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Huang B, Yang M, Kou Y, Jiang B. Absorbable implants in sport medicine and arthroscopic surgery: A narrative review of recent development. Bioact Mater 2024; 31:272-283. [PMID: 37637087 PMCID: PMC10457691 DOI: 10.1016/j.bioactmat.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/29/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
Over the past two decades, advances in arthroscopic and minimally invasive surgical techniques have led to significant growth in sports medicine surgery. Implants such as suture anchors, interference screws, and endo-buttons are commonly used in these procedures. However, traditional implants made of metal or inert materials are not absorbable, leading to complications that affect treatment outcomes. To address this issue, absorbable materials with excellent mechanical properties, good biocompatibility, and controlled degradation rates have been developed and applied in clinical practice. These materials include absorbable polymers, absorbable bioceramics, and absorbable metals. In this paper, we will provide a comprehensive summary of these absorbable materials from the perspective of clinicians, and discuss their clinical applications and related research in sport medicine.
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Affiliation(s)
- Boxuan Huang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
| | - Ming Yang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
| | - Yuhui Kou
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
| | - Baoguo Jiang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
- Medical School, Shenzhen University, Shenzhen, 518060, Guangdong, China
- Shenzhen University General Hospital, Shenzhen, 518055, Guangdong, China
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Kreulen RT, Agarwal AR, Nayar SK, Wang KY, Miller AS, Best MJ, Srikumaran U. SLAP repair and bicep tenodesis: a comparison of utilization and revision rates for SLAP tears. JSES Int 2023; 7:290-295. [PMID: 36911775 PMCID: PMC9998736 DOI: 10.1016/j.jseint.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hypothesis The management of superior labrum anterior to posterior (SLAP) tears typically consists of either repair or biceps tenodesis (BT). While repair is more frequently recommended in younger patients, patients older than 40 years are often treated with BT. The purpose of this study is to determine whether there has been a change in utilization of these procedures over the past decade with respect to patient age as well as compare reoperation rates between the two procedures. Methods The Pearldiver database was queried to identify BT and SLAP repairs indicated for SLAP tears performed from 2010 to 2019. The primary outcome was utilization rate, stratified by age. A secondary outcome was 2-year shoulder reoperation rates. Trends were reported in terms of compounded annual growth rate. Outcome analysis was conducted using univariate and multivariable analysis. Results From 2010 to 2019, SLAP repair was the most common procedure performed for SLAP tears. Regardless of age, BT performed for SLAP tear had a significantly increased utilization rate; whereas, SLAP repair had a significantly decreased utilization rate. SLAP repair was more commonly performed in younger patients compared to BT. Following multivariable analysis, patients who underwent SLAP repair had significantly higher odds (odds ratio (OR): 1.453; 95% confidence interval (CI): 1.26-1.68; P < .001) of requiring an arthroscopic reoperation within 2 years when compared to those who underwent BT with no significant difference with respect to 2-year open reoperation. Conclusion Although SLAP repair is still more commonly used to treat SLAP tears than BT, especially for younger patients, the utilization of SLAP repair is decreasing while BT is increasing. The increased utilization of BT may be associated with lower rates of shoulder reoperation for problematic SLAP tears.
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Affiliation(s)
| | | | | | | | | | | | - Uma Srikumaran
- Johns Hopkins Hospital, Baltimore, MD, USA
- Corresponding author: Uma Srikumaran, MD, MBA, MPH, Johns Hopkins Orthopaedic Surgery at Howard County General Hospital, 10700 Charter Drive, Suite 310, Columbia, MD 21044, USA.
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All-suture anchors versus metal suture anchors in the arthroscopic treatment of traumatic anterior shoulder instability: A comparison of mid-term outcomes. Jt Dis Relat Surg 2021; 32:101-107. [PMID: 33463424 PMCID: PMC8073447 DOI: 10.5606/ehc.2021.75027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/18/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study aims to compare metal suture anchors and all-suture anchors clinically and radiologically in arthroscopic Bankart repair. PATIENTS AND METHODS In this retrospective study, 67 patients (61 males, 6 females; mean age 26.0±5.8; range, 18 to 43 years) who underwent arthroscopic Bankart repair between April 2009 and October 2016 were divided into two groups depending on the type of the suture anchor used in different periods. Group A comprised 32 patients with arthroscopic Bankart repair performed with metal suture anchors, and Group B comprised 35 patients with arthroscopic Bankart repair performed with all-suture anchors. The patients were clinically evaluated using Rowe scores, Constant scores, redislocation rates, and positive apprehension test rates. Radiographic evaluation was performed using the Samilson-Prieto classification to observe the development of glenohumeral osteoarthritis. RESULTS The mean follow-up period was 41.1±10.4 (range, 30 to 60) months in Group A, and 39.6±9.4 (range, 28 to 60) months in Group B, with no significant difference between the two groups (p=0.559). No significant difference was observed between Group A and Group B in terms of mean Rowe score (89.2±13.8 [range, 40 to 100] vs. 88.7±16.9 [range, 25 to 100]; p=0.895) or Constant score (87.2±8.9 [range, 48 to 96] vs. 86.9±9.0 [range, 46 to 96]; p=0.878), which were the clinical outcomes at the final follow-up examination. Postoperative redislocation rates (3.1% vs. 2.9%, p=1.0) and positive apprehension test rates (6.3% vs. 8.6%, p=1.0) were found to be similar in both groups. According to the Samilson-Prieto classification, there was no evidence of glenohumeral osteoarthritis in any of the patients in either group. CONCLUSION Satisfactory outcomes were obtained with the use of all-suture anchors in arthroscopic Bankart repair for traumatic anterior shoulder instability. All-suture anchors and metal suture anchors, have similar outcomes in the mid-term and all-suture anchors are a reliable and effective option for arthroscopic Bankart repair.
