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ABSTRACT: The purpose of the present study concerning high-strength sutures was to determine whether increasing the number of locking loops with different size sutures or decreasing the suture size with increased suture strands would have any influence on the strength of Achilles tendon repair. A total of 32 fresh bovine Achilles tendon specimens were randomly assigned to 4 groups. For 3 of the groups, 1 suture was used (no. 2 or no. 5 FiberWire™ with 2 or 4 Krackow locking loops). For the fourth group, 2 sutures (2-0 FiberWire™) with 2 locking loops were used. After repair, the study groups underwent cyclic loading (0 to 200 N, 200 cycles) and then underwent tension to failure in a testing machine. Cyclic elongation, peak to peak displacement, ultimate load, stiffness, and failure mode were recorded for each specimen. The tendon width and thickness were measured in all specimens. The mean width, thickness, cyclic displacement, load to failure, and pull-out stiffness showed no differences among the 4 groups. The cyclic peak to peak displacements (0.01 ± 0.01 mm) were smallest with the no. 5 suture with 4 locking loops (p < .05), with no failure during cyclic loading, unlike in the other groups. In the group with 2-0 suture with 4 strands and 2 locking loops, 6 failed during cyclic loading. The number of locking loops used might have had an influence on the strength of the Krackow suture configuration using the larger diameter, high-strength sutures. However, decreasing the suture diameter, with a simultaneous increase in the number of strands, failed to improve the initial strength of the repair.
The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 04/2013;
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ABSTRACT: PURPOSE: Vertical mattress configuration is the strongest of all other configurations and the repairing devices of meniscus repair. The purpose was whether increasing the inclination angle between two strands of the vertical mattress configuration by increasing the amount of meniscus tissue captured would enhance the initial strength of the construction. METHODS: A 2-cm long anteroposterior vertical longitudinal incision was created in two groups of bovine medial menisci. In the first group, the distance between the two vertical suture strands and the vertical horizontal sutures on the capsular side of the meniscal lesion was 2 mm (Group 1). In the second group, the distance was 5 mm (Group 2). The following repair specimens underwent cyclic loading prior to loading the failure testing. The endpoints included ultimate failure load (N), stiffness (N/mm) and cyclic displacement (mm) after the 100 cycles and the mode of failure. RESULTS: Group 1 (2 mm) (90.7 (±19.9) N) had lower ultimate load than Group 2 (5 mm) (120.8 (±24.5)) (P < 0.05). Stiffness and displacements during the cycling were not different between the groups (n.s.). All specimens failed by suture rupture. CONCLUSION: Increased inclination angle with increased distance between the two vertical suture strands on the capsular side of the meniscal lesion resulted in higher failure load compared to control group with lower inclination angle and distance on the capsular side.
Knee Surgery Sports Traumatology Arthroscopy 04/2013; · 2.21 Impact Factor
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ABSTRACT: PURPOSE: Comparison of the mechanical characteristics of meniscal repair fixation using horizontal sutures and six different sutures under submaximal cyclic and load to failure test conditions may aid physicians in selecting a suture type. METHODS: A 2-cm long anteroposterior vertical longitudinal incision was created in six groups of bovine medial menisci. Lesions were repaired using a No. 2 suture either composed of polyester or polyester and ultra high-molecular weight polyethylene (UHMWPE), or UHMWPE and polydioxanone or pure UHMWPE. Endpoints included ultimate failure load (N), pull-out stiffness (N/mm), pull-out displacement (mm), cyclic displacement (mm) after 100cycles, after 500cycles, and mode of failure. RESULTS: Polyester suture had lower ultimate load than all groups except the suture composed of polyester and UHMWPE (P<.05). Pure UHMWPE suture had higher ultimate failure load than sutures composed of either polyester or polyester plus UHMWPE (P<.05). Predominant failure mode was suture cutting through the meniscus for the groups except for polyester suture which failed by suture rupture. CONCLUSION: Under cyclic loading conditions in bovine meniscus, braided polyester suture fixation provided lower initial fixation strength than fixation with various high strength sutures composed of pure UHMWPE or a combination of absorbable monofilament polydioxanone and UHMWPE, except for combination of polyester and UHMWPE sutures. CLINICAL RELEVANCE: Present study does not support the usage of the braided polyester sutures instead of high strength sutures composed either partially or totally of ultra-high molecular weight polyethylene for the horizontal suture configuration of meniscus repair.
