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PushLock

Manufactured by Arthrex
Sourced in United States

The PushLock is a surgical implant device designed for use in orthopedic procedures. It is a bioabsorbable tack used to secure soft tissue to bone. The core function of the PushLock is to provide fixation and attachment of soft tissue structures during the healing process.

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15 protocols using PushLock

Twenty-four fresh-frozen human cadaveric ankle specimens, donated to the Department of Anatomy of our university, were used and randomly divided into 4 groups of 6 specimens: group A received complete ATFL section and 1–suture anchor (SutureTak; Arthrex) repair with knot, group B received complete ATFL section and 1-anchor (PushLock; Arthrex) knotless repair, group C received partial ATFL section and 1–suture anchor (SutureTak) repair with knot, and group D received partial ATFL section and 1-anchor (PushLock) knotless repair. The mean ± SD age of the cadavers was 66 ± 7 years (range, 55-78 years), and the age distribution was similar among the 4 groups. The cadavers were stored at –20°C and were thawed at room temperature for 24 hours before use.
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Then, two to three anchors (Pushlock, Arthrex, Florida, USA) (Figure 2B) were implanted in the cartilage surface beside the edge of the glenoid fracture from low to high. Anchor 1 at 6 o'clock was used to reduce and lift the glenoid capsule tissue, and the fracture block was implanted with anchor 2 (Pushlock, Arthrex, Florida, USA) at the ideal reduction point (Figure 2C). A layout around the bone fragment was formed with two anchors screwed inside and outside, with the other two anchors screwed up and down (Figure 2D).
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The same arthroscopic procedure was performed as described above. Approximately 1.5-cm transverse skin incision was made and the ulnar foveal site was approached through the volar capsule. A mattress suture loop using a 2–0 FiberWire (Arthrex, Naples, FL, USA) was established in the same manner as the transosseous pull-out technique. Instead of making a bone tunnel, a 2.5-mm knotless suture anchor (PushLock; Arthrex, Naples, FL, USA) was used to fix the TFCC foveal site avulsion [Figure 4]. After a hole was drilled at the foveal insertion site, both ends of suture strands were passed through the eyelet of the anchor. These were placed into the drill hole with tension and securely fixed by tapping the button on the proximal end of the driver handle to impact the anchor body portion into the bone [Figures 5 and 6].
Long arm cast immobilization with the forearm in the neutral rotation was maintained for 4 weeks. It was substituted by a long arm thermoplastic brace and wrist motion exercise was initiated. The patients were instructed to perform active assisted wrist mobilization and supination/pronation of forearm until the full motion was restored. The patients were permitted to do unrestricted daily activities after 2 months. Sports and heavy work activities were allowed 4 months postoperatively.
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Operative technique was carried out in a Beach-chair position using a standard posterior viewing portal in addition to two anterior working portals in the rotator interval, as described in several publications [23 (link), 39 , 46 (link)].
After a standardized diagnostic arthroscopy, the Bankart lesion was confirmed and evaluated. Using a Bankart-Chisel, the detached labrum, was mobilized and elevated from the anterior glenoid. An arthroscopic rasp or a shaver was used to create a bleeding bed along the glenoid edge. In all patients, a capsular plication was performed in addition. Using a suture passing instrument, a suture was advanced through the capsulolabral complex to be used as a shuttle suture. Drill holes were created on the glenoid at the 3 and 5:30 o’clock position for the right shoulder and the 6:30 and 9 o’clock for the left shoulder. Additional anchors were placed as necessary. According to the extent of the capsulolabral defect, one to four anchors were used: PushLock® (Arthrex), PANALOK® (DePuy) and Lupine® Loop (DePuy).
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Two single loaded medial-row suture anchors (Corkscrew, 5.0 mm, Arthrex, Naples, FL, USA) were placed at an orientation of 45° (dead man’s angle) on the articular margin of the humeral head. The second medial anchor was implanted 1.5 cm posterior to the first one, after which the sutures (No. 2 FiberWire, Arthrex) were threaded through the intact cuff connected to the GT fragments as a mattress suture. The medial mattress sutures were tied first. Two pilot holes for the knotless suture anchors, PushLock (3.5 mm, Arthrex, Naples, FL, USA), were precisely aligned with the medial anchors and approximately 5 mm distal to the lateral edge of the GT fragment. A suture limb from each medial suture anchor was then passed through the PushLock eyelet on the distal end of the driver. With continuous applied force, two PushLock anchors were implanted into the pilot holes using the suture-bridge technique.

