OBJECTIVE: To investigate the effectiveness of nickel-titanium shape memory staples in treating multiple metatarsal fractures. METHODS: The clinical data of 27 patients with multiple metatarsal fractures who were treated between January 2022 and June 2023 and met the selection criteria were retrospectively analysed. The cohort consisted of 16 males and 11 females, aged 33-65 years (mean, 47.44 years). The causes of injury included heavy object impact in 11 cases, traffic accidents in 9 cases, and crush in 7 cases. Simultaneous fractures of 2, 3, 4, and 5 bones occurred in 6, 6, 4, and 8 cases, respectively, with tarsometatarsal joint injury in 3 cases. Fixation was performed using staples for 16, 22, and 9 fractures in the metatarsal neck, shaft, and the base, respectively, and 5 tarsometatarsal joint injuries. Preoperative soft tissue injuries were identified in 8 cases and classified according to the Tscherne-Oestern closed soft tissue injury classification as type Ⅰ in 5 cases and type Ⅱ in 3 cases. One case of type Ⅱexhibited preoperative skin necrosis. The patients were treated with fixation using nickel-titanium shape memory staples. Complications and fracture healing were documented. At last follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was used to evaluate the function, and the visual analogue scale (VAS) score was used to evaluate the pain. RESULTS: The 27 patients were followed up 9-19 months (mean, 12.4 months). Postoperative X-ray films revealed no loss of fracture reduction, and all fractures achieved bony union. No internal fixator loosening, breakage, or other mechanical failures was observed. The mean fracture healing time was 3.13 months (range, 3-4 months). Postoperatively, 4 cases (2 of Tscherne-Oestern type Ⅰ, 2 of type Ⅱ) developed superficial skin necrosis, which resolved with dressing changes. No infection was observed in the remaining patients, and all wounds healed. At last follow-up, the AOFAS forefoot score ranged from 70 to 95, with an average of 86.6, of which 19 cases were excellent, 6 cases were good, and 2 cases were fair, with an excellent and good rate of 92.6%; the VAS score ranged from 0 to 3, with an average of 0.9, of which 24 cases were excellent, and 3 cases were good, with an excellent and good rate of 100%. CONCLUSION The use of nickel-titanium shape memory staples in the treatment of multiple metatarsal fractures can effectively protect local skin and soft tissues and minimize secondary damage associated with internal fixator insertion. It is a viable surgical option for management of multiple metatarsal fractures.
Humans ; Male ; Female ; Middle Aged ; Adult ; Titanium ; Nickel ; Retrospective Studies ; Fracture Fixation, Internal/instrumentation* ; Aged ; Metatarsal Bones/surgery* ; Fractures, Bone/surgery* ; Treatment Outcome ; Sutures ; Fractures, Multiple/surgery*

OBJECTIVE: To summarize the research progress of suture augmentation (SA) in anterior cruciate ligament (ACL) reconstruction. METHODS: A comprehensive review of recent literature about SA in ACL reconstruction at home and abroad was conducted. The efficacy of SA in ACL reconstruction was evaluated by examining the definition, biomechanics, and histological studies of SA, along with its clinical application status in ACL reconstruction. RESULTS: SA demonstrates significant advantages in enhancing the biomechanical stability of ACL grafts, reducing the risk of re-rupture, and accelerating postoperative recovery. Specifically, SA improves graft stiffness, ultimate failure strength, and cyclic stability, thereby diminishing the risk of early postoperative failure and joint instability. Histologically, it fosters remodeling and tendon-bone integration through early load-sharing mechanisms; however, stress shielding may interfere with natural remodeling processes, warranting further attention. Clinically, SA reduces graft failure rates and the need for revision surgeries, markedly improving knee joint stability and functional recovery in young patients. Nevertheless, its impact on graft maturation and potential complications remains controversial. CONCLUSION Despite the many advantages of SA in ACL reconstruction, future endeavors should focus on optimizing tensioning techniques, developing bioactive materials, and conducting large-scale randomized controlled trials to further elucidate its clinical value and scope of applicability, providing a more reliable solution for ACL reconstruction.
Humans ; Anterior Cruciate Ligament Reconstruction/methods* ; Biomechanical Phenomena ; Anterior Cruciate Ligament/surgery* ; Anterior Cruciate Ligament Injuries/surgery* ; Suture Techniques ; Sutures ; Tendons/transplantation* ; Joint Instability/prevention & control* ; Knee Joint/surgery*

