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SUTURE ANCHORS

One of the most common injuries among athletes is the partial or complete detachment of ligaments, tendons and/or other soft tissues from their associated bones. These injuries occur as a result of excessive stresses placed on these soft tissues. In severe cases of detachment of these soft tissues, surgery might be required to reattach these soft tissues to their associated bones. Numerous fixation devices are currently available to fix these soft tissue to the bones.

Examples include staples, screws, suture anchors and tacks.

Suture Anchor fixation is one of the most important innovations in arthroscopic surgeries. The original suture anchor was reported to be developed over three decades ago. There is mention of suture anchors made from flax, hemp and hair by Sushruta, the ancient Indian Plastic Surgeon (AD c380-c450). Since then, suture anchors have undergone a variety of modifications in terms design, material used, size etc. Suture Anchors are now increasingly used in the surgical repair of full thickness rotator cuff tears as it helps in the effective fixation of soft tissues to the bone. Potential benefits include decreased bone damage.

One end of the suture is tied to the soft tissue and the other end to the device which anchors the suture to the bone.

Suture anchors are made up of:

1. The Anchor – conical screw like structures, which is inserted into the bone and made up of metal or biodegradable material.

2. The Eyelet – This is a loop in the anchor which links anchor to the suture.

3. The Suture – This is a biodegradable or non-absorbable material which is attached to the anchor through the eyelet of the anchor.

Suture anchors are available in various designs, sizes, configurations and materials used. Two main types of Suture anchors are:

1. Bio-absorbable Sutures

Generally used in many of the inner tissues of the body. These sutures are broken down in tissue in ten days to four weeks. These are used in cases where wound heals fast and thus there is no requirement of a foreign material left inside the body.The absorbable suture anchors are the preferred fixation devices as it has least chances of causing post-surgery complications.

Biodegradable suture anchors are now increasingly used for various procedures in sports medicine.

2. Non-absorbable Sutures

There are few cases, where non-absorbable sutures are more apt. These type of sutures are not metabolized by the body. In cases like heart and blood vessels which need more time to heal, use of non-absorbable sutures are appropriate. However, in shoulder surgeries, most of the times the preferred ones are the absorbable suture anchors as the non-absorbable ones have a possibility of causing coconut scraper effect in case of implant dislodgement which might lead to serious arthritic changes due to the scraper effect on the bone. Metal, Plastic type suture anchors are of this type.

Suture anchors have become an invaluable tool for the orthopaedic surgeons.