Bodybuilders are uniquely at risk of shoulder injuries given training intensity, frequency, and heavy overhead loads through a full arc of motion. Latissimus tears are rare injuries that have increased incidence in overhead and weightlifting athletes, following forceful hyperabduction/adduction during sport-specific activities. Humeral avulsions of the latissimus tendon are treated with endosteal button fixation. Endosteal button repair is indicated for acute or chronic latissimus tears up to 2 years after injury, in patients who are unable to return to their desired level of competition or activities of daily living. Retracted tears or repairs under significant tension are often salvageable given the latissimus tendon's ability to stretch, and concurrent teres major injury may be addressed in a similar fashion. Latissimus repair entails posterior axillary dissection of the tendinous stump, identification and protection of the radial nerve intersecting the common brachial artery, tagging the tendon with polyethylene suture tape, and reduction to the footprint with endosteal buttons. Key steps of the technique involve protecting the neurovascular bundle and restoring the 90° turn of the tendon before inserting it on the humerus. Latissimus repair has excellent patient-reported outcomes and return to elite competition in 2 prior case series of professional overhead athletes. Our patient was able to return to amateur bodybuilding without persistent pain or strength deficit. Bodybuilders are at a unique risk of latissimus tendon ruptures given their high-demand training. Here, we present our best practices for endosteal button fixation in this unique population of athletes. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
The Latarjet procedure is the most commonly used technique for recurrent anterior instability with significant bone loss. However, the screws used to fix the coracoid are the major risk for postoperative complications including screw penetration and glenoid articular cartilage damage, prominence and impingement of the screw head onto the humeral head, and metalwork breakage. The use of suture-button and cerclage fixation can significantly decrease this risk but has been primarily designed for arthroscopic use. We describe an open Latarjet technique using a modification of suture-button fixation that does not require any additional specialized instrumentation. This allows surgeons who currently undertake an open Latarjet procedure to easily transition to suture-button fixation with a minimal change to their established technique.
The guided arthroscopic Latarjet procedure with double suture-button fixation has emerged as an alternative to traditional open or arthroscopic screw fixation technique for treating anterior shoulder instability in patients at high risk of recurrence. The purpose of this study was to analyze the learning curve (LC), clinical outcomes, computed tomography findings, and complications associated with this technique by evaluating the first 80 consecutive cases performed at 2 institutions. This retrospective cohort study analyzed prospectively collected data from 80 patients (mean age 27.3 ± 7.7 years) who underwent this technique for traumatic anterior shoulder instability between 2017 and 2024. Patients were divided into 2 groups (Group A: first 40 cases; Group B: subsequent 40 cases) based on cumulative sum analysis of operative time. The LC was assessed by comparing operative time and complication rates between groups. Clinical evaluation included Subjective Shoulder Value and Rowe scores. Computed tomography scans were used to assess graft positioning and healing. Minimum clinical follow-up was 6 months (mean 27 ± 20 months). Operative time decreased significantly from 167 minutes in the first 40 cases to 110 minutes in the most recent 40 cases (P < .001). At final follow-up, mean Subjective Shoulder Value was 91.2% and mean Rowe score was 94 points. Optimal graft positioning was achieved in most cases in the sagittal and axial planes (subequatorial: 87.5%; flush: 92%). Graft rotation was observed in 29% of cases during the LC. Radiographic graft healing within the first 6 months was 68%. The main intraoperative problem was conversion to open procedure (5%), all in Group A. The rate of adverse events (problems and complications) decreased from 20% in the early cohort to 12.5% in the late cohort. Reoperation and redislocation rates were 3.7% and 2.5%, respectively. No hardware-related complications were observed. The arthroscopic Latarjet using double suture-button fixation provides satisfactory short- to medium-term clinical outcomes and reliable graft positioning, with operative time decreasing significantly after 20 cases. Although graft rotation and delayed healing may be observed in some cases, they do not appear to affect clinical outcomes. The guided nature of this technique and the use of a low-profile endobutton device reduce the adverse events rate (problems and complications) and eliminate hardware-related morbidity and reoperations. Based on these findings, surgeons with adequate arthroscopic experience who are considering adopting the arthroscopic Latarjet may regard this technique as an accurate, reproducible, and reliable alternative to traditional screw fixation.
