Meniscal tears are the most common knee injuries, occurring in acute ruptures or in chronic degenerative conditions. Meniscectomy and meniscal repair are two surgical treatment options. Meniscectomy is easier, faster, and the patient can return to their normal activities earlier. However, this procedure has long-term consequences in the development of degenerative changes in the knee, potentially leading to knee replacement. On the other hand, meniscal repair can offer prolonged benefits to the patients, but it is difficult to perform and requires longer rehabilitation. Sutures are used for meniscal repairs, but they have limitations. They induce tissue damage when passing through the meniscus. Furthermore, under dynamic loading of the knee, they can cause tissue shearing and potentially lead to meniscal repair failure. Our team has developed a new technology of resistant adhesive hydrogels to coat the suture used to repair meniscal tissue. The objective of this study is to biomechanically compare two suture types on bovine menisci specimens: 1) pristine sutures and 2) gel adhesive puncture sealing (GAPS) sutures, on a repaired radial tear under cyclic tensile testing. Five bovine knees were dissected to retrieve the menisci. On the 10 menisci, a complete radial tear was performed. They were separated in two groups and repaired using either pristine (2-0 Vicryl) or GAPS (2-0 Vicryl coated with adhesive hydrogels) with a single stitch and five knots. The repaired menisci were clamped on an Instron machine. The specimens were cyclically preconditioned between one and 10 newtons for 10 cycles and then cyclically loaded for 500 cycles between five and 25 newtons at a frequency of 0.16 Hz. The gap formed between the edges of the tear after 500 cycles was then measured using an electronic measurement device. The suture loop before and after testing was also measured to ensure that there was no suture elongation or loosening of the knot. The groups were compared statistically using Mann-Whitney tests for nonparametric data. The level of significance was set to 0.05. The mean gap formation of the pristine sutures was 5.61 mm (SD = 2.097) after 500 cycles of tensile testing and 2.38 mm (SD = 0.176) for the GAPS sutures. Comparing both groups, the gap formed with the coated sutures was significantly smaller (p = 0.009) than with pristine sutures. The length of the loop was equal before and after loading. Further investigation of tissue damage indicated that the gap was formed by suture filament cutting into the meniscal tissue. The long-term objective of this research is to design a meniscal repair toolbox from which the surgeon can adapt his procedure for each meniscal tear. This preliminary experimentation on bovine menisci is promising because the new GAPS sutures seem to keep the edges of the meniscal tear together better than pristine sutures, with hopes of a clinical correlation with enhanced meniscal healing

Meniscal tears are the most common knee injuries, occurring in acute ruptures or in chronic degenerative conditions. Meniscectomy and meniscal repair are two surgical treatment options. Meniscectomy is easier, faster, and the patient can return to their normal activities earlier. However, this procedure has long-term consequences in the development of degenerative changes in the knee, potentially leading to knee replacement. On the other hand, meniscal repair can offer prolonged benefits to the patients, but it is difficult to perform and requires longer rehabilitation. Sutures are used for meniscal repairs, but they have limitations. They induce tissue damage when passing through the meniscus. Furthermore, under dynamic loading of the knee, they can cause tissue shearing and potentially lead to meniscal repair failure. Our team has developed a new technology of resistant adhesive hydrogels to coat the suture used to repair meniscal tissue. The objective of this study is to biomechanically compare two suture types on bovine menisci specimens: 1) pristine sutures and 2) gel adhesive puncture sealing (GAPS) sutures, on a repaired radial tear under cyclic tensile testing. Five bovine knees were dissected to retrieve the menisci. On the 10 menisci, a complete radial tear was performed. They were separated in two groups and repaired using either pristine (2-0 Vicryl) or GAPS (2-0 Vicryl coated with adhesive hydrogels) with a single stitch and five knots. The repaired menisci were clamped on an Instron machine. The specimens were cyclically preconditioned between one and 10 newtons for 10 cycles and then cyclically loaded for 500 cycles between five and 25 newtons at a frequency of 0.16 Hz. The gap formed between the edges of the tear after 500 cycles was then measured using an electronic measurement device. The suture loop before and after testing was also measured to ensure that there was no suture elongation or loosening of the knot. The groups were compared statistically using Mann-Whitney tests for nonparametric data. The level of significance was set to 0.05. The mean gap formation of the pristine sutures was 5.61 mm (SD = 2.097) after 500 cycles of tensile testing and 2.38 mm (SD = 0.176) for the GAPS sutures. Comparing both groups, the gap formed with the coated sutures was significantly smaller (p = 0.009) than with pristine sutures. The length of the loop was equal before and after loading. Further investigation of tissue damage indicated that the gap was formed by suture filament cutting into the meniscal tissue. The long-term objective of this research is to design a meniscal repair toolbox from which the surgeon can adapt his procedure for each meniscal tear. This preliminary experimentation on bovine menisci is promising because the new GAPS sutures seem to keep the edges of the meniscal tear together better than pristine sutures, with hopes of a clinical correlation with enhanced meniscal healing

