Nonanatomic and Suture-Based Coracoclavicular Joint Stabilization Techniques Provide Adequate Stability at a Lower Cost of Implants in Biomechanical Studies When Compared With Anatomic Techniques: A Systematic Review and Meta-Analysis

Fermín, Theodorakys Marín; Hovsepian, Jean Michel; Fernandes, Víctor Miguel Rodrigues; Terzidis, Ioannis; Papakostas, Emmanouil; Koh, Jason L.

doi:10.1016/j.asmr.2020.12.007

Cited by 5 publications

(7 citation statements)

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“…Zhang et al [59] exposed the contrasting cost differences of a pair of suture anchors and three high-strength sutures (US$800 vs. US$100, respectively) when comparing two different patellar fixation techniques. In fact, various authors have remarked on the high costs of suture anchors and interference screws [25,26,29]. Biomechanical studies have found no significant differences among fixation methods in MPFL reconstruction, and all provide higher failure loads than the native ligament [24,60,61].…”

Section: Discussionmentioning

confidence: 99%

Hardware-free MPFL reconstruction in patients with recurrent patellofemoral instability is safe and effective

et al. 2022

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Purpose This systematic review evaluated the clinical outcomes of hardware-free MPFL reconstruction techniques in patients with recurrent patellofemoral instability, focusing on patient-reported outcome measures (PROMs), redislocation rate, and complications. The hypothesis was that hardware-free MPFL reconstruction in patients with recurrent patellofemoral instability is safe and effective. Methods This systematic review was conducted following the PRISMA guidelines. PubMed, Scopus, and Virtual Health Library databases were accessed in October 2021. All the clinical studies investigating the efficacy and feasibility of hardware-free MPFL reconstruction were screened for inclusion. Only studies with a minimum 24-month follow-up were considered eligible. Kujala Anterior Knee Pain Scale improvement and redislocation rate after surgical treatment were evaluated as primary outcomes. The rate of postoperative complications was evaluated as a secondary outcome. The quality of the methodological assessment was assessed using the Modified Coleman Methodology Score. Results Eight studies were included in the present systematic review. The quality of the methodological assessment was moderate. Short- to long-term improvement of Kujala score was observed in all included studies. Mean score improvement ranged from + 13.2/100 to + 54/100, with mean postoperative scores ranging from 82/100 to 94/100. Patellar redislocation was observed in 8.33% (8 of 96) patients. Conclusion Hardware-free MPFL reconstruction with or without associated soft-tissue or bony realignment procedures provided reliable clinical improvements and was associated with a low rate of redislocation in patients with recurrent patellofemoral instability. Advantages such as safety, femoral physis preservation, and comparable complication profiles with implant-based techniques endorse its implementation. Orthopedic surgeons in cost-sensitive environments may also benefit their patients with lower costs, no need for implants, lack of implant-related complications, or surgery for implant removal. Level of evidence: Level IV.

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Section: Discussionmentioning

confidence: 99%

Hardware-free MPFL reconstruction in patients with recurrent patellofemoral instability is safe and effective

et al. 2022

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“…Numerous surgical techniques have been described for the treatment of acute AC joint dislocation. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 The goals of the new anatomic CC ligament reconstruction techniques are to achieve anatomic reduction of the ACJ and adequate fixation in order to allow and facilitate primary healing of AC and CC ligaments, and also to minimize the risk of associated complications.…”

Section: Discussionmentioning

confidence: 99%

“…2 Also, as shown in a recent meta-analysis, suture-based techniques may provide more cost-effective and greater value treatment for AC joint injury and could be considered in the surgical management especially of cost-sensitive populations. 23 Finally, the percentage of associated lesions, mostly intra-articular (rotator cuff tears, superior labrum anterior to posterior SLAP tears, biceps pathology), that can be treated at the time of the ACJ procedure has been reported ranging from 18 to 49%. 24 , 25 …”

