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Kumar PV, Sugath S, Mohan V, Moharana AK, Angrish S, TS D. Assessing clinical and patient reported outcomes of Sironix suture anchors in rotator cuff and Bankart repair surgeries. World J Orthop 2024; 15:1183-1190. [DOI: 10.5312/wjo.v15.i12.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 11/05/2024] [Accepted: 12/05/2024] [Indexed: 12/17/2024] Open
Abstract
BACKGROUND Rotator cuff tears and Bankart lesions significantly affect shoulder function and quality of life. Arthroscopic rotator cuff repair and Bankart repair has become the standard treatment for restoring function and reducing pain. Recent advancements include new suture anchor technologies, such as the Sironix suture anchor known for its biomechanical strength and promising outcomes. However, there are limited real-world data on its effectiveness and safety, particularly in the Indian population.
AIM To evaluate the effectiveness and safety of Sironix suture anchors in rotator cuff and Bankart repair surgeries.
METHODS Sixty participants underwent surgery between January 2021 and December 2022, and demographic data and postoperative outcomes were collected through retrospective reviews and telephonic interviews. Validated scales, including the PENN Shoulder Score (PSS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Single Assessment Numeric Evaluation (SANE), were utilized for assessment.
RESULTS Treatment with Sironix suture anchor devices, including Ceptre Knotted UHMWPE Suture Titanium Anchor, Spyke Knotted UHMWPE Suture Peek Anchor, Stativ Knotted UHMWPE Suture Anchor, and Viplok Knotless Peek Screw Anchor with Titanium Tip, revealed no repair failures. Participants demonstrated high satisfaction and functional improvement, as evidenced by the mean Quick DASH score (32.01) and PSS (71.65) and the satisfactory SANE scores for both injured joints (74.33) and non-injured (83.67) shoulder joints.
CONCLUSION The study yielded favorable outcomes for rotator cuff tear repair and Bankart repair. No repair failures were observed, supporting the safety and efficacy of these devices in shoulder injury management.
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Affiliation(s)
| | - Subin Sugath
- Department of Orthopedic Oncology, Aster Medcity, Kochi 682027, Kerala, India
| | - Vijay Mohan
- Department of Orthopedics, Aster Medcity, Kochi 682027, Kerala, India
| | - Ashok Kumar Moharana
- Department of Clinical Affairs, Healthium Medtech Limited, Bangalore 560058, Karnātaka, India
| | - Sachin Angrish
- Department of Clinical Affairs, Healthium Medtech Limited, Bangalore 560058, Karnātaka, India
| | - Deepak TS
- Department of Clinical Affairs, Healthium Medtech Limited, Bangalore 560058, Karnātaka, India
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Kurtaliaj I, Hoppe ED, Huang Y, Ju D, Sandler JA, Yoon D, Smith LJ, Betancur ST, Effiong L, Gardner T, Tedesco L, Desai S, Birman V, Levine WN, Genin GM, Thomopoulos S. Python tooth-inspired fixation device for enhanced rotator cuff repair. SCIENCE ADVANCES 2024; 10:eadl5270. [PMID: 38941456 PMCID: PMC11212709 DOI: 10.1126/sciadv.adl5270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/23/2024] [Indexed: 06/30/2024]
Abstract
Rotator cuff repair surgeries fail frequently, with 20 to 94% of the 600,000 repairs performed annually in the United States resulting in retearing of the rotator cuff. The most common cause of failure is sutures tearing through tendons at grasping points. To address this issue, we drew inspiration from the specialized teeth of snakes of the Pythonoidea superfamily, which grasp soft tissues without tearing. To apply this nondamaging gripping approach to the surgical repair of tendon, we developed and optimized a python tooth-inspired device as an adjunct to current rotator cuff suture repair and found that it nearly doubled repair strength. Integrated simulations, 3D printing, and ex vivo experiments revealed a relationship between tooth shape and grasping mechanics, enabling optimization of the clinically relevant device that substantially enhances rotator cuff repair by distributing stresses over the attachment footprint. This approach suggests an alternative to traditional suturing paradigms and may reduce the risk of tendon retearing after rotator cuff repair.
