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Surgical Materials

Fixation devices, biological augmentations, and irrigation solutions used in shoulder surgery, with a focus on biomechanical stability and healing potential.

Overview

Surgical management of orthopaedic defects and soft-tissue reconstructions requires careful selection of materials based on emerging evidence and specific patient factors. While clinical outcome studies comparing suture materials remain elusive [1], there is little reason not to use stronger suture material, which is an option within the surgeon's control [1]. Complications related to suture anchors and tacks can be categorized as technique-related or device-related issues [2]. Prevention of complications related to suture anchors and tacks depends on the surgeon's familiarity with the devices and knowledge of their indications and limitations [2].

Biologic reconstructions with viable bone autograft can provide more durable long-term reconstructions [6]. Biologic reconstructions with viable bone autograft can provide growing reconstructions in the pediatric population [6]. However, biologic reconstructions with viable bone autograft come at the expense of high short-term complication rates [6]. Biologic reconstructions with viable bone autograft come at the expense of donor-site morbidity [6]. The use of structural allograft has decreased due to increased long-term failure rates [4]. The use of structural allograft has decreased due to the introduction of highly porous metal augments [4]. Understanding the current evidence and appropriate indications of emerging technologies is of critical importance for their utilization [5].

Bone substitutes display a wide range in structural properties and compression strength [7]. The wide range in structural properties and compression strength of bone substitutes indicates that they will be suitable for different clinical indications [7]. Early-generation absorbable implants had mechanical strength insufficient for some orthopaedic applications [9]. Absorbable implants offer major clinical advantages by negating the need for subsequent removal [9]. Complications are ubiquitous with all methods of managing segmental bone defects [16]. Complications in managing segmental bone defects can be limited with careful surgical judgment, patient optimization, and technique [16]. The use of strut grafts is safe and beneficial in a selected group of patients with major femoral deficiencies [20]. Maximum stability must be achieved at the time of surgery through careful implant selection and insertion for the use of strut grafts in patients with major femoral deficiencies [20]. Some suture materials may provide a superior alternative to wire for cerclage fixation techniques with select clinical application [40]. Reoperation rates for clavicle fracture exceed 20% [43]. The vast majority of reoperations for clavicle fracture are performed for device removal [43].

Anatomy & Pathophysiology

Osseous and Glenoid Morphology

Labral morphology does not compensate for reduced bony glenoid concavity in clinically stable shoulders [47]. The size and orientation of Hill-Sachs defects have important contributions to glenohumeral joint function [61]. Glenoid reconstruction with distal tibial allograft (DTA) provides near anatomic reconstruction, leading to increased stability, improved contact area, and decreased loading pressures [59]. Reconstruction of posterior glenoid bone defects with distal tibial allograft (DTA) demonstrated at least equivalent biomechanical properties compared to reconstruction with iliac crest bone graft (ICBG) [90].

Graft Biomechanics and Stability

Autologous iliac crest bone grafting (ICBGT) biomechanically improves anterior shoulder stability in long-term follow-up [69]. Usage of allografts did not show any bone-mediated biomechanical effect at follow-up due to resorption [69]. Modified coracoid grafts are more effective than natural coracoid grafts in scenarios with bone loss, providing improved biomechanical stability and optimized force distribution [70]. Mechanical tests and finite element analysis support the concept of inset glenoid fixation in minimizing the risk of glenoid loosening [67].

Soft Tissue and Kinematics

Superior capsule reconstruction for irreparable rotator cuff tears demonstrates a humeral head–stabilizing effect that appears to translate into improved clinical outcomes [41]. Repair grafts for rotator cuff repair displayed significant variation in mechanical properties and had at least some reduced parameters compared with human rotator cuff tendons [78]. Biomechanical testing demonstrated superior suture strength for knotless suture anchors compared with standard suture anchors [81]. The combined 10-strand grasping and locking core suture technique is stronger biomechanically than its grasping and locking components in zone II flexor tendon repair [89].

Significant previous injury resulting in abnormal shoulder mechanics is associated with abnormal values for excursion of the instant center and of the humeral head [66]. An abnormal glenohumeral-to-scapulothoracic ratio is associated with significant pain in the shoulder [66].

Classification

Complication Categories: Complications related to suture anchors and tacks are categorized as technique-related or device-related issues [2]. Prevention of these complications depends on the surgeon's familiarity with the devices and knowledge of their indications and limitations [2].

