors associated with loss of extension were identified, the exact trajectory of knee extension deficits was difficult to infer due to discrepancies in measurement techniques and patient variation. On average, 1 in 3 patients may present with loss of extension of at least 3 degrees at 12-month follow-up, decreasing to 1 in 4 at 2 years. These results may be used by clinicians as an upper threshold for acceptable complication rates following ACLR. Future work should focus on LOE as a clinically relevant complication of ACL injury and treatment with appropriate attention to standardisation of definitions, measurements and better understanding of natural history. PROSPERO REGISTRATION NUMBER CRD42018092295. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
| | | | | | - Maha Jegatheesan
- Orthopaedics Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, QLD, Australia
| | - Ashwin Rajesh
- Orthopaedics Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, QLD, Australia
| | - Garry Kirwan
- Physiotherapy Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, QLD, Australia
| | - Christopher Bell
- Orthopaedics Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, QLD, Australia.
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13
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Wei Z, Zhang Z, Zhu W, Weng X. Polyetheretherketone development in bone tissue engineering and orthopedic surgery. Front Bioeng Biotechnol 2023; 11:1207277. [PMID: 37456732 PMCID: PMC10345210 DOI: 10.3389/fbioe.2023.1207277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Polyetheretherketone (PEEK) has been widely used in the medical field as an implant material, especially in bone tissue engineering and orthopedic surgery, in recent years. This material exhibits superior stability at high temperatures and is biosecured without harmful reactions. However, the chemical and biological inertness of PEEK still limits its applications. Recently, many approaches have been applied to improve its performance, including the modulation of physical morphology, chemical composition and antimicrobial agents, which advanced the osteointegration as well as antibacterial properties of PEEK materials. Based on the evolution of PEEK biomedical devices, many studies on the use of PEEK implants in spine surgery, joint surgery and trauma repair have been performed in the past few years, in most of which PEEK implants show better outcomes than traditional metal implants. This paper summarizes recent studies on the modification and application of biomedical PEEK materials, which provides further research directions for PEEK implants.
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Affiliation(s)
- Zhanqi Wei
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Ze Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Wei Zhu
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xisheng Weng
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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14
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Götschi T, Hodel S, Kühne N, Bachmann E, Li X, Zimmermann SM, Snedeker JG, Fucentese SF. Osteoconductive Scaffold Placed at the Femoral Tunnel Aperture in Hamstring Tendon ACL Reconstruction: A Randomized Controlled Trial. Orthop J Sports Med 2023; 11:23259671231174478. [PMID: 37347015 PMCID: PMC10280525 DOI: 10.1177/23259671231174478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/22/2023] [Indexed: 06/23/2023] Open
Abstract
Background Bone tunnel enlargement after single-bundle anterior cruciate ligament reconstruction remains an unsolved problem that complicates revision surgery. Hypothesis Positioning of an osteoconductive scaffold at the femoral tunnel aperture improves graft-to-bone incorporation and thereby decreases bone tunnel widening. Study Design Randomized controlled trial; Level of evidence, 1. Methods In a 1:1 ratio, 56 patients undergoing primary anterior cruciate ligament reconstruction were randomized to receive femoral fixation with cortical suspension fixation and secondary press-fit fixation at the tunnel aperture of the tendon graft only (control) or with augmentation by an osteoconductive scaffold (intervention). Adverse events, patient-reported outcomes, and passive knee stability were recorded over 2 years after the index surgery. Three-dimensional bone tunnel widening was assessed using computed tomography at the time of surgery and 4.5 months and 1 year postoperatively. Results The intervention group exhibited a similar number of adverse