The Knee 01/2013; · 1.74 Impact Factor
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ABSTRACT: In this study, the results of local injection of platelet-rich plasma (PRP) and corticosteroids in the treatment of plantar fasciitis were compared.
Sixty patients who were diagnosed as plantar fasciitis and treated conservatively for at least 3 months and had no response to conservative treatment modalities were involved in this study. The first 30 consecutive patients were treated by local injection of 2 mL of 40 mg Methylprednisolone with 2 mL of 2% prilocaine (metilprednizalone) and the second 30 patients were treated by injecting 3 mL PRP after 2 mL of 2% prilocaine injection. Patients were evaluated according to the modified criteria of the Roles and Maudsley scores and visual analog scale before injection and 3 weeks and 6 months following injection.
The mean VAS heel pain scores measured 6 months after treatment were 3.4 in steroid group and 3.93 in PRP group, and the scores in both groups were significantly lower when compared with pretreatment levels (6.2 in steroid group and 7.33 in PRP group). There was no significant difference between steroid and PRP groups in visual analog scale scores and modified criteria of the Roles and Maudsley scores measured at 3 weeks and 6 months (P > 0.05).
Our results revealed that both methods were effective and successful in treating plantar fasciitis. When the potential complication of corticosteroid treatment was taken into consideration, PRP injection seems to be safer and at least having same effectivity in the treatment of plantar fasciitis.
Archives of Orthopaedic and Trauma Surgery 03/2012; 132(6):781-5. · 1.37 Impact Factor
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ABSTRACT: To biomechanically compare anterior cruciate ligament (ACL) tibial bony avulsion fixation by suture anchors, EndoButtons (Smith & Nephew, Andover, MA), and high-strength sutures subjected to cyclic loading.
Type III tibial eminence fractures were created in 49 ovine knees, and 7 different types of repairs were performed. Each repair group contained 7 specimens. The repair groups were as follows: No. 2 FiberWire (Arthrex, Naples, FL); No. 2 UltraBraid (Smith & Nephew); No. 2 MaxBraid (Arthrotek, Warsaw, IN); No. 2 Hi-Fi (ConMed Linvatec, Largo, FL); No. 2 OrthoCord (DePuy Mitek, Raynham, MA); Ti-Screw suture anchor (Arthrotek); and titanium EndoButton. These constructs were cyclically loaded (500 cycles, 0 to 100 N, 1 Hz) in the direction of the native ACL and loaded to failure (100 mm/min). Endpoints included ultimate failure load (in Newtons); pullout stiffness (in Newtons per millimeter); cyclic displacement (in millimeters) after 100 cycles, between 100 and 500 cycles, and after 500 cycles; and mode of failure. Bone density testing was performed in all knees.
Bone density was not different among the groups. The EndoButton group had a higher ultimate failure load than the FiberWire, UltraBraid, Hi-Fi, and suture anchor groups (P < .05). The MaxBraid and OrthoCord groups had higher failure loads than the suture anchor group (P < .05). The MaxBraid group also had a higher failure load than the Hi-Fi group (P < .05). Stiffness was not statistically different for the various tested constructs. After 100 cycles, the EndoButton group had less displacement than the FiberWire, UltraBraid, MaxBraid, and Hi-Fi groups (P < .05). The suture anchor group had less displacement than the Hi-Fi and FiberWire groups (P < .05). The displacements of the different tested constructs between 100 and 500 cycles and total displacements after 500 cycles were not statistically different. The predominant failure mode was suture rupture.
Under cyclic loading conditions in an ovine model, EndoButton fixation of tibial eminence fractures provided greater initial fixation strength than suture anchor fixation or fixation with various high-strength sutures except for OrthoCord.
During initial cyclic loading of ACL tibial eminence fractures, the strength of the repair construct should be taken into consideration because conventional suture repair even with ultrahigh-molecular-weight polyethylene sutures may not provide enough strength.
