Soft-Tissue AnchorsAmol Saxena, DPM

I have recently evaluated my first 100 cases using Mitek l

soft-tissue anchors over the past 5 years. There were170 anchors used for various procedures: 146 GIl, 12Super (G4), 6 Mini, 5 Panalok (new FDA-approved 100%bioabsorbable), and I Fastin (similar to Zimmer Statak-)(Table 1).

Only 1 anchor out of 170 inserted failed when a350-pound lady, in whom I had previously repaired aperoneal retinaculum, stepped in a pothole, sustaining aJones fracture in the process. The reconstructed ligamentwas intact; however, the calcaneal anchor that failed wasinsufficiently placed by me; it was partially inserted intothe calcaneus. Allergic reaction to the titanium requiringremoval was absent. One patient did complain of atransient itching sensation. This could have been due tothe polyester suture. No removals of the anchors havebeen needed to this date. There were a total of six "mis­fires," three with the Mini-Quick anchors. My assumptionwould be that this is statistically significant. I am toldthe inserter for the Mini-Quick anchors is currently beingchanged. One patient noted bony hypertrophy over thebone tunnel on the distal fibula. This problem has beenalleviated by drilling perpendicular to the cortex of hardbone such as the fibula.

TABLE 1 Mltek: 100 cases (170 anchors),11/92-11/97

Anchors~ 1~

Super 12Mini 6Panalok 5Fastin 1

ProceduresAnkle stabilizations 21Achilles/Haglund's 36Posterior tibial/Kidner 19Peroneal retinaculum repair 7Tibialis anterior procedures 5Miscellaneous fore-/rearloot procedures 12

1 Mitek Surgical Products, Inc., 60 Glacier Drive, Westwood, MA 02090.2 Zimmer, P.O. Box 708, Warsaw, IN 46580.

TIPS, QUIPS AND PEARLS

FIGURE 1 Tying a half-knot after engaging the Mitek anchor toeliminate slippage..

One technique I have found extremely useful that Iwanted to share is to tie a half-knot after engagingthe anchor. This eliminates slippage when trying tosuture a structure such as an ankle ligament of poste­rior tibial tendon which needs a desired amount of

VOLUME 37, NUMBER 2, MARCH/APRIL 1998 169

FIGURE 2 Use of Mitek Panalok anchor when repairing an extensively debrided Achilles tendon ..

tension (Fig. 1). I have also seen beneficial affects ofusing the new Panalok anchor with PDS suture whenrepairing an extensively debrided Achilles tendon (intra­tendinously near the insertion) (Fig. 2). I still use nonab­sorbable anchors and suture for the majority of therepair.

170 THE JOURNAL OF FOOT & ANKLE SURGERY

Overall, my feelings are that the soft-tissue anchors nowavailable allow for decreased healing time and thereforeearly return to activity. Also, I feel greater security withdebriding bone and soft tissue, allowing for more appro­priate resection, particularly with retrocalcaneal problems.