OBJECTIVE: To investigate the surgical method and short-term effectiveness of arthroscopy edge-to-edge #-shaped suture in the treatment of the complete radial tear of the lateral meniscus body. METHODS: The clinical data of 13 patients with complete radial tear of lateral meniscus body between May 2020 and August 2023 were retrospectively analyzed. There were 10 males and 3 females, aged 15-38 years (mean, 24.2 years). There were 11 cases of acute injury and 2 cases of chronic injury, with time from injury to admission ranging from 2 days to 5 months. All patients had tenderness in the lateral joint space, and 2 patients with chronic injury had positive McMurray's sign. All patients were treated with arthroscopic edge-to-edge #-shaped suture technique. The knee joint activity and tenderness in the lateral joint space were detected, and the healing of the incision and the occurrence of complications were observed. X-ray films and MRI of the knee joint were performed to evaluate joint degeneration and meniscus healing. Lysholm score, International Knee Documentation Committee (IKDC) subjective score, Tegner score, and visual analogue scale (VAS) score were used to evaluate the functional recovery before and after operation. RESULTS: The operation time ranged from 46 to 100 minutes (mean, 80.08 minutes). All the incisions healed by first intention, and no complication such as intraoperative vascular and nerve injury or postoperative infection occurred. All 13 patients were followed up 20-59 months (mean, 29.3 months). All patients had no limitation of knee extension and flexion. One patient with chronic injury continued to have tenderness in the lateral space of the knee joint, while the remaining patients had no tenderness, swelling, and locking in the lateral space. Immediate postoperative MRI of knee joint showed continuous recovery of the lateral meniscus. At last follow-up, no degenerative changes were observed in X-ray films of knee joint. Except for 1 patient with chronic injury, the MRI of the other patients showed the healing performance after lateral meniscus suture. Lysholm score, IKDC subjective score, Tegner score, and VAS score all significantly improved when compared with those before operation (P<0.05). CONCLUSION The edge-to-edge #-shaped suture technique can effectively repair the complete radial tear of the lateral meniscus body, and the short-term effectiveness is satisfactory.
Humans ; Male ; Female ; Adult ; Tibial Meniscus Injuries/surgery* ; Arthroscopy/methods* ; Retrospective Studies ; Adolescent ; Young Adult ; Suture Techniques ; Treatment Outcome ; Menisci, Tibial/surgery* ; Sutures ; Knee Joint/surgery* ; Magnetic Resonance Imaging

OBJECTIVE: To explore clinical effect of iliac bone graft fixed with high strength suture arthroscopy in treating shoulder joint forward instability with high risk of dislocation. METHODS: The clinical data of 22 patients with shoulder forward instability with high risk of dislocation treated with iliac bone graft fixed with high-strength suture arthroscopy from January 2021 to January 2023 were retrospectively analyzed, including 14 males and 8 females, aged from 17 to 46 years old with an average of (26.50±8.26) years old;the times of dislocation ranged from 4 to 22 (11.08±5.82) times;7 patients on the left side and 15 patients on the right side. American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) score and Constant-Murley score were to evaluate the improvement of shoulder joint function before operation and 12 months after operation. Three-dimensional CT reconstruction was performed to evaluate the repair of glenoid bone defect, bone remodeling and bone healing before operation, immediately after and 12 months after operation. RESULTS: All patients were followed up for 12 to 24 months with an average of (18.68±3.92) months. No further dislocation or subluxation occurred in all patients. Scores of ASES, UCLA and Constant-Murley were improved from (69.50±2.26), (23.86±2.27), (75.64±3.58) before operation to (91.09±1.57), (32.27±2.03), (91.95±3.00) at 12 months after operation (P<0.05). The defect of glenoid bone was (12.41±7.55) %, (-37.23±3.75) %, (-22.41±3.58) % before opertaion, immediately and 12 months after operation, respectively, and the difference was statistically significant (P<0.05). Bone healing of iliac bone graft was achieved at 12 months after operation. CONCLUSION High strength suture arthroscopy to fix iliac bone graft for the treatment of shoulder forward instability with high dislocation risk is a safe and effective method, which could effectively restore shoulder stability and reduce surgical injury.
Humans ; Male ; Female ; Adult ; Arthroscopy/methods* ; Middle Aged ; Ilium/transplantation* ; Adolescent ; Joint Instability/physiopathology* ; Shoulder Dislocation/surgery* ; Shoulder Joint/physiopathology* ; Young Adult ; Retrospective Studies ; Bone Transplantation ; Sutures