Arthroscopy The Journal of Arthroscopic and Related Surgery 01/2012; 28(5):681-7. · 3.02 Impact Factor
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ABSTRACT: The purpose of this experimental study was to analyze the effects of local autologous platelet-rich plasma (PRP) injection on tendon-to-bone healing in a rotator cuff repair model in rats.
Rotator cuff injury was created in 68 left shoulders of rats. PRP was obtained from the blood of an additional 15 rats. The 68 rats were divided into 4 groups with 17 rats in each group; PRP group (Week 2), control group (Week 2), PRP group (Week 4), and control group (Week 4). Platelet-rich plasma or saline was injected to the repair area intraoperatively. Rats were sacrificed 2 and 4 weeks after the surgery. Histological analysis using a semiquantitative scoring was performed on 7 rats per group. Tendon integrity and increases in vascularity and inflammatory cells and the degree of new bone formation were evaluated and compared between the groups. The remaining tendons (n=10) were mechanically tested.
Degree of inflammation and vascularity were less in the study group at both time intervals (p<0.05). Tendon continuity was better in the study group at 2 weeks (p<0.05). Obvious new bone formation was detected in the control group at 4 weeks (p<0.05). Biomechanically, platelet-rich plasma-treated specimens were stronger at 2 weeks (p<0.05).
Local autologous PRP injection may have beneficial effects on initial rotator cuff tendon-to-bone healing and enhance initial tendon-to-bone healing remodeling. This may represent a clinically important improvement in rotator cuff repair.
acta orthopaedica et traumatologica turcica 01/2012; 46(4):301-7. · 0.34 Impact Factor
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Arthroscopy The Journal of Arthroscopic and Related Surgery 11/2011; 27(11):1456-7. · 3.02 Impact Factor
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ABSTRACT: To assess the effect of platelet-rich plasma fibrin matrix (PRPFM) construct augmentation on postoperative tendon healing as determined by magnetic resonance imaging (MRI) and clinical outcome of arthroscopic rotator cuff repair.
A comparative series of patients undergoing arthroscopic rotator cuff repair was studied. Two matched groups of patients (20 each) were included: rotator cuff repairs without PRPFM augmentation (group 1) and rotator cuff repairs augmented with 2 sutured platelet-rich plasma (PRP) constructs (group 2). A single-row cuff repair to the normal footprint without tension or marrow vents was performed by a single surgeon. Postoperative rehabilitation was held constant. Postoperative MRI scans were used to evaluate rotator cuff healing. Outcome measures included American Shoulder and Elbow Surgeons, Rowe, Single Assessment Numeric Evaluation, Simple Shoulder Test, and Constant scores.
We followed up 40 patients (2 matched groups with 20 patients each) with a mean age of 57 years (range, 44 to 69 years) for a mean of 31 months (range, 24 to 44 months). Postoperative MRI studies showed persistent full-thickness tendon defects in 60% of controls (12 of 20) and 30% of PRPFM-augmented repairs (6 of 20) (P = .03). Of the control group tears measuring less than 3 cm in anteroposterior length, 50% (7 of 14) healed fully, whereas 86% of the PRPFM group tears measuring less than 3 cm in anteroposterior length (12 of 14) healed fully (P < .05). There was no significant difference between groups 1 and 2 in terms of American Shoulder and Elbow Surgeons (94.7 and 95.7, respectively; P = .35), Single Assessment Numeric Evaluation (93.7 and 94.5, respectively; P = .37), Simple Shoulder Test (11.4 and 11.3, respectively; P = .41), and Constant (84.7 and 88.1, respectively; P = .19) scores. The Rowe scores (84.8 and 94.9, respectively; P = .03) were statistically different.
The addition of 2 PRPFM constructs sutured into a primary rotator cuff tendon repair resulted in lower retear rates identified on MRI than repairs without the constructs. Other than the Rowe scores, there was no postoperative clinical difference by use of standard outcome measures.
Level III, case-control study.
Arthroscopy The Journal of Arthroscopic and Related Surgery 08/2011; 27(8):1029-35. · 3.02 Impact Factor
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ABSTRACT: To evaluate the biomechanical and design characteristics of newer suture anchors.
