Modified laparoscopic Sugarbaker repair of parastomal hernia with a three-point anchoring technique

AIMTo retrospectively evaluate the safety and feasibility of a new modified laparoscopic Sugarbaker repair in patients with parastomal hernias.METHODSA retrospective study was performed to analyze eight patients who underwent parastomal hernia repair between June 2016 and January 2018. All of these patients received modified laparoscopic Sugarbakerhernia repair treatment. This modifed technique included an innovative three-point anchoring and complete su-turing technique to fix the mesh. All procedures were performed by a skilled hernia surgeon. Demographic data and perioperative outcomes were collected to eva-luate the safety and effcacy of this modifed technique.RESULTSOf these eight patients, two had concomitant incisional hernias. All the hernias were repaired by the modifed laparoscopic Sugarbaker technique with no conversion to laparotomy. Three patients had in-situ reconstruc-tion of intestinal stoma. The median mesh size was 300 cm2, and the mean operative time was 205.6 min. The mean postoperative hospitalization time was 10.4 d, with a median pain score of 1 （visual analog scale method） at postoperative day 1. Two patientsdeveloped postoperative complications. One patient had a pocket of effusion surrounding the biologic mesh, and one patient experienced an infection around the reconstructed stoma. Both patients recovered after conservative management. There was no recurrence during the follow-up period （6-22 mo, average 13 mo）.CONCLUSIONThe modifed laparoscopic Sugarbaker repair could fx the mesh reliably with mild postoperative pain and a low recurrence rate. The technique is safe and feasible for parastomal hernias.

Degradation behavior of ZE21C magnesium alloy suture anchors and their effect on ligament-bone junction repair

Current materials comprising suture anchors used to reconstruct ligament-bone junctions still have limitation in biocompatibility,degradability or mechanical properties.Magnesium alloys are potential bone implant materials,and Mg^(2+) has been shown to promote ligament-bone healing.Here,we used Mg-2 wt.%Zn-0.5 wt.%Y-1 wt.%Nd-0.5 wt.%Zr(ZE21C)alloy and Ti6Al4V(TC4)alloy to prepare suture anchors to reconstruct the patellar ligament-tibia in SD rats.We studied the degradation behavior of the ZE21C suture anchor via in vitro and in vivo experiments and assessed its reparative effect on the ligament-bone junction.In vitro,the ZE21C suture anchor degraded gradually,and calcium and phosphorus products accumulated on its surface during degradation.In vivo,the ZE21C suture anchor could maintain its mechanical integrity within 12 weeks of implantation in rats.The tail of the ZE21C suture anchor in high stress concentration degraded rapidly during the early implantation stage(0-4weeks),while bone healing accelerated the degradation of the anchor head in the late implantation stage(4-12weeks).Radiological,histological,and biomechanical assays indicated that the ZE21C suture anchor promoted bone healing above the suture anchor and fibrocartilaginous interface regeneration in the ligament-bone junction,leading to better biomechanical strength than the TC4 group.Hence,this study provides a basis for further research on the clinical application of degradable magnesium alloy suture anchors.

Operative treatment of acromioclavicular joint dislocation：a new technique with suture anchors

Objective：To evaluate clinical outcome of suture anchors in strengthening both acromioclavicular and coracoclavicular ligaments in the surgical treatment of acromioclavicular joint dislocation.Methods：Twenty-eight patients with acute traumatic Rockwood Ⅲ,Ⅳ and Ⅴ dislocations of the acromioclavicular joint surgically treated at our institute between October 2010 and January 2012 were recruited.All patients underwent open reduction combined with suture anchors.Function was evaluated using the ConstantMurley shoulder score.Clinical and radiographic shoulder ratings were evaluated using Taft criteria at 3,6 and 12 months.Results：Two cases with fixation loosening were not included in final statistical analysis.Other patients obtained full joint reposition on immediate postoperative radiographs.Follow-up was performed with an average of 15.6 months （range,12-19）.After early range of motion exercises,96.2％ of the patients （25/26） could abduct and elevate their shoulders more than 90 degrees within postoperative 3 months.There was no infection.Average Constant-Murley score was 96.3 points （range,94-100）and mean Taft shoulder rating was 10.7 points （range,8-12） at 12 months.Conclusion：The suture anchor is a relatively simple technique and can avoid screw removal which is helpful in reconstructing both acromioclavicular and coracoclavicular ligaments in acute traumatic acromioclavicular joint dislocation.