Bone Substitute Materials: Bone substitutes display a wide range in structural properties and compression strength, indicating suitability for different clinical indications [7]. Clinical applications for these materials are dictated by their particular structural and biochemical properties [25]. No single alternative graft material provides all three components for bone regeneration [25].

Biocomposite Anchors: Not all biocomposite anchors are the same; they have different chemical compositions, resorption patterns, timelines, and ability to be replaced by bone [26].

Bone Matrix Composition: The cement substance, rather than collagen fibers, is the important factor differentiating the bone matrix from other calcifying fibrous tissues [46].

Suture Materials: Significant differences were found between ultimate failure loads of various suture types and sizes [39]. New polyblend suture materials show distinct mechanical properties compared to traditional materials [39]. Differences exist between traditional and newer suture materials when tying various types of knots under arthroscopic conditions [42]. The self-tensioning suture showed dynamic properties, demonstrating a decrease in loop length when soaked in a saline bath [50]. FiberTape consistently displayed less creep, greater stiffness, and less extensibility than other suture types [51].

Implant Systems: The BISS screw system design simplifies implantation, facilitates removal, and avoids the risk of cable tears associated with traditional systems [52].

Other Considerations: Regarding platelet concentrate classifications, authors assert that reviews aimed to highlight the role of various classifications in improving orthobiologics knowledge rather than favoring one [53]. Observed differences in knee scores between different study groups that have not been matched for various clinically relevant factors are at least as likely to represent differences in the patient populations as they are to represent differences in the operative technique or the design of the implant [56].

Clinical Presentation

Complication Classification: Complications related to suture anchors and tacks are categorized as technique-related or device-related issues [2]. Complications are ubiquitous with all methods of managing segmental bone defects but can be limited with careful surgical judgment, patient optimization, and technique [16]. Postoperative complaints may result from the disease process rather than the surgery [34].

Biocompatibility and Material Response: Methyl methacrylate caused no gross reaction that could be recognized clinically or roentgenographically in thirty-three patients after being in contact with bone for periods as long as fourteen years and four months [3]. No adverse clinical reactions to rotator cuff patches have been observed to date, although no randomized clinical trials have been performed [19]. Early-generation absorbable implants had insufficient mechanical strength for some orthopaedic applications [9].

Specific Pathology Presentations: * Subchondral Cysts: Intraosseous bioplasty should be considered in patients in whom conservative management fails to ameliorate symptoms of subchondral cysts in the lateral condyle of the femur [17]. * Dupuytren’s Disease: Early recurrence of Dupuytren's disease is most common in individuals with Dupuytren's diathesis [31]. Clinical recurrence of Dupuytren's contracture was related to electron microscopic findings of myofibroblasts in nodules and fibroblasts containing prominent microtubules in the fascia, rather than patient age, disease duration, or severity [33]. * Deltoid Contracture: Contracture of the deltoid muscle procedure resolved pain, skin dimpling, palpable fibrous bands, and winging of the scapula, with no infections or neuromuscular complications [35].

Outcomes and Functional Status: The presented patient with extensive osteochondral defect correction using structured bone graft and collagen membrane coating was in good clinical function after an 18-month follow-up with no recurrence of the preoperative clinical condition [12]. Patients are expected to present similar performance at 1 year postoperatively following total knee replacement regardless of preoperative strengthening plus balance training [32]. The modified PHILOS system utilizing a single bone cement calcar screw achieved outstanding clinical outcomes in the current patient series [29]. An injectable biphasic bone substitute demonstrated acceptable surgical outcomes in a limited case series for treating benign bone lesions [18].

Limitations of Evidence: Clinical outcome studies comparing suture materials remain elusive [1]. The application of free microvascular epiphyseal-plate transplantation clinically is minimum [8].

Investigations

Plain radiography: Radiographs demonstrate complete incorporation of nonresorbable bioactive–ceramic implanted into long bone defects [54]. Roentgenograms reveal apparent complete regeneration of both articular surfaces of a transplanted joint while preserving original contours in ten-year follow-up [65]. Standing X-rays indicate that double semitendinosus anterior cruciate ligament reconstruction stabilises the evolution of degenerative lesions [74].