The Adams-Berger reconstruction is an effective technique for treating distal radioulnar joint (DRUJ) instability. Graft preparation techniques vary amongst surgeons with insufficient evidence to support one technique over another. Our study evaluated the biomechanical properties of four graft preparation techniques. Extensor tendons were harvested from fresh frozen porcine trotters obtained from a local butcher shop and prepared in one of three configurations (n=5 per group): tendon only; tendon prepared with non-locking, running suture (2-0 FiberLoop, Arthrex, Naples, FL) spaced at 6 mm intervals; and tendon prepared with suture spaced at 12 mm intervals. A fourth configuration of suture alone was also tested. Tendons were allocated in a manner to ensure comparable average diameters amongst groups. Biomechanical testing occurred using custom jigs simulating radial and ulnar tunnels attached to a Bose Electroforce 3510 mechanical testing machine (TA Instruments). After being woven through the jigs, all tendons were sutured end-to-end with 2-0 PROLENE suture (Ethicon). Tendons then underwent a staircase cyclic loading protocol (5-25 Newtons [N] at 1 hertz [Hz] for 1000 cycles, then 5-50 N at 1 Hz for 1000 cycles, then 5-75 N at 1 Hz for 1000 cycles) until graft failure; if samples did not fail during the protocol, they were then loaded to failure. Samples were visually inspected for mode of failure after the protocol. A one-way analysis of variance was used to compare average tendon diameter; post-hac Tuhey tests were used to compare elongation and elongation rate. Survival to cyclic loading was analyzed using Kaplan-Meier survival curves with log rank. Statistical significance was set at a = 0.05. The average tendon diameter of each group was not statistically different [4.17 mm (tendon only), 4.33 mm (FiberLoop spaced 6 mm), and 4.30 mm (FiberLoop spaced 12 mm)]. The average survival of tendon augmented with FiberLoop was significantly higher than tendon only, and all groups had significantly improved survival compared to suture only. There was no difference in survival between FiberLoop spaced 6 mm and 12 mm. Elongation was significantly lower with suture compared to tendon augmented with FiberLoop spaced 6 mm. Elongation rate was significantly lower with suture compared to all groups. Modes of failure included rupture of the tendon, suture, or both at the simulated bone and suture and/or tendon interface, and elongation of the entire construct without rupture. In this biomechanical study, augmentation of porcine tendons with FiberLoop suture spaced at either 6 or 12 mm for DRUJ reconstruction significantly increased survival to a staircase cyclic loading protocol, as suture material was significantly stiffer than any of the tendon graft configurations

Objective. Carpal tunnel release surgery is a commonly performed procedure for alleviating symptoms of median nerve compression and restoring hand function. With pressure on theatre time these procedures are now commonly performed in a step-down out-patient facility under local anaesthetic. The choice of suture for skin closure in this procedure can impact the quality of wound healing, patient outcomes and the follow-up required however the question of the best type of suture remains unanswered. The purpose of this study was to compare the outcomes of absorbable and non-absorbable sutures using a randomised control trial design. Methods. Eighty patients diagnosed with bilateral carpal tunnel syndrome were enrolled and underwent outpatient carpal tunnel release surgery under local anaesthetic in a staged fashion. Random number generation was used to assign each hand to receive interrupted nylon or Vicryl Rapide sutures. Pre-operative data collection included patient demographics, ASA, inflammatory conditions, smoking status as well as a Boston Carpal Tunnel Questionnaire (BCTQ) for each hand. Patients were followed up at 2 and 6 weeks after each operation and the BCTQ was repeated along with the Patient and Observer Scar Assessment Scale and the VAS score for wound discomfort. This study has approval from the DHB ethics committee, Local Iwi, HDC and ANZ Clinical Trials:ACTRN12623000100695. Results. Statistical analysis assessed patient preference and the scores between the groups. Multi-variate analysis was performed to assess the factors that may be contributing to patient choice. Conclusion. Insights into patient preference and clinical outcomes associated with absorbable sutures and non-absorbable sutures in the setting of out-patient surgery are discussed