Surgical stabilization of the acromioclavicular joint can be achieved using a variety of techniques. Coracoclavicular fixation with tapes, sutures, and button systems is one of the surgical methods used to restore stability of the acromioclavicular joint. There is currently no definitive superior technique for acromioclavicular joint fixation, and complications such as loss of reduction and implant-related issues remain a concern. The purpose of this Technical Note is to describe a reproducible surgical technique for acromioclavicular joint stabilization that employs a tensionable coracoclavicular button system augmented with cerclage suture tapes. This construct allows for precise tensioning, improved stability, and the potential to minimize the need for additional fixation or hardware removal.
Flexor digitorum profundus (FDP) avulsion injuries require secure tendon fixation within the limited footprint of the distal phalanx to achieve strong tendon purchase while minimizing tendon trauma, while osseous compromise remains a surgical challenge. We propose a novel surgical technique for FDP avulsion repair using a baseball suture configuration, a single transosseous bone tunnel, and dorsal pullout button fixation. The tendon is secured with a multi-pass baseball suture technique and advanced through a single bone tunnel in the distal phalanx, thereby providing stable fixation while minimizing osseous disruption. A protective interface is interposed beneath the dorsal button to reduce pressure-related complications at the nail apparatus. This approach is designed to improve tendon purchase while reducing tendon penetrations and minimizing osseous disruption. The accompanying images are derived from a cadaveric specimen to enhance visualization of the described technique. This method represents a simple and reproducible option for FDP avulsion repair, offering potential mechanical and practical advantages. Further biomechanical and clinical studies are required to validate its effectiveness.
To evaluate patient reported outcomes following combined ACJ stabilization using a clavicle hook plate and coracoclavicular augmentation with double-button fixation. This retrospective case series analyzed prospectively included all patients who underwent surgical treatment for isolated grade III or V acromioclavicular joint (ACJ) dislocation between 2021 and 2024. Inclusion criteria comprised age between 18 and 60 years and a minimum follow-up of 2 years. Associated traumatic injuries or fractures, and chronic cases defined in excess of more than three weeks from injury to surgery, were excluded. Clinical outcomes were assessed using the QuickDASH and Simple Shoulder Test (SST) scores. Twenty-three patients (mean age 48.3 ± 10.2 years; mean follow-up 27.7 ± 2.8 months; n = 17 Type V, n = 6 Type III) were included. The mean preoperative QuickDASH score of 56.6 improved to 1.2 at 24 months, with 87% achieving MCID and SCB by 6 months and 100% reaching all clinical thresholds by 12 months. The mean SST score improved from 33.0 to 100. All patients reached MCID, SCB, and PASS by 12 months. Hook plates were removed at a mean of 5.6 months; four required early removal at 3 months due to pain and limited function. Two patients had mild superficial wound infections. Combined suture button and hook plate fixation in acute acromioclavicular joint dislocations results in excellent patient-reported outcomes, with return to normal shoulder function by 12 months. At six months, all patients met thresholds for MCID and SCB on the Simple Shoulder Test, while 87% achieved both benchmarks on the QuickDASH, indicating a high rate of clinically meaningful recovery. Level IV; Case series.