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Nadeem IM, Vancolen S, Horner NS, Leroux T, Alolabi B, Khan M. Management of Failed SLAP Repair: A Systematic Review. HSS J 2020; 16:261-271. [PMID: 33088240 PMCID: PMC7534879 DOI: 10.1007/s11420-019-09700-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/07/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Superior labrum anterior to posterior (SLAP) tears are a very common shoulder injury. The success rate of SLAP repair, particularly in the throwing athlete, has been variable in the literature. QUESTIONS/PURPOSES The purpose of this systematic review was to evaluate the reported post-operative outcomes of management techniques for failed SLAP repair. METHODS The electronic databases MEDLINE, Embase, and PubMed were searched for relevant studies, and pertinent data was abstracted. Only studies reporting outcomes of management techniques for failed SLAP repairs were included. RESULTS A total of 10 studies (levels III to IV) evaluating 176 patients were included in this systematic review. Most subjects were male (86.6%), with a mean age at surgery of 36.3 years (range, 17 to 67 years). The most commonly reported reason for failed SLAP repair was persistent post-operative mechanical symptoms after index SLAP repair. Common techniques used in the management of failed SLAP repair include biceps tenodesis and revision SLAP repair. Return to activity was significantly higher after biceps tenodesis than after arthroscopic revision SLAP repair. However, compared to primary SLAP repair, biceps tenodesis demonstrated no statistically significant differences in return to work rates. Complications reported in one case were resolved post-operatively, and there was no reported revision failure or reoperation after revision surgery. CONCLUSION The most common reason for failed SLAP repair is persistent post-operative mechanical symptoms. Revision surgery for failed SLAP repair has a high success rate. The rate of return to activity after biceps tenodesis was significantly higher than the rate after revision SLAP repair. Large high-quality randomized trials are required to provide definitive evidence to support the optimal treatment for failed SLAP repair.
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Affiliation(s)
- Ibrahim M. Nadeem
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario Canada
| | - Seline Vancolen
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario Canada
| | - Nolan S. Horner
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, St Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6 Canada
| | - Tim Leroux
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario Canada
| | - Bashar Alolabi
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, St Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6 Canada
| | - Moin Khan
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, St Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6 Canada
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Hamada H, Sugaya H, Takahashi N, Matsuki K, Tokai M, Ueda Y, Hoshika S, Kuniyoshi K. Incidence of Axillary Nerve Injury After Arthroscopic Shoulder Stabilization. Arthroscopy 2020; 36:1555-1564. [PMID: 32109573 DOI: 10.1016/j.arthro.2020.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the incidence of axillary nerve palsy after arthroscopic shoulder stabilization and to measure the distance between the nerve and capsule in shoulders with a capsular lesion. METHODS This retrospective study included 2,027 shoulders (1,909 patients; 1,433 male and 476 female patients; mean age, 32 years [age range, 13-81 years]) subjected to arthroscopic soft-tissue stabilization for recurrent shoulder instability from 2005 to 2017. The exclusion criteria were bone grafting or transfer and preoperative axillary nerve symptoms. We retrospectively reviewed patient records and investigated the incidence and clinical features of axillary nerve palsy. We measured the closest distance between the axillary nerve and capsule on preoperative magnetic resonance images. RESULTS Postoperative axillary nerve palsy occurred in 4 shoulders (0.2% of all arthroscopic stabilizations). Capsular repair was performed in 2 shoulders (1.2% of 160 capsular repairs); humeral avulsion of the glenohumeral ligament (HAGL) repair, 1 shoulder (2% of 47 HAGL repairs); and isolated Bankart repair, 1 shoulder (0.05% of 1,941 Bankart repairs). The closest distance between the nerve and capsule was 3.4 ± 3.2 mm in shoulders with capsular or HAGL lesions and less than 1 mm in the 3 shoulders with palsy. The common symptoms in axillary nerve palsy cases were shoulder discomfort, delayed recovery of range of motion, and deltoid weakness and atrophy. A definitive diagnosis was made with electromyography in all cases. Nerve injury by a suture was confirmed during revision surgery in 3 shoulders subjected to capsular or HAGL repair during the initial operation. The palsy was transient and fully recovered in 1 shoulder with isolated Bankart repair. CONCLUSIONS The incidence of axillary nerve palsy after arthroscopic soft-tissue shoulder stabilization was low but higher in shoulders subjected to capsular or HAGL repair. We should always consider the possibility of axillary nerve palsy in shoulders that require capsular or HAGL repair. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Hiroshige Hamada
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Hiroyuki Sugaya
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan.
| | - Norimasa Takahashi
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Keisuke Matsuki
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Morihito Tokai
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Yusuke Ueda
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Shota Hoshika
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
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Gül O, Okutan AE, Ayas MS. Arthroscopic glenoid labral lesion repair using all-suture anchor for traumatic anterior shoulder instability: short-term results. J Shoulder Elbow Surg 2019; 28:1991-1997. [PMID: 31101476 DOI: 10.1016/j.jse.2019.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study presents the preliminary clinical results of arthroscopic glenoid labral lesion repair using all-suture anchors in the treatment of recurrent traumatic anterior shoulder instability. METHODS Seventy patients who underwent arthroscopic shoulder stabilization for traumatic anterior shoulder instability were evaluated in this single center-based retrospective study. Patients with a glenoid defect greater than 20%, off-track engaging Hills-Sachs lesion, multidirectional instability, and generalized ligamentous laxity were excluded. The 62 included patients treated with arthroscopic glenoid labral lesion repair using all-suture anchors were evaluated. The Rowe and Constant scores were used to assess the results. RESULTS We evaluated 62 patients with a mean age of 26.7 ± 12 years. The mean Rowe and Constant scores were 35 ± 7.2 and 65 ± 6.3, respectively, preoperatively and increased to 93.6 ± 5.3 and 92 ± 4.3, respectively, postoperatively at the mean follow-up of 28.8 months (range, 24-48 months) (P < .001). The redislocation rate was 8.1%. Of the patients, 91.9% had good to excellent clinical scores. Younger age and contact sports were associated with a higher risk of recurrent dislocation (P = .012 and P = .041, respectively). The postoperative functional results were not significantly correlated with the findings concerning the number of dislocations, time until surgery, degree of anterior translation, and number of anchors. CONCLUSION The use of all-suture anchors for arthroscopic glenoid labral lesion repair for the treatment of recurrent traumatic anterior shoulder instability yields satisfactory clinical results and is a safe and effective option.