Suture anchors were tested in fresh porcine metaphyseal cortex and cancellous troughs by use of an established protocol. A mechanical testing machine applied tensile loads parallel to the axis of insertion at 12.5 mm/s until failure, and mean anchor failure strengths were calculated. The mode of failure was recorded. Rotator cuff anchors tested included the Doubleplay and Opus SpeedScrew (ArthroCare Sports Medicine, Sunnyvale, CA); PEEK Intraline and PEEK Zip (Stryker, San Jose, CA); Paladin, SuperRevo FT, and CrossFT (ConMed Linvatec, Largo, FL); Piton (Tornier, Warsaw, IN); Ti Screw, ALLthread PEEK, LactoScrew, ALLthread Ti, and ALLthread PEEK knotless (Biomet Sports Medicine, Warsaw, IN). Glenoid anchors included the Gryphon BR P (DePuy-Mitek, Raynham, MA) and JuggerKnot 1.4 (Biomet Sports Medicine).
Mean cortical failure loads for cuff anchors were as follows: Doubleplay 5.0, 279 N; Doubleplay 6.5, 338 N; Opus SpeedScrew 5.5, 356 N; Opus SpeedScrew 6.5, 336 N; PEEK Intraline 5.5, 263 N; PEEK Intraline 6.5, 344 N; PEEK Zip 5.5, 435 N; PEEK Zip 6.5, 502 N; Paladin 5.0, 500 N; Paladin 6.5, 521 N; SuperRevo FT, 496 N; CrossFT, 569 N; Piton, 379 N; Ti Screw 5.0, 457 N; Ti Screw 6.5, 443 N; ALLthread PEEK 5.5, 476 N; LactoScrew 5.5, 403 N; ALLthread Ti 5.0, 526 N; ALLthread Ti 6.5, 653 N; and ALLthread PEEK knotless, 441 N). Mean cortical failure loads for glenoid anchors were 161 N for Gryphon BR P and 239 N for JuggerKnot 1.4. Mean cancellous bone failure loads for cuff anchors were Doubleplay 5.0, 263 N; Doubleplay 6.5, 340 N; Opus SpeedScrew 5.5, 356 N; Opus SpeedScrew 6.5, 344 N; PEEK Intraline 5.5, 274 N; PEEK Intraline 6.5, 327 N; PEEK Zip 5.5, 401 N; PEEK Zip 6.5, 396 N; Paladin 5.0, 427 N; Paladin 6.5, 491 N; SuperRevo FT, 483 N; CrossFT, 547 N; Piton, 365 N; Ti Screw 5.0, 420 N; Ti Screw 6.5, 448 N; ALLthread PEEK 5.5, 475 N; LactoScrew 5.5, 435 N; ALLthread Ti 5.0, 512 N; ALLthread Ti 6.5, 612 N; and ALLthread PEEK knotless, 466 N). Mean cancellous failure loads for glenoid anchors were 117 N for Gryphon BR P and 194 N for JuggerKnot 1.4. None of the anchors had pullout as the predominant failure mode. Eyelet failure was the predominant failure mode for Doubleplay, Opus SpeedScrew, PEEK Intraline, Gryphon BR P, ALLthread Ti 6.5, ALLthread PEEK 5.5, and LactoScrew.
Failure load was not dependent on anchor location (cancellous or cortical bone) (P = .58) but was dependent on anchor type (cuff anchor or glenoid anchor) (P < .001).
Whereas larger fully threaded screw anchors designed for rotator cuff repair showed higher failure strengths than smaller non-screw anchors designed for glenoid repairs (P < .05), the larger version of a screw anchor for a cuff repair did not provide a statistically greater failure load than the smaller screw anchor.
Arthroscopy The Journal of Arthroscopic and Related Surgery 07/2011; 27(7):895-905. · 3.02 Impact Factor
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ABSTRACT: Medial patellofemoral ligament (MPFL) reconstruction is an effective option for the treatment of recurrent patellar instability. Most techniques utilize the passage of a tendon graft through tunnels at the patella with the risk of patellar fracture. The purpose of this study was to investigate the strength of the recent MPFL reconstruction techniques (transverse tunnel, interference screw, anchor, and docking technique).