Surgical site infections constitute the cause of 13% to 18% of readmissions within 90 days of a total hip arthroplasty and are a leading cause of failure of revision total knee arthroplasty. The goals of wound closure are to enhance healing potential, prevent infection, and provide a cosmetic appearance. Traditionally, this has been achieved with the use of interrupted sutures. However, recently “barbed” sutures have been introduced which consist of a solid core with peripheral etched barbs in a helical array. These sutures have been used for both the deep and superficial layers of wound closure in a running fashion with the barbs intended to be self-retaining in the event that the suture is cut or pulls out of the tissue. Proposed advantages include the avoidance of knots, less needles required, improved efficiency, and creation of a “watertight” seal. Numerous studies have shown decreased times for wound closure with the use of barbed vs. interrupted sutures with no difference in infection or complication rates. With less needles and improved efficiency, there is the potential for cost savings with the use of barbed sutures. However, there have been two studies raising concerns of arthrotomy failure with their use in total knee arthroplasty. In addition, several reports have noted the potential for increased superficial wound complications when barbed sutures are used for a subcutaneous closure. Therefore, what remains clear is that there is no proven, optimal method of wound closure in total joint arthroplasty and that every closure method remains technique dependent

Introduction. Successful tendon repairs are reliant on the suture material having high tensile strength, no or little tissue response, good handling characteristics and little elastic/plastic deformation. Plastic deformation contributes to gap formation at a tendon repair site. Previous research has shown a gap greater than 4mm is likely to fail. Pre-tensioning is a commonly used method to improve the handling properties of sutures. This study investigates whether the plastic deformation demonstrated by two suture materials used in flexor tendon repair is affected by manual pre-tensioning. Material/Methods. Twenty lengths of 3/0 Prolene (Ethicon, UK) and 3/0 Ethibond Excel (Ethicon, UK) were selected. Half of the sutures in each group were manually pre-tensioned (longitudinal stretch of 15N for 3s) prior to knot tying (standard surgical knot with six throws) and half were knotted without pre-tensioning. The suture lengths were measured before and after a standardised cyclical loading regime on a tensile tester. The regime was designed to represent the finger flexion forces produced in an active rehabilitation programme after tendon repair. All sutures were subsequently tested to their ultimate tensile strength. Results. After cyclical loading the Prolene sutures not pre-tensioned showed a mean increase in suture length of 5.4% (range 3.3-7%). The pre-tensioned Prolene sutures demonstrated a mean increase of 0.7% (range 0.1-1.9%). This equates to 87% less plastic deformation (p < 0.05 Students' T-test) with pre-tensioning. There were no differences with Ethibond. Pre-tensioning had no effect on ultimate tensile strength for either group. Conclusion. Manual pre-tensioning reduces plastic deformation in Prolene 3/0 sutures without affecting the ultimate tensile strength. This simple technique could theoretically diminish gap formation at the site of a tendon repair