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Affiliation(s)
- Orkun Gül
- Department of Orthopaedic Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ahmet Emin Okutan
- Department of Orthopaedic Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
| | - Muhammet Salih Ayas
- Department of Orthopaedic Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
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Erickson J, Chiarappa F, Haskel J, Rice J, Hyatt A, Monica J, Dhawan A. Biomechanical Comparison of a First- and a Second-Generation All-Soft Suture Glenoid Anchor. Orthop J Sports Med 2017; 5:2325967117717010. [PMID: 28795073 PMCID: PMC5524240 DOI: 10.1177/2325967117717010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background: All–soft tissue suture anchors provide advantages of decreased removal of bone and decreased glenoid volume occupied compared with traditional tap or screw-in suture anchors. Previous published data have led to biomechanical concerns with the use of first-generation all-soft suture anchors. Purpose/Hypothesis: The purpose of this study was to evaluate the load to 2-mm displacement and ultimate load to failure of a second-generation all-soft suture anchor, compared with a first-generation anchor and a traditional PEEK (polyether ether ketone) anchor. The null hypothesis was that the newer second-generation anchor will demonstrate no difference in loads to 2-mm displacement after cycling compared with first-generation all-soft suture anchors. Study Design: Controlled laboratory study. Methods: Twenty human cadaveric glenoids were utilized to create 97 total suture anchor sites, and 1 of 3 anchors were randomized and placed into each site: (1) first-generation all-soft suture anchor (Juggerknot; Biomet), (2) second-generation all-soft suture anchor (Suturefix; Smith & Nephew), and (3) a control PEEK anchor (Bioraptor; Smith & Nephew). After initial cyclic loading, load to 2 mm of displacement and ultimate load to failure were measured for each anchor. Results: After cyclic loading, the load to 2-mm displacement was significantly less in first-generation anchors compared with controls (P < .01). However, the load to 2-mm displacement was significantly greater in second-generation anchors compared with controls (P < .01). There was no difference in ultimate load to failure between the first- and second-generation all-soft suture anchors (P > .05). Conclusion: The newer generation all-soft suture anchors with a theoretically more rigid construct and deployment configuration demonstrate biomechanical characteristics (specifically, with load to 2-mm displacement after cyclic loading) that are improved over first-generation all-soft suture anchors and similar to a traditional solid tap-in anchor. The configuration of these newer generation all-soft suture anchors appears to mitigate the biomechanical concerns of decreased load to failure with first-generation all–soft tissue suture anchors. Clinical Relevance: The theoretical advantages of all-soft anchors may be particularly valuable in revision surgery or in cases where multiple anchors are being placed into a small anatomic area.
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Affiliation(s)
- John Erickson
- Department of Orthopaedics, Rutgers-Robert Wood Johnson Medical School (UMDNJ Legacy), New Brunswick, New Jersey, USA
| | - Frank Chiarappa
- Department of Orthopaedics, Rutgers-Robert Wood Johnson Medical School (UMDNJ Legacy), New Brunswick, New Jersey, USA
| | - Jonathan Haskel
- Department of Orthopaedics, Rutgers-Robert Wood Johnson Medical School (UMDNJ Legacy), New Brunswick, New Jersey, USA
| | - Justin Rice
- Department of Orthopaedics, Rutgers-Robert Wood Johnson Medical School (UMDNJ Legacy), New Brunswick, New Jersey, USA
| | - Adam Hyatt
- Department of Orthopaedics, Rutgers-Robert Wood Johnson Medical School (UMDNJ Legacy), New Brunswick, New Jersey, USA
| | - James Monica
- Department of Orthopaedics, Rutgers-Robert Wood Johnson Medical School (UMDNJ Legacy), New Brunswick, New Jersey, USA
| | - Aman Dhawan
- Penn State Hershey Bone and Joint Institute, Hershey, Pennsylvania, USA
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Barber FA, Spenciner DB, Bhattacharyya S, Miller LE. Biocomposite Implants Composed of Poly(Lactide-co-Glycolide)/β-Tricalcium Phosphate: Systematic Review of Imaging, Complication, and Performance Outcomes. Arthroscopy 2017; 33:683-689. [PMID: 27998641 DOI: 10.1016/j.arthro.2016.09.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 09/22/2016] [Accepted: 09/28/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the degradation and performance outcomes of poly(lactide-co-glycolide)/β-tricalcium phosphate (PLGA/β-TCP) implants. METHODS A MEDLINE and Embase search for randomized or nonrandomized controlled studies and prospective or retrospective case series that used biocomposite interference screws or suture anchors composed of PLGA/β-TCP was performed. Main outcomes included volume of implant resorption and incidence of osteoconductivity at implant sites, imaging findings, adverse events, and the frequency of reoperations. RESULTS A total of 13 studies representing 668 patients with either knee or shoulder implants were included. Median follow-up was 28 months (range: 12-37 months). Biocomposite implants lost 88% of their original volume during follow-up. Osteoconductivity at the implant site was identified in 63% of cases. Adverse events included tunnel widening (3%), effusion (5%), and cyst formation (4%). Synovitis was not reported. CONCLUSIONS Biocomposite interference screws or suture anchors composed of PLGA/β-TCP almost fully absorb over 3 years while promoting osteoconductivity with few reported adverse events. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- F Alan Barber
- Plano Orthopedic Sports Medicine and Spine Center, Plano, Texas, U.S.A
| | | | | | - Larry E Miller
- Miller Scientific Consulting, Inc., Asheville, North Carolina, U.S.A
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Cancienne JM, Brockmeier SF, Werner BC. Tobacco use is associated with increased rates of infection and revision surgery after primary superior labrum anterior and posterior repair. J Shoulder Elbow Surg 2016; 25:1764-1768. [PMID: 27262413 DOI: 10.1016/j.jse.2016.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/02/2016] [Accepted: 03/13/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although the general health consequences of tobacco use have been well defined, the effects of perioperative tobacco use on arthroscopic shoulder procedures remain largely unknown. The purpose of this study is to use a national database to investigate the relationship between tobacco use and rates of superior labrum anterior and posterior (SLAP) repair failure and postoperative infection after primary SLAP repair compared with matched controls. METHODS A national private-payer insurance database was queried for patients who underwent arthroscopic primary SLAP from 2005-2012. These patients were divided into tobacco use and non-tobacco use cohorts using International Classification of Diseases, Ninth Revision coding. The non-tobacco use patients were then matched to the patients with coded tobacco use. Both cohorts were assessed for postoperative infection within 90 days and subsequent ipsilateral revision SLAP repair or biceps tenodesis within up to 7 years postoperatively. RESULTS The incidences of revision SLAP repair or revision to a biceps tenodesis (P = .023) and postoperative infection (P = .034) were significantly higher in patients who used tobacco versus matched controls. CONCLUSIONS SLAP repair in patients who use tobacco is associated with significantly increased rates of postoperative infection and revision SLAP repair or conversion to a biceps tenodesis.