Thirty-six saw bones were divided into four groups (transverse tunnel, interference screw, anchor fixation, and docking technique) with nine patellae in each. Patella-tendon constructs were pre-loaded to 10 N and cyclically loaded for 20 cycles from 2 to 30 N under load control at a rate of 5 N/sec. The construct was then tested to failure at a constant displacement rate of 6 mm/sec. Ultimate load (N), stiffness (N/mm), and failure mode were recorded for each specimen.
The docking group had lower ultimate load [106 (SD 41) N] and stiffness [14 (SD 2) N/mm] values than the other groups tested (P = 0.007). The anchor group had lower stiffness [21 (SD 6) N/mm] values than the tunnel group [28 (SD 3) N/mm (P = 0.01)] and the interference screw group [31 (SD 6) N/mm, (P = 0.004)]. There was no significant difference in the ultimate load between anchor [299 (SD 116) N], tunnel [304 (SD 140) N], and interference screw groups [241 (SD 103) N] (n.s.).
Aperture fixation techniques, especially interference screw fixation, were as strong as the technique utilizing tunnels in the patella for MPFL reconstruction.
Knee Surgery Sports Traumatology Arthroscopy 06/2011; 20(2):322-6. · 2.21 Impact Factor
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ABSTRACT: In this study we evaluated the effects of montelukast, a leukotriene-receptor antagonist, on fracture healing, and investigated the hypothesis that enhanced fracture healing would be observed with montelukast in a rat tibia fracture model.
Sixty adult (6 months old) female Wistar albino rats (mean weight 220 g, range 210-270 g) were randomly divided into two groups: a montelukast group (n=30) and a control group (n=30). Closed tibia fractures were created and fixed by intramedullary Kirschner wire. The rats were sacrificed three and six weeks after the fractures. Radiological and histological evaluations were performed, and bone mineral density was measured.
Three rats died in the montelukast group, whereas only one died in the control group during the study. Initial weight and weight gain at the 3rd and 6th weeks were not significantly different between the groups (p>0.05). Bone mineral densities in the control and study groups were 0.13±0.009 gr/cm2, and 0.13±0.01 gr/cm2 at week three and 0.16±0.02 gr/cm2, and 0.13±0.01 gr/cm2 at week six, respectively. Histopathological scores in the control and study groups were 3.42±0.6, and 3.0±0.0 at week three and 3.5±0.5, and 3.4±0.8 at week six, respectively. Radiological scores in the control and study groups were 1.19±0.6, and 1.0±0.6 at week three and 3.0±0.8, and 2.9±0.9 at week six, respectively. There were no significant differences between the two groups in any parameters evaluated at either time interval (p>0.05).
Our study failed to show a possible positive effect of leukotriene receptor inhibition on fracture healing at the 3rd and 6th postoperative weeks.
Eklem hastalıkları ve cerrahisi = Joint diseases & related surgery. 04/2011; 22(1):43-7.
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ABSTRACT: the purpose of this study was to compare the mechanical characteristics of meniscal repair fixation using horizontal sutures and two different diameter sutures under submaximal cyclic and load to failure test conditions.
a 2-cm long anteroposterior vertical longitudinal incision was created in two groups of bovine medial menisci. Lesions were repaired using either #2-0 (Group 1), or #2 (Group 2) Fiberwire suture. Following repair, the lesion was extended through the posterior and anterior meniscal horns so that no tissue secured the repair site. Specimens underwent submaximal cyclic (5-50 N at 1 Hz for 500 cycles) and load to failure testing (5 mm/min crosshead speed) in a servo hydraulic device. Specimen failure mode was verified by the primary investigator. An alpha level of P < 0.05 was selected to indicate statistical significance.
group 2 displayed greater load at failure (132.1 ± 54.4 N) than Group 1 (91.9 ± 26.2 N) (P = 0.02). Group 2 also displayed greater stiffness (47.1 ± 8.3 N/mm) than Group 1 (38.5 ± 10.2 N/mm) (P = 0.03). The failure mode for all specimens was suture pull-through the meniscal tissue. Larger diameter suture provided superior mechanical meniscal fixation.
if horizontal suture would be used in meniscal repair, the most suitable larger diameter suture should be used.
