Internal Derangement Of The Knee

The term internal derangement of the knee was used by Hey in 1782 (1), usually to describe problems associated with knee motion. Surgical interventions were limited prior to the introduction of anesthesia and Hey advocated prolonged immobilization. Internal derangement of the knee was subsequently used to specify the functional insufficiency linked to cruciate ligament injuries for more than 200 yr, despite that his publications were more concerned with meniscal pathology than cruciate ligament...

Coracoacromial Ligament

The coracoacromial ligament (CAL) is a trapezoidal shaped ligament twisted into a helix between the coracoid and acromion (13). As shown in Fig. 2, the CAL courses an oblique pattern over the rotator cuff and shoulder capsule, with which it has a close spatial relationship (4). In fetal development, the CAL is visible by 13-wk gestation as a band that is continuous with the acromion's undersurface. By 36-wk gestation, fibers of the CAL are well organized (14). Fig. 2. Anterior view of the right...

Patient Satisfaction

Not all repairs of the rotator cuff are associated with satisfactory pain relief or the return of shoulder function. Realistic assessment of the likelihood of patient satisfaction is an essential component of preoperative counseling. The surgeons are interested in the precise range of motion and return to strength, whereas the patient's interests are in pain relief and restored ability to undertake activities of daily living, employment, and recreation. Many structural factors, such as tear...

Artificial Ligaments And Prostheses

During the last decades, several attempts have been proposed to use artificial ligaments or even ligament prostheses. In 1933, Bircher published his experience of using kangaroo tendons for the replacement of both anterior and posterior cruciate ligaments (30). He recommended early postoperative range of motion training, and the results were reported as satisfactory in many cases. During the 1980s and 1990s, an increased interest in using allografts was noted, and several publications have...

Modalities Of Thermal Energy Delivery

Initial studies of thermal shrinkage used the Holmium-YAG laser the first laser system designed for use with fiberoptic cables and in a saline environment. However, the laser relies on absorption of light by water molecules in the tissue therefore, the probe tip must be held away from the tissue surface. Because of the relative expense of laser generation and associated safety issues, many clinicians have preferred electrothermal energy generation using either monopolar or bipolar probes. In...

Tendon Healing In The Hand

Microanatomy and Nutrition of the Tendon in the Hand Tendons are remarkably organized structures adapted to transmit force generated by muscle. Ancient surgeons commented on the tendon injuries and proposed various treatments, including tendon repair. Due to Galen's work and his profound influence on the practice of surgery, tendon injuries were allowed to heal without intervention this method of treatment continued until the 19th century. Although early observations on tendon morphology date...

Abnormal Biomechanics

Differences Between Primary Frozen Shoulder and Posttraumatic Stiff Shoulder Movement at the shoulder occurs between the two articular surfaces of the glenohumeral joint and between the scapula and thoracic wall in a ratio of 2 1 (31). Movement at the glenohumeral joint is facilitated by the mutual sliding of a set of bursal-lined surfaces, including the deep sides of the deltoid, acromion, corocoid process, and its tendons against the proximal humerus, rotator cuff, and long biceps head....

Youngs Ligament Anchor

Young and An reported a new adjustable screw anchor to secure artificial ACL prosthesis to the femur and tibia (8,9). Fixation was provided by screw threads on the exterior surface of a hollow cylinder that was placed in the bone tunnels created in the femoral condyle and tibial plateau. The artificial ACL was attached to a sliding portion inside the threaded cylinder, which was adjusted for tension by a screw accessed from outside of the exterior bone surfaces. Push-out tests of anchors...

Background

Elastic energy storage in tendons in the legs and feet of many animals is an important mechanism that saves substantial quantities of muscular energy during locomotion (4,5). During normal gait, potential energy is stored as strain energy in the muscles and tendons that are stretched upon impact with the ground (4,5). Elastic recoil, primarily by the tendons, converts most of the stored energy back to kinetic energy. Elastic energy storage in tendons has been studied in several animal models....

References

Roberts TJ, Marsh RL, Weyand PG, Taylor CR. Muscular force in running turkeys The economy of minimizing work. Science 1997 275 113-115. 2. Silver FH, Christiansen DL, Snowhill PB, Chen Y. Role of storage on changes in the mechanical properties of tendon and self-assembled collagen fibers. Connect Tissue Res 2000 42 155-164. 3. Silver FH, Christiansen DL, Snowhill PB, Chen Y. Transition from viscous to elastic-dependency of mechanical properties of self-assembled collagen fibers. J Appl Polymer...