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Affiliation(s)
- Jourdan M Cancienne
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Stephen F Brockmeier
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
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Mollon B, Mahure SA, Ensor KL, Zuckerman JD, Kwon YW, Rokito AS. Subsequent Shoulder Surgery After Isolated Arthroscopic SLAP Repair. Arthroscopy 2016; 32:1954-1962.e1. [PMID: 27083535 DOI: 10.1016/j.arthro.2016.01.053] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 01/23/2016] [Accepted: 01/27/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify the incidence of and identify the risk factors for subsequent shoulder procedures after isolated SLAP repair. METHODS New York's Statewide Planning and Research Cooperative System database was searched between 2003 and 2014 to identify individuals with the sole diagnosis of a SLAP lesion who underwent isolated arthroscopic SLAP repair. Patients were longitudinally followed up for a minimum of 3 years to analyze for subsequent ipsilateral shoulder procedures. RESULTS Between 2003 and 2014, 2,524 patients met our inclusion criteria. After 3 to 11 years of follow-up, 10.1% of patients (254 of 2,524) underwent repeat surgical intervention on the same shoulder as the initial SLAP repair. The mean time to repeat shoulder surgery was 2.3 ± 2.1 years. Subsequent procedures included subacromial decompression (35%), debridement (26.7%). repeat SLAP repair (19.7%), and biceps tenodesis or tenotomy (13.0%). After isolated SLAP repair, patients aged 20 years or younger were more likely to undergo arthroscopic Bankart repair (odds ratio [OR], 2.91; 95% confidence interval [CI], 1.36-6.21; P = .005), whereas age older than 30 years was an independent risk factor for subsequent acromioplasty (OR, 2.3; 95% CI, 1.4-3.7; P < .001) and distal clavicle resection (OR, 2.5; 95% CI, 1.1-5.5; P = .030). The need for a subsequent procedure was significantly associated with Workers' Compensation cases (OR, 2.4; 95% CI, 1.7-3.2; P < .001). CONCLUSIONS We identified a 10.1% incidence of subsequent surgery after isolated SLAP repair, often related to an additional diagnosis, suggesting that clinicians should consider other potential causes of shoulder pain when considering surgery for patients with SLAP lesions. In addition, the number of isolated SLAP repairs performed has decreased over time, and management of failed SLAP repair has shifted toward biceps tenodesis or tenotomy over revision SLAP repair in more recent years. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Brent Mollon
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, U.S.A
| | - Siddharth A Mahure
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, U.S.A..
| | - Kelsey L Ensor
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, U.S.A
| | - Joseph D Zuckerman
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, U.S.A
| | - Young W Kwon
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, U.S.A
| | - Andrew S Rokito
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, U.S.A
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Serial MRI evaluation following arthroscopic rotator cuff repair in double-row technique. Arch Orthop Trauma Surg 2016; 136:665-72. [PMID: 26837222 DOI: 10.1007/s00402-016-2409-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Indexed: 02/09/2023]
Abstract
INTRODUCTION So far, recurrent rotator cuff defects are described to occur in the early postoperative period after arthroscopic repair. The aim of this study was to evaluate the musculotendinous structure of the supraspinatus, as well as bone marrow edema or osteolysis after arthroscopic double-row repair. Therefore, magnetic resonance (MR) images were performed at defined intervals up to 2 years postoperatively. STUDY DESIGN Case series; Level of evidence, 3. MATERIALS AND METHODS MR imaging was performed within 7 days, 3, 6, 12, 26, 52 and 108 weeks after surgery. All patients were operated using an arthroscopic modified suture bridge technique. Tendon integrity, tendon retraction ["foot-print-coverage" (FPC)], muscular atrophy and fatty infiltration (signal intensity analysis) were measured at all time points. Furthermore, postoperative bone marrow edema and signs of osteolysis were assessed. RESULTS MR images of 13 non-consecutive patients (6f/7m, ∅ age 61.05 ± 7.7 years) could be evaluated at all time points until ∅ 108 weeks postoperatively. 5/6 patients with recurrent defect at final follow-up displayed a time of failure between 12 and 24 months after surgery. Predominant mode of failure was medial cuff failures in 4/6 cases. The initial FPC increased significantly up to 2 years follow-up (p = 0.004). Evaluations of muscular atrophy or fatty infiltration were not significant different comparing the results of all time points (p > 0.05). Postoperative bone marrow edema disappeared completely at 6 months after surgery, whereas signs of osteolysis appeared at 3 months follow-up and increased to final follow-up. CONCLUSIONS Recurrent defects after arthroscopic reconstruction of supraspinatus tears in modified suture bridge technique seem to occur between 12 and 24 months after surgery. Serial MRI evaluation shows good muscle structure at all time points. Postoperative bone marrow edema disappears completely several months after surgery. Signs of osteolysis seem to appear caused by bio-absorbable anchor implantations.
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Schwartzberg R, Reuss BL, Burkhart BG, Butterfield M, Wu JY, McLean KW. High Prevalence of Superior Labral Tears Diagnosed by MRI in Middle-Aged Patients With Asymptomatic Shoulders. Orthop J Sports Med 2016; 4:2325967115623212. [PMID: 26779556 PMCID: PMC4710128 DOI: 10.1177/2325967115623212] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background: The incidence of superior labral surgery has increased in the past decade in the United States, and a contributing factor could be an increased rate of superior labral tears diagnosed with magnetic resonance imaging (MRI). Prior MRI studies of the asymptomatic shoulder have focused on rotator cuff pathology or pathology in a narrow and specific group of athletes. Labral abnormalities have not previously been thoroughly evaluated in asymptomatic middle-aged individuals. Purpose: To evaluate the prevalence of superior labral tears diagnosed by MRI in the asymptomatic shoulders of middle-aged people (age range, 45-60 years). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 53 asymptomatic adults (age range, 45-60 years) with no history of surgery or injury to either shoulder were included in the study. Physical examinations of all shoulders were performed. Noncontrast MRI (1.5 T) was performed in 1 randomly determined shoulder of each subject. Two fellowship-trained musculoskeletal radiologists who were blinded to the purpose of the study and ages of the subjects evaluated each MRI. Results: Radiologists interpreted the MRIs as consistent with superior labral tears in 55% and 72% of the cohort. Comparison of the radiological evaluations of the superior labra were moderate (κ = 0.410, P = .033). There were no differences in readings for superior labral tear regarding age (P = .87), sex (P = .41), whether the dominant shoulder underwent MRI (P = .99), whether the subject worked a physical job (P = .08), or whether the subject participated in overhead sports for a period of 1 year (P = .62). Conclusion: Superior labral tears are diagnosed with high frequency using MRI in 45- to 60-year-old individuals with asymptomatic shoulders. These shoulder MRI findings in middle-aged populations emphasize the need for supporting clinical judgment when making treatment decisions for this patient population. Clinical Relevance: To avoid overtreatment, physicians should realize that superior labral tears diagnosed by MRI in individuals between the ages of 45 and 60 years may be normal age-related findings.