Syndesmotic fixation in ankle fractures remains controversial. Hybrid fixation combines a suture button device and a syndesmotic screw, but comparative evidence remains limited. This study compared hybrid, suture button (SB), and screw fixation in isolated Danis Weber type B or C fibular fractures requiring syndesmotic stabilization. This single-center retrospective cohort study evaluated 90 patients. Groups were Hybrid (n = 28), SB (n = 31), and Screw (n = 31). The primary endpoint was 6-month Olerud Molander Ankle Score (OMAS). Secondary outcomes included visual analog scale (VAS) score, serial OMAS values, 12-month ankle range of motion (ROM), radiographic measurements, and complications. Six-month OMAS did not differ significantly among groups (Hybrid 82.32 ± 7.51, SB 79.35 ± 9.29, Screw 77.10 ± 8.24, P = .091). Plain radiographic measurements were similar throughout follow-up. At 12 months, operated to intact ROM percentage was higher in the SB group than in the Screw group (82.69% ± 9.77% vs 79.54% ± 7.71%, adjusted P = .049). The difference was small, approximately 3.15 percentage points, corresponding to 2.68° of operated-side total ROM. Complication rates remained similar, including and excluding screw breakage (P = .495 and P = .361). Hybrid fixation was not associated with significantly higher 6-month OMAS compared with SB or screw fixation. Because this study was powered for a large effect and was not designed for noninferiority or equivalence, smaller group differences cannot be excluded. The proportion of patients achieving the OMAS MCID threshold was higher in the Hybrid group (85.7%) than in the SB and Screw groups (both 32.3%), reflecting larger within-group score improvement from 12 weeks to 6 months rather than differences in absolute 6-month scores; the clinical significance of this finding is uncertain. The small ROM percentage difference favoring SB over screw fixation was hypothesis generating and of uncertain clinical relevance. These findings suggest that hybrid fixation is a clinically usable option, but future prospective studies should clarify whether combined dynamic and static stabilization offers added value in selected fracture patterns, instability profiles, or patient subgroups. Level III, retrospective cohort study.
Fuzz buttons are formed by interweaving and compacting fine metallic wires, resulting in a highly porous architecture with complex internal contact interactions. Their compressive behavior is governed by the evolution of wire-wire contacts, frictional sliding, local bending, and plastic deformation, which cannot be adequately captured by conventional homogenized models. To address this limitation, a process-informed finite element modeling approach based on virtual fabrication is proposed. First, the spatial trajectories of 24 beryllium copper wires are generated using a parametric three-dimensional weaving algorithm and smoothed by cubic spline interpolation to obtain continuous wire centerlines. The resulting preform is then virtually compacted to reconstruct the densified wire network and its contact topology. The model employs a globally controlled solid-element mesh, a penalty-based general contact algorithm, a Coulomb friction model, and an explicit quasi-static solution scheme. The size-dependent plastic response of the fine wires is further incorporated through a Nix-Gao-based correction to the constitutive relation. The model is validated against quasi-static compression experiments at compressive strains of 15%, 20%, and 25%. The relative errors in the predicted peak forces are 2.12%, 5.65%, and 6.81%, respectively, while the corresponding coefficients of determination for the force-displacement curves are 0.984, 0.970, and 0.973. The model successfully reproduces the nonlinear loading-unloading response and hysteretic energy dissipation over the investigated strain range. The proposed approach provides a physically grounded numerical framework for predicting the compressive behavior of fuzz buttons and investigating the mesoscopic mechanics of complex interwoven wire networks.
Recurrent posterior shoulder instability associated with posterior glenoid bone loss remains challenging. Arthroscopic bone block procedures have gained popularity due to their minimally invasive nature and their ability to restore glenoid concavity while addressing associated intra-articular pathology. We describe a fully arthroscopic posterior glenoid bone block technique using a tricortical iliac crest autograft fixed with independent cortical buttons from the Glenoid Bone Loss-Advanced Instability System (Smith & Nephew Andover, MA, USA). A commonly available anterior glenoid guide is used with an adapted posterior application. The technique emphasizes meticulous posterior capsulolabral mobilization, preparation of a bleeding posterior glenoid bone bed, direct visualization for accurate tunnel placement, progressive independent button tensioning, and posterior capsulolabral reconstruction, leaving the graft extra-articular.
Acromioclavicular joint injury reconstructive options include a wide number of described techniques. Although no single technique has consistently demonstrated superior clinical outcomes in the literature, there are theoretical biomechanical benefits to a combined reconstructive technique using cortical suture button and semitendinosus allograft. This review describes an acromioclavicular joint reconstruction using a cortical suture button and semitendinosus allograft.