OBJECTIVE: To compare the effectiveness between lower tibial tunnel placement combined with internal tension relieving suture and simple lower tibial tunnel placement for posterior cruciate ligament (PCL) reconstruction. METHODS: The clinical data of 83 patients with simple PCL injury who met the selection criteria between January 2014 and February 2022 were retrospectively analyzed. Among them, 44 patients underwent PCL reconstruction through lower tibial tunnel placement combined with internal tension relieving suture (tension relieving suture group), and 39 patients underwent PCL reconstruction through simple lower tibial tunnel placement (control group). Baseline characteristics, including gender, age, body mass index, side of injury, cause of injury, preoperative side-to-side difference (SSD) in posterior tibial translation, visual analogue scale (VAS) score, knee range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) scores (including symptom, daily activities, and knee function scores) were compared between the two groups, showing no significant difference ( P>0.05). The operation time and intraoperative blood loss were recorded and compared between the two groups. The effectiveness was evaluated by Lysholm score, IKDC scores, Tegner score, VAS score, knee ROM, SSD in posterior tibial translation before operation and at last follow-up, the patient satisfaction at last follow-up, and the postoperative graft recovery was evaluated by MRI. RESULTS: There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). All patients were followed up 12-60 months, and there was no significant difference between the two groups ( P>0.05). Postoperative MRI showed that the graft was in good condition, and the reconstructed PCL graft had good signal, continuity, and tension. During the follow-up, there was no complication such as re-rupture or donor site discomfort in both groups. At last follow-up, the Lysholm score, IKDC scores, Tegner score, VAS score, knee ROM, and SSD in posterior tibial translation significantly improved in both groups when compared with those before operation ( P<0.05). The changes of Lysholm score, Tegner score, IKDC knee symptom score, and SSD in posterior tibial translation between pre- and post-operation were significantly superior in the tension relieving suture group compared to the control group ( P<0.05). However, no significant difference was found between the two groups in the changes of VAS score, knee ROM, IKDC daily activities score or knee function score between pre- and post-operation, and the satisfaction score ( P>0.05). CONCLUSION Lower tibial tunnel placement combined with internal tension relieving suture PCL reconstruction represents a more effective surgical approach for improving postoperative laxity of PCL and knee function recovery comparing to simple lower tibial tunnel placement PCL reconstruction.
Humans ; Posterior Cruciate Ligament/injuries* ; Tibia/surgery* ; Posterior Cruciate Ligament Reconstruction/methods* ; Range of Motion, Articular ; Treatment Outcome ; Knee Joint/surgery* ; Sutures ; Retrospective Studies ; Suture Techniques ; Female ; Male ; Adult ; Knee Injuries/surgery*

OBJECTIVE: To investigate the effectiveness of modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy for temporomandibular joint anterior disc displacement (ADD). METHODS: A clinical data of 30 patients (45 sides) with temporomandibular joint ADD, who met selective criteria and were admitted between September 2022 and February 2024, was retrospectively analyzed. Among them, 15 patients (23 sides) were treated with temporomandibular joint disc reduction and suture via small incision (open operation group), and 15 patients (22 sides) with modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy (arthroscopy group). There was no significant difference in gender, age, disease duration, affected side, Wilkes-Bronstein stage, preoperative visual analogue scale (VAS) score, maximal interincisal opening (MIO), and temporomandibular joint dysfunction index (DI), craniomandibular index (CMI), palpation index (PI), and other baseline data between groups ( P>0.05). VAS score, MIO, and temporomandibular joint function indicators (PI, DI, CMI) of patients were recorded at 3 months after operation, and the difference (change value) of the above indicators between pre- and post-operation was calculated. At 1 week after operation, MRI was performed to evaluate the reduction of the articular disc compared to the preoperative image. The results were classified as excellent, good, and poor, with excellent and good being considered effective reduction. The condition of condyle process repair was observed by cone beam CT (CBCT) at 3 months after operation. RESULTS: All incisions healed by first intention in the two groups. All patients were followed up 3-18 months (mean, 8.2 months). Facial nerve injury occurred in 3 cases in the open operation group and 1 case in the arthroscopy group, all of which returned to normal after physiotherapy and drug treatment. At 3 months after operation, MIO and VAS scores of both groups significantly improved when compared with those before operation ( P<0.05), and temporomandibular joint function indicators (PI, DI, CMI) significantly decreased ( P<0.05). The change values of MIO and temporomandibular joint function indicators in arthroscopy group were significantly higher than those in open operation group ( P<0.05). There was no significant difference in the change value of VAS score between groups ( P>0.05). There was no recurrence during follow-up. Postoperative MRI review showed that the effective reduction rate of joint disc was 95.65% (22/23) in the open operation group and 95.45% (21/22) in the arthroscopy group, with no significant difference between groups ( P>0.05). Postoperative CBCT found that early and timely effective reduction of joint disc was conducive to condyle process repair and reconstruction. CONCLUSION Modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy has a clear effect in the treatment of ADD, with less trauma, fewer postoperative complications, and good early effectiveness.
Humans ; Arthroscopy/methods* ; Retrospective Studies ; Temporomandibular Joint Disorders/surgery* ; Temporomandibular Joint Disc/surgery* ; Male ; Treatment Outcome ; Female ; Suture Techniques ; Adult ; Joint Dislocations/surgery* ; Range of Motion, Articular ; Middle Aged ; Pain Measurement ; Young Adult ; Sutures