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Affiliation(s)
| | | | | | | | - James Y Wu
- Center for Diagnostic Imaging, Winter Park, Florida, USA
| | - Kevin W McLean
- Center for Diagnostic Imaging, Winter Park, Florida, USA
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Oh JH, Song BW, Rhie TY. Two Cases of Biodegradable Suture Anchor Displacement Diagnosed with Ultrasonography following Arthroscopic Rotator Cuff Repair. Clin Shoulder Elb 2015. [DOI: 10.5397/cise.2015.18.4.254] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Agrawal V, Pietrzak WS. Triple labrum tears repaired with the JuggerKnot™ soft anchor: Technique and results. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2015; 9:81-9. [PMID: 26288537 PMCID: PMC4528288 DOI: 10.4103/0973-6042.161440] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose: The 2-year outcomes of patients undergoing repair of triple labrum tears using an all-suture anchor device were assessed. Materials and Methods: Eighteen patients (17 male, one female; mean age 36.4 years, range: 14.2-62.3 years) with triple labrum tears underwent arthroscopic repair using the 1.4 mm JuggerKnot Soft Anchor (mean number of anchors 11.5, range: 9-19 anchors). Five patients had prior surgeries performed on their operative shoulder. Patients were followed for a mean of 2.0 years (range: 1.6-3.0 years). Constant–Murley shoulder score (CS) and Flexilevel scale of shoulder function (FLEX-SF) scores were measured, with preoperative and final postoperative mean scores compared with a paired Student's t-test (P < 0.05). Magnetic resonance imaging (MRI) was also performed at final postoperative. Results: Overall total CS and FLEX-SF scores increased from 52.9 ± 20.4 to 84.3 ± 10.7 (P < 0.0001) and from 29.3 ± 4.7 to 42.0 ± 7.3 (P < 0.0001), respectively. When divided into two groups by whether or not glenohumeral arthrosis was present at the time of surgery (n = 9 each group), significant improvements in CS and FLEX-SF were obtained for both groups (P < 0.0015). There were no intraoperative complications. All patients, including contact athletes, returned to their preinjury level of sports activity and were satisfied. MRI evaluation revealed no instances of subchondral cyst formation or tunnel expansion. Anchor tracts appeared to heal with fibrous tissue, complete bony healing, or combined fibro-osseous healing. Conclusion: Our results are encouraging, demonstrating a consistent healing of the anchor tunnels through arthroscopic treatment of complex labrum lesions with a completely suture-based implant. It further demonstrates a meaningful improvement in patient outcomes, a predictable return to activity, and a high rate of patient satisfaction. Level of Evidence: Level IV case series.
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Affiliation(s)
- Vivek Agrawal
- Department of Orthopedics, Marian University School of Medicine; The Shoulder Center, Carmel, IN 46032, USA
| | - William S Pietrzak
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
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Santiago-Torres J, Flanigan DC, Butler RB, Bishop JY. The effect of smoking on rotator cuff and glenoid labrum surgery: a systematic review. Am J Sports Med 2015; 43:745-51. [PMID: 24859982 DOI: 10.1177/0363546514533776] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several orthopaedic conditions have been reported to be adversely affected by smoking. Only a few studies have looked at outcomes related to smoking in shoulder surgery. PURPOSE/HYPOTHESIS To determine whether smoking has a negative influence on tendinous, ligamentous, and cartilaginous shoulder surgery. The hypothesis was that smoking has a negative influence from both a basic science and clinical outcomes perspective on soft tissue shoulder surgery. STUDY DESIGN Systematic review. METHODS A systematic review of multiple medical databases was performed evaluating clinical outcomes and basic science studies to determine the effects of smoking on tendinous, ligamentous, and cartilaginous shoulder surgery. The search strategy was based on "shoulder AND [smoke OR smoking OR nicotine OR tobacco]." English language clinical outcomes or basic science studies following soft tissue surgery of the shoulder were included. Studies excluded consisted of those with evidence level 5, partial or total shoulder arthroplasty, fracture reduction and fixation, oncologic mass excision, and osteotomy around the shoulder. RESULTS Ten studies were identified for inclusion and analysis. Eight of these studies, which included 1 basic science study, investigated the relationship between smoking and outcomes of rotator cuff repair (RCR), and 2 examined the effects of smoking on outcomes of glenoid labrum repair. No studies were found that specifically explored the effects of smoking on cartilaginous shoulder surgery. The basic science study and 3 of the 7 clinical outcomes studies investigating smoking and rotator cuff (RTC) surgery outcomes found a statistically significant negative association resulting in decreased RTC tendon repair quality, decreased biomechanics, poorer clinical outcomes, and impaired healing of small-medium RTC tears as assessed by magnetic resonance imaging. In addition, 1 of 2 clinical outcomes studies examining smoking and glenoid labrum repair reported an increased need for surgical revision of superior labral anterior to posterior (SLAP) tears in smokers. No basic science studies were found that investigated the effects of smoking on glenoid labrum surgery. CONCLUSION Smoking has a negative influence on RCR clinical outcomes and is associated with decreased healing of small-medium RTC tears after repair. The current literature suggests a negative influence of nicotine and smoking on RCR from both a basic science and clinical outcomes perspective. Smoking cessation would benefit patients undergoing RCR and improve clinical outcomes. The relationship of smoking and labral/SLAP repair or articular cartilage is less clear. Further research is needed to evaluate associations with these surgeries and outcomes. CLINICAL RELEVANCE Smoking has a negative influence on RCR clinical outcomes and is associated with decreased healing of small-medium RTC tears after repair.
