Komplikationen bei rekonstruktiven arthroskopischen Schulteroperationen

Arthroscopic removal of proud metallic suture anchors after Bankart repair

INTRODUCTION

This study presents an arthroscopic removal technique for proud metallic suture anchor after Bankart repair and analyzes the cause of anchor failures.

PATIENTS

Six male patients with an average age 23 years who had proud anchor on the glenoid surface were included. The diagnosis of six patients at the time of the primary surgery was traumatic anterior shoulder instability. Four patients had arthroscopic repair and two had open Bankart repair previously. Four patients complained of pain accompanying a metallic clicking sound during shoulder motion which increased with abduction and external rotation. One patient had pain with apprehension of dislocation and another patient suffered from only pain. Most symptoms had been revealed during the rehabilitation period (average 8.3 months) and confused with postoperative pain. The protruded anchors were detected through plain radiographs in four patients and during arthroscopic examination in two patients.

METHOD

To extract the proud anchor arthroscopically, a screw driver of a larger diameter than that of the proud suture anchor was used to retrieve the anchor. A larger screw driver was striked with a hammer along the previous suture anchor hole to make a room between the suture anchor and the adjacent glenoid bone so that the hole of the suture anchor became larger. After the hole was widened, the suture anchor had enough room to move freely and it could be removed with a grasper or a mosquito easily. The location of the proud anchor was 2, 3 and 5 o'clock in three patients and 4 o'clock in three patients. In two patients, the suture anchor was malpositioned about 5 mm medial from the anterior glenoid rim. All patients had chondral damage on the humeral head.

RESULTS

Following the procedure none had shoulder instability in 3 years of follow-up. Preoperative visual analog scale score for pain was an average of 3.5. The visual analog scale score for pain was decreased to 1.2 after surgery. All patients had a slight limitation of external rotation preoperatively, and they showed a normal range of motion postoperatively. Constant score improved from 65 to 89, and similarly, American Shoulder and Elbow Society score increased from 67 to 88 after the operation.

CONCLUSION

Despite small numbers of patients, a successful removal of proud metal suture anchors was achieved using a large empty suture anchor screw driver, which is a simple and reproducible method to remove a proud metallic suture anchor arthroscopically.

[Unstable shoulder dislocation]

Shoulder dislocations are a frequent event and the severity is often underestimated. A thorough clinical investigation and adapted imaging diagnostics are able to detect age-dependent injury patterns. A biphasic conservative treatment keeping the arm in a neutral to mild external rotation for 3 weeks has proven to be most effective and should be followed by an intensive physiotherapy. Nevertheless, conservative treatment protocols show unacceptable recurrence rates particularly in young men active in sport, therefore, surgical stabilisation is recommended. In the past open procedures were accepted as the gold standard, but today arthroscopic Bankart repair using suture anchors shows comparable recurrence rates. However, the clinical outcome with respect to the shoulder function is much better without compromising the subscapularis muscle.