events as the control group (8 vs 10; P = .775) including 2 partial reruptures in both groups. The approach was feasible, although 1 case was encountered where the osteoconductive scaffold was malpositioned without adversely affecting the patient's recovery. There was no difference between the intervention and control groups in femoral bone tunnel enlargement, as expressed by the relative change in tunnel volume from surgery to 4.5 months (mean ± SD, 36% ± 25% vs 40% ± 25%; P = .644) and 1 year (19% ± 20% vs 17% ± 25%; P =.698). Conclusion Press-fit graft fixation with an osteoconductive scaffold positioned at the femoral tunnel aperture is safe but does not decrease femoral bone tunnel enlargement at postoperative 1 year. Registration NCT03462823 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Tobias Götschi
- Department of Orthopaedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich,
Zurich, Switzerland
| | - Sandro Hodel
- Department of Orthopaedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
| | - Nathalie Kühne
- Department of Orthopaedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Xiang Li
- ZuriMED Technologies AG, Zurich,
Switzerland
| | - Stefan M. Zimmermann
- Department of Orthopaedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
| | - Jess G. Snedeker
- Department of Orthopaedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich,
Zurich, Switzerland
| | - Sandro F. Fucentese
- Department of Orthopaedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
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15
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Gao P, Yuan M, Xu Y, Wu Y, Lin X, Li Y, Li S, Wang J. The safety and effectiveness comparison of Delta Medical's PEEK interface screw and Endobutton and that of Smith & Nephew's in arthroscopic anterior cruciate ligament reconstruction: A multicenter prospective double-blind randomized controlled clinical trial. Front Public Health 2022; 10:1003591. [PMID: 36419987 PMCID: PMC9676447 DOI: 10.3389/fpubh.2022.1003591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
Background To reduce the costs and financial burden in the ACLR treatment, we compare the early clinical outcomes and Magnetic Resonance Imaging (MRI) results of Delta Medical's PEEK (polyether ether ketone) interference screw and EndoButton with those of Smith & Nephew's PEEK interference screw and EndoButton in patients with arthroscopic anterior cruciate ligament reconstruction. Methods A total of 104 patients in five different medical centers were randomly allocated into two groups: 1: Delta Medical's PEEK interference screw and EndoButton (53 patients); 2: Smith & Nephew's PEEK interference screw and EndoButton (51 patients). The modified Lysholm knee score, the laxity examination, and clinical and functional range of motion were evaluated at 3 and 6 months postoperatively. The clinical effective rate was calculated and classified as excellent and good at 6 months postoperatively. MRI examinations were performed at 3 and 6 months postoperatively to determine the healing process. Computerized tomography (CT) was performed at 2 weeks and 3 months postoperatively to evaluate the complications. Results Significant improvements in knee function and functional scores were observed in both groups after surgery regardless of the fixation materials applied (P < 0.05). No differences were observed in the functional scores and range of motion. The assessments of Lysholm knee scores at 3 and 6 months produced no statistical differences (both P > 0.05). The clinical effective rate revealed no difference between the groups at 6 months postoperatively (non-inferiority analysis P = 0.0220). The differences of laxity examination between the groups were not statistically significant (Fisher's test, P = 0.6139, 0.2004, respectively). No significant differences in the functional range of motion were found at each follow-up time-point (P > 0.05). No major intra- or postoperative complications, such as infection, and vessel or nerve injury were observed. Conclusions Knee function and functional scores were improved after ACLR in both groups, regardless of the PEEK interference screw and EndoButton applied. The difference in functional scores and range of motion were not significant in groups 1 and 2. Delta Medical's PEEK interference screw and EndoButton had a non-inferiority effect compared to Smith & Nephew's PEEK interference screw and EndoButton. Delta Medical's PEEK interference screw and EndoButton were suitable for arthroscopic ACLR.