MRI: Magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue after autologous osteochondral mosaicplasty for cartilaginous lesions of the elbow joint [45]. Metal suppression magnetic resonance imaging techniques provide a comprehensive overview of different metal artifacts in orthopaedic MRI and factors affecting their magnitude, discussing commonly applied techniques and recent technological advances to facilitate better-informed diagnostic decisions [36].

Bone scan: Patients with diaphyseal implantation of nonresorbable bioactive glass–ceramic experienced increased scintigraphic uptake compared to cancellous allografts [54].

Other Considerations: Clinical outcome studies comparing suture materials remain elusive [1]. There is little reason not to use stronger suture material, which is an option within the surgeon's control [1]. Understanding the current evidence and appropriate indications of emerging technologies is of critical importance for their utilization [5]. Bone substitutes display a wide range in structural properties and compression strength, indicating suitability for different clinical indications [7]. The clinical application of free microvascular epiphyseal-plate transplantation is minimum [8]. Autografts produce a superior possibility of radiologic complete bone union than other fillers in medial opening-wedge high tibial osteotomy [13]. The overall certainty of the evidence synthesis regarding bone void filling materials in medial opening-wedge high tibial osteotomy is low [13]. If anatomical and technical considerations are respected, such as preserving the outer table and reconstructing the defect, the patient could be spared iliac wing fracture following graft harvesting from the anterior iliac crest [14]. Trabecular metal augments provide the surgeon with the ability to reconstruct each absent supporting structure independently with the possibility of biologic fixation [71]. Both autograft and allograft lateral collateral ligament reconstructions offer reliable and similar radiographic and clinical results, allowing for shared decision-making between surgeon and patient [72]. Double semitendinosus anterior cruciate ligament reconstruction is efficient in restoring a satisfactory stability for most patients [74]. The technique of vascularized and non-vascularized segmental fibular canine autografts allows for osseous union in the majority of cases, although serious problems persist [75]. Preoperative opioid usage predicts markedly inferior outcomes 2 years after reverse total shoulder arthroplasty [76]. Opioid users had significantly increased rates of periprosthetic radiolucency and revision after reverse total shoulder arthroplasty [76]. Use of structural allograft bone in spine fusion and other orthopaedic surgical applications continues to increase [77]. To prevent hernias through donor sites for iliac-bone grafts, full-thickness iliac-crest bone grafts should be taken from the anterior or posterior portion of the crest rather than the middle [85]. The reverse-reamed intercalary allograft technique is simple to perform and allows for rotational and angular corrections during reconstruction [86]. Magnesium calcium phosphate-based cement merits further study for use in intraoperative fixation of small bone fragments [87]. Methyl methacrylate caused no gross reaction that could be recognized clinically or roentgenographically in thirty-three patients after being in contact with bone for periods as long as fourteen years and four months [3].

Treatment

Non-Operative

Surgical management of coxa vara is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, whereas moderate nonprogressive deformity often does not require surgery [64]. For subchondral cysts in the lateral condyle of the femur, intraosseous bioplasty (IOBP) should be considered in patients in whom conservative management fails to ameliorate symptoms [17].

Operative

Indications: Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors [57]. Severe glenoid cartilage lesions are a contraindication for partial humeral head resurfacing [44].

Surgical Approach / Technique: Direct exchange can yield a rate of success comparable with that of delayed exchange if antibiotic-loaded cement and appropriate postoperative antibiotics are used [11]. Inserting suture anchors at 90° is recommended due to the significantly larger ultimate failure load in both decorticated and non-decorticated bones [88].

Implant Selection: Extensively coated uncemented stems provide 10-year survival rates of 90% and have clinical results equivalent to cemented stems [10]. The use of structural allograft has decreased due to increased long-term failure rates and the introduction of highly porous metal augments [4]. Absorbable implants offer major clinical advantages by negating the need for subsequent removal, although the mechanical strength of early-generation absorbable devices was insufficient for some orthopaedic applications [9].

Adjuncts: Complications related to suture anchors and tacks can be categorized as technique-related or device-related issues [2]. Prevention of complications related to suture anchors and tacks depends on the surgeon's familiarity with the devices and knowledge of their indications and limitations [2].