Interference Screw

The recent trend toward early motion and aggressive postoperative rehabilitation emphasizes the need for secure initial graft fixation before bony incorporation of the graft (15,55). Interference screw fixation appears to meet the needs for most activities of daily living and rehabilitation programs and has therefore become the standard for bone-tendon-bone graft fixation in ACL repair (54). In 1983, Lambert (56) first described interference fixation using a 6.5-mm cancellous screw. Later,...

Inflammatory And Traumatic Pathologies

The conditions that affect the tendons, as well as the manifestations of each, are diverse. The mechanisms and pathogenesis of these injuries are also quite different. From Orthopedic Biology and Medicine Repair and Regeneration of Ligaments, Tendons, and Joint Capsule Edited by W. R. Walsh Humana Press Inc., Totowa, NJ Tendinopathies may involve the tenosynovium, the peritenon, the tendon itself, or a combination of these structures. One current view espouses that the initial condition is...

Biologic Response Modifiers

The Bone Morphogenentic Protein (BMP) Family of Growth Factors BMPs and CDMPs are members of the transforming growth factor-P (TGF-P) super-family that have been shown to enhance the formation of bone and cartilage formation at fracture sites. BMP-12 is a recently discovered member of the BMP family. It is the human homolog of mouse GDF-7. BMP-12 has been shown to induce some cells to form tendon. Recent in vitro studies have shown that rhBMP12 could increase the proliferation of tendon...

Clinical Significance

Postmortem studies suggest that degeneration of the rotator cuff is progressive with age, but controversy continues to exist concerning the pathogenesis of rotator cuff disease. The heterogeneity of the disorder and the notion that rotator cuff disease may not actually represent a continuum of the same process, but instead, is a compilation of independent disorders, may partly explain the differing viewpoints on its origin. Epidemiological studies imply that the prevalence of symptomatic...

Early Treatment

Early descriptions of surgical treatment of knee disorders are focused on infectious conditions in most cases, tuberculosis. Par performed the first known surgical correction of a knee dysfunction. He reported removal of a loose body from the knee joint in 1558. The first surgical removal of a torn and displaced medial meniscus was performed by Brodhurst in 1866. Annandale (9) introduced the antiseptic surgical technique until then, surgical treatment of the knee joint had mainly been confined...

Nj O

Quarter-stagger packing pattern of type I collagen molecules in collagen fibrils. (A) In the quarter-stagger packing pattern, neighboring collagen molecules (4.4 D long) are staggered relative to their nearest neighbors. In the tendon, ligament, and joint capsule, the collagen molecules are shifted by a distance D (equal to 67 nm) with respect to their nearest neighbors after they are self-assembled into fibrils in tissues. When collagen molecules are stained with metal ions, then...

Treatment

The natural history of the frozen shoulder has already been presented. Typically, it is divided into four stages, lasting at least 18 mo and often with incomplete symptom resolution. Treatment should be aimed at pain relief, improving the quality of the recovery and reducing the time taken to achieve this recovery. High-risk groups include patients undergoing shoulder, arm, and cardio-thoracic surgery and neurosurgery. Early mobilization is of great importance in the prevention of shoulder...

A

Fig. 16. (A) Tibial specimen 9 wk following ACL reconstruction with interference screw fixation. A blending already occurs between the mineralized cartilage tissue (MC) and the graft (G) (Alcian Blue stain, x200 original magnification). (Reprinted from ref. 16.) (B) Tibial specimen 12 wk after ACL reconstruction. A further maturation of the interface is present with a large amount of fibers extending into the zone of mineralized cartilage and woven bone. Note the appositional bone growth,...

Tissue Engineering Strategies For Acl Regeneration

Tissue engineering is an emerging discipline that blends the fields of biomaterials, bioengineering, and cell biology and has the goal of inducing tissue repair or regeneration. What differentiates this from more traditional biomaterials fields is that implants are designed to induce a response from the recipient and provide a biological tissue replacement. Typically, a temporary biomaterial scaffold, cells, and or cell signals are combined in vitro or in vivo to elicit the desired response....