Knee Surgery Sports Traumatology Arthroscopy 02/2011; 19(2):202-6. · 2.21 Impact Factor
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ABSTRACT: Different surgical techniques exist for biceps tenodesis. The most secure fixation technique is with interference screws. The purpose of the study was to compare the biomechanical performance of three different interference screw biceps tenodesis fixation methods, which involve different tunnel preparation methods. Using a sheep shoulder model and metal interference screws, a bone wedge technique was compared to serial tunnel dilation and a control group. After a preload, all repairs were cyclically loaded (20-60 N) for 100 cycles followed by destructive testing. Biceps tenodesis using an interference screw--bone wedge technique showed statistically lower cyclic displacement (8.1 ± 6.4 mm) than serial dilatation with an interference screw (21.3 ± 8.4 mm) or interference screw fixation alone (18.3 ± 8.3 mm) (P = 0.02). There were no statistically significant differences in ultimate failure strength for any of the interference screw biceps tenodesis techniques tested. The tunnel preparation method chosen for interference screw fixed biceps tenodesis can have a positive effect on tenodesis performance. Using the bone wedge technique may allow a more rapid rehabilitation program applicable for the traumatic biceps tendon rupture seen in young, athletic patients with high demands.
Knee Surgery Sports Traumatology Arthroscopy 12/2010; 18(12):1779-84. · 2.21 Impact Factor
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ABSTRACT: The purpose of the present study is to evaluate the mechanical performance and initial strength of the arthroscopic Mason-Allen, double mattress, inclined Mason-Allen, and lasso loop stitch configurations.
Using 36 sheep infraspinatus tendons, tendon widths and thicknesses were measured with a digital caliper to confirm standardization of the tendons. Four different stitch configurations (Mason-Allen, inclined Mason-Allen, double mattress, and lasso loop) were biomechanically tested with cyclic loading followed by load to failure testing. The cyclic elongation, peak-to-peak displacement, ultimate tensile strength, stiffness, and mode of failure were recorded.
Mean tendon widths and thicknesses were statistically the same. The lasso loop (0.7 ± 0.1 mm) demonstrated a mean cyclic elongation greater than the Mason-Allen (0.5 ± 0.3 mm) and double mattress (0.5 ± 0.3 mm) groups (P = 0.011; P = 0.013). No differences were found in ultimate failure load, stiffness, and peak-to-peak displacement for the Mason-Allen (mean 99 ± 42 N, 39 ± 9 N/mm, 0.6 ± 0,1 mm), inclined Mason-Allen (113 ± 52 N, 44 ± 14 N/mm, 0.5 ± 0.1 mm), double mattress stitch (119 ± 68 N, 45 ± 10 N/mm, 0.5 ± 0.1 mm), or lasso loop (100 ± 38 N, 42 ± 7 N/mm, 0.5 ± 0.1 mm) groups (n.s.). Each specimen failed at the suture-tendon interface. Three specimens (two Mason-Allen and one inclined Mason-Allen) failed during cyclic testing.
Conventional Mason-Allen configuration can be applied with double-loaded suture anchor safely. Recent modifications of the configurations offer no biomechanical advantage.
Knee Surgery Sports Traumatology Arthroscopy 11/2010; 19(10):1749-54. · 2.21 Impact Factor
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ABSTRACT: To compare isolated medial-row with isolated lateral-row anchor performance by use of cyclic loading followed by destructive testing in an in vitro cadaveric model.
Using 16 human cadaveric humeri without tendons, we rotated 4 medial-row (Bio-Corkscrew FT [Arthrex, Naples FL], CrossFT PK [ConMed Linvatec, Largo, FL], TwinFix PK FT [Smith & Nephew Endoscopy, Andover, MA], and Healix PK [DePuy Mitek, Raynham, MA]) and 4 lateral-row (PopLok PK [ConMed Linvatec], PEEK [polyetheretherketone] PushLock [Arthrex], Footprint PEEK [Smith & Nephew Endoscopy], and Versalok [DePuy Mitek]) anchors among different medial (articular cartilage edge) and lateral greater tuberosity sites (anterior, central, posterior). All medial anchors were inserted into the humeral head at an angle no greater than 45 degrees . All lateral anchors were inserted "over the top," nearly planar to the superior humeral surface. After preloading, the constructs were cycled 500 times from 10 to 60 N at 1 Hz with the loads applied to the accompanying sutures. Those constructs surviving cycling were destructively tested. Cyclic displacement, ultimate load, and failure mode were recorded.