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Affiliation(s)
- Iden Kurtaliaj
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ethan D. Hoppe
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Yuxuan Huang
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - David Ju
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Jacob A. Sandler
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Donghwan Yoon
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Lester J. Smith
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Linda Effiong
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
- Koru Medical Systems, Mahwah, NJ 07430, USA
| | - Thomas Gardner
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
| | - Liana Tedesco
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
| | - Sohil Desai
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
| | - Victor Birman
- Department of Mechanical and Aerospace Engineering, Missouri University of Science and Technology, St. Louis, MO 65409, USA
| | - William N. Levine
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
| | - Guy M. Genin
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Stavros Thomopoulos
- Department of Orthopaedic Surgery, Columbia University, New York, NY 10032, USA
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
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LeVasseur MR, Mancini MR, Williams N, Obopilwe E, Cote MP, Coyner KJ, Arciero RA, Caldwell PE, Mazzocca AD. Ability to Retension Knotless Suture Anchors: A Biomechanical Analysis of Simulated Bankart Lesions. Orthop J Sports Med 2022; 10:23259671221098726. [PMID: 35734768 PMCID: PMC9208049 DOI: 10.1177/23259671221098726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Knotless suture anchors are gaining popularity in arthroscopic glenohumeral labral repairs. The ability to retension knotless designs after initial anchor placement has been reported; however, no studies have quantified this claim or investigated the biomechanical consequence of retensioning. Purpose/Hypothesis: To determine whether knotless and knotted suture anchors have biomechanical or anatomic differences with regard to labral repairs and to determine whether retensioning of knotless suture anchors affects capsular tension, labral height, and capsular shift. We hypothesized that retensioning of knotless anchors would result in improved capsular tension compared with conventional knotted suture anchors. Study Design: Controlled laboratory study. Methods: A total of 18 fresh-frozen cadaveric shoulders with a mean age of 56 years were dissected to the capsule and disarticulated at the humeral capsular insertion. The scapula was potted and placed in a custom shoulder simulator to tension the capsule via braided sutures localized to the anteroinferior glenohumeral ligament. Specimens were randomized into 3 groups: (1) Knotted (KT), (2) Knotless with end retensioning (KLend), and (3) Knotless with stepwise retensioning (KLstepwise). All repairs were completed using all-suture anchors placed at the 5-, 4-, and 3-o’clock positions. KLstepwise was used to simulate an intraoperative technique. Resultant mean capsular tension under 5 mm of displacement (subfailure loading) was measured for each anchor placement and retensioning step. Labral height and capsular shift were measured using a MicroScribe digitizer. Results: The intact, defect, 1-anchor, 2-anchor, and 3-anchor tensions were not significantly different between the KT and KLend groups. For the latter, retensioning of all knotless anchors increased capsular tension by 2.1 N compared with its 3-anchor state, although this was not statistically significant (P = .081). The KLstepwise group explored an alternative method to retension the capsule using knotless anchors, with similar final capsular tensions compared with the other groups. All repairs had similar improvements in capsulolabral height and superior capsular shift. Conclusion: Knotted and knotless suture anchors provided similar overall restorations in anteroinferior glenohumeral ligament tension. However, knotless devices were capable of small but statistically insignificant improvements in capsular tension with retensioning. Clinical Relevance: Retensioning of knotless anchors allows the surgeon to tighten regions of the glenohumeral capsule that remain lax after repair.
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Affiliation(s)
- Matthew R LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Michael R Mancini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Nicholas Williams
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Katherine J Coyner
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Robert A Arciero
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Paul E Caldwell
- Tuckahoe Orthopaedics, Richmond, Virginia, USA.,Orthopaedic Research of Virginia, Richmond, Virginia, USA
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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Rajagopalan S, Bellal Sridharan R, Ravi N. Surgical Technique of Arthroscopic Transosseous Implant-Less Rotator Cuff Repair Using "Arthrocuff" System. Arthrosc Tech 2022; 11:e833-e839. [PMID: 35646580 PMCID: PMC9134680 DOI: 10.1016/j.eats.2021.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/27/2021] [Indexed: 02/03/2023] Open
Abstract
Rotator cuff tears remain one of the most common causes of shoulder pain and disability. Although many repair techniques like single-row, double-row, and transosseous equivalent repair have become popular, transosseous repair still remains the gold standard. Arthroscopic transosseous repair is a safe and affordable alternative to suture anchors. Considering this fact, a reusable instrumentation "ArthroCuff", was developed by SpowerN Medical Equipment (Chennai, India) in collaboration with the National Hub for Healthcare Device Development, India. Arthrocuff system not only aids a robust transosseous rotator cuff repair, but it is also cost-effective. We present the video technique of Arthrocuff for rotator cuff repair.
