Dataset Information

Laparoscopic Treatment of Pubic Symphysis Instability With Anchors and Tape Suture.

ABSTRACT: Patients with pubic symphysis instability who had failed nonoperative treatments may benefit from surgical repair. This disease process is rare, most commonly seen in postpartum women and athletes, and its surgical treatment is invasive and nonphysiological. Currently described surgical interventions, although limited, include plating, which provides an overly rigid construct with the risk of failure and possibly poor long-term outcomes particularly in athletes, and treatments such as curettage, more commonly used in the treatment of osteitis pubis. An emerging option is minimally invasive laparoscopic fixation using knotless anchors with a tape suture in a crisscross configuration. This possibly allows more physiological movement of the pubic symphysis in a less invasive manner. A detailed technical description and discussion of the technique are provided.

SUBMITTER: Arner JW

PROVIDER: S-EPMC5786148 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Laparoscopic Treatment of Pubic Symphysis Instability With Anchors and Tape Suture.

Arner Justin W JW Albers Marcio M Zuckerbraun Brian S BS Mauro Craig S CS

Arthroscopy techniques 20171211 1

Patients with pubic symphysis instability who had failed nonoperative treatments may benefit from surgical repair. This disease process is rare, most commonly seen in postpartum women and athletes, and its surgical treatment is invasive and nonphysiological. Currently described surgical interventions, although limited, include plating, which provides an overly rigid construct with the risk of failure and possibly poor long-term outcomes particularly in athletes, and treatments such as curettage, ...[more]

PMID: 29379710

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Project description:IntroductionDiastasis of the pubic symphysis has been reported to occur in 13-16% of pelvic ring injuries. In Asians, there are only a few data showing the width of the pubic symphysis. The aim of this study is to see the width of pubic symphysis relating to age and sex in Koreans.MethodsWidth of pubic symphysis was measured in pelvis AP and pelvic CT of 784 peoples (392 males, 392 females).ResultsIn supine AP, the width at the upper end was 4.8±2.5 mm (males; 3.46±1.38 mm, females; 4.04±2.76 mm). The width at the midpoint was 4.7±2.0 mm (males; 4.64±1.58 mm, females; 4.75±2.29 mm). The width at the lower end was 4.8±2.5 mm (males; 4.58±2.19 mm, females; 5.08±2.76 mm). In abducted AP, the width at the upper end was 3.8±2.9 mm (males; 3.65±1.50 mm, females; 3.97±3.85 mm). The width at the midpoint was 4.6±2.3 mm (males; 4.45±2.16 mm, females; 5.18±3.79 mm). The width at the lower end was 4.8±3.1 mm (males; 4.55±1.30 mm, females; 4.74±3.06 mm). In axial CT, the width at the anterior border was 15.0±6.2 mm (males; 14.50±6.62 mm, females; 16.44±6.22 mm). The width at the narrowest point was 3.1±1.5 mm (males; 3.19±1.53 mm, females; 3.09±1.50 mm). The width at the widest point was 4.1±1.6 mm (males; 4.27±1.60 mm, females; 4.00±1.50 mm). The width at the posterior border was 2.3±1.3 mm (males: 2.20±1.30 mm, females; 2.44±1.40 mm). Axial thickness was 27.1±5.3 mm (males; 29.48±4.60 mm, females; 24.70±4.82 mm). In coronal CT, the width at the upper end was 3.1±4.1 mm (males; 2.28±1.26 mm, females; 3.83±5.48 mm). The width at beginning of widening was 3.6±4.5 mm (males; 2.68±1.63 mm, females; 4.54±6.08 mm). The width at the lower end was 20.5±8.2 mm (males; 17.49±4.53 mm, females; 23.60±9.86 mm). Coronal thickness was 20.4±7.1 mm (males; 24.50±5.98 mm, females; 16.23±5.61 mm). In supine film, width significantly increased with age at the upper end (p=0.022) and midpoint (p< 0.001); however, it decreased at the lower end (p< 0.001). In abduction film, width at midpoint increased with age (p=0.003).ConclusionPelvic malunion should be defined according to the population and age. These results could be a reference in assessing the quality of reduction after internal fixation of the patients with traumatic diastasis of the pubic symphysis.