In this laboratory setting, most displacement occurred in the first 100 cycles except for the Footprint anchor. Lateral-row anchors had greater mean displacements (2.6 mm) than medial-row anchors (1.2 mm) at 100 cycles and between 100 and 500 cycles (1.8 mm v 0.75 mm). Lateral-row anchors also had more total displacement (4.4 mm) than medial-row anchors (1.9 mm). A 5-mm displacement gap, defined as failure, was not seen in the Bio-Corkscrew FT, TwinFix PK FT, and Versalok anchors. Ultimate failure loads ranged from 163 N (Footprint) to 308 N (Versalok) (P < .05). The principal failure mode was anchor pullout, followed by eyelet breakage. Medial-row eyelet failures only occurred after 500 cycles at loads higher than each anchor's mean failure load. Eyelet failure for lateral-row anchors occurred before 500 cycles and at failure loads lower than each anchor's mean.
Lateral row anchors benefit from medial row anchors for their security, and because of design differences demonstrate more displacement. When lateral-row anchors fail at the eyelet, it is at lower failure loads, while if medial-row anchors fail at the eyelet, it is at higher loads.
Anchors designed to function as lateral-row fixation provide fixation strength inferior to that of medial-row anchors and are more likely to be subject to suture slippage.
Arthroscopy The Journal of Arthroscopic and Related Surgery 09/2010; 26(9 Suppl):S134-41. · 3.02 Impact Factor
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ABSTRACT: The relation between serum vascular endothelial growth factor (VEGF) level and bone mineral density (BMD) value was evaluated to investigate the role of VEGF at etiopathogenesis of the osteoporosis.
Bone scanning with dual energy X-ray absorptiometry (DEXA) was performed on a total of 276 patients more than 40 years of age between September 2007 and January 2008 in our hospital's radiology department. A total of 88 patients (44 females; mean age 62.8+/-12.2 year, 44 males; mean age 58.7+/-12.1 year) meeting the study criteria were included. These patients formed four groups; osteoporotic male patients (group MO, n=22, BMD< -2.5), normal males (group MN, n=22, BMD> -1), osteoporotic female patients (group FO, n=22, BMD< -2.5), and normal females (group FN, n=22, BMD> -1). Bone mineral density measurements were performed with DEXA. Serum VEGF level was determined by the endogenous human ELISA kit. The relationships between body mass index (BMI), age, BMD and serum VEGF levels were analyzed.
The difference between male and female participants in terms of serum VEGF levels was not statistically significant (p>0.05). The differences in terms of mean VEGF values between the MO and MN groups and the FO and FN groups were not statistically significant (p>0.05). In MN cases, BMD was negatively correlated with VEGF levels (p<0.05). In MO group, the correlation between BMD and serum VEGF levels was not statistically significant (p>0.05).
Although the plasma levels of osteoporotic subjects are relatively higher than in the normal groups, this was not statistically significant in either male or female subjects. The small sample size could be a reason for this insignificance. The negative correlation between serum VEGF and BMD levels in the MN group was not present in the MO group. When the various effects of serum VEGF on bone metabolism are taken into account, to clarify the pathophysiology of male osteoporosis, this association between BMD values and VEGF in male population must be investigated in further studies.
Eklem hastalıkları ve cerrahisi = Joint diseases & related surgery. 08/2010; 21(2):91-7.
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ABSTRACT: Mechanical factors play a role in pathogenesis of primary osteoarthritis of the hip. Torsion measures were made to detect whether there is a causal relationship between increase or decrease of femoral anteversion, acetabular anteversion, and osteoarthritis. There are no studies in the literature indicating a relationship between axial plane coverage and osteoarthritis of the hip. Deficient axial plane coverage of femoral head may also play a role in pathogenesis of osteoarthritis.