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Affiliation(s)
- Peng Gao
- Department of Joint Surgery and Sports Medicine, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, China,Clinical Research Center for Sports Medicine in Hunan Province, Changsha, China
| | - Minghao Yuan
- Department of Joint Surgery and Sports Medicine, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Yongsheng Xu
- Department of Bone and Joint Surgery, Inner Mongolia Autonomous Region People's Hospital, Huhhot, China
| | - Yufeng Wu
- Department of Orthopedics, Traditional Chinese Medicine Hospital of Zhongshan, Zhongshan, China
| | - Xiaohang Lin
- Department of Orthopedics, Traditional Chinese Medicine Hospital of Zhongshan, Zhongshan, China
| | - Yanlin Li
- Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shensong Li
- Department of Sports Medicine, The 940 Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Jing Wang
- Department of Joint Surgery and Sports Medicine, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, China,Clinical Research Center for Sports Medicine in Hunan Province, Changsha, China,*Correspondence: Jing Wang
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16
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Häberli J, Heilgemeir M, Valet S, Aiyangar A, Overes T, Henle P, Eggli S. Novel press-fit technique of patellar bone plug in anterior cruciate ligament reconstruction is comparable to interference screw fixation. Arch Orthop Trauma Surg 2022; 142:1963-1970. [PMID: 34462826 DOI: 10.1007/s00402-021-04137-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 08/20/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE Conventional press-fit technique for anterior cruciate ligament reconstruction (ACLR) is performed with extraction drilling of the femoral bone tunnel and manual shaping of the patellar bone plug. However, the disadvantages of this technique include variation in bone plug size and, thus, the strength of the press-fit fixation, bone loss with debris distribution within the knee joint, potential heat necrosis, and metal wear debris due to abrasion of the guide wire. To overcome these disadvantages, a novel technique involving punching of the femoral bone tunnel and standardized compression of the bone plug was introduced. In this study, the fixation strength and apparent stiffness were tested and compared to that of the gold-standard interference screw fixation technique in three flexion angle configurations (0°/45°/90°) in a porcine model. We hypothesized that the newly developed standardized press fit fixation would not be inferior to the gold standard method. METHODS Sixty skeletally mature porcine knees (30 pairs) were used. Full-thickness central third patellar tendon strips were harvested, including a patellar bone cylinder of 9.5 mm in diameter. The specimens were randomly assigned to 10 pairs per loading angle (0°, 45°, 90°). One side of each pair was prepared with the press-fit technique, and the contra-lateral side was prepared with interference screw fixation. Equivalent numbers of left- and right-sided samples were used for both fixation systems. A three-way multifactor ANOVA was carried out to check for the influence of (a) fixation type, (b) flexion angle, and (c) side of the bone pair. RESULTS The primary fixation strength of femoral press-fit graft fixation with punched tunnels and standardized bone plug compression did not differ significantly from that of interference screw fixation (p = 0.51), which had mean loads to failure of 422.4 ± 134.6 N and 445.4 ± 135.8 N, respectively. The flexion angle had a significant influence on the maximal load to failure (p = 0.01). Load values were highest in 45° flexion for both fixations. The anatomical side R/L was not a statistically significant factor (p = 0.79). CONCLUSION The primary fixation strength of femoral press-fit graft fixation with punched femoral tunnels and standardized bone plug compression is equivalent to that of interference screw fixation in a porcine model. Therefore, the procedure represents an effective method for ACL reconstruction with patellar or quadriceps tendon autografts including a patellar bone plug.
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Affiliation(s)
- Janosch Häberli
- Sonnenhof Orthopaedic Center, Buchserstrasse 30, 3006, Bern, Switzerland.
| | | | - Sebastian Valet
- Laboratory for Mechanical Systems Engineering, Empa, Swiss Federal Laboratories for Materials Science and Technology, 8600, Dübendorf, Switzerland
| | - Ameet Aiyangar
- Laboratory for Mechanical Systems Engineering, Empa, Swiss Federal Laboratories for Materials Science and Technology, 8600, Dübendorf, Switzerland
| | - Tom Overes
- Ignite Concepts, Hüslerhofstrasse 6, 4513, Langendorf, Switzerland
| | - Philipp Henle
- Sonnenhof Orthopaedic Center, Buchserstrasse 30, 3006, Bern, Switzerland
| | - Stefan Eggli
- Sonnenhof Orthopaedic Center, Buchserstrasse 30, 3006, Bern, Switzerland
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17
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Lalehzarian SP, Agarwalla A, Liu JN. Management of proximal biceps tendon pathology. World J Orthop 2022; 13:36-57. [PMID: 35096535 PMCID: PMC8771414 DOI: 10.5312/wjo.v13.i1.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/10/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