We describe a modified technique for anterior cruciate ligament (ACL) repair in skeletally immature patients with the bridge-enhanced ACL restoration (BEAR) implant (Miach Orthopaedics) utilizing an arthroscopic, all-epiphyseal approach. This technique uses a button on the proximal tibial epiphysis and an extra-articular knotless anchor on the lateral femoral epiphysis to hold the ACL repair sutures and ACL seatbelt sutures. The all-epiphyseal approach is advantageous for BEAR in skeletally immature patients, preserving the physis and minimizing potential complications. Additionally, this technique facilitates delivery of the BEAR implant by blunt tip syringe under arthroscopic guidance, eliminating the anteromedial arthrotomy for manual implant insertion.
Chronic lateral ankle instability (CLAI) with concomitant syndesmotic injury presents a complex challenge for elite athletes. The arthroscopic modified Broström procedure (AMBP) is the gold-standard surgical treatment for CLAI, and suture button fixation (SBF) is an effective method for dynamically stabilizing the syndesmosis. To evaluate functional outcomes and return-to-sport (RTS) metrics and identify prognostic factors after combined AMBP and SBF in this specific population. Case series; Level of evidence, 4. A total of 70 elite athletes with CLAI and a confirmed syndesmotic injury who underwent AMBP and SBF between January 2021 and June 2023 were prospectively enrolled. Outcomes included the Foot and Ankle Outcome Score (FAOS), Karlsson-Peterson score, mean time to RTS, RTS rate, ankle range of motion (ROM), and complication rates. Weightbearing computed tomography was analyzed to measure anatomical parameters, including anterior, posterior, and maximum tibiofibular distances (ATFD, PTFD, maxTFD), angle of fibular rotation (AFR), and syndesmotic area (SA). Univariate and multivariate regression analyses identified factors associated with improvement in FAOS (Δ-FAOS). A total of 68 patients (68 ankles [97.1%]), with a minimum 2-year follow-up, were included in our analysis. The mean time to unrestricted RTS was 53.2 ± 14.7 days, with a 98.5% (67/68) successful RTS rate. All FAOS subscales and the Karlsson-Peterson score demonstrated significant improvements from baselines (P < .001). Ankle ROM was restored to symmetry in all patients. One patient (1.5%) experienced transient superficial wound irritation. Univariate analysis indicated that Δ-FAOS was associated with sex, reduction in body mass index (BMI) (ΔBMI), duration of symptoms before surgery, and preoperative PTFD, maxTFD, AFR, and SA. Multivariate analysis confirmed that a greater reduction in BMI (P = .032; β = 1.8; [95% CI, 1.1-3.1]) and a smaller preoperative SA (P = .018; β = -0.7 [95% CI, 0.5-0.9]) were independent predictors of greater Δ-FAOS. Our study demonstrated that the combined AMBP and SBF procedure may facilitate rapid, successful RTS, with satisfactory patient-reported outcomes and a low complication rate among elite athletes. Preoperative SA and postoperative weight management (ΔBMI) may be significant prognostic factors for optimal clinical outcome.
Tensioning and relaxation of grafts in tendon and ligament reconstruction surgeries significantly influence operation success, yet there are no clinically available technologies that can effectively measure both graft tension intra-operatively and during post-surgical recovery and rehabilitation. To address the lack of an effective technology to measure graft tension intra-operatively and post-operatively, an implantable sensor was developed to provide real-time suture loading biofeedback both during reconstruction for surgeons and during rehabilitation exercises for physical therapists. This paper introduces a passively powered wireless sensor designed to monitor tension of tendon and ligament sutures fixed in orthopedic reconstruction surgeries. The inductive-capacitive-resistive (LCR) based sensor was designed to be used along with commercially available suture buttons to monitor loading in reconstructed tendons and ligaments. Sensor loading experiments demonstrated a detection range from 5 N to 180 N with high repeatability (1.8 % change in sensitivity over 10,000 cycles). Additionally, the effects of depth, alignment, and orientation on signal transmission between the implantable sensor and an external detection device were characterized. Finally, the sensor was deployed in an anterior cruciate ligament reconstructed cadaver knee and used to detect graft loading during various knee joint movements. This study established the design and basic functionality of a suture button accessory loading sensor to potentially assist orthopedic surgeons with surgical technique and help physical therapists with optimizing rehabilitation protocols for enhanced recovery in an effort to reduce failure rates.