Thirty patients with primary osteoarthritis of the hip and 29 control cases were included in the study. We used the method of Anda et al. (Acta Radiol Diagn 27:443-447, 1986; Comput Assist Tomogr 15:115-120, 1991) to measure axial plane anterior, posterior coverages in patients with primary osteoarthritis of the hip. The computerized tomography sections and pelvic radiographs indicated good frontal plane coverage and spherical femoral head. In addition to anterior acetabular sector angle, posterior acetabular sector angle, horizontal acetabular sector angles for axial plane coverage detection, femoral anteversion, acetabular anteversion, and McKibbin instability index were also measured.
Posterior coverage was lower at osteoarthritic hips than the control group's hips (96.0 ± 16.7, 104.2 ± 10.6) (p < 0.05).
The results may indicate that in addition to other mechanical factors, axial plane coverage, especially the posterior coverage deficiency, may play a role in the pathogenesis of hip osteoarthritis.
Archives of Orthopaedic and Trauma Surgery 03/2010; 130(10):1305-10. · 1.37 Impact Factor
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ABSTRACT: Patellar tendon ossification is a rare pathology that may be seen as a complication after sleeve fractures of the tibial tuberosity, total patellectomy during arthroplasty, intramedullary nailing of tibial fractures, anterior cruciate ligament reconstruction with patellar tendon autograft and knee injury without fracture. However, its occurrence after partial patellectomy surgery has never been reported in the literature.
We present the case of a 35-year-old Turkish man with a comminuted inferior patellar pole fracture that was treated with partial patellectomy. During the follow-up period, his patellar tendon healed with ossification and then ruptured from the inferior attachment to the tibial tubercle. The ossification was excised and the tendon was subsequently repaired.
To the best of our knowledge, this is the first report of patellar tendon ossification occurring after partial patellectomy. Orthopaedic surgeons are thus cautioned to be conscious of this rare complication after partial patellectomy.
Journal of Medical Case Reports 02/2010; 4:47.
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ABSTRACT: The number of distal locking screws may have an effect on union, complication rates and operation time. The purpose of this study was to determine the effect of one or two distal locking screws in unreamed intramedullary nailing of closed or grade 1 open, simple or wedge tibial shaft fractures on the incidence of malunion, delayed union, non-union, and screw failure.
Fifty-seven patients (39 male, 18 female; mean age 38.5+/-10.7 years) were randomized to two groups as either one or two distal locking screws and were evaluated prospectively for the incidences of malunion, delayed union, non-union, and screw failure. Twenty-nine patients were included in the two distal screws group and 28 patients in the single distal screw group. Groups were then subdivided to end fractures (proximal+distal end fractures) or mid-shaft fractures and reevaluated for the incidences of complications. Mann-Whitney U, chi-square and T tests were used for statistical analysis.
Mean follow-up was 2.4 years (range, 1.5-4.7 years). There was no case of malunion in either group. The incidences of delayed union, non-union or screw failure were not different (p>0.05). However, complication rate for end fractures in the two screw group was higher than that in the one screw group (p:0.04).
For non-complex, closed or grade 1 open tibial shaft fractures, locking of an intramedullary nail with a single distal screw is safe, and may help to decrease operation time and radiation exposure.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 01/2010; 16(1):33-7. · 0.33 Impact Factor
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ABSTRACT: Secure graft fixation for anterior cruciate ligament reconstruction is an important goal. Optimally, graft fixation allows for an aggressive postoperative rehabilitation program with the goals of immediate full range of motion, full weight bearing, and an early return to athletic activity. Current anterior cruciate ligament reconstruction techniques advance soft tissue grafts with or without bone plugs into the joint to replace the damaged ligament. Segments of these grafts are fixed within a bone tunnel or on the periosteum at a distance from the normal ligament attachment site. The graft fixation should be secure, allow normal tendon healing, and provide the graft construct with biomechanical properties, which approach that of the native ligament. Several different fixation devices are available for anterior cruciate ligament construction.
Sports medicine and arthroscopy review 12/2009; 17(4):217-23. · 1.16 Impact Factor