The long head of the biceps tendon is widely recognized as an important pain generator, especially in anterior shoulder pain and dysfunction with athletes and working individuals. The purpose of this review is to provide a current understanding of the long head of the biceps tendon anatomy and its surrounding structures, function, and relevant clinical information such as evaluation, treatment options, and complications in hopes of helping orthopaedic surgeons counsel their patients. An understanding of the long head of the biceps tendon anatomy and its surrounding structures is helpful to determine normal function as well as pathologic injuries that stem proximally. The biceps-labral complex has been identified and broken down into different regions that can further enhance a physician’s knowledge of common anterior shoulder pain etiologies. Although various physical examination maneuvers exist meant to localize the anterior shoulder pain, the lack of specificity requires orthopaedic surgeons to rely on patient history, advanced imaging, and diagnostic injections in order to determine the patient’s next steps. Nonsurgical treatment options such as anti-inflammatory medications, physical therapy, and ultrasound-guided corticosteroid injections should be utilized before entertaining surgical treatment options. If surgery is needed, the three options include biceps tenotomy, biceps tenodesis, or superior labrum anterior to posterior repair. Specifically for biceps tenodesis, recent studies have analyzed open vs arthroscopic techniques, the ideal location of tenodesis with intra-articular, suprapectoral, subpectoral, extra-articular top of groove, and extra-articular bottom of groove approaches, and the best method of fixation using interference screws, suture anchors, or cortical buttons. Orthopaedic surgeons should be aware of the complications of each procedure and respond accordingly for each patient. Once treated, patients often have good to excellent clinical outcomes and low rates of complications.
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Affiliation(s)
- Simon P Lalehzarian
- The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, United States
| | - Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Joseph N Liu
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA 90033, United States
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18
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Lee HY, Cheon SJ, Seo H, Lee BY, Nam JH, Lee DY. Periimplant osteolysis does not affect the outcome of rotator cuff repair: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:3910-3920. [PMID: 33090240 DOI: 10.1007/s00167-020-06328-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/08/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The goal of this study was to perform a systematic review and meta-analysis to compare the clinical and radiologic outcomes of rotator cuff repair, depending on the presence of developed periimplant osteolysis (PIO) after using suture anchors. METHODS The electronic databases of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for articles published up until October 2019 to find relevant articles comparing the outcomes of rotator cuff repair between the periimplant osteolysis group and non-periimplant osteolysis group. Data searching, extraction, analysis, and quality assessment were performed according to the Cochrane Collaboration guidelines. The results are presented as risk ratio (RR) for binary outcomes and standardised mean difference (SMD) for continuous outcomes with 95% confidence intervals (CI). RESULTS Six clinical studies were included. No significant differences were found between the group with periimplant osteolysis and the group without periimplant osteolysis regarding retear rate (RR = 1.34; 95% CI 0.93-1.94; I2 = 28%), postoperative clinical scores (SMD = 0.29; 95% CI - 0.26 to 0.83; I2 = 80%) and range of motion (ROM); forward flexion (SMD = 0.39; 95% CI - 0.16 to 0.93; I2 = 0%), external rotation (SMD = - 0.10; 95% CI - 0.64 to 0.45; I2 = 0%) and internal rotation (SMD = - 0.37; 95% CI - 0.92 to 0.17; I2 = 0%). CONCLUSION The presence of periimplant osteolysis after rotator cuff repair with suture anchor does not affect the clinical outcomes such as retear rate, clinical scoring, and ROM. However, as there was no standard consensus on the criteria for evaluating periimplant osteolysis, this result may not fully reflect the effect of periimplant osteolysis depending on its severity. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hyo Yeol Lee
- Department of Orthopaedic Surgery, The Armed Forces Daegu Hospital, Gyeongsan, Republic of Korea
| | - Sang Jin Cheon
- Department of Orthopaedic Surgery, BioMedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Haneol Seo
- Department of Orthopaedic Surgery, BioMedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Beom Yeol Lee
- Faculty of Nanotechnology Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Jun Ho Nam
- Department of Orthopaedic Surgery, The Armed Forces Daegu Hospital, Gyeongsan, Republic of Korea.,Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Dong-Yeong Lee
- Department of Orthopaedic Surgery, The Armed Forces Daegu Hospital, Gyeongsan, Republic of Korea. .,Department of Orthopaedic Surgery, Barun Hospital, Jinju, 52725, Republic of Korea.