Info

High efficiency of transfection Infection of nondividing cells Fig. 3. Fusigenic viral liposome developed for direct introduction of macromolecules into the cytoplasm through cell fusion mediated. Fig. 3. Fusigenic viral liposome developed for direct introduction of macromolecules into the cytoplasm through cell fusion mediated. into the cellular genome at random locations, there are safety concerns regarding the possibility of insertional mutagenesis that leads to cell transformation. AAVs...

Incidence

The precise incidence of rotator cuff pathology is not known until recently, estimates were based on postmortem studies (1-3). Some studies do not report age distribution and correlation, some do not distinguish between partial and full thickness of cuff tears, and others only report findings from the examination of the dorsal surface. Many partial thickness tears are confined to the articular (deep) surface and are not visible from the dorsal surface. Human rotator cuff pathology is not...

Bone Or Absorbable Plug

Bioabsorbable plugs and press fitting of bone plugs are used to avoid the pitfalls of interference screw fixation, i.e., thread damage to the graft or suture, possible complicated hardware removal, disturbed MRI, or breakage of the absorbable screw (126). Bone plugs may be used with either artificial ligaments or biological grafts (44,127). Rupp et al. used a porcine model to compare fixation strengths of bone-patellar tendon-bone grafts using a titanium interference screw, bioabsorbable...

Resorbable Matrices And Tissue Engineering Of Ligaments Future Possibilities

This review has shown that some work on artificial ligaments that used relatively inert polymer fibers as a scaffold was successful in obtaining collagenous tissue ingrowth. Many features of normal ligament development and maturation were observed. Initially, there was a delicate fibroblastic response that left much of the cross-sectional area filled with fluid. As time increased, collagen production and reorganization led to a greater proportion of the cross-section being occupied by tissue...

Conclusions

This chapter has shown that the interior of the knee is a very demanding environment in which to test new materials and that debris from degrading ligament implants causes adverse tissue reactions. Even when a material was used that already had a long history of successful tissue integration elsewhere in the body, in addition to animal studies up to 2 yr, undesirable reactions were still revealed only after years of clinical use. Thus, it appears that artificial ligaments based on permanent,...

Normal Healing Responses

Tendons pass through three phases in their healing process that have characteristic cellular, temporal and biomechanical patterns. The first phase is considered the inflammatory phase and occurs in the first week following injury. It starts with the migration of macrophages from tissues surrounding the injury. During this phase, the macrophages remove necrotic tissue and hematoma from the area of the injury thereby preparing the tissue bed for reconstruction. Collagenases and matrix...

Experimental Biomechanical Testing

The mechanical properties of intact and injured tendons and ligaments in animals and humans have been a topic of intense scrutiny for decades. Excellent review chapters have been published over the years detailing the static and viscoelastic properties of tendons and ligaments. Work published by Woo and his group (41-54), Professor Butler and his research group, along with Amis can provide the interested reader with endless information related to tendon and ligament biomechanics. This chapter...

Classification

There is no universally accepted classification scheme for rotator cuff disease, making studies difficult to compare. Aspects to consider when reviewing rotator cuff lesions include the duration, depth, and size of a tear, as well as the condition of the muscle and tendon. Tears can be acute or chronic and may be associated with a variable degree of weakness and discomfort. Gradation of partial-thickness lesions has been described however, difficulty lies in the definition and accurate...

Tendon Anatomy

The skin on the palm is the thickest in the body as a result of a thickened stratum corneum in the epidermis layer (the dermis is as thick as on the dorsum of the hand). The skin has a rich supply of sweat glands but contains no hair or sebaceous glands. Examination of the palmar hand shows a multitude of flexor creases (lines of the hand) and papillary ridges (fingerprints). The function of the latter is controversial, but they may function to improve grip, like the tread on a car tire. Skin...

Mechanical Considerations

Although ligaments are innervated and therefore contribute to knee stability via prop-rioception, their primary role is that of passive tensile restraints to limit the separation distance between their attachments on different bones. Their tensile behavior should be considered with any artificial ligament and is now reviewed briefly. The loads imposed in use are usually cyclic, based on the activity and joint position. For an artificial structure, this implies a tendency to cause progressive...

Staple

Many brands of commercial fixation staples are currently available, such as the Richards type CC1A XSMO staple (spiked 36). Single staples are convenient to use, but recorded fixation strengths are consistently lower than that of other fixation forms (2,6,17). Studies testing single staples in single or cyclic loading show them to be no stronger or stiffer than direct tendon-to-tendon attachment using suture (2,6). Graft-tunnel length mismatch is considered one of the primary indications for...