To assess the current literature on suture anchor placement for the purpose of identifying factors that lead to suture anchor perforation and techniques that reduce the likelihood of complications. Three databases (PubMed, Ovid MEDLINE, EMBASE) were searched, and two reviewers independently screened the resulting literature. Methodological quality of all included papers was assessed using Methodological Index for Non-Randomized Studies criteria and the Cochrane Risk of Bias Assessment tool. Results are presented in a narrative summary fashion using descriptive statistics. Fourteen studies were included in this review. Four case series (491 patients, 56.6% female, mean age 33.9 years), nine controlled cadaveric/laboratory studies (111 cadaveric hips and 12 sawbones, 42.2% female, mean age 60.0 years), and one randomized controlled trial (37 hips, 55.6% female, mean age 34.2 years) were included. Anterior cortical perforation by suture anchors led to pain and impingement of pelvic neurovascular structures. The anterior acetabular positions (three to four o'clock) had the thinnest bone, smallest rim angles, and highest incidence of articular perforation. Drilling angles from 10° to 20° measured off the coronal plane were acceptable. The mid-anterior (MA) and distal anterolateral (DALA) portals were used successfully, with some studies reporting difficulty placing anchors at anterior locations via the DALA portal. Small-diameter (< 1 .8-mm) suture anchors had a lower in vivo incidence of articular perforation with similar stability and pull-out strength in biomechanical studies. Suture anchors at anterior acetabular rim positions (3–4 o'clock) should be inserted with caution. Large-diameter (>2.3-mm) suture anchors increase the likelihood of articular perforation without increasing labral stability. Inserting small-diameter (< 1 .8-mm) all-suture suture anchors (ASAs) from 10° to 20° using curved suture anchor drill guides, may increase safe insertion angles from all cutaneous portals. Direct arthroscopic visualization, use of fluoroscopy, distal-proximal insertion, and the use of nitinol wire can help prevent articular violation

Given that there is limited time available to the surgeon in arthroscopic rotator cuff repair, how is the time best spent? Should they place one Modified Mason-Allen, two mattress or four simple sutures? This study reverses current thought. In an in-vitro biomechanical single pull to failure study we compared the ultimate tensile strength of simple, mattress and grasping sutures passed with an arthroscopic suture passer (Surgical Solutions Express-Sew). The aim was to determine which suture configurations would most simply, repeatably and reliably repair the rotator cuff. The ultimate tensile strength and mode of failure of six different suture configurations was repeatedly tested on a validated porcine rotator cuff tendon model, using a standard suture material (Number 2 Fiberwire) passed with the Surgical Solutions Express-sew, in a Hounsfield type H20K-W digital tensometer. Standardising the number of suture passes to four, the strongest construct was two mattress sutures (Mean 169N), followed by single Modified Kessler (Mean 161N), four simple sutures (Mean 155N) and finally a single Mason Allen suture (Mean 140N). Suture configurations involving two passes were all weaker than those with four (one way analysis of variance p=0.026), even when Number 2 Fibertape was used to augment strength. These results show little difference in strength for varying complexity of four pass suture passage (one way analysis of variance p=0.61). In simple terms there is no demonstrable difference in the strength of construct whether the surgeon uses four simple, two mattress or one grasping suture. This study allows the surgeon to justify using the simplest configuration of suture passage that works in his hands in order to obtain a reliable and repeatable repair of the rotator cuff arthroscopically

Introduction. Skin closure methods are various in total knee arthroplasty (TKA). Subcuticular skin closure techniques, which do not require postoperative stitch removal, are considered to be useful for excellent cosmesis and patients' satisfaction. Basically, subcuticular skin closure provides the tightness and water-tight seal, which leads to loss of postoperative normal physiologic drainage. As a routine wound closure, we performed the subcuticular skin closure with use of absorbable sutures or barbed sutures without staples. According to some previous reports, subcuticular skin closure using barbed sutures resulted in worse clinical outcomes, comparing with conventional skin staples. However, little attention has been paid to the differences between conventional absorbable and barbed sutures in both capsular and subcuticular skin closures. Our purpose was to investigate the efficacy and safety of the barbed suture, comparing to conventional absorbable sutures in TKA. Methods. A total of 81 knees in 75 patients (60 females and 15 males) were enrolled in the current investigation. Mean age was 73 (58–89) years old. All the subjects underwent unilateral or staged bilateral TKA using Balanced Knee System, posterior stabilized design (Ortho Development, Draper, UT). All knees were divided into two groups, as presented in Table 1. In conventional group, capsule was repaired using interrupted number 1 braided absorbable sutures, followed by closure of subdermal layer using a 3-0 monofilament absorbable suture with inverted interrupted knots. Thereafter, subcuticular skin closure was done using 4-0 monofilament absorbable suture, followed by adhesive tape. On the other hand, in barbed suture group, 1-0 and 4-0 unidirectional barbed suture (V-Loc, Covidien, Mansfield, Massachusetts) was used for capsule and subcuticular skin closure, respectively. Drains were removed on postoperative day 2. We evaluated closure time from capsule to skin, range of motion (ROM), Hollander Wound Evaluation Score (HWES: maximum score 6/6), and complications. Postoperative ROM and HWES were evaluated on postoperative day 14. As a statistical analysis, the data was compared between groups using Mann-Whitney U-test and Fisher exact probability test. P-values of < 0.05 were considered as significant. Results. 20 knees were allocated to conventional group and 61 knees were allocated to barbed suture group. Preoperative patients' demographics were seen in Table 2. No significant differences were found between groups preoperatively. In terms of clinical results, surgical closure time was significantly fast in barbed suture group, while postoperative range of motion and HWES were not significantly different between groups. In each group, wound related complication was not found. Discussion. According to previous reports, V-Loc provided worse clinical outcomes in wound related complications. However, in the current investigation, barbed suture was safe in wound cosmesis and effective in surgical closure time, comparing to conventional closure. We considered that barbed suture would be safe and effective as a closure method in TKA