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Affiliation(s)
- Juan Santiago-Torres
- OSU Sports Medicine and Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - David C Flanigan
- OSU Sports Medicine and Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - R Bryan Butler
- Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Julie Y Bishop
- OSU Sports Medicine and Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
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Abstract
Hand and wrist arthroscopy has gained popularity over the past few decades. Arthroscopy is a valuable diagnostic tool in cases where clinical and radiographic findings do not show a clear picture of the patient's pathologic condition. Arthroscopy also allows care providers to perform therapeutic interventions in a less invasive manner than would have been possible with a standard open approach. Over the past three decades, there have been substantial advances in the techniques and outcomes in hand and wrist arthroscopy. With this article, the authors aim to introduce the application of newer arthroscopic techniques in the hand and wrist that may be of diagnostic and/or therapeutic value.
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Abstract
In general, favorable outcomes have been achieved with arthroscopic repair of superior labral anterior-posterior (SLAP) tears. However, some patients remain dissatisfied or suffer further injury after SLAP repair and may seek additional treatment to alleviate their symptoms. The cause of persistent pain or recurrent symptoms after repair is likely multifactorial; therefore, careful preoperative workup is required to elucidate the cause of pain. Review of the details of previous surgical procedures is crucial because certain fixation methods are prone to failure or can cause additional injury. Failed SLAP repair can be managed with nonsurgical or surgical options. Nonsurgical modalities include physical therapy and strengthening programs, anti-inflammatory agents, and activity modification. Surgical options include revision SLAP repair and biceps tenotomy or tenodesis with or without revision SLAP repair. Outcomes after surgical management of failed SLAP repair are inferior to those of primary repair. Select patients may be better served by primary biceps tenodesis rather than SLAP repair.
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Cobaleda Aristizabal AF, Sanders EJ, Barber FA. Adverse events associated with biodegradable lactide-containing suture anchors. Arthroscopy 2014; 30:555-60. [PMID: 24650833 DOI: 10.1016/j.arthro.2014.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 02/05/2014] [Accepted: 02/06/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the occurrence of adverse events and inflammatory reactions related to the use of biodegradable anchors. METHODS A retrospective review of a consecutive series of arthroscopic shoulder procedures using biodegradable suture anchors performed by a single surgeon was undertaken. The database was purged of patient identifiers. The blinded data were analyzed for procedure type, anchor type and composition, associated procedures, and general demographic data. Anchor composition and number were recorded. A shoulder procedure after the index operation was considered an adverse event. The nature of these procedures was evaluated using medical records, operative images, and video, looking specifically for inflammatory reactions. Any anchor-related issues were documented. RESULTS Three hundred sixty cases met the inclusion criteria. The procedure was a tendon repair (rotator cuff or biceps) in 265 cases and a labral repair (instability or SLAP) in 97, 2 of which were combined instability and tendon repairs. Nine different biodegradable anchors were identified, possessing 4 different polymer combinations. Adverse events (reoperations) were identified in 18 of 360 patients (5%): 13 tendon repairs and 5 labral/instability repairs. Only 2 were anchor related. In 1 tendon repair case, the anchor broke and an anchor fragment required removal. In 1 labral repair case, the anchor eyelet (a suture) loosened from the anchor body and eroded the humeral head. No cases of inflammatory synovitis were observed. No statistical difference in adverse event rates existed between tendon and labral repairs (P > .05). CONCLUSIONS Anchor-specific adverse events occurred in 2 of 360 procedures (0.5%). One was anchor design related (the prominent head containing the suture eyelet broke off) in a poly-L-lactic acid (PLLA) anchor. One was anchor material related and occurred when the poly-levo (70%)/dextro (30%)-lactide anchor body reabsorbed, loosening the encased eyelet suture and allowing this suture to migrate into the joint. No inflammatory reactions were documented in the slowly degrading pure PLLA or more rapidly degrading biocomposite PLLA/β-tricalcium phosphate-based anchors. LEVEL OF EVIDENCE Level IV, retrospective review, therapeutic study.
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Affiliation(s)
| | - Eric J Sanders
- Plano Orthopedic Sports Medicine and Spine Center, Plano, Texas, U.S.A
| | - F Alan Barber
- Plano Orthopedic Sports Medicine and Spine Center, Plano, Texas, U.S.A
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Kim SH, Oh JH, Lee OS, Lee HR, Hargens AR. Postoperative imaging of bioabsorbable anchors in rotator cuff repair. Am J Sports Med 2014; 42:552-7. [PMID: 24431337 DOI: 10.1177/0363546513517538] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bioabsorbable anchors may lead to osteolysis and cyst formation. However, the prevalence of these outcomes is not known for rotator cuff repairs. PURPOSE To evaluate cyst formation after placement of bioabsorbable anchors for rotator cuff repairs and to verify whether bioabsorbable anchors degraded as intended and preserved bone stock for possible revision compared with metal anchors. The null hypothesis was that the rate and severity of cyst formation around the anchor are negligible. STUDY DESIGN Case series; Level of evidence, 4. METHODS Between April 2008 and November 2011, a total of 209 patients (85 men, 124 women) underwent rotator cuff repair with bioabsorbable suture anchors (113 with polylactic acid enantiomers [PLLA] and 96 with poly-D,L-lactide from L-lactide and D-lactide [PLDLA]); the patients underwent magnetic resonance imaging (MRI) evaluation more than 10 months after surgery. The fluid signal around the anchor on T2-weighted MRI scans was graded as follows: grade 0, no fluid around anchor; grade 1, minimal fluid around anchor; grade 2, local fluid around anchor; grade 3, fluid collection around entire length of anchor with cyst diameter less than twice the anchor diameter; and grade 4, cyst diameter larger than grade 3. The integrity of repairs was also evaluated. RESULTS Cysts were observed in 97 instances (46.4%). There were 41 grade 1 cases (19.6%), 16 grade 2 (7.7%), 22 grade 3 (10.5%), and 18 grade 4 (8.6%). Healing of repaired tendon was observed in 131 patients (62.7%). There was no statistical difference in healing rate between patients with and without cyst formation (66.1% vs 58.8%; P = .276). Altered anchor shape and absorption were not observed in most of the patients. However, in 12 patients (6 with PLLA and 6 with PLDLA anchors), T2-weighted scans showed that the signal intensity of anchors had changed since surgery, which could indicate that absorption had taken place; nonetheless, even in these 12 patients, anchors were clearly visible on T1-weighted scans. CONCLUSION Osteolysis and cyst formation are common complications following the use of bioabsorbable anchors in rotator cuff repairs. Considering that adequate absorption of anchors and preservation of bone stock are the reasons for using bioabsorbable anchors, use of these anchors should be reconsidered because of possible interference with revision surgery.