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Affiliation(s)
- Senthilvelan Rajagopalan
- Department of Shoulder and Upper Limb Surgery, MIOT International, No. 4/112, Manapakkam, Chennai, India,Address correspondence to Senthilvelan Rajagopalan, F.R.C.S. (Tr. & Orth.), Clinical Lead, Shoulder and Upper Limb Surgery, MIOT International, Chennai, India, 600089.
| | - Rajsirish Bellal Sridharan
- Department of Shoulder and Upper Limb Surgery, MIOT International, No. 4/112, Manapakkam, Chennai, India
| | - Nehru Ravi
- Department of Orthopedics, Sri Narayani Hospital and Research Center, Thirumalaikodi, Vellore, Tamil Nadu, India
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Comparison of Occurrence of Bone Tunnel Laceration, Clinical Results, and Cuff Repair Integrity of Transosseous Arthroscopic Rotator Cuff Repair With and Without Lateral Cortical Augmentation. Arthrosc Sports Med Rehabil 2021; 3:e981-e988. [PMID: 34430876 PMCID: PMC8365204 DOI: 10.1016/j.asmr.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 02/10/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose To compare the occurrence of bone tunnel laceration, the short-term clinical results, and cuff repair integrity of transosseous arthroscopic rotator cuff repair (ARCR) using a tunneling device, with and without lateral cortical augmentation. Methods A retrospective review of patients who underwent transosseous ARCR from May 2012 to December 2017 was conducted. The inclusion criterion was repairable medium- to massive-sized full-thickness rotator cuff tear. This study included 2 consecutive series of patients undergoing transosseous ARCR with and without lateral cortical augmentation, called the ITO method and AT method, respectively. The incidence of bone tunnel laceration was evaluated intraoperatively. Patients were assessed through a range of motion and Constant scores preoperatively and at final follow-up. Further, magnetic resonance imaging was performed at 24 months postoperatively to examine the repaired rotator cuff integrity. Results A total of 121 subjects were included: 33 in the AT group and 88 in the ITO group. The intraoperative bone tunnel laceration occurrence rate was 67% and 4% for the AT and ITO methods, respectively; the difference was significant (P = .001). Anatomic failure rate (Sugaya Ⅲ, Ⅳ, and Ⅴ) rate for medium- to large-sized tears was significantly lower for the ITO than for the AT method (29% vs 65%, P = .004), but not for massive tears (61% vs 69%, P = .515). The mean forward elevation, abduction, external rotation, internal rotation, and Constant score were significantly improved at final follow-up from preoperative values. There were no significant differences between the 2 methods. Conclusions Transosseous ARCR using a tunneling device with and without lateral cortical augmentation is a reliable method of improving clinical results at a minimum follow-up of 2 years. The intraoperative occurrence rate of bone tunnel laceration occurrence rate and the anatomic failure rate of medium- to large-sized cuff tear were lower with lateral cortical augmentation than without it. Level of Evidence Level Ⅳ, therapeutic cases series.
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Zhang Q, Qiao Y, Li C, Lin J, Han H, Li X, Mao J, Wang F, Wang L. Chitosan/gelatin-tannic acid decorated porous tape suture with multifunctionality for tendon healing. Carbohydr Polym 2021; 268:118246. [PMID: 34127225 DOI: 10.1016/j.carbpol.2021.118246] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/31/2021] [Accepted: 05/19/2021] [Indexed: 12/28/2022]
Abstract
The inferior tendon healing after surgery is inextricably linked to the surgical suture. Poor load transfer along the suture often results in a high tendon re-tear rate. Besides, the severe inflammation and infection induced by sutures even cause a second surgery. Herein, to alleviate the above-mentioned issues, a multifunctional suture was fabricated by decorating chitosan/gelatin-tannic acid (CS/GE-TA) on the porous tape suture. The porous tape suture ensured the required mechanical properties and sufficient space for tissue integration. Compared to the pristine suture, the CS/GE-TA decorated suture (TA100) presented a 332% increase in pull-out force from the tendon, indicating potentially decreased re-tear rates. Meanwhile, TA100 showed superior anti-inflammatory and antibacterial performances. In vivo experiments further proved that TA100 could not only reduce inflammatory action but also facilitate collagen deposition and blood vessel formation. These results indicate that the multifunctional sutures are promising candidates for accelerating tendon healing.