Other Considerations: Clinical outcome studies comparing suture materials remain elusive [1]. There is little reason not to use stronger suture material, and this is an option within the surgeon's control [1]. Biologic reconstructions with viable bone autograft can provide more durable long-term reconstructions and growing reconstructions in the pediatric population, but come at the expense of high short-term complication rates and donor-site morbidity [6]. The application of free microvascular epiphyseal-plate transplantation clinically is minimum [8]. Understanding the current evidence and appropriate indications of emerging technologies is of critical importance for their utilization [5].

Bone Grafts and Substitutes: Autografts produce a superior possibility of radiologic complete bone union than other fillers in medial opening-wedge high tibial osteotomy, although the overall certainty of the evidence synthesis regarding bone void filling materials is low [13]. The combination of demineralized bone matrix (DBM) and platelet-rich plasma (PRP) could serve as a safe bone graft substitute in clinical practice for non-union, achieving a low incidence of postoperative complications and satisfactory bony healing rate, though larger and higher quality studies are needed to assess routine use [79]. No single alternative graft material provides all three components for bone regeneration, and clinical applications for bone graft substitutes are dictated by their particular structural and biochemical properties [25]. Operations involving a nonmassive allograft about the olecranon process may display minimal side effects in comparison to massive allografts, specifically regarding nonunion [82].

Graft Comparisons: Direct repair, autograft reconstruction, or allograft reconstruction are all viable treatment options for chronic distal biceps tendon ruptures with similar outcomes [37]. Allografts may be comparable to autografts for crucial effectiveness outcomes in posterior cruciate ligament reconstruction surgery, but insufficient evidence was found to judge crucial safety outcomes due to poor reporting of safety measures and outcomes [38]. The use of strut grafts is safe and beneficial in a selected group of patients with major femoral deficiencies, provided maximum stability is achieved at the time of surgery through careful implant selection and insertion [20].

Rotator Cuff Patches: To date, no adverse clinical reactions to patches in rotator cuff repair have been observed, but no randomized clinical trials have been performed on patches for rotator cuff repair [19].

Complications

Device-Related and Technique-Related Issues: Complications associated with suture anchors and tacks are classified as either technique-related or device-related [2]. Prevention of these complications relies on the surgeon’s familiarity with the specific devices and a thorough understanding of their indications and limitations [2].

Allograft and Biologic Reconstruction: The use of structural allograft has declined due to increased long-term failure rates [4]. Biologic reconstructions utilizing viable bone autograft are associated with high short-term complication rates and significant donor-site morbidity [6]. Further studies with long-term follow-up are required to determine whether the grafted area in Autologous Matrix-Induced Chondrogenesis maintains structural and functional integrity over time [15].

Vascularized Fibula and Induced Membrane: The combination of an allograft reinforced by a free vascularized fibula promotes initial and long-term mechanical stability with few complications, particularly of a mechanical nature [22]. A longer follow-up is necessary to assess and confirm the superiority of the induced membrane procedure in pediatric reconstruction [24].

Prosthetic Outcomes: Despite major primary complications and a high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis [60].

Bone Graft Harvest: The harvest of autologous bone graft is frequently associated with complications [62]. However, the method for taking the iliac-bone graft was used more than 200 times with no hematomas requiring drainage, no wound infections, no muscle herniation, and no need for later removal of the wire [68].

Other Considerations: Methyl methacrylate caused no gross reaction that could be recognized clinically or roentgenographically in thirty-three patients after being in contact with bone for periods as long as fourteen years and four months [3].

Recovery

Clinical outcome studies comparing suture materials remain elusive [1]. There is little reason not to use stronger suture material, which is an option within the surgeon's control [1].

Light activity (weeks): Evidence does not provide specific week ranges for light activity, desk work, or driving.

Full activity (months): Evidence does not provide specific month ranges for manual work, sport, or full ROM/strength return.

Complete recovery / outcome plateau (months): Evidence does not provide specific month ranges for the stabilization of pain, strength, and final functional outcomes.

Rehabilitation protocol: Evidence does not specify PT phasing, immobilisation duration, weight-bearing/ROM progression, or sling/brace removal timing.

Functional milestones: Evidence does not report validated PROM trajectories or outcome-measure benchmarks (e.g., Constant, ASES, WOMAC).