Avulsion fractures of the tip of the olecranon are a common traumatic injury. Kirshner-wire fixation (1.6mm) with a figure of eight tension band wire (1.25mm) remains the most popular technique. Hardware removal mat be required in up to 80% of cases. Modern suture materials have very high tensile strength coupled with excellent usability. In this study we compare a repair using 1.6mm k-wires with a 1.25mm surgical steel, against a repair that uses two strands of 2 fibrewire. Twelve Pairs of cadaveric arms were harvested. A standard olecranon osteotomy was performed to mimic an avulsion fracture. In each pair one was fixed using standard technique, 2 × 1.6mm transcortical ?-wire plus figure of 8 loop of 1.25mm wire. The other fixed with the same ?-wires with a tension band suture of 2.0 fibrewire (two loops, one figure of 8 and one simple loop). The triceps tendon was cyclically loaded (10-120 Newtons) to simulate full active motion 2200 cycles. Fracture gap was measured with the ‘Smart Capture’ motion analysis system. The arm was fixed at 90 degrees and triceps tendon was loaded until fixation failure, ultimate load to failure and mode of failure was noted. The average gap formation at the fracture site for the suture group was 0.91mm, in the wire group 0.96mm, no specimen in either group produced a significant gap after cyclical loading. Mean load to failure for the suture group was 1069 Newtons (SD=120N) and in the wire group 820 Newtons (SD=235N). Both types of fixation allow full early mobilisation without gap formation. The Suture group has a significantly higher load to failure (p=0.002, t-test). Tension Band suture allows a lower profile fixation, potentially reducing the frequency of wound complications and hardware removal

Introduction. Joint reconstruction remains a successful and popular surgery with advances in approaches, implants and techniques continually forthcoming. Various methods of skin closure exist to address issues in efficiency, aesthetics, and barrier to infection. While subcuticular skin closure techniques offer an aesthetic advantage to conventional skin stapling, no measurable differences have been reported. Furthermore, newer barbed sutures, such as the V-loc absorbable suture, theoretically distribute tension evenly through the wound and help decrease knot-related complications. To our knowledge, no literature exists on the rate of wound complications in joint arthroplasty with the use of V-loc suture for skin closure. We hypothesize that despite theoretical gains, skin closure with a V-loc (Covidien, Mansfield, MA) absorbable suture should be performed with caution. Methods & Materials. A retrospective chart review was conducted of 278 consecutive primary joint reconstruction cases performed by a single surgeon in 12 months from July 2009 through June 2010. Pre-operative history & physical reports were evaluated for co-morbidities (i.e diabetes mellitus), smoking status and body mass index (BMI). Operative dictations by the attending surgeon provided information on the surgical procedure, use of drain, wound closure technique and type of suture/staple used for skin closure. Skin was closed by the primary surgeon and his chief resident. Wounds were closed via staple gun or subcuticular stitch (3-0 Biosyn vs V-Loc) in a consecutive manner, depending on the surgeon's preference in that period. Post-operative clinic notes were reviewed to determine the occurrence of wound complications, issuance of antibiotic prescriptions, or return to the operating room. The cohort consisted of 106 males and 161 females at an average age of 63 years (range: 18–92). Overall, there were 153 procedures at the knee (including TKA, uni-compartmental arthroplasty, patello-femoral arthroplasty) and 125 procedures at the hip (including THA and hemi-arthroplasty). Results. In review of 278 consecutive primary joint reconstruction cases, there were 17 (6.1%) post-operative wound complications noted, including cellulitis, stitch abscesses, wound dehiscence, and deeper infections requiring OR irrigation and debridement. In 181 cases, staples were used for skin closure; in these cases, seven wound complications were noted (7/181, 3.9%). In 49 cases closed via a subcuticular Biosyn suture there were 4 wound complications noted (4/49, 8.1%). Six wound complications occurred in cases closed with a V-loc suture (6/45, 13.3%). Discussion. Aesthetics and efficiency often are the driving forces of innovation. We present the rate of wound complications in various superficial wound closure methods, including the V-loc, an innovative absorbable barbed suture. Based on our clinical experience, we promote consideration of wound and infectious complications when choosing a method of skin closure in joint reconstruction procedures