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Affiliation(s)
- Sae Hoon Kim
- Joo Han Oh, Department of Orthopedic Surgery, Seoul National University College of Medicine, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam 463-707, Korea.
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Haneveld H, Hug K, Diederichs G, Scheibel M, Gerhardt C. Arthroscopic double-row repair of the rotator cuff: a comparison of bio-absorbable and non-resorbable anchors regarding osseous reaction. Knee Surg Sports Traumatol Arthrosc 2013; 21:1647-54. [PMID: 23604175 DOI: 10.1007/s00167-013-2510-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 04/15/2013] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study was to analyse the osseous reaction after arthroscopic double-row rotator cuff repair using bio-absorbable poly-L-lactic acid (PLLA) and non-absorbable polyetheretherketone (PEEK) suture anchors. Focus of interest was the appearance of peri-implant fluid and anchor tunnel widening. METHODS Thirty-six patients were evaluated at final follow-up (16 PLLA and 20 PEEK). Clinical results were acquired by use of the subjective shoulder value, the Constant score and the Western Ontario Rotator Cuff Index. Radiological results were analysed by supraspinatus tendon integrity, footprint coverage, muscular atrophy and fatty infiltration. Furthermore, anchor tunnel expansion was measured, anchor structure and peri-implant fluids graduated. RESULTS At 28.4 ± 8.9-month follow-up, clinical outcome was similar (n.s.). MRI investigation revealed osseous reaction in both groups; tunnel widening was 0.9 ± 0.7 mm in PLLA and 0.8 ± 0.6 mm in PEEK anchors (n.s.). Peri-implant fluid was pronounced in PLLA anchors (p < 0.05). Tunnel widening was significantly higher in lateral anchors irrespectively of the material used. Tendon integrity, muscular atrophy, fatty infiltration and footprint coverage were not significantly different (n.s.). CONCLUSION Both materials lead to osseous reaction in this study, whereas consequences of pronounced fluid in PLLA patients remain unclear. Pronounced tunnel widening in lateral anchors leads to the assumption that other causes such as mechanical stress potentially have to be considered when analysing osseous reaction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hendrik Haneveld
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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McCarty LP, Buss DD, Datta MW, Freehill MQ, Giveans MR. Complications observed following labral or rotator cuff repair with use of poly-L-lactic acid implants. J Bone Joint Surg Am 2013; 95:507-11. [PMID: 23407607 DOI: 10.2106/jbjs.l.00314] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A variety of complications associated with the use of poly-L-lactic acid (PLLA) implants, including anchor failure, osteolysis, glenohumeral synovitis, and chondrolysis, have been reported in patients in whom these implants were utilized for labral applications. We report on a large series of patients with complications observed following utilization of PLLA implants to treat either labral or rotator cuff pathology. METHODS Patients who had undergone arthroscopic debridement to address pain and loss of shoulder motion following index labral or rotator cuff repair with PLLA implants were identified retrospectively with use of our research database. A total of forty-four patients in whom macroscopic anchor debris had been observed and/or biopsy samples had been obtained during the debridement were included in the study. Synovial biopsy samples taken at the time of the arthroscopic debridement were available for thirty-eight of the forty-four patients and were analyzed by a board-certified pathologist. Magnetic resonance imaging (MRI) scans acquired after the index procedure and data from the arthroscopic debridement were available for all patients. RESULTS Macroscopic intra-articular anchor debris was observed in >50% of the cases. Giant cell reaction was observed in 84%; the presence of polarizing crystalline material, in 100%; papillary synovitis, in 79%; and arthroscopically documented Outerbridge grade-III or IV chondral damage, in 70%. A significant correlation (rho = 0.36, p = 0.018) was observed between the time elapsed since the index procedure and the degree of chondral damage. A recurrent rotator cuff tear that was larger than the tear documented at the index procedure was observed in all patients whose index procedure included a rotator cuff repair. CONCLUSIONS Clinically important gross, histologic, and MRI-visualized pathology was observed in a large cohort of patients in whom PLLA implants had been utilized to repair lesions of the labrum or rotator cuff.
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Affiliation(s)
- L Pearce McCarty
- Sports & Orthopaedic Specialists, 8100 West 78th Street, Edina, MN 55417, USA
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Mok D, Wang EL. Does age or gender of the patient influence the outcome of type II superior labrum anterior and posterior repair? INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2013; 6:112-5. [PMID: 23493640 PMCID: PMC3590701 DOI: 10.4103/0973-6042.106223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIMS To assess whether patients above 50 years of age, particularly female, would benefit from repair of their SLAP tears. SETTINGS AND DESIGN Review of patients' records followed by telephone interview at a minimum of two years after surgery. MATERIALS AND METHODS Seventy-two consecutive patients who had their SLAP repaired were retrospective reviewed by an independent examiner. Follow up was by telephone interview with pain and functional results measured according to the Oxford Shoulder Questionnaire. The patients were asked whether they would undergo the same operation if they had a similar injury. STATISTICAL ANALYSIS USED OKS - One way ANOVA, followed by Tukey HSD multiple comparisons were used to assess the Oxford Shoulder score. Kruskal-Wallis Test was used to assess the final VAS Pain Score. Student's T tests for Oxford scores before and after surgery. RESULTS Between 2007-2008, 38 male patients and 34 female patients with an average age of 53 (19-75) years had their SLAP repair. Good to excellent results in Oxford shoulder scores were reported in 94%. 68 0f 72 patients would undergo the same if they had a similar injury. No statistical correlation was found between the patient's age, gender and outcome scores. CONCLUSIONS Neither the patients' gender nor their age above 50 affected the outcome after surgery.