Other Considerations: Methyl methacrylate caused no gross reaction recognizable clinically or roentgenographically in thirty-three patients after contact with bone for periods as long as fourteen years and four months [3]. The use of structural allograft has decreased due to increased long-term failure rates and the introduction of highly porous metal augments [4]. Biologic reconstructions with viable bone autograft can provide more durable long-term reconstructions and growing reconstructions in the pediatric population [6]. Biologic reconstructions with viable bone autograft come at the expense of high short-term complication rates and donor-site morbidity [6]. Extensively coated uncemented stems provide 10-year survival rates of 90% [10]. Extensively coated uncemented stems have clinical results equivalent to cemented stems [10]. Direct exchange can yield a rate of success comparable with that of delayed exchange if antibiotic-loaded cement and appropriate postoperative antibiotics are used [11]. A patient presented with good clinical function after an 18-month follow-up with no recurrence of the preoperative clinical condition following correction of an extensive osteochondral defect with structured bone graft associated with collagen membrane coating [12]. Further studies with long-term follow-up are needed to determine whether the grafted area in autologous matrix-induced chondrogenesis will maintain structural and functional integrity over time [15]. An injectable biphasic bone substitute demonstrated acceptable surgical outcomes in a limited case series for the treatment of benign bone lesions [18]. The combination of an allograft reinforced by a free vascularized fibula promotes initial and long-term mechanical stability with few complications, particularly of mechanical order, in children's reconstruction for lower limb defects following bone tumour resection [22]. New implants must withstand vigorous challenges [23]. Future extensive and long-term studies can enable improved implants using human tissue [23]. A longer follow-up is necessary to assess and confirm the superiority of the induced membrane procedure in pediatric reconstruction [24]. Not all biocomposite anchors are the same; they have different chemical compositions, resorption patterns, timelines, and ability to be replaced by bone [26]. Early clinical experience involving reamed autogenous bone graft in the management of nonunion, bone defects, and arthrodesis has been encouraging and has demonstrated the necessary properties to warrant regular consideration of reamed graft for these applications [28]. There are no statistically significant differences at a mean follow-up of 4.05 + 2 years in clinical and functional outcomes of single row arthroscopic rotator cuff repair using metallic or biodegradable suture anchors for rotator cuff tears less than 5 cm [48]. All patients achieved bone union, and maintained bone union was observed in 95.1% of patients at follow-up visits at least 2 years after Ilizarov treatment for nonunion of the tibia [92]. Eighteen of nineteen patients were asymptomatic with no evidence of progression of necrosis or collapse at an average follow-up of eight years following structural bone-grafting for early atraumatic avascular necrosis of the femoral head [93]. Although the ultimate fate of allografts is not known, clinical results appear to justify continuation of allograft replacement of all or part of the end of a long bone following excision of a tumor in selected cases in preference to amputation [94]. Optimizing treatment with osteochondral allografts in shoulder surgical procedures relies on long-term results, careful patient selection, and realistic expectations [95].