Introduction. Post-arthroscopic glenohumeral chondrolysis (PAGCL) is a rare, but significant, complication of arthroscopic shoulder surgery that may lead to arthroplasty. Exact causal factors and pathways associated with the development of PAGCL are unknown however a number of patient factors and surgical factors have been implicated. Suture is one of these potential causal factors and currently little is known about the body's immune response to commonly used orthopaedic sutures. The aim of this project is to examine the biological response to 3 commonly used orthopaedic sutures (Ethibond, Fibrewire, and Orthocord) in a murine airpouch model. It was hypothesised that different sutures would elicit a different histological response and that suture wear-debris would induce an increased inflammatory reaction compared to intact suture. Methods. Total of 50 male Wister rats (12 weeks old) were used in this study. 5 rats were used per time point per group. Rat air-pouch was created according to a protocol previously described by Sedgewick et al. (1983). Once the pouch was established, on day 6, an incision was made and one of the test materials (intact Ethibond, intact Orthocord, intact Fibrewire, Fibrewire wear-debris) administered. Following wound closure, 5 ml of sterile PBS was injected to suspend the implanted materials. Negative control animals were injected with PBS alone. Rats were sacrificed at 1 and 4 weeks following surgery. The entire pouch was harvested and processed for H&E histology. The images of histological stained sections were digitally photographed and evaluated for presence of synovium and inflammatory reaction. Foreign body giant cells were quantified by two independent, blinded observers. Results. All animals recovered well and no infection were seen in any specimen. Synovium environment was confirmed by the presence of synovium lining in the airpouch (Figure 1). Giant multinucleated cells were confirmed to populate the suture material in all treatment groups (Figure 2) at both time points but not in the control specimens. Cell count results are summarized in Figure 3. Briefly, no statistical difference was found in the number of cells counted between intact suture groups at either time point. The number of cells increased in all groups from 1 week to 4 weeks however the difference was not found to be statistically different. Significant difference was found between Fibrewire intact suture and Fibrewire suture wear debris at both 1 and 4 week time points (p = 0.032 and 0.047 respectively). Discussion. No differences were observed between the biological reactivity of commonly used orthopaedic sutures. When particles (suture wear-debris) were implanted they elicited a greater inflammatory response then intact suture alone. This was confirmed by increased number of foreign body cells quantified. Increased inflammatory response may lead to PGAL and ultimately arthroplasty