Section: Discussionmentioning

confidence: 99%

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Arthroscopically Assisted Double-Loop Suture Repair for Acute Acromioclavicular Joint Disruption

Fandridis¹,

Zampeli²,

Dimakopoulos

2022

Arthroscopy Techniques

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“…Despite many of these techniques being associated with satisfactory outcomes, loss of reduction is one of the most frequently encountered complications, with data suggesting that this occurs in 20.8% of patients. 2,13,17 It was initially hypothesized that the strength of the CC ligament reconstructions would be additive in that supplementation of a tendon graft reconstruction, whether anatomic or nonanatomic, with a suture cerclage would confer a higher load to failure. This was partially observed, as the TGS + C and the ACCR + C constructs had higher loads to failure and less superior displacement than the ACCR alone.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Efficacy of Tape Cerclage as an Augment or Stand-alone for Coracoclavicular Ligament Reconstruction

et al. 2022

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Background: Loss of initial reduction of the acromioclavicular joint after coracoclavicular (CC) ligament reconstruction remains a challenge for various repair techniques. Previous studies using polydioxanone suture cerclage augments for CC ligament reconstruction demonstrated poor clinical and biomechanical outcomes. Tape-style sutures have recently gained popularity because of their added stiffness and strength relative to traditional sutures. These tape cerclage systems have yet to be biomechanically studied in CC ligament reconstruction. Purpose: To determine the efficacy of a tape cerclage system as an augment to CC ligament reconstruction. Study Design: Controlled laboratory study. Methods: A total of 24 human cadaveric shoulders were utilized. These were divided into 4 repair groups: anatomic CC ligament reconstruction (ACCR), ACCR with a tape cerclage augment (ACCR + C), tendon graft sling with a cerclage augment (TGS + C), or tape cerclage sling alone (CS). The repairs underwent superior/inferior cyclic loading to evaluate for displacement. Specimens were visually inspected for cortical erosion by the tape cerclage after cyclic loading. Finally, the constructs underwent superior plane load-to-failure testing. Results: Less displacement after cyclic loading was observed in the ACCR + C (mean ± SD, 0.42 ± 0.32 mm), TGS + C (0.92 ± 0.42 mm), and CS (0.93 ± 0.39 mm) groups as compared with the ACCR group (4.42 ± 3.40 mm; P = .002). ACCR + C (813.3 ± 257.5 N), TGS + C (558.0 ± 120.7 N), and CS (759.5 ± 173.7 N) demonstrated significantly greater load at failure relative to ACCR (329.2 ± 118.2 N) ( P < .001). ACCR + C (60.88 ± 17.3 N/mm), TGS + C (44.97 ± 9.15 N/mm), and CS (54.52 ± 14.24 N/mm) conferred greater stiffness than ACCR (27.43 ± 6.94 N/mm) ( P = .001). No cortical erosion was demonstrated in any specimen after cyclic loading. Conclusion: In a cadaveric model at time zero, repairs utilizing a tape cerclage system confer significantly greater load to failure and stiffness, as well as decreased displacement with cyclic loading, when compared with traditional ACCR repair. Clinical Relevance: Tape cerclage augmentation may provide a useful augment for CC ligament reconstruction.

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Nonanatomic and Suture-Based Coracoclavicular Joint Stabilization Techniques Provide Adequate Stability at a Lower Cost of Implants in Biomechanical Studies When Compared With Anatomic Techniques: A Systematic Review and Meta-Analysis

Cited by 5 publications

References 60 publications

Hardware-free MPFL reconstruction in patients with recurrent patellofemoral instability is safe and effective

Hardware-free MPFL reconstruction in patients with recurrent patellofemoral instability is safe and effective

Arthroscopically Assisted Double-Loop Suture Repair for Acute Acromioclavicular Joint Disruption

Biomechanical Efficacy of Tape Cerclage as an Augment or Stand-alone for Coracoclavicular Ligament Reconstruction

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