Key Evidence

  • [L5] Clinical outcome studies comparing suture materials remain elusive, but there is little reason not to use stronger suture material, and this is an option within the surgeon's control. (10.1016/j.arthro.2019.12.009)
  • [L4] Complications related to suture anchors and tacks can be categorized as technique-related or device-related issues, and prevention depends on the surgeon's familiarity with the devices and knowledge of their indications and limitations. (10.1177/0363546505284240)
  • [L4] Methyl methacrylate caused no gross reaction that could be recognized clinically or roentgenographically in thirty-three patients, after being in contact with bone for periods as long as fourteen years and four months. (10.2106/00004623-197254020-00005)
  • [L4] The use of structural allograft has decreased due to increased long-term failure rates and the introduction of highly porous metal augments. (10.1302/2058-5241.6.210007)
  • [L5] Biologic reconstructions with viable bone autograft can provide more durable long-term reconstructions and growing reconstructions in the pediatric population at the expense of high short-term complication rates and donor-site morbidity. (10.5435/jaaos-d-25-00228)
  • [L5] The bone substitutes tested display a wide range in structural properties and compression strength, indicating that they will be suitable for different clinical indications. (10.1186/1471-2474-12-34)
  • [L5] The application of this technique clinically is minimum. (10.2106/00004623-198466090-00016)
  • [L4] Extensively coated uncemented stems provide 10-year survival rates of 90%, with clinical results equivalent to cemented stems. (10.5435/00124635-199503000-00003)
  • [L4] The experience suggests that direct exchange can yield a rate of success comparable with that of delayed exchange if antibiotic-loaded cement and appropriate postoperative antibiotics are used. (10.2106/00004623-199807000-00004)
  • [Case_report] The presented patient is in good clinical function after an 18-month follow-up, with no recurrence of the preoperative clinical condition. (10.1177/2325967124s00448)
  • [L1] Although autografts produce a superior possibility of radiologic complete bone union than other fillers, the overall certainty of the evidence synthesis is low. (10.1016/j.arthro.2022.11.039)
  • [Case_report] If anatomical and technical considerations are respected, such as preserving the outer table and reconstructing the defect, the patient could be spared this inconvenience. (10.1016/j.otsr.2011.03.026)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L5] Complications are ubiquitous with all methods but can be limited with careful surgical judgment, patient optimization, and technique. (10.5435/jaaos-d-14-00018r1)
  • [L4] In patients in whom conservative management fails to ameliorate symptoms, IOBP should be considered. (10.3390/jcm9051358)
  • [L4] In a limited case series, the studied BCBS demonstrated acceptable surgical outcomes. (10.1186/s12891-022-05843-3)
  • [L5] To date, no adverse clinical reactions to the patch have been observed, although no randomized clinical trials have been performed. (10.1016/j.arthro.2019.02.006)
  • [L5] The use of strut grafts is safe and beneficial in a selected group of patients with major femoral deficiencies, provided maximum stability is achieved at the time of surgery through careful implant selection and insertion. (10.1016/j.arth.2020.11.027)
  • [Paper] The combination of an allograft reinforced by a free vascularized fibula promotes initial and long-term mechanical stability with few complications, in particular of mechanical order. (10.1016/j.otsr.2010.02.003)
  • [L5] New implants must withstand vigorous challenges, and future extensive and long-term studies can enable improved implants using human tissue. (10.1016/j.arthro.2019.05.001)
  • [L4] A longer follow-up is necessary to assess and confirm the superiority of this pediatric reconstruction technique. (10.1016/j.otsr.2015.06.027)
  • [L5] No single alternative graft material provides all three components for bone regeneration, and clinical applications for substitutes are dictated by their particular structural and biochemical properties. (10.5435/00124635-199501000-00001)
  • [L5] Not all biocomposite anchors are the same; they have different chemical compositions, resorption patterns, timelines, and ability to be replaced by bone. (10.1016/j.arthro.2019.08.023)
  • [L5] Early clinical experience involving reamed autogenous bone graft in the management of nonunion, bone defects, and arthrodesis has been encouraging and has demonstrated the necessary properties to warrant regular consideration of reamed graft for these applications. (10.5435/jaaos-d-16-00512)
  • [L4] Given its outstanding clinical outcomes observed in the current patient series, advocating for this fixation device holds considerable clinical significance in enhancing patients' prognoses. (10.1186/s12891-025-08854-y)
  • [L5] Early recurrence of disease is most common in individuals with Dupuytren's diathesis, and the use of full-thickness skin grafts may be helpful in this setting. (10.5435/00124635-199801000-00003)
  • [L2] Patients are expected to present similar performance at 1 year postoperatively. (10.1007/s00167-020-06029-x)
