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      Initial Experience With a Bioresorbable Polymer Anchor

      research-article
      1 , , 2 , 1 , 1
      ,
      Cureus
      Cureus
      soft tissue fixation, lateral ankle ligament instability, deltoid ligament repair, bioresorbable implant, polymer implant, sonicanchor

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          Abstract

          Background

          Anchors are frequently used in reconstructive orthopedic surgery to achieve fixation of soft tissue to bone. Anchors vary with respect to material composition, configuration, and methods of fixation at the site of attachment. The fixation component of anchoring devices has generally evolved from metal-fabricated implants to various types of bioresorbable anchors. The SonicAnchor TM (Stryker, Kalamazoo, MI USA) polymer implant provides a unique form of anchor fixation using SonicFusion TM technology to achieve interdigitation within cancellous bone while being radiolucent and providing a small footprint.

          Methods

          During a four-year period, 116 patients underwent a reconstructive orthopedic foot and ankle surgical procedure with the use of at least one bioresorbable polymer anchor (SonicAnchor implant). There were 59 males and 57 females, with an average age of 42 years (range: 12-83 years).

          Results

          A total of 233 bioresorbable anchor (SonicAnchor) implants were used in 116 patients. Of the 116 patients, 108 (93.1%) achieved successful clinical healing of their surgery at their most recent follow-up. The average follow-up duration was 309 days (range: 14-1,429 days). Eight (6.9%) patients were lost to follow-up prior to clinical healing. Two (1.7%) patients underwent reoperation. Also, 65 (56%) patients had at least six months of follow-up and 36 (31%) had at least one year of follow-up.

          Conclusions

          This preliminary clinical trial of patients undergoing soft tissue repair or reconstruction with a bioresorbable polymer appears to perform comparably to other commercially available devices. The lack of adverse events, mechanical failures, or infections further supports the safety of this device.

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          Most cited references25

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          Tendon-to-bone pressure distributions at a repaired rotator cuff footprint using transosseous suture and suture anchor fixation techniques.

          Interface contact pressure between the tendon and bone has been shown to influence healing. This study evaluates the interface pressure of the rotator cuff tendon to the greater tuberosity for different rotator cuff repair techniques. The transosseous tunnel rotator cuff repair technique provides larger pressure distributions over a defined insertion footprint than do suture anchor techniques. Controlled laboratory study. Simulated rotator cuff tears over a 1 x 2-cm infraspinatus insertion footprint were created in 25 bovine shoulders. A transosseous tunnel simple suture technique (n = 8), suture anchor simple technique (n = 9), and suture anchor mattress technique (n = 8) were used for repair. Pressurized contact areas and mean pressures of the repaired tendon against the tuberosity were determined using pressure-sensitive film placed between the tendon and the tuberosity. The mean contact area between the tendon and tuberosity insertion footprint was significantly greater for the transosseous technique (67.7 +/- 5.8 mm(2)) compared with the suture anchor simple (34.1 +/- 9.4 mm(2)) and suture anchor mattress (26.0 +/- 5.3 mm(2)) techniques (P < .05). The mean interface pressure exerted over the footprint by the tendon was also greater for the transosseous technique (0.32 +/- 0.05 MPa) compared with the suture anchor simple (0.26 +/- 0.04 MPa) and suture anchor mattress (0.24 +/- 0.02 MPa) techniques (P < .05). The transosseous tunnel rotator cuff repair technique creates significantly more contact and greater overall pressure distribution over a defined footprint when compared with suture anchor techniques. Stronger and faster rotator cuff healing may be expected when beneficial pressure distributions exist between the repaired rotator cuff and its insertion footprint. Tendon-to-tuberosity pressure and contact characteristics should be considered in the development of improved open and arthroscopic rotator cuff repair techniques.
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            Femoral cortical suspension devices for soft tissue anterior cruciate ligament reconstruction: a comparative biomechanical study.

            Optimization of anterior cruciate ligament (ACL) fixation is desired to improve graft healing. New soft tissue cortical suspension devices for femoral tunnel fixation should be biomechanically evaluated.
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              Comparison between different femoral fixation devices for ACL reconstruction with doubled hamstring tendon graft: a biomechanical analysis.

              The aim of the present study was to compare the mechanical behavior of some devices used for femoral fixation of doubled hamstring tendon graft in anterior cruciate ligament (ACL) reconstruction when included in a graft fixation complex (GFC). An ACL reconstruction was performed on 90 porcine knees. The graft used was the doubled lateral extensor of toes (DLET). Nine different femoral fixation devices were tested and classified according to their fixation mechanism: compression (Bioscrew and RCI screw); expansion (Rigidfix); cortical suspension (Ligament Anchor, EndoButton-CL, and Swing Bridge); cancellous suspension (Linx-HT); and cortical-cancellous suspension (Transfix and Bio-Transfix). All GFC were subjected to a cyclic loading test, then to a load-to-failure test. Graft elongation after 1,000 load cycles, failure load, and stiffness were calculated for each device. Regarding graft elongation, Bioscrew and RCI screws showed the highest mean values. All the other GFC showed no significant differences between them when delta elongation (elongation(1,000 cycles) - elongation(20 cycles)) was considered. For failure load, the highest mean values were observed for Bio-Transfix, Transfix, and Swing Bridge; a homogeneous subset with the lowest mean values was formed by Ligament Anchor, RCI screw, Bioscrew, and Linx-HT. For stiffness, the greatest values were observed for Bio-Transfix, Transfix, and Swing Bridge; all other groups showed no significant differences between them. Cortical-cancellous suspension fixation seemed to offer the best and most predictable results in terms of elongation, fixation strength, and stiffness. For both compression and suspension, the weakest fixation was attained with cancellous fixation devices. Cortical suspension devices showed a greatly variable mechanical behavior, according to their design. Transcondylar devices offer the best structural properties for femoral fixation of doubled hamstring tendon graft in ACL reconstruction.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                29 December 2020
                December 2020
                : 12
                : 12
                : e12370
                Affiliations
                [1 ] Orthopaedic Surgery, Loyola University Medical Center, Maywood, USA
                [2 ] Orthopaedic Surgery, Loyola University Chicago Stritch School of Medicine, Maywood, USA
                Author notes
                Robert R. Burnham Jr. robert.burnham@ 123456lumc.edu
                Article
                10.7759/cureus.12370
                7842253
                33527051
                758f369e-bf97-45d2-980f-4518eab2af91
                Copyright © 2020, Burnham et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 29 December 2020
                Categories
                Orthopedics

                soft tissue fixation,lateral ankle ligament instability,deltoid ligament repair,bioresorbable implant,polymer implant,sonicanchor

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