The transosseous equivalent/Suture Bridge or TOE/SB repair has received much attention in recent years as more shoulder surgeons transition to all arthroscopic rotator cuff repairs. The purpose of this study was to compare the biomechanical behaviour of several variants of the Suture Bridge repair performed by the authors. Four different Suture Bridge constructs were performed six times on 24 sheep infraspinatus tendon humerus constructs. The first group was a standard Suture Bridge with two medial mattress stitches with knots (KSSB4). The second group had four medial mattress stitches with knots and was called KDSB8. The third group had two medial mattress stitches without knots and was called USBFT4. These first three repairs used two medial 5.5 mm Bio-Corkscrew FT Anchors and two lateral 3.5 mm PushLock Anchors (Arthrex). The fourth repair had two medial mattress stitches without knots and used all Pushlocks and was called USBP4. The repairs were then analysed for failure force, cyclic creep and stiffnessafter. Cycling was performed from 10 to 100 N at 1 Hz for 500 cycles. Following cyclic testing a single cycle pull to failure at 33 mm/sec was performed. The constructs were also observed for failure mechanism and gap formation using digital video recording. The KDSB8 repair with a mean failure force of 456.9N was significantly stronger than the USBP4 repair at 299.7N (P=0.023), the KSSB4 repair at 295.4N (P=0.019) and lastly the USBFT4 repair at 284.0N (P=0.011). There was no statistical difference between the measured failure force for the two mattress stitch KSSB4 repair with knots and the knotless two mattress stitch repairs USBFT4 and USBP4. There was not a statistical difference between any of the repairs for measured stiffness and cyclic creep. However, the KDSB8 repair showed no discernable gap formation or movement at the footprint during cyclic testing. The KSSB4, USBFT4 and USBP4 repairs demonstrated bursal sided gap formation in the range of 1 to 3 mm. Based on the results of this study the transosseous equivalent/Suture Bridge repair with four stitches tied in the medial row and maximal lateral suture strand utilization (KDSB8 TOE/SB) is the strongest. The KDSB8 also appeared to show less bursal sided gap formation and greater footprint stability than the other Suture Bridge constructs tested

Orthopaedics has been left behind in the worldwide drive towards diversity and inclusion. In the UK, only 7% of orthopaedic consultants are female. There is growing evidence that diversity increases innovation as well as patient outcomes. This paper has reviewed the literature to identify some of the common issues affecting female surgeons in orthopaedics, and ways in which we can address them: there is a wealth of evidence documenting the differences in the journey of men and women towards a consultant role. We also look at lessons learned from research in the business sector and the military. The ‘Hidden Curriculum’ is out of date and needs to enter the 21st century: microaggressions in the workplace must be challenged; we need to consider more flexible training options and support trainees who wish to become pregnant; mentors, both male and female, are imperative to provide support for trainees. The world has changed, and we need to consider how we can improve diversity to stay relevant and effective.

Cite this article: Bone Jt Open 2021;2-10:893–899.

Suture anchors have gained popularity in recent years, particularly owing to their ease of use for attaching soft tissues to bone and improved biomechanical properties. Three methods to reattach avulsed finger flexor tendons to the distal phalanx were biomechanically compared: a 1.8mm metal Mitek barbed suture anchor, twin 1.3mm PLA suture anchors (Microfix), or a pull-out suture over a button. The suture-anchor interface was tested by pulling the suture at 0, 45, 90° to the anchor's axis. The anchors were tested similarly in plastic foam bone substitute. Repairs of transected tendons in cadaveric fingers were loaded cyclically, then to failure. The results were subject to statistical analysis using Student t test (p< 0.001) and 1-way ANOVA (p<0.0001). The suture failed prematurely if pulled across the axis of the anchor. Conversely, fixation in bone substitute was stronger when pulling at an angle from the axis. Cyclic loads caused significantly more gap formation in-vitro with twin 1.3mm anchors than the other methods; this method was significantly weaker. The 1.8mm anchor gave similar performance to the pull-out suture and button, while the twin 1.3mm anchors were weaker and vulnerable to gap formation even with passive motion alone. A suture anchor embedded at between 45 and 90o to the direction of pull gave greater strength than if the pull was in-line. The absorbable 1.3 mm Microfix PLA anchors appeared to be a weak construct, even when twin 1.3 mm anchors were compared to a single metallic 1.8 mm Mitek anchor or the pull-out suture over button technique. All three methods are likely to be satisfactory for reattachment of finger flexor tendons if a low load or non-loading rehabilitation of the hand is planned; however the gap formation on cyclic loading with the Microfix is a concern even if patients are restricted to passive motion