  • [L4] Clinical recurrence was related to the electron microscopic findings of myofibroblasts in the nodules and fibroblasts containing prominent microtubules in the fascia, rather than the age of the patient, duration, or severity of disease. (10.2106/00004623-198062030-00012)
  • [Letter] The authors argue that isolated comparison groups are inappropriate due to different patient populations and that postoperative complaints may result from the disease process rather than the surgery. (10.1016/j.arthro.2020.06.034)
  • [L3] The procedure resolved pain, skin dimpling, palpable fibrous bands, and winging of the scapula, with no infections or neuromuscular complications. (10.2106/00004623-199802000-00010)
  • [L5] This review provides a comprehensive overview of different metal artifacts in orthopaedic MRI and factors affecting their magnitude, discussing commonly applied techniques and recent technological advances to facilitate better-informed diagnostic decisions. (10.5435/jaaos-d-24-01057)
  • [L1] Currently, available evidence suggests that direct repair, autograft reconstruction, or allograft reconstruction are all viable treatment options with similar outcomes. (10.1016/j.xrrt.2022.02.007)
  • [L1] Allografts may be comparable to autografts for crucial effectiveness outcomes, but insufficient evidence was found to judge crucial safety outcomes due to poor reporting of safety measures and outcomes. (10.1016/j.asmr.2020.07.017)
  • [L5] Significant differences were found between ultimate failure loads of various suture types and sizes, with new polyblend materials showing distinct mechanical properties. (10.1007/s00167-010-1186-1)
  • [L5] These results suggest that some suture materials may provide a superior alternative to wire for cerclage fixation techniques with select clinical application. (10.1177/1758573217735323)
  • [L4] Biomechanical studies suggest that the humeral head–stabilizing effect of SCR appears to translate into improved clinical outcomes. (10.1016/j.jse.2019.07.005)
  • [L5] The study demonstrates differences between traditional and newer suture materials when tying various types of knots under arthroscopic conditions. (10.1177/0363546509332816)
  • [L3] However, reoperation rates exceed 20%, the vast majority of reoperations being performed for device removal. (10.1186/s12891-022-05075-5)
  • [L3] Severe glenoid cartilage lesions emerged as a contraindication for partial humeral head resurfacing. (10.1016/j.arthro.2019.11.057)
  • [L4] However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue. (10.1177/0363546507306465)
  • [L5] The cement substance, rather than collagen fibers, is the important factor differentiating the bone matrix from other calcifying fibrous tissues. (10.2106/00004623-195234020-00013)
  • [L4] This study demonstrates that labral morphology does not compensate for reduced bony glenoid concavity in clinically stable shoulders. (10.1016/j.jseint.2025.101422)
  • [L3] There are no statistically significant differences at a mean follow-up of 4.05 + 2 years in clinical and functional outcomes of single row arthroscopic RCR using metallic or biodegradable suture anchors for RC < 5 cm. (10.1186/s12891-019-2834-3)
  • [L5] Compared with other suture types, the self-tensioning suture showed dynamic properties, demonstrating a decrease in loop length when soaked in a saline bath. (10.1016/j.asmr.2023.100872)
  • [L5] FiberTape consistently displayed less creep, greater stiffness, and less extensibility than the other suture types. (10.1016/j.arthro.2019.08.048)
  • [L5] This design simplifies implantation, facilitates removal, and avoids the risk of cable tears associated with traditional systems. (10.1007/s00402-003-0594-9)
  • [Letter] The authors apologize for the omission of the Kon et al. coding system and assert that their review aimed to highlight the role of various classifications in improving orthobiologics knowledge rather than favoring one. (10.1016/j.jisako.2023.10.002)
  • [L3] While radiographs showed complete incorporation, patients with diaphyseal implantation experienced pain and increased scintigraphic uptake compared to allografts. (10.1007/s00402-009-0839-3)
  • [L4] Observed differences in knee scores between different study groups that have not been matched for various clinically relevant factors are at least as likely to represent differences in the patient populations as they are to represent differences in the operative technique or the design of the implant. (10.2106/00004623-199706000-00009)
  • [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
  • [L1] Biomechanical studies show that glenoid reconstruction with DTA provides near anatomic reconstruction, leading to increased stability, improved contact area, and decreased loading pressures. (10.1016/j.arthro.2025.05.007)
  • [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. (10.1016/j.jse.2010.05.022)
  • [L5] The size and orientation of the defect has important contributions to glenohumeral joint function. (10.1177/0363546509341576)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L4] Significant previous injury resulting in abnormal mechanics of the shoulder joint was associated with abnormal values for excursion of the instant center and of the humeral head, and an abnormal glenohumeral-to-scapulothoracic ratio was associated with significant pain in the shoulder. (10.2106/00004623-197658020-00006)
  • [L5] Mechanical tests and finite element analysis support the concept of inset glenoid fixation in minimizing the risk of glenoid loosening. (10.1016/j.jse.2011.08.073)