Two double-row fixation configurations. a Double-row suture anchor fixation. b Suture bridge technique

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After graft position and stiffness was checked, 2 suture anchors (Pushlock; Arthrex) were used to repair the labrum and anchor the graft. Two sockets were drilled onto the surface close to the anterior edge, usually at the 5- and 3-o’clock positions for the 2.9-mm Pushlocks. The conjoint tendon--sutured Orthocord was passed through the labrum and capsule to the joint and then tightened and fixed to the 5 o’clock Pushlock to prevent rotation of the graft. Another suture anchor was used to repair the upper labrum at 3 o’clock. These 2 Pushlocks provided extra fixation of the coracoid graft by balancing the torque of the conjoint tendon toward the glenoid rim.
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For the tensile testing of the knotless anchor (PushLock Arthrex, Naples, FL, USA), a 3.5 mm drilling guide was placed at the anatomic insertion of the ACL. Beforehand, the two ends of the suture (Fiberwire®, 2/5 metric, 38“ Arthrex, Naples, FL, USA) were passed through the suture clamp, leaving a loop of 3 cm length. Thereafter, the anchor was introduced using the insertion device (Arthrex, Naples, FL, USA) into the drill hole until the marked spot on the introducer was reached. Then, with the gentle use of a hammer, the screw was introduced to secure the loop in the anchor.
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A 16-year-old male high-school swimmer with mixed FAI which was treated with elective arthroscopic rim trimming and femoroplasty. During suture anchor placement via mid-anterior portal for anterosuperior labral refixation, the acetabular articular cartilage was elevated but not penetrated by a 3.5-mm knotless anchor (Push-lock, Arthrex, Naples, FL, USA). The anchor was not removed. The patient had an uneventful post-operative course and eventually resumed asymptomatic competitive swimming and intramural collegiate basketball. His pre-operative non-arthritic hip score (NAHS) was 34 and his latest post-operative NAHS was 89 at 6 years following surgery and radiographs show no joint deterioration or narrowing.
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The primary cultured cells from each flask were trypsin digested and combined. The cells were seeded into 6-well culture plates (Greiner Bio-One, Frickenhausen, Germany) at a density of 1 × 105 cells/well. After incubation overnight, sterile anchors were added to 10 of 12 wells, 2 containing Opus LabraFix (ArthroCare), 2 containing PushLock (Arthrex), 2 containing BioKnotless (DePuy Mitek), 2 containing Suretac II (Smith & Nephew), and the remaining 2 wells with no anchor as control.
One set of plates was then incubated for 48 hours and the other for 72 hours. At each time point, the corresponding plate was removed to perform the light microscopy, trypan blue exclusion assay and 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assay.
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All patients were placed in the lateral decubitus position and underwent
diagnostic arthroscopy utilizing a standard posterior viewing portal and an
anterior working portal within the rotator interval. Concomitant pathology was
noted and addressed on a case-by-case basis to include debridement or repair of
the labrum and rotator cuff.
The location of the capsular tear was carefully assessed, taking note of
continuation to either the humeral or glenoid attachment. All tears were found
within the axillary pouch between the anteroinferior and posteroinferior
glenohumeral ligaments (Figure
1A
). Accessory anteroinferior or posteroinferior portals were placed
to facilitate suture passage. Medially based tears were repaired from lateral to
medial in a “baseball stitch” fashion using a nonabsorbable 1.3-mm tape suture
(SutureTape; Arthrex) successively passed between leaflets using an
appropriately curved 25-degree suture shuttling device (SutureLasso; Arthrex)
(Figure 1B). Suture
limbs were tensioned and then secured at the glenoid insertion with a 2.9-mm
knotless anchor (PushLock; Arthrex) (Figure 1C). Laterally based tears were
repaired in a reverse fashion from medial to lateral with eventual fixation into
the humeral insertion.
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