[This corrects the article DOI: 10.1016/j.jcot.2026.103427.].
Distal biceps tendon ruptures significantly impair forearm flexion and supination strength, particularly in active individuals. Suspensory fixation using cortical button devices is a widely accepted surgical approach. Adjustable-loop techniques allow maximal tendon-to-bone apposition, while fixed-loop methods are simpler but may leave a gap. Biomechanical differences between these techniques specific to the distal biceps tendon remain poorly investigated, especially given the unique loading patterns of the elbow compared to other joints. Finite element analysis was performed using ANSYS software. Three-dimensional models of the radius and distal biceps tendon were constructed from computed tomography data. Three configurations were compared: Model 1 (adjustable-loop with dense tendon-to-bone contact, 0 mm gap), Model 2 (fixed-loop with 1.0 mm gap), and Model 3 (fixed-loop with 5.0 mm gap). Cortical bone, tendon, suture, and titanium button properties were assigned based on literature values. A 500 N tensile load was applied at the proximal tendon boundary simulating 90° elbow flexion. Stress, strain, and displacement distributions were analyzed in the fixation system and tendon. Maximum tensile stresses in the fixation system were lowest in Model 1 (353 MPa) compared to Model 2 (407 MPa, + 15%) and Model 3 (423 MPa, + 20%). Tendon maximum stresses were similar across models (170-175 MPa), exceeding ultimate tendon strength only at isolated concentration nodes. Maximum strains in the fixation system followed the same pattern: 0.29 (Model 1), 0.33 (Model 2), 0.35 (Model 3). Maximum tendon displacements (d_t) were 5.4 mm (Model 1), 5.7 mm (Model 2), and 6.9 mm (Model 3), primarily due to suture elongation. The 90th percentile stresses (σ_P90) and strains (ε_P90) remained consistent across configurations. The superior biomechanical performance of the adjustable-loop technique primarily reflects its ability to achieve zero tendon-to-bone gap rather than the loop mechanism itself. Suspensory fixation with zero tendon-to-bone gap (achieved by adjustable-loop technique) demonstrated superior biomechanical performance, exhibiting lower peak stresses, strains, and displacements in the fixation system compared to fixed-loop techniques with gaps. These findings suggest improved construct stability with zero-gap apposition. Further in vitro cyclic loading studies and clinical validation are required.
The increasing global demand for affordable, nutrient-dense plant-based foods highlights the need to valorize underutilized legumes through suitable processing technologies. This study developed extruded chunk products from blends of fermented and unfermented pigeon pea (Cajanus cajan L.) flour, button mushroom powder, and cassava starch at ratios of 90:2.5:7.5, 90:5.0:5.0, and 90:7.5:2.5 (w/w/w) using a single-screw extruder. Button mushroom powder was incorporated to increase dietary fiber and mineral content due to its abundance of β-glucans and chitin, whereas cassava starch served as a texturizing and binding agent, promoting melt cohesion and expansion during extrusion. Optimal processing conditions were 13-15% feed moisture and a barrel temperature gradient of 100-140 °C. Fermentation significantly improved textural properties, increasing hardness (up to 22,802 g) and crispness (up to 55,099 g/s), likely due to protein modifications that enhanced matrix formation. In contrast, unfermented samples exhibited higher water holding capacity (264-286 g/100 g). All formulations showed low water activity (0.426-0.524), indicating good shelf stability. Protein content remained consistent (18.80-19.45%), while crude fiber ranged from 18.15 to 21.80%. These results showed that the integration of fermentation and extrusion provides an effective, low-cost approach for improving the structural, nutritional, and storage properties of pigeon pea-based products, supporting the development of nutrient-dense plant-based foods industry that are acceptable and sustainable, thereby supporting sustainable agriculture.