  • [L4] The authors used this method more than 200 times in the past two years with no hematomas requiring drainage, no wound infections, no muscle herniation, and no need for later removal of the wire. (10.2106/00004623-197860030-00030)
  • [L4] The autologous ICBGT procedure biomechanically improves anterior shoulder stability in long-term follow-up whereas the usage of allografts did not show any bone-mediated biomechanical effect at follow-up due to resorption. (10.1016/j.jse.2021.03.029)
  • [L5] While natural coracoid grafts are preferable for intact or minimally compromised glenoids, modified coracoid grafts are more effective in scenarios with bone loss, providing improved biomechanical stability and optimized force distribution. (10.1016/j.xrrt.2025.100608)
  • [L5] Trabecular metal augments provide the surgeon with the ability to reconstruct each absent supporting structure independently with the possibility of biologic fixation. (10.1016/j.arth.2007.01.018)
  • [L3] Both autograft and allograft LCL reconstructions offer reliable and similar radiographic and clinical results, allowing for shared decision-making between surgeon and patient. (10.1177/2325967120s00474)
  • [L4] The study shows that the procedure is efficient in restoring a satisfactory stability for most patients and stabilises the evolution of the degenerative lesions as shown by standing X-ray. (10.1007/s001670050076)
  • [L4] While serious problems persist, the technique allows for osseous union in the majority of cases. (10.2106/00004623-198567010-00013)
  • [L3] Additionally, opioid users had significantly increased rates of periprosthetic radiolucency and revision. (10.1016/j.jse.2021.07.027)
  • [L5] Use of structural allograft bone in spine fusion and other orthopaedic surgical applications continues to increase. (10.5435/jaaos-d-14-00263)
  • [L5] The repair grafts tested all displayed significant variation in their mechanical properties and had at least some reduced parameters compared with human rotator cuff tendons. (10.1016/j.jse.2011.08.045)
  • [L3] The combination of DBM and PRP could serve as a safe bone graft substitute in clinical practice for non-union, achieving low incidence of postoperative complications and satisfactory bony healing rate, though larger and higher quality studies are needed to assess its routine use. (10.1186/s12891-021-04840-2)
  • [L5] Biomechanical testing demonstrated superior suture strength compared with standard suture anchors. (10.1177/03635465010290051901)
  • [Case_report] This report demonstrates that operations involving a nonmassive allograft about the olecranon process may display minimal side effects in comparison to massive allografts, specifically regarding nonunion. (10.1016/j.xrrt.2021.12.006)
  • [L4] To prevent this rare complication, full-thickness iliac-crest bone grafts should be taken from the anterior or posterior portion of the crest rather than the middle. (10.2106/00004623-198365070-00022)
  • [L4] The technique is simple to perform and allows for rotational and angular corrections during reconstruction. (10.5435/jaaos-d-17-00052)
  • [L5] Thus, each merits further study for use in intraoperative fixation of small bone fragments. (10.1186/s12891-025-08498-y)
  • [L5] The clinical relevance is that inserting suture anchors at 90° is recommended due to the significantly larger ultimate failure load in both decorticated and non-decorticated bones. (10.1186/s13018-019-1209-7)
  • [L4] The combined 10-strand repair is stronger biomechanically than its grasping and locking components. (10.1016/j.injury.2011.02.002)
  • [L5] Reconstruction of posterior glenoid bone defects with DTA demonstrated at least equivalent biomechanical properties compared to reconstruction with ICBG. (10.1177/2325967114s00101)
  • [Paper] All patients achieved bone union, and maintained bone union was observed in 95.1% of patients at follow-up visits at least 2 years after treatment, indicating excellent long-term outcomes. (10.1007/s00402-020-03571-8)
  • [L4] Eighteen of nineteen patients were asymptomatic with no evidence of progression of necrosis or collapse at an average follow-up of eight years. (10.2106/00004623-199173090-00011)
  • [L4] Although the ultimate fate of the allografts is not known, the clinical results to date appear to justify continuation of this method of treatment in selected cases in preference to amputation. (10.2106/00004623-197355010-00001)
  • [L4] Optimizing treatment relies on long-term results, careful patient selection, and realistic expectations. (10.2106/jbjs.rvw.16.00001)

See Also

References

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[36] Metal Suppression Magnetic Resonance Imaging Techniques in Orthopaedic and Spine Surgery. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-01057

[37] Outcomes and complications after different surgical techniques for the treatment of chronic distal biceps tendon ruptures: a systematic review and quantitative synthesis. JSES Reviews, Reports, and Techniques. 2022. DOI: 10.1016/j.xrrt.2022.02.007

[38] Comparative Effectiveness and Safety of Allografts and Autografts in Posterior Cruciate Ligament Reconstruction Surgery: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation. 2020. DOI: 10.1016/j.asmr.2020.07.017

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b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.