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19
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Luo Y, Zhang C, Wang J, Liu F, Chau KW, Qin L, Wang J. Clinical translation and challenges of biodegradable magnesium-based interference screws in ACL reconstruction. Bioact Mater 2021; 6:3231-3243. [PMID: 33778201 PMCID: PMC7966853 DOI: 10.1016/j.bioactmat.2021.02.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/07/2021] [Accepted: 02/23/2021] [Indexed: 12/27/2022] Open
Abstract
As one of the most promising fixators developed for anterior cruciate ligament (ACL) reconstruction, biodegradable magnesium (Mg)-based interference screws have gained increasing attention attributed to their appropriate modulus and favorable biological properties during degradation after surgical insertion. However, its fast degradation and insufficient mechanical strength have also been recognized as one of the major causes to limit their further application clinically. This review focused on the following four parts. Firstly, the advantages of Mg or its alloys over their counterparts as orthopaedic implants in the fixation of tendon grafts in ACL reconstruction were discussed. Subsequently, the underlying mechanisms behind the contributions of Mg ions to the tendon-bone healing were introduced. Thirdly, the technical challenges of Mg-based interference screws towards clinical trials were discussed, which was followed by the introduction of currently used modification methods for gaining improved corrosion resistance and mechanical properties. Finally, novel strategies including development of Mg/Titanium (Ti) hybrid fixators and Mg-based screws with innovative structure for achieving clinically customized therapies were proposed. Collectively, the advancements in the basic and translational research on the Mg-based interference screws may lay the foundation for exploring a new era in the treatment of the tendon-bone insertion (TBI) and related disorders.
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Affiliation(s)
- Ying Luo
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, 510006, China
| | - Chao Zhang
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, 510006, China
| | - Jue Wang
- Hanglok-Tech Co., Ltd., Hengqin New Area, China
| | - Fangfei Liu
- State Key Laboratory for Advanced Metals and Materials, University of Science and Technology Beijing, Beijing, 100083, China
| | - Kelvin Wingho Chau
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ling Qin
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Jiali Wang
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, 510006, China
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21
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Fang CH, Li M, Zhang YF, Liu H. Extra-articular migration of PEEK interference screw after anterior cruciate ligament reconstruction: a report of two cases. BMC Musculoskelet Disord 2021; 22:498. [PMID: 34051767 PMCID: PMC8164745 DOI: 10.1186/s12891-021-04387-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/19/2021] [Indexed: 11/27/2022] Open
Abstract
Background The interference screw is the most popular device that fixes the graft for anterior cruciate ligament reconstruction, reducing the incidence of windshield effect and bungee effect. For the screw, either metallic, “bioresorbable,” or polyetheretherketone (PEEK) material is available. PEEK is popular and extensively used due to its stability, biocompatibility, radiolucency, and elastic modulus. Rare relevant complications were reported, but here, we report two cases of extra-articular migrations of PEEK interference screw from the tibial tunnel after anterior cruciate reconstruction. Case report An 18-year-old boy and a 56-year-old woman underwent anterior cruciate ligament reconstruction using a PEEK interference screw to fix the graft in the tibial tunnel. They suffered from screw extrusion from the tibial tunnel after 40 days and six months, respectively, with an incision rupture or palpable subcutaneous mass. They underwent a second operation and recovered well. Conclusions The exact incidence of extra-articular migrations of PEEK interference screws is unknown, but it seems to be quite low; despite this and its uncertain cause, the negative effects caused by the PEEK material need to be considered.
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Affiliation(s)
- Chao-Hua Fang
- Department of Joint Surgery, Ningbo No.6 Hospital, No.1059 Zhongshan road, Yinzhou District, Zhejiang, 315000, Ningbo, People's Republic of China.,School of Biomedical Engineering, Shanghai Jiao Tong University, No.1954 Huashan Road, Xuhui District, 200240, Shanghai, People's Republic of China
| | - Ming Li
- Department of Joint Surgery, Ningbo No.6 Hospital, No.1059 Zhongshan road, Yinzhou District, Zhejiang, 315000, Ningbo, People's Republic of China
| | - Yun-Feng Zhang
- Department of Joint Surgery, Ningbo No.6 Hospital, No.1059 Zhongshan road, Yinzhou District, Zhejiang, 315000, Ningbo, People's Republic of China
| | - Hua Liu
- Department of Joint Surgery, Ningbo No.6 Hospital, No.1059 Zhongshan road, Yinzhou District, Zhejiang, 315000, Ningbo, People's Republic of China.