Acknowledgments

Integrin And Collagen

The authors would like to acknowledge the assistance of graduate students, Gurinder P. Seehra and Istvan Horvath, in preparing some of the figures used in this chapter. Fig. 13. (Oppositepage) Putative mechanisms for mechanochemical transduction in ECM. Generalized oversimplified scheme for how external mechanical stress is transduced into changes in cell genetic expression. Tensile stresses applied to the cell through direct stretching of the cell membrane, stretching of ion channels in the...

Conclusion

In the early postoperative period, the site of graft fixation remains the weak link whenever tendon or ligament is affixed to bone. It is imperative that the chosen method of fixation is able to withstand the demands of postoperative rehabilitation. Motion at the bone-graft interface may cause delayed healing or nonhealing with eventual failure of the repair. Over a period of months, the graft will become progressively incorporated into bone, and the strength of the repair will become more...

Viscoelastic Properties

Considering the complex hierarchical organization of tendons and ligaments, surrounding proteins, and ground substance, it is not surprising that they demonstrate nonlinear viscoelastic properties that are both time- and history-dependent. This essentially means that the elongation of the tissue is based not only on the amount of force but on the time and history of force application. A Medline search reveals published literature as early as 1969 on the viscoelastic properties of collagenous...

Other Ligaments

The coracoglenoid ligament has been described as a bundle of dense, parallel-oriented collagen fibers with good vascularity that stretches between the coracoid and superior glenoid tubercle. Its origin is in the middle of the posterior surface of the coracoid process, between the two limbs of the acromioclavicular ligament. Its glenoid insertion separates the inferior portion of the CHL and base of the coracoid process. The existence of this ligament is controversial and is not recognized by...

Historical Review Of Artificial Ligaments

The potential of cruciate ligament reconstruction received widespread attention as a result of trauma during World War I, when the first attempts at artificial ligaments appeared. This focus was not revisited until the 1970s, which was followed by a period of intense activity that peaked in the mid-1980s (Fig. 1). A rapid collapse of the use of these devices arose in the early 1990s. Because of the many different approaches pursued during that time, it would be confusing to discuss events in a...

Contributors

Allen, md Department of Orthopaedic Surgery, Brown University School of Medicine, Providence, Rhode Island Andrew A. Amis, dsc Departments of Mechanical Engineering and Musculoskeletal Surgery, Imperial College of Science, Technology, & Medicine, London, UK Yuehuei H. An, md Orthopaedic Research Laboratory, Medical University of South Carolina, Charleston, SC Maria Apreleva, PhD Center for Musculoskeletal Surgery, Sports Traumatology and Arthroscopy Service, Charit , Campus Virchow...

Aclreconstruction Bone-tendon Healing

Fig. 10. (A) Sagital cut through a proximal tibia 6 wk after ACL reconstruction with a soft-tissue graft and extracortical fixation in sheep. There is an intensive granulation-like calcification of the FIZ (double-headed arrow) between the bone (B) and the graft (G) (Safranin O-van Kossa stain, x200 original magnification).(B) Sagital cut through a proximal tibia 6 wk after ACL reconstruction with a soft-tissue graft and extracortical fixation in sheep. There is appo-sitional bone growth (woven...

Acromioclavicular Ligament

Acromioclavicular Joint

The acromioclavicular ligaments, including the coracoclavicular ligament (CCL), reinforce all aspects of the acromioclavicular joint capsule. In turn, the deltoid and From Orthopedic Biology and Medicine Repair and Regeneration of Ligaments, Tendons, and Joint Capsule Edited by W. R. Walsh Humana Press Inc., Totowa, NJ Fig. 1. Lateral view of the coracoacromial arch and glenoid fossa. Note the distinct insertions of the conoid and trapezoid ligaments on the clavicle and the close approximation...

Spiked Washer Bushing Or Plate

Currently, several brands of commercial spiked washers or plates are available, such as the Synthes type 65.00.11 soft-tissue fixation plate (36), the AO polyacetal resin-spiked washer, and AO soft-tissue fixation plate (1). Robertson et al. compared the immediate holding strength of various types of soft-tissue fixation, including spiked washer, soft-tissue plate, staples, and suture techniques. Holding strength and stiffness was tested in three different types of soft tissue using cyclical...