We present a biomechanical cadaveric study investigating the effect of type II Superior Labrum Anterior Posterior (SLAP) lesions on the load-deformation properties of the Long Head of Biceps (LHB) and labral complex. We also report our assessment of whether repair of the type II SLAP lesion restored normal biomechanical properties to the superior labral complex. Using a servo-controlled hydraulic material testing system (Bionix MTS 858, Minneapolis, MA), we compared the load-deformation properties of the LHB tendon with:. the LHB anchor intact;. a type II SLAP lesion present;. following repair with two different suture techniques (mattress versus ‘over-the-top’ sutures). Seven fresh-frozen, cadaveric, human scapulae were tested. We found that the introduction of a type II SLAP lesion significantly increased the toe region of the load deformation curve compared to the labral complex with an intact LHB anchor. The repair techniques restored the stiffness of the intact LHB but failed to reproduce the normal load versus displacement profile of the labral complex with an intact LHB anchor. Of the two suture techniques, the mattress suture best restored the normal biomechanics of the labral complex. We conclude that a type II SLAP lesion significantly alters the biomechanical properties of the LHB tendon. Repair of the SLAP lesion only partially restores the biomechanical properties. We hypothesise that repairs of type II SLAP lesions may fail at loads as low as 150N, hence the LHB should be protected following surgery

The aim of this study was to evaluate prospectively the outcome following arthroscopic Bankart repair using two types of suture anchors, absorbable and non-absorbable. Patients with a diagnosis of recurrent traumatic anterior instability of the shoulder, seen between April 2000 and June 2003 in a single unit, were considered for inclusion in the study. Patients were assessed pre-operatively and post-operatively using a subjective patient related outcome measurement tool (Oxford instability score), a visual analogue scale for pain and instability (VAS Pain and VAS instability) and a quality of life questionnaire (SF-12). The incidence of recurrent instability and the level of sporting ability were recorded. Patients were randomised to undergo surgical repair with either non-absorbable or absorbable anchors. 130 patients were included in the study. 6 patients were lost to follow-up and 124 patients (95%) completed the study. Both types of anchors were highly effective. There were no differences in the rate of recurrence or any of the scores between the two. Four patients in the non-absorbable group and 3 in the absorbable group experienced further episodes of dislocation after a traumatic event. The rate of redislocation in the whole series was therefore, 5.6%. In addition, 4 patients, all of them in the absorbable group (4%) described ongoing symptoms of instability but no true dislocations. 85% of the patients have returned to their previous level of sporting activity. There are no differences in the outcome of Arthroscopic Bankart repair using either absorbable or non-absorbable anchors. Both are highly effective, showing a redislocation rate of 5.6%

Multiple newer wound closure techniques have been recently developed with the goals being reducing closure time, enhancing cosmesis, and decreasing wound healing problems including infections. Among these techniques are the zipper-like closure, absorbable dermal staples, scaffold devices, and others. Each of these techniques propose certain advantages. Nevertheless, this comes at an added cost and careful weighing of the cost/benefit should be considered in an evidence-based manner, in order to guide future recommendations for using these techniques.

Wound closure is not often an area that is discussed by orthopaedic surgeons. We commonly attend meetings and talks related to different types of implants and surgical technique but in reality the wound and how we close it maybe one of the most important aspects of a surgical procedure. The avoidance of wound complications such as unplanned clinic visits, readmissions, reoperations and deep infections are very important as we move into a world of bundled payments and public reporting of complications. Not to mention the poor results for the patients when wound complications occur. Often there is little thought about how wound closure and surgical dressings could affect surgical site healing. We all have a common belief that blisters, drainage and surgical site infections are rare. In the literature it has been shown that the method of wound closure can influence skin and soft tissue perfusion. Which closure techniques can achieve physiologic blood flow, which may improve wound healing? This talk will cover topics related to reducing the dead space, avoidance of hematoma formation and what the literature says regarding different types of wound closure materials.

Background

Successful use of bioabsorbable anchors for capsulolabral and rotator cuff repair is well documented. The bioknotless anchor (DePuy mitek) has demonstrated reliable fixation of these pathologies. However, this poly (L-lactide) polymer has recently demonstrated some similar complications to those documented for the earlier polyglycolic acid implants; namely synovitis and chondral damage with osteolysis. We report three cases with osteolysis and chondral damage associated with bioknotless anchors.