Arthroscopic Bankart repair with all-suture anchors does not cause important glenoid bone osteolysis: a volumetric CT study of 143 anchors

Abstract

Purpose To evaluate with computed tomography (CT) the incidence of anchor-related osteolysis after implantation of two types of all-suture anchors for the management of labral lesions in shoulder instability. Methods Single-cohort, observational study with 12-month follow-up. Thirty-three participants (27 males/6 females; age 38.3 years [SD 11.3]) with anterior labral lesions in which 143 all-suture anchors (71 Iconix 1.4 mm and 72 Sutureix 1.7 mm) were implanted were evaluated with a CT performed a mean of 15.4 [3.85] months after surgery. The volume of the bone defects was measured in the CT. Every anchor was classiied into one of four groups: (1) no bone defect. (2) Partial bone defect (defects smaller than the drill used for anchor placement). (3) Tunnel enlargement (defects larger than the drill volume but smaller than twice that volume). (4) Cystic lesion (defects larger than twice the drill volume). Results No bone defect was identiied in 16 anchors (11.2%, [95% CI 6.5-17.5%]). A partial bone defect was found in 84 anchors (58.7% [50.2-66.9%]). Tunnel enlargement was found in 43 anchors (30.11% [22.6-37.6%]). No anchor caused cystic lesions (0% [0-2.5%]). The defect volume was a mean of 27.8 mm 3 (SD 18.4 mm 3 , minimum 0 mm 3 , maximum 94 mm 3 ). Neither the position in the glenoid nor the type of implant used had a signiicant efect in the type or size of the defects. Conclusion When using all-suture anchors in the glenoid during instability surgery, relevant bone osteolytic defects are rare at 1-year follow-up. Most anchor insertion tunnels will ill completely (11%) or partially (59%) with bone. Tunnel enlargement will develop in 30% of anchors. No cystic defects larger than 0.125 cm 3 were observed. There is a low risk that all-suture anchors cause signiicant osteolytic bone defects in the glenoid. These implants can be used safely. Level of evidence IV

Arthroscopic remplissage with all-suture anchors causes cystic lesions in the humerus: a volumetric CT study of 55 anchors

“…All measurements were made twice and the mean was used for further calculations. This measurement method has showed a high intraobserver and interobserver reproducibility (Intraclass Correlation Coeicient > 0.9) [24].…”

“…All patients received oral and written information about the study and written consent for participation and follow-up for 12 months was obtained. This is a post hoc analysis of the images available from a previous study designed to assess the incidence of glenoid osteolysis after implantation of all-suture anchors for the management of labral lesions [24]. A total of 33 subjects in which an arthroscopic Bankart repair performed with allsuture anchors were included in the initial study; these subjects were evaluated prospectively with a computed tomography (CT) at 1-year follow-up.…”

“…This osteolisis (in the form of cysts) might have clinical relevance as the cysts could efectively decrease the humeral bone stock (a risk factor for recurrence of shoulder instability after surgery [4]). Recent research has shown that, when using all-suture anchors in the glenoid bone, anchorrelated osteolisis is not a big problem as cyst formation is rare, occurring in between 0 to 5% of cases [24,25,27]. When these all-suture anchors have been used in the humeral bone for rotator cuf repair, large cysts develop in 0-3% of cases [13,21,26].…”

Clinical and radiological outcome of all-suture anchors in shoulder and elbow surgery

“…Cyst formation and statistically significant increased tunnel expansion was seen in postoperative CT imaging, but it did not influence clinical outcomes. 39,[43][44][45] MRI studies showed various bone reactions, such as tunnel widening, cyst formation and rims of fluid around the anchors, but these reactions were considered as not statistically significant. 36,41 However, one MRI study executed by Ro et al 40 did show a peri-anchor cystic bone reaction being associated with a higher rate of rotator cuff retears.…”

“…The radiographs were evaluated by two independent researchers, with a detailed review of the presence of bony abnormalities at the site of the anchor. 45 ASAs could not be evaluated on postoperative imaging, mostly due to metallic artifacts of osteosynthesis material, and were not included in the final analysis. The diameter of the anchor drill hole was measured and the morphology of the drill hole was documented.…”