OBJECTIVE: To investigate the effect of different degrees of wound eversion on scar formation at the donor site of anterolateral thigh flaps by a prospective clinical randomized controlled study. METHODS: According to the degree of wound eversion, the clinical trial was designed with groups of non-eversion (group A), eversion of 0.5 cm (group B), and eversion of 1.0 cm (group C). Patients who underwent anterolateral femoral flap transplantation between September 2021 and March 2023 were collected as study subjects, and a total of 36 patients were included according to the selection criteria. After resected the anterolateral thigh flaps during operation, the wound at donor site of each patient was divided into two equal incisions, and the random number table method was used to group them ( n=24) and perform corresponding treatments. Thirty of these patients completed follow-up and were included in the final study (group A n=18, group B n=23, and group C n=29). There were 26 males and 4 females with a median age of 53 years (range, 35-62 years). The body mass index was 17.88-29.18 kg/m ² (mean, 23.09 kg/m ²). There was no significant difference in the age and body mass index between groups ( P>0.05). The incision healing and scar quality of three groups were compared, as well as the Patient and Observer Scar Assessment Scale (POSAS) score [including the observer component of the POSAS (OSAS) and the patient component of the POSAS (PSAS)], Vancouver Scar Scale (VSS) score, scar width, and patient satisfaction score [visual analogue scale (VAS) score]. RESULTS: In group C, 1 case had poor healing of the incision after operation, which healed after debridement and dressing change; 1 case had incision necrosis at 3 months after operation, which healed by second intention after active dressing change and suturing again. The other incisions in all groups healed by first intention. At 6 months after operation, the PSAS, OSAS, and patient satisfaction scores were the lowest in group B, followed by group A, and the highest in group C. The differences between the groups were significant ( P<0.05). There was no significant difference between the groups in the VSS scores and scar widths ( P>0.05). CONCLUSION Moderate everted closure may reduce the formation of hypertrophic scars at the incision site of the anterior lateral thigh flap to a certain extent.
Humans ; Male ; Female ; Prospective Studies ; Cicatrix/prevention & control* ; Thigh/surgery* ; Wound Healing ; Surgical Flaps ; Plastic Surgery Procedures/methods* ; Suture Techniques ; Middle Aged ; Transplant Donor Site ; Sutures ; Adult

OBJECTIVE: To compare the effectiveness of Achillon Achilles tendon suture guide combined with circuit suture under the perineural channel and Krachow suture with posterolateral incision of Achilles tendon in the treatment of Kuwada type Ⅱ acute closed Achilles tendon rupture. METHODS: The clinical data of 38 patients with Kuwada type Ⅱ acute closed Achilles tendon rupture who met the selection criteria between January 2020 and December 2023 were retrospectively analyzed. Krachow suture via posterolateral incision was used in 24 cases (traditional group), and Achillon Achilles tendon suture guide combined with circuit suture via perineural channel was used in 14 cases (minimally invasive group). There was no significant difference in baseline data such as age, gender, body mass index, cause of injury, time from injury to operation, characteristics of Achilles tendon injury (broken end distance, stump length), and preoperative Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot function score between the two groups ( P>0.05). The operation time, incision length, hospital stay, and complications (re-tear, incision infection, sural nerve irritation, deep venous thrombosis) were recorded. ATRS score and AOFAS ankle and hindfoot function score were used to evaluate the effectiveness before operation and at 3 and 6 months after operation. RESULTS: All patients successfully completed the operation. The operation time, incision length, and hospital stay in the minimally invasive group were significantly shorter than those in the traditional group ( P<0.05). Patients in both groups were followed up 8-16 months, with an average of 12.7 months. There was no sural nerve injury or re-tear of Achilles tendon in both groups. In the traditional group, 1 case had incision infection,1 case had suture rejection, and 1 case had intermuscular venous thrombosis; in the minimally invasive group, no incision healing complication, suture knot discomfort, or thrombosis occurred. There was no significant difference in the incidence of complications between the two groups ( P=0.283). The ATRS score and AOFAS ankle and hindfoot function score of the two groups were improved after operation, but there was no significant difference ( P>0.05). Except that there was no significant difference in AOFAS ankle and hindfoot function scores between the two groups at 6 months after operation ( P>0.05), the ATRS scores and AOFAS ankle and hindfoot function scores in the minimally invasive group were significantly better than those in the traditional group at other time points ( P<0.05). CONCLUSION The treatment of Kuwada type Ⅱ acute closed Achilles tendon rupture with Achillon Achilles tendon suture guide combined with circuit suture via the perineural channel has similar ankle function comparable to traditional operation, but the incision is smaller and the incidenc of incision infection is lower, which is beneficial for patients to recover early ankle function.
Humans ; Achilles Tendon/injuries* ; Suture Techniques ; Retrospective Studies ; Tendon Injuries/surgery* ; Rupture/surgery* ; Sutures ; Male ; Treatment Outcome ; Female ; Minimally Invasive Surgical Procedures/methods* ; Adult