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22
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Imaging Assessment of the Postoperative Spine: An Updated Pictorial Review of Selected Complications. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9940001. [PMID: 34113681 PMCID: PMC8154286 DOI: 10.1155/2021/9940001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/25/2021] [Accepted: 05/05/2021] [Indexed: 02/05/2023]
Abstract
Imaging of the postoperative spine requires the identification of several critical points by the radiologist to be written in the medical report: condition of the underlying cortical and cancellous bone, intervertebral disc, and musculoskeletal tissues; location and integrity of surgical implants; evaluation of the success of decompression procedures; delineation of fusion status; and identification of complications. This article presents a pictorial narrative review of the most common findings observed in noninstrumented and instrumented postoperative spines. Complications in the noninstrumented spine were grouped in early (hematomas, pseudomeningocele, and postoperative spine infection) and late findings (arachnoiditis, radiculitis, recurrent disc herniation, spinal stenosis, and textiloma). Complications in the instrumented spine were also sorted in early (hardware fractures) and late findings (adjacent segment disease, hardware loosening, and implant migration). This review also includes a short description of the most used diagnostic techniques in postoperative spine imaging: plain radiography, ultrasound (US), computed tomography (CT), magnetic resonance (MR), and nuclear medicine. Imaging of the postoperative spine remained a challenging task in the early identification of complications and abnormal healing process. It is crucial to consider the advantages and disadvantages of the imaging modalities to choose those that provide more accurate spinal status information during the follow-up. Our review is directed to all health professionals dealing with the assessment and care of the postoperative spine.
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Geng YM, Ren DN, Li SY, Li ZY, Shen XQ, Yuan YY. Hydroxyapatite-incorporation improves bone formation on endosseous PEEK implant in canine tibia. J Appl Biomater Funct Mater 2020; 18:2280800020975172. [PMID: 33307948 DOI: 10.1177/2280800020975172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Poly Ether Ether Ketone (PEEK) has been considered as a potential alternative material for endosseous dental implants, for its low elastic modulus, biocompatibility, and low cost in customized device manufacture. Hydroxyapatite-incorporation is supposed to improve the poor osseointegration of PEEK. METHODS In the present study we analyzed the in vivo response of hydroxyapatite-incorporated PEEK (PEEK-HA) implants in canine tibia. PEEK-HA and PEEK implants were implanted and were examined 4 weeks and 12 weeks after implantation with radiology and histology. Commercial titanium dental implants served as controls. RESULTS The ratio of bone volume to tissue volume of PEEK-HA implants was higher than that of PEEK implants 4 weeks after implantation in the μ-CT analysis. The bone implant contact of PEEK and PEEK-HA implants showed no statistical difference in the histological examination, but newly-formed bone around PEEK-HA implants showed more signs of mineralization than that around PEEK implants. CONCLUSION The study suggested that bone formation was improved with hydroxyapatite-incorporation in PEEK. Hydroxyapatite-incorporated PEEK implants may represent a potential material for endosseous dental implant.
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Affiliation(s)
- Yuan-Ming Geng
- Department of Stomatology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Dong-Ni Ren
- Medprin Regenerative Medical Technologies Co., Ltd., Guangzhou, China.,School of Materials Science and Engineering, South China University of Technology, Guangzhou, China
| | - Shu-Yi Li
- Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam Movement Science, Amsterdam, The Netherlands
| | - Zong-Yi Li
- Medprin Regenerative Medical Technologies Co., Ltd., Guangzhou, China
| | - Xiao-Qing Shen
- Department of Stomatology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yu-Yu Yuan
- Medprin Regenerative Medical Technologies Co., Ltd., Guangzhou, China
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