Background

We prospectively studied achilles tendon acute rupture cases operated over 2 years and reviewed the causes, treatment options, outcome and complications. Our Aim of the study was to look at the different suture materials used and to observe for their complications.

Introduction: Arthroscopic stabilisation of shoulder joint for instability following a traumatic dislocation is gaining popularity. It has various advantages like being minimally invasive, causes minimal damage to the shoulder muscles, quicker rehabilitation, minimal loss of external rotation, and addresses the pathology. This can be performed using non-absorbable suture anchors to repair the Bankart’s lesion, which involves arthroscopic knot tying. Recently, devices, which avoid tying knots, and are absorbable, have been developed for arthroscopic shoulder stabilisation.

Aim: To evaluate the clinical results of arthroscopic Bankart’s repair using knotless, bio-absorbable suture anchor device.

Methods: A total of 32 patients with recurrent anterior dislocation of shoulder of traumatic origin underwent arthroscopic stabilisation using absorbable knotless suture anchors (Mitek U.K.). Average follow up was 2.4 years. Oxford shoulder instability score were used to evaluate clinical outcomes.

Results: The average age of patients at surgery was 24 (18–28). The average number of dislocations per patient were three. The average hospital stay was 1.1 days. The mean operating time was 70 minutes. 90.6 % (29 out of 32) had no further instability or dislocation. The recurrence rate was 9.4% (3 out of 32). The two redislocations required open repair and one patient has a residual instability. The average Oxford instability score was 22. All the patients returned to their pre-operative occupation. Of the 7 keen sportsmen, 5 returned to their contact sports at pre-injury level and 2 returned to their contact sports at a slightly lower level. In two cases we had breakage of anchor loop intraoperatively. Two patients had initial stiffness, which eventually resolved. No other complication was noted.

Conclusion: The clinical outcome of arthroscopic stabilisation of shoulder using knotless bio-absorbable suture anchors are good and are comparable to other methods of arthroscopic Bankart’s repair. The advantages are that the anchors are absorbable and there is no knot tying involved.

The August 2015 Foot & Ankle Roundup. 360 . looks at: Is orthosis more important than physio in tibialis posterior deficiency?; Radiographic evaluation of ankle injury; Sciatic catheter quite enough!; A fresh look at avascular necrosis of the talus; Total ankle and VTE; Outcomes of posterior malleolar fracture; Absorbable sutures in the Achilles tendon; Lisfranc injuries under the spotlight

Absorbable suture anchors have become more and more important in rotator cuff surgery due to their easy revisability. In osteoporotic bone however they are thought to be of minor primary stability. Purpose of the present study was to compare different absorbable and non-absorbable suture anchors in their pullout strength depending on bone density. The absorbable screw-anchor SPIRALOK5mm (DePuyMitek, Raynham, MA, USA), the titanium screw-anchor SUPER-REVO5mm and the tilting-anchor ULTRASORB (both ConmedLinvatec, Largo, FL, USA) were tested, each anchor representing a different material and design. On the basis of bone density measurement by CT-scans a healthy (mean-age. 42 years) and a osteopenic (mean-age: 74 years) group of cadaveric human humeri were formed. Each anchor was inserted in the greater tuberosity six times. They were inserted according to the manufacturers instructions with the supplied suture material. An incremental cyclic loading was performed, starting with 75N. Until failure the tensile load was increased by 25N after every 50 cycles. The ultimate failure loads, the anchor displacements and the modes of failure were recorded. In the non-osteopenic bone group, the absorbable SPIRALOK achieved a significantly better pullout strength (mean: 274N) than the titanium screw-anchor SUPER-REVO (mean: 188N) and the tilting-anchor ULTRASORB (mean: 192N). In the osteopenic bone group no significant difference in the pullout strength was found. The failure mechanisms, such as anchor pullout, rupture at eyelet, suture breakage and breakage of eyelet, varied between the anchors. In the osteopenic group the number of anchor pullouts clearly increased. The present study demonstrates that absorbable suture anchors do not have lower pullout strengths than metal anchors. Depending on their design they can even outmatch metal anchor systems. The results of our study suggest that the anchor design has a crucial influence on primary stability, whereas the anchor material is less important

Introduction

In response to the COVID-19 pandemic, there was a rapidly implemented restructuring of UK healthcare services. The The Royal National Orthopaedic Hospital, Stanmore, became a central hub for the provision of trauma services for North Central/East London (NCEL) while providing a musculoskeletal tumour service for the south of England, the Midlands, and Wales and an urgent spinal service for London. This study reviews our paediatric practice over this period in order to share our experience and lessons learned. Our hospital admission pathways are described and the safety of surgical and interventional radiological procedures performed under general anaesthesia (GA) with regards to COVID-19 in a paediatric population are evaluated.