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Affiliation(s)
- Daniel Mok
- Shoulder and Upper Limb Unit, Epsom & St Helier NHS Trust,Epsom General Hospital, Surrey, UK
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de Moraes VY, Godin K, Tamaoki MJS, Faloppa F, Bhandari M, Belloti JC. Workers' compensation status: does it affect orthopaedic surgery outcomes? A meta-analysis. PLoS One 2012; 7:e50251. [PMID: 23227160 PMCID: PMC3515555 DOI: 10.1371/journal.pone.0050251] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 10/17/2012] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Previous reviews have demonstrated that patient outcomes following orthopaedic surgery are strongly influenced by the presence of Workers' Compensation. However, the variability in the reviews' methodology may have inflated the estimated strength of this association. The main objective of this meta-analysis is to evaluate the influence of Workers' Compensation on the outcomes of orthopaedic surgical procedures. METHODS We conducted a systematic search of the literature published in this area from 1992-2012, with no language restrictions. The following databases were used MEDLINE (Ovid), Embase (Ovid), CINAHL, Google Scholar, LILACS and Pubmed. We also hand-searched the reference sections of all selected papers. We included all prospective studies evaluating the effect of compensation status on outcomes in adult patients who had undergone surgery due to orthopaedic conditions or diseases. Outcomes of interest included disease specific, region specific and/or overall quality of life scales/questionnaires and surgeons' personal judgment of the results. We used an assessment tool to appraise the quality of all included studies. We used Review Manager to create forest plots to summarize study data and funnel plots for the assessment of publication bias. RESULTS Twenty studies met our eligibility criteria. The overall risk ratio for experiencing an unsatisfactory result after orthopaedic surgery for patients with compensation compared to non-compensated patients is 2.08 (95% CI 1.54-2.82). A similar association was shown for continuous data extracted from the studies using assessment scales or questionnaires (Standard Mean Difference = -0.70 95% CI -0.97- -0.43). CONCLUSIONS Among patients who undergo orthopaedic surgical procedures, those receiving Workers' Compensation experience a two-fold greater risk of a negative outcome. Our findings show a considerably lower estimate of risk compared to previous reviews that include retrospective data. Further research is warranted to determine the etiological explanation for the influence of compensation status on patient outcomes. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42012002121.
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Affiliation(s)
- Vinícius Ynoe de Moraes
- Division of Hand and Upper Limb Surgery, Department of Orthopaedics and Trauma, Universidade Federal de São Paulo, São Paulo, Brazil.
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Abstract
Suture anchors are an important tool in the orthopedist's armamentarium. Their use is prevalent in surgery of the entire upper limb. Suture anchors have mostly obviated the need for multiple drill holes when striving for secure fixation of soft tissue to bone. As with most other orthopedic products, the designs of these anchors and the materials used to fabricate them have evolved as their use increased and their applications became more widespread. It is ultimately the surgeon's responsibility to be familiar with these rapidly evolving technologies and to use the most appropriate anchor for any given surgery.
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Affiliation(s)
- Min Jung Park
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 2501 Christian Street 103, Philadelphia, PA 19146, USA
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Abstract
Arthroscopic surgery has become the mainstay of treatment of several common glenohumeral pathologies such as tears of the rotator cuff and labrum. Arthroscopic rotator cuff and labral repair provide outcomes comparable to those achieved with traditional open techniques, with the benefits of smaller incisions and less soft-tissue disruption. Development and improvement of tissue anchors and arthroscopic instrumentation has been integral to the increased popularity of arthroscopic glenohumeral repairs. Current anchors can be categorized by design and material composition. Awareness of the advantages and limitations of these implants may influence anchor selection.
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Milewski MD, Diduch DR, Hart JM, Tompkins M, Ma SY, Gaskin CM. Bone replacement of fast-absorbing biocomposite anchors in arthroscopic shoulder labral repairs. Am J Sports Med 2012; 40:1392-401. [PMID: 22523371 DOI: 10.1177/0363546512441589] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Newer generation biocomposite anchors are hypothesized to resorb more reliably and faster, while allowing for bone ingrowth and replacement. PURPOSE The purposes of this study were to (1) assess anchor resorption and bone ingrowth over time, (2) identify tunnel widening or potential reactions to the implants, (3) compare imaging findings for different sites of labral repair, and (4) determine patient subjective outcomes with the use of biocomposite anchors in glenoid labral repair. STUDY DESIGN Case series; Level of evidence, 4. METHODS We enrolled 22 patients to participate in a 24-month outcomes study that included subjective and objective outcome assessments after glenoid labrum repair surgery. Magnetic resonance imaging (MRI) was performed at 6 and 12 months to identify any potential reactions to implants. Computed tomography (CT) scans were performed at 12 and 24 months to determine anchor resorption and bone ingrowth. Sixteen patients and 47 anchors were available for follow-up at 24 months. An independent, fellowship-trained musculoskeletal radiologist read the scans. Subjective outcome scores measured at 24 months postoperatively included Simple Shoulder Test, Tegner activity scale, American Shoulder and Elbow Surgeons (ASES), and University of California, Los Angeles (UCLA) shoulder scores. RESULTS No adverse events were reported with the use of biocomposite anchors at the end of the study period. At 12 and 24 months, respectively, CT scans demonstrated that an estimated 68% and 98% of combined anchor material had been absorbed, 56% and 78% of the anchor material had been replaced by soft tissue of variable density, and 9% and 20% of total anchor volume was replaced by bone. No obvious mechanical failure of the labral repairs was detected on nonarthrogram MRI. Three of the 47 anchors showed bone cyst formation. Tunnel widening (expansion beyond tunnel diameter of 3 mm; 2.9-mm drill hole utilized) was seen in 55% of the anchors but decreased between 12 and 24 months, consistent with bone replacement. Tunnel widening was seen more in anteroinferior and posterior glenoid anchor locations (84% and 57%, respectively) than in superior labral anchors (13%). Subjective outcome scores at 24 months for ASES and UCLA shoulder scores averaged 88 and 30, respectively. All but one patient were satisfied with their outcome at 24 months. CONCLUSION Our imaging evaluation indicates resorption of newer generation biocomposite anchors with progressive bone replacement at 12 and 24 months while maintaining acceptable subjective outcomes.
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Hiemstra LA, Sasyniuk TM. Assessing and reporting anchor performance. Arthroscopy 2012; 28:593; author reply 593-4. [PMID: 22542431 DOI: 10.1016/j.arthro.2012.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 03/27/2012] [Indexed: 02/02/2023]
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The current issue: clinical shoulder, knee, wrist, hip, and cost-effectiveness analysis. Arthroscopy 2011; 27:1313-6. [PMID: 21955391 DOI: 10.1016/j.arthro.2011.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 07/07/2011] [Indexed: 02/02/2023]
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