Double-row repair of rotator cuff tears: Comparing tendon contact area between techniques

BACKGROUND In rotator cuff repair surgery,the double-row technique is widely performed.Studies have shown that with increased contact area and pressure between tendon and bone interface,better healing is promoted.AIM To assess the different suture configurations with the double-row technique and how this influences the contact area of the rotator cuff tendon to bone.METHODS This was a controlled laboratory study where identical tears were created in 24 fresh porcine shoulders over a 1.5 cm×2.5 cm infraspinatus insertion footprint.Double-row repair techniques,with 3 to 4-suture anchors in different configurations(2 medial,2 lateral vs 2 medial,1 lateral vs 1 medial,2 lateral),were employed for three control groups.Each group consisted of eight shoulders with identical repair configurations.Footprint contact areas of the repaired tendon against the tuberosity were determined using pressure sensitive Fujifilm placed between the tendon and tuberosity.RESULTS The mean contact area between tendon and insertion footprint from the imprinted Fujifilm was obtained using computer software.The contact area measured from a standard 4-suture anchor double row repair was 75.1±9.3 mm2,whereas areas obtained for the 2 lateral-1 medial and 2 medial-1 lateral anchor configurations were 72.9±5.2 mm2 and 75.0±4.9 mm2 respectively.No statistical significance was noted between the three groups.CONCLUSION In the technique of double-row repair,using a 3-suture anchor configuration may offer a non-inferior alternative to the standard 4-anchor construct in terms of efficacy.This may also result in overall cost reduction and shorter surgical time.

Biomechanical comparison of double-row versus transtendon single-row suture anchor technique for repair of the grade III partial articular-sided rotator cuff tears

Background For partial-thickness tears of the rotator cuff, double-row fixation and transtendon single-row fixation restore insertion site anatomy, with excellent results. We compared the biomechanical properties of double-row and transtendon single-row suture anchor techniques for repair of grade Ⅲ partial articular-sided rotator cuff tears.Methods In 10 matched pairs of fresh-frozen sheep shoulders, the infraspinatus tendon from 1 shoulder was repaired with a double-row suture anchor technique. This comprised placement of 2 medial anchors with horizontal mattress sutures at an angle of .≤45° into the medial margin of the infraspinatus footprint, just lateral to the articular surface, and 2 lateral anchors with horizontal mattress sutures. Standardized, 50% partial, articular-sided infraspinatus lesions were created in the contralateral shoulder. The infraspinatus tendon from the contralateral shoulder was repaired using two anchors with transtendon single-row mattress sutures. Each specimen underwent cyclic loading from 10 to 100 N for 50 cycles, followed by tensile testing to failure. Gap formation and strain over the footprint area were measured using a motion capture system; stiffness and failure load were determined from testing data.Results Gap formation for the transtendon single-row repair was significantly smaller （P 〈0.05） when compared with the double-row repair for the first cycle （（1.74±0.38） mm vs. （2.86±0.46） mm, respectively） and the last cycle （（3.77±0.45） mm vs. （5.89±0.61） mm, respectively）. The strain over the footprint area for the transtendon single-row repair was significantly smaller （P 〈0.05） when compared with the double-row repair. Also, it had a higher mean ultimate tensile load and stiffness.Conclusions For grade Ⅲ partial articular-sided rotator cuff tears, transtendon single-row fixation exhibited superior biomechanical properties when compared with double-row fixation.

Mini suture anchor: An effective device for reduction and fixation of displaced temporomandibular joint disc with intracapsular condylar fracture

Purpose::The main aim is to provide clinical reference for the application of mini suture anchor in the reduction and fixation of displaced temporomandibular joint(TMJ)disc with intracapsular condylar fracture.Methods::From October 2018 to October 2019,21 patients(31 sides)with intracapsular condylar fractures and articular disc displacement from West China Hospital of Stomatology,Sichuan University were included.The selection criteria were:(1)mandibular condylar fractures accompanied by displacement of the TMJ disc,confirmed by clinical examination,CT scan and other auxiliary examinations;(2)indication for surgical treatment;(3)no surgical contraindications;(4)no previous history of surgery in the operative area;(5)no facial nerve injury before the surgery;(6)informed consent to participate in the research program and(7)complete data.Patients without surgical treatment were excluded.The employed patients were followed up at 1,3,6 and 12 months after operation.Outcomes were assessed by success rate of operation,TMJ function and radiological examination results at 3 months after operation.Data were expressed as number and percent and analyzed using SPSS 19.0.Results::All the surgical procedures were completed successfully and all the articular discs were firmly attached to the condyles.The articular disc sufficiently covered the condylar head after the fixation.The fixation remained stable when the mandible was moved in each direction by the surgeons.No complications occurred.The functions of the TMJ were well-recovered postoperatively in most cases.CT scan revealed that the screws were completely embedded in the bone without loosening or displacement.Conclusion::Mini suture anchor can provide satisfactory stabilization for the reduced articular disc and also promote the recovery of TMJ functions.

Central tendon splitting combined with SutureBridge double-row technique as a surgical treatment for insertional Achilles tendinopathy

Background Surgical treatment of insertional Achilles tendinopathy should be considered when a variety of conservative measures fail. To achieve a satisfactory outcome, thorough debridement of the Achilles tendon is critical, besides excision of the bursitis and the calcaneal exostosis. Central tendon-splitting provides straightforward access to the calcified or degenerative tissue within the Achilles tendon. For Achilles tendon reconstruction if detachment is present, several surgical techniques have been reported. Controversy surrounds the technique can provide maximum security for reattachment of the Achilles tendon. The SutureBrid^e double-row construct, initially used in rotator cuff repair, is Drobablv a aood choice.