Quarter Staggered Triple Helical Structure

Diagram of the knee joint. (A) Frontal view of the knee and the location of dense connective tissue, including the anterior and posterior cruciate ligaments, medial and lateral collateral ligaments, and joint capsule in the knee. The patellar tendon (not shown) is found in front of the cruciate ligaments. All these structures contained aligned collagen fibrils composed of collagen molecules in a quarter-staggered packing pattern shown in Fig. 2. (Continued on next page.) Fig. 1. Diagram...

Coracohumeral Ligament

Delamination Tear Rotator Cuff

The coracohumeral ligament (CHL) is a trapezoidal ligament located in the superior part of the shoulder capsule (on its nonarticulating surface) and runs parallel to and is closely overlaid by the CAL. It is present in fetal development by 14-wk gestation as a small band of tissue between the CHL and the CAL. The origin of the CHL is at the most posterior point on the lateral aspect of the coracoid process base (deep relative to the origin of the CAL). It appears as a broad band (2.5 cm wide)...

Techniques

In our practice (as in many centers) arthroscopic shoulder surgery is performed under interscalene regional anesthesia, where the patients are sedated and placed in the beach-chair position on the operating table. The beach-chair position facilitates examination under anesthesia (EUA) and functional assessment during arthroscopy. However, these evaluations can also be undertaken using the lateral decubitus position, but the traction apparatus must be temporarily disengaged. The EUA is an...

Tendon Repairs

One of the greatest challenges hand surgeons face is to restore normal function to the hands of patients who have sustained flexor tendon injuries. Bunnell first coined the term no man's land to refer to zone II flexor tendon injuries in 1944, as results were so poor after tendon repair in this zone (34). He advocated removing the injured tendon and replacing it with a tendon graft as a secondary procedure. However, during the 1960s, several surgeons challenged this practice by performing...

Koch Mason Suture For Tendon

Horizontal Mattress Suture Tendon Repair

Recovering function after a tendon injury to the hand continues to remain a challenge in clinical practice. Although suturing the two ends of a severed tendon may seem to be the most intuitive method today, tendon lacerations have been controversial for two centuries. Various researchers in both clinical and experimental fields have held contrasting views on all aspects of tendon injuries, from physiology of the normal tendon and its response to injury to the timing and technique of repair and...

Lamination

Many full-thickness tears of the rotator cuff are associated with tendon lamination (37). The deeper layer is generally thinner at surgery, the deeper layer is often found to be retracted further that the dorsal layer (DS, personal observation). The multilaminar structure of the rotator cuff has been well described (4), but the mechanism is not understood. It may be multifactorial. It is not uncommon to find a rim rent of the deep surface in the critical zone of Codman (6), representing a...

Introduction The Challenge Of Acl Regeneration

The anterior cruciate ligament (ACL) is a primary stabilizer of the knee joint that is frequently injured, compromising knee stability and leading to degeneration of other joint structures. Because the ACL has a poor intrinsic healing capacity, surgical reconstruction is required to restore knee function in young active patients. Biological grafts are the gold standard for ACL reconstruction, resulting in formation of scar-like tissue, which remodels but remains structurally and biomechanically...

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C-proteinase and Additional Lateral Growth Fig. 5. Directed cellular self-assembly of axial collagen fibrils during chick tendon development. Transmission electron micrograph showing collagen fibrils (see arrow in box) from a 7-d-old chick leg extensor tendon that appear to be connecting two fibroblasts during tendon development. Insert shows a high-magnification view of the collagen fibrils that originate from invaginations in the cell membranes on either side of the fibril. The collagen...

Tendon Rehabilitation

Extensor Tendon Injury Wrist Splinting

The ultimate goal of flexor tendon repair is to restore normal digital function. Historically, repaired flexor tendons were treated with immobilization (161). This produced a strong repair but also led to uncontrolled tendon adhesion, loss of tendon gliding, secondary joint contracture, and unsatisfactory digital function. Scientific and clinical research since this time has demonstrated the beneficial effects of applying early controlled stress to the healing tendon (43,45,49,160,176)....

Middle Glenohumeral Ligament

The MGHL is the second of three glenohumeral ligaments and is attached to the nonarticulating surface of the glenohumeral joint capsule 31 . In fetal development, the MGHL is present by 14-wk gestation as a distinct thickening of the joint capsule 14 . The MGHL originates on the lesser tuberosity of the humerus along the anatomic neck and blends with the insertion of the subscapularis tendon into the humerus 28,42,47 . The MGHL then passes across the subscapularis tendon in an oblique manner,...