Project description:PurposeSuture anchors are commonly used to repair rotator cuff tendons in arthroscopy surgery, and several anchor materials have been created to maximize pull-out strength and minimize iatrogenic damage. We hypothesized that all-suture anchors have biomechanical properties equivalent to those of conventional anchors. Our purpose is to compare the biomechanical properties of different anchors used for rotator cuff repair.MethodsThe Embase, PubMed, Cochrane, and Scopus databases were searched for biomechanical studies on various suture anchors. The search keywords included rotator cuff tears and suture anchors, and two authors conducted study a selection, risk of bias assessment, and data extraction. The failure load, stiffness, and displacement were calculated using the mean differences with 95% confidence intervals (CIs). Failure modes were estimated using summary odds ratios with 95% CIs. The surface under the cumulative ranking curve was used for the relative ranking probabilities. A sensitivity analysis was performed by excluding studies using synthetic bones.ResultsThe polyetheretherketone (PEEK) (p < 0.001) and all-suture anchors (p < 0.001) had higher failure loads than the biocomposite anchors, whereas no significant difference was observed in stiffness among the anchors. The all-suture (p = 0.006) and biocomposite anchors (p < 0.001) had displacements higher than the metal anchors. The relative ranking of the included anchors in failure loads and displacement changed in sensitivity analysis. The meta-analysis did not find significant differences, but the relative ranking probabilities suggested that all-suture anchor had a higher rate of anchor pull-out and a lower rate of eyelet or suture breakage. In contrast, the metal anchors were associated with a higher number of eyelet breakage episodes.ConclusionsAll-suture anchors showed significantly higher failure loads than the biocomposite anchors and similar cyclic displacements to the biocomposite and PEEK anchors. There were no significant differences in stiffness between all-suture and conventional suture anchors. The relative ranking of biomechanical properties changed in sensitivity analysis, suggesting the potential effect of bone marrow density.Level of evidenceLevel IV.

Project description:PurposeTo analyze the literature to compare outcomes and complications following primary lateral ankle ligament repair compared with lateral ankle ligament reconstruction and the suture tape augmentation in patients with lateral ankle instability.MethodsFollowing the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria, a systematic literature review using the PubMed/Ovid Medline database was performed (October 11, 1947, to October 1, 2019). Clinical trials that included all the following criteria were considered eligible; published in the English language; patients undergoing primary lateral ankle repair or reconstruction with/without autograft or allograft (anterior talofibular ligament, anterior talofibular ligament + calcaneofibular ligament) or suture tape augmentation; a follow-up at least 1 year; reported least 1 of the measured outcomes (The American Orthopaedic Foot Ankle Score, Karlsson Score, return to sport [RTS], complications, skin wound complications, reoperation). Surgical techniques were evaluated, and studies were subdivided by the following categories: primary repair (PR), reconstruction with graft (GR), and suture tape augmentation (STA). Complications, radiographic outcomes, functional outcome scores, and RTS were analyzed.ResultsA total of 41 of 1,991 studies met the criteria for final analysis. This included 1,920 patients who underwent surgical intervention for chronic lateral instability with at least a 1-year follow-up. There were 350 patients who had GR, 1,486 who underwent the PR, and 84 who had STA. GR group appeared to have the lowest rate of complications: GR 3.1% (11 of 350), PR 4.2% (63 of 1486), and STA 10.7% (9 of 84). Postoperative American Orthopaedic Foot Ankle Score ranged from 89.0 to 95.1 for GR and 90.0 to 98.8 for PR. Postoperative Karlsson scores ranged from 80.9 to 94.4 for GR and from 89.2 to 94.1 for PR. Anterior drawer postoperative scores ranged from 1.4 to 30.3 mm for GR, 2.7 to 8.6 mm for PR, and 4.1 to 4.2 mm for STA. Postoperative talar tilt ranged from 2.4 to 7.3° for GR, 1.9 to 6.0° for PR, and 3.6 to 4.5° for STA. RTS ranged from 9.5 to 20.4 weeks for the PR group; one study reported a RTS of 10.6 weeks for STA.ConclusionsExcellent outcomes were noted across all intervention groups. Current literature may suggest there is no difference in functional outcomes between patients treated with PR versus GR. However, there may be a potential improvement in functional outcomes with PR versus STA.Level of evidenceLevel IV, systematic review of Level I to Level IV studies.

Dataset Information

Laparoscopic Treatment of Pubic Symphysis Instability With Anchors and Tape Suture.

Publications

Laparoscopic Treatment of Pubic Symphysis Instability With Anchors and Tape Suture.

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