Light is the primary stimuli for the entrainment of human circadian rhythms and holds enormous potential in aiding precision medicine. Laboratory studies highlight the roles of photic history, intensity, spectrum, and timing, but field translation gets complicated by real-world confounds. Measuring daily light exposure in realistic conditions requires an accurate, durable, and affordable wearable light dosimeter. Here, the spectral, spatial, and thermal performance of three wearable dosimeters (LYS Buttons, Blue Iris Specks, and Actiwatch Spectrum Plus) are investigated and benchmarked against a calibrated spectroradiometer under multipole lighting conditions. Light measurements taken by dosimeters under various lighting conditions are then used to calculate melanopic and photometric measures. The LYS Button was the easiest to use, albeit with reduced accuracy. The Blue Iris Speck had the highest photometric and data-logging accuracy. The Actiwatch had the poorest photometric performance, which raises caution for scientific use. The results inform device development and protocol design for chronobiology and sleep research. Future studies should evaluate and compare the performance of the dosimeters based on body-worn position.
Instrument tuning is crucial for the performance quality of orchestral concerts. In most cases, the standard pitch is usually given by the oboist, and then the rest of the orchestra adjusts their instruments to match it. However, in the individual training scene, music instrument players often rely on a piano or a pitch pipe for the standard pitch. The piano is not portable, and the pitch pipe could be inaccurate. Therefore, a portable, accurate and user-friendly tuning device is urgently required. In this work, we sought to design a wearable music ring using high-performance PVDF/BCZT composites to stimulate the standard pitch when needed anywhere and anytime. In the music ring, there are two core buttons that stimulate and modulate the output voltage and create the standard pitch. To optimize the performance, we constructed a composite structure, with BCZT particles embedded in highly oriented polyvinylidene fluoride (PVDF) fibers. The composite presents an aligned fiber structure, which endows it with high piezoelectricity. It presents sensitivity as high as 0.12 V N-1 and remains stable after 10,000 cycles at 1 Hz. Furthermore, the volume of the standard pitch could be modulated by switching the buttons on the wearable music ring, which meets real application needs. This research presents a protocol showing a typical application of wearable technology, which not only shapes the development of flexible electronics but also redefines the tuning experience for musicians.
Distal tibiofibular syndesmotic instability in Weber B ankle fractures remains challenging, as fixation constructs and insertion parameters alter ankle biomechanics. A 3D finite element ankle model was developed from CT/MRI data of a healthy adult. Residual instability was simulated by transecting the anterior inferior tibiofibular and interosseous ligaments after anatomical reduction and fixation of all malleolar fractures. Eighteen fixation models were created using tricortical screws or suture-buttons, placed 20, 30, or 40 mm above the tibial plafond with anterior tilt angles of 12.5°, 27.5°, or 42.5°. Outcomes included peak tibiotalar contact stress, fibular displacement, and peak implant von Mises stress under axial loading and external rotation. Residual instability increased peak tibiotalar contact stress by 36.8% and markedly increased fibular translation. Fixation at 20-30 mm restored near-physiologic mechanics, while 40 mm fixation showed biomechanical deterioration. At equivalent heights, tricortical screws better restrained fibular translation, whereas suture-buttons preserved more micromotion but had higher implant stress concentrations. Fixation height had a larger biomechanical effect than anterior tilt angle. Fixation 20-30 mm above the tibial plafond is recommended, with construct selection balancing rigidity and physiologic syndesmotic motion.
Our purpose is to report a unique case of Candida interface keratitis that remained quiescent for 3 years after Descemet's stripping endothelial keratoplasty (DSEK), within the endokeratoplasty graft itself, in a patient with underlying uveitis and local immunosuppression from a corticosteroid implant. We describe a 20-year-old woman with a history of congenital glaucoma and secondary corneal edema who exhibited delayed worsening of fungal keratitis requiring treatment 3 years after a DSEK and concurrent fluocinolone acetonide intravitreal implantation. The patient was treated with topical, oral, and intrastromal antifungals without resolution of infection, necessitating a therapeutic penetrating keratoplasty. The corneal button showed Candida lusitaniae infection located between the posterior stroma and Descemet's membrane within the endokeratoplasty graft. This report describes a case of late-developing fungal keratitis 3 years after DSEK that occurred in the graft itself, in the plane between the posterior stroma and Descemet's membrane, rather than between the donor and host cornea. This highlights the importance of maintaining a high index of suspicion for fungal keratitis in patients with persistent or worsening opacities in endothelial keratoplasty grafts.