Inferior Glenohumeral Ligament

Intercapsular Ligament

In 1981, Turkel et al. described the IGHL as a structure attached to the inferior, anterior, and posterior margins of the glenoid labrum just below the epiphyseal line and the humeral neck 42 . In fetal development, the IGHL is present by 14-wk gestation and appears as several layers of poorly organized collagen fibers, which are better organized than their surrounding capsular structure. With gestational time, the amount of fibrous tissue increases while the cellularity decreases 14,43 . The...

Summary

Tissue engineering strategies may provide alternatives to biological grafts and permanent prostheses by improving repair or inducing regeneration of soft connective tissues, such as skin, cartilage, meniscus, and ligaments. The success of the musculoskeletal soft-tissue reconstruction procedure depends on three major factors implant char acteristics scaffolds, cells, and signals , surgical procedure, and the postsurgery rehabilitation protocol. Tissue-engineered implants combine three dominant...

Ligament And Tendon Insertions

Sharpey Fibers

The firm attachment of tendons and ligaments to the underlying bone is essential for the force transmission between soft and hard tissue. These insertion sites present a highly differentiated tissue structure that serves as a stress absorber during mechanical From Orthopedic Biology and Medicine Repair and Regeneration of Ligaments, Tendons, and Joint Capsule Edited by W. R. Walsh Humana Press Inc., Totowa, NJ Fig. 1. An indirect type of ligament insertion. There is a broad zone of fibrous...

Tendon Healing To A Bone Surface

Tendon healing to a bone surface can be observed in numerous structures, including the rotator cuff tendons in the shoulder, flexor tendons in the hand, tibial insertion site of the medial collateral ligament in the knee, and the Achilles tendon in the foot. This section focuses on the rotator cuff and the supraspinatus tendons, particularly, as representatives. It is interesting to note that the number of studies investigating tendon-to-bone healing in the knee joint far exceed those performed...

Superior Glenohumeral Ligament

The SGHL is the third of the glenohumeral ligaments and is attached to the nonarticulating edge of the glenohumeral joint capsule. The origin of the SGHL is near the top of the lesser tuberosity of the humerus, and it blends with the anterior edge of the CHL beneath the superior edge of the subscapularis tendon to insert into the fovea capitas 28,31,47 . In fetal development, the SGHL is present as thickenings of the joint capsule by 14-wk gestation 14 . The SGHL faces the glenohumeral joint...

Problems In Ligament Healing

Animal studies on ligament healing have revealed that the same sequence of events appears to occur in the ligament as observed in skin wound healing. The healing processes consist of inflammation days to weeks , repair proliferation weeks , and remodeling months to years see Fig. 1 . Through these biological processes, ligaments heal with scarring that is inferior to normal tissue biologically and biomechanically. In addition, owing to their relative hypocellularity and hypovascularity,...

Strategies To Improve Ligament Healing

Exogenous Addition of Biological Factors Involved in Tissue Repair Researchers have tried to develop strategies to improve and speed up the healing process of injured ligaments. To this end, biological manipulation of scar-tissue formation has predominantly focused on the overexpression of growth factors, which have been revealed as an important influence to cutaneous wound healing. As described previously, this is because the healing process of the ligament is basically analogous to that of...

Tendon Healing In A Bone Tunnel

Direct Tendon Bone Insertion

The major indication for tendon tissue to be implanted into a bone tunnel is the reconstructive surgery of the cruciate ligaments. Especially with soft-tissue grafts, hamstring tendons or the proximal part of a quadriceps tendon graft and special allograft tissues, two major problems are encountered. The first is to regain a neoligament with normal tissue morphology and mechanical properties after graft remodeling the second is to reestablish the normal insertion to bone, thus reconstructing...

Suture Anchor

Suture anchors are increasingly being used for a wide variety of orthopedic applications that include rotator cuff repairs, Bankart repairs, and reattachment of various tendons and ligaments to bone 106-110 . Recently, different suture anchors have been developed 111,112 that are made of metal, nonabsorbable 34 , and absorbable materials e.g., Expanding Suture Plug Arthrex 35,111-114 . Shall et al. 115 compared failure loads of a metallic suture anchor SuperAnchor with either a bioabsorbable...