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Affiliation(s)
- Qian Zhang
- Key Laboratory of Textile Science and Technology of Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China; Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Yansha Qiao
- Key Laboratory of Textile Science and Technology of Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China; Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Chaojing Li
- Key Laboratory of Textile Science and Technology of Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China; Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Jing Lin
- Key Laboratory of Textile Science and Technology of Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China; Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Hui Han
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Xiaoli Li
- Key Laboratory of Biomedical Materials and Implants, Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, China
| | - Jifu Mao
- Key Laboratory of Textile Science and Technology of Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China; Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China.
| | - Fujun Wang
- Key Laboratory of Textile Science and Technology of Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China; Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Lu Wang
- Key Laboratory of Textile Science and Technology of Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China; Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China.
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Abstract
Although open transosseous repair was historically used as a gold-standard surgical solution for rotator cuff tears, this procedure was largely replaced by anchor-based techniques because of the advancement of arthroscopic surgery. However, the ability of anchor-based repair to achieve similar biomechanical fixation remains uncertain. Despite the proposals of numerous methods over the last decade, there remains demand for a standard, reliable technique that integrates the biomechanical advantages of transosseous fixation within the realm of arthroscopy. We describe a technique for transosseous rotator cuff repair using the Omnicuff, a needle-based transosseous suture-passing device that minimizes the risk of failure of suture passage between the bone tunnels. With potential advantages of this design including automated-assisted suture passage, improved bone-tendon healing, and anchorless fixation, surgeons may be inclined to consider these biomechanical and cost-saving benefits. Future studies are warranted to determine clinical outcomes of this technique and its suitability for tears of varying degrees and patterns.
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Abstract
Transosseous repair has been used safely and effectively for primary and revision rotator cuff repair for decades; as a result, it is considered by many the historical gold standard of open repair techniques. Transosseous repair offers the advantage of excellent biology, double-row anatomic footprint reconstruction, and the ability to create multiple low-cost fixation points per surface area of tendon with high-strength suture, while avoiding anchor pullout, cyst formation, and imaging artifact. More recently, in arthroscopic applications, transosseous-equivalent anchor-based repairs have been introduced that have shown satisfactory clinical and biomechanical results; however, these attributes have been coupled with increased cost, nonbiologic burden to the healing interface of the tendon, and new catastrophic failure modes including tendon transection, anchor pullout, and bone voids. This article delineates a technique for arthroscopic true transosseous hybrid cuff repair that combines the use of anchors and transosseous techniques to maximize the benefits and minimize the detriments of both techniques. Level 1 (shoulder); level 2 (rotator cuff).
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Affiliation(s)
- Brett Sanders
- Address correspondence to Brett Sanders, M.D., Center for Sports Medicine, 2415 McCallie Ave, Chattanooga, TN 37404, U.S.A.
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Gasbarro G, Neyton L. The Arthroscopic "Montgolfier Double-Row Knotless" Rotator Cuff Repair Technique. Arthrosc Tech 2019; 8:e669-e674. [PMID: 31467835 PMCID: PMC6713846 DOI: 10.1016/j.eats.2019.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/25/2019] [Indexed: 02/03/2023] Open
Abstract
Contemporary arthroscopic double-row suture anchor rotator cuff repairs have superior biomechanics compared with prior iterations. Numerous techniques have been described, but consensus regarding value has yet to be established. We describe an effective and easily reproducible technique: the arthroscopic "Montgolfier double-row" repair technique. This knotless construct has an evenly distributed, load-sharing, radially oriented suture limb configuration much like the envelope cables of a Montgolfier hot-air balloon, its namesake. Other advantages include the ability to apply manual, progressive and calculated tension on each suture limb and easy intraoperative modification depending on tear size, shape, and delamination, as well as tissue tension and quality. Future studies are needed to validate the biomechanics and clinical outcomes of this technique.
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Affiliation(s)
- Gregory Gasbarro
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Lionel Neyton
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopedique Santy, Lyon, France,Address correspondence to Lionel Neyton, M.D., Centre Orthopedique Santy, 24 Avenue Paul Santy, 69008, Lyon, France.
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