OBJECTIVE: To investigate effectiveness of a novel suture method-stepwise progressive ultra-tension-reducing suture method in closing high-tension wounds on the chest, back, and limbs. METHODS: A retrospective analysis was conducted on 25 patients with high-tension wounds on the chest, back, and limbs who were treated with stepwise progressive ultra-tension-reducing suture method between January 2022 and December 2022. Among the patients, there were 8 males and 17 females, with an average age of 30.5 years (range, 18-56 years). All wounds after scar or tumor resection were located on the chest, back, upper limbs, and lower limbs in 8, 6, 9, and 2 cases, respectively. The size of wounds ranged from 3.5 cm×2.8 cm to 40.0 cm×15.0 cm. All patients were advised to use topical silicone-based treatments postoperatively. The protrusion of the incision, the height of the protrusion, and the duration of the tension reduction effect were observed. The scar formation at the incision site at 6 months after operation was observed, the scar appearance was evaluated by Vancouver Scar Scale (VSS) score, and the scar width was measured. The patient's satisfaction and adverse reactions to incisions were also evaluated. RESULTS: The incisions significantly elevated, with a height of 0.3-2.5 cm, and the tension reducing effect lasted for 8.5-18.0 weeks after operation, with an average of 13.6 weeks. All incisons healed by first intention. One patient experienced transient hyperpigmentation, which resolved spontaneously. Three keloid patients showed localized redness postoperatively, and 2 experienced local recurrence, which improved significantly after treatment with triamcinolone, 5-fluorouracil injections, and laser therapy. All patients were followed up 6.0-13.5 months, with an average of 10.1 months. At 6 months after operation, all patients had linear scars, with VSS scores ranging from 1.0 to 3.5 (mean, 2.0). The width of the scars ranged from 0.5 to 3.0 mm (mean, 1.4 mm). The patients expressed satisfaction with the effectiveness. CONCLUSION The stepwise progressive ultra-tension-reducing suture method for high-tension wounds can effectively reduce the tension at the wound edges, providing a prolonged tension-reducing effect and satisfactory effectiveness.
Humans ; Male ; Female ; Adult ; Middle Aged ; Retrospective Studies ; Suture Techniques ; Adolescent ; Young Adult ; Cicatrix/prevention & control* ; Wound Healing ; Back ; Treatment Outcome ; Sutures ; Thorax ; Extremities/surgery*

OBJECTIVE: To study the mechanical properties related to the typical functional failure modes of non-absorbable suture anchor in clinical use, and to support product design, development and verification. METHODS: By retrieving the database of relevant adverse events, the typical functional failure modes of non-absorbable suture anchor were summarized, and the influencing factors of functional failure were further analyzed by studying the mechanical properties related to functional failure. The publicly available test data was retrieved for verification and provided reference for the researchers. RESULTS: The typical functional failure modes of non-absorbable suture anchor include anchor failure, suture failure, fix loosening, inserter failure, which are related to the mechanical properties of products, such as screw-in torque and break torque of screw-in anchors, insertion force of knock-in anchors, suture strength, pull-out force before and after system fatigue test and elongation of sutures after fatigue test. CONCLUSIONS Enterprises should pay attention to improving the mechanical performance level of products through material, structural design and the suture weaving process to ensure the safety and effectiveness of products.
Suture Anchors ; Suture Techniques ; Sutures ; Absorbable Implants ; Biomechanical Phenomena ; Materials Testing