Arthroscopic rotator cuff repair: suture anchor properties, modes of failure and technical considerations

Abstract

Rotator cuff injury and tears are a common source of shoulder pain, particularly among the elderly. Arthroscopic repair has now become the mainstay in the treatment of significant injuries that have failed conservative therapy. Compared with the traditional open technique, arthroscopic repair offers patients smaller incisions and less soft-tissue trauma, which result in improved postoperative pain and rehabilitation. The advances that have made arthroscopic repairs a reality includes improvement in arthroscopic rotator cuff instrumentation, particularly suture anchors. Suture anchors are used to reattach the torn rotator cuff tissue back onto the bone. Current rotator cuff anchors vary by design, anchor composition and suture materials. A treating physician should be aware of the advantages and limitations of these implants, which may influence the choice of one anchor over another. In addition to anchor variables, other factors that may affect the success of the repair include the local environment and surgical technique. In this article, various aspects of anchor design will be discussed. In addition, a concise review of technical considerations will also be discussed.

Evaluation of Focal Bone Mineral Density Using Three-dimensional Measurement of Hounsfield Units in the Proximal Humerus

“…15) Failure at the anchor-bone interface is not uncommon, and some recent clinical studies have assessed the suitability of this interface with respect to bone quality. [1][2][3][4][5] BMD has been proposed as a good predictor of the mechanical integrity of trabecular bone. 16) However, global measures of bone quality can only explain implant stability to a limited extent.…”

“…Failure could occur at the anchor-bone interface, the tendon suture interface, the anchor-suture interface, or the suture itself. [1][2][3][4][5] In addition, poor bone quality caused by osteoporosis has been suggested to play a role in suture anchor failure at the anchorbone interface after rotator cuff repair. [6][7][8] Bone quality is usually evaluated by dual energy X-ray absorptiometry (DXA), which is regarded as the gold standard for determining global bone mineral density (BMD); however, it does not correlate with the proximal humerus BMD.…”

Evaluation and Comparison of Eyelet Durability in Generic and Brand PEEK Rotator Cuff Anchors in Porcine Cortical and Cancellous Bone

“…Anchors pulled out of cancellous bone 18% of the time at an average of 4300 cycles of the 10 -180 N load which is significantly greater than a RCR would be subjected to during the healing phase. A previous study of RCRs concluded that condition of the tissue or bone was the limiting reason for repair failure [15][16][17]. High UFLs and the high number of cycles before pullout of generic anchors from cancellous bone indicate the anchors will not be the limiting factor of RCRs.…”

Antibiotic-impregnated cement spacer as a definitive treatment for post-arthroscopy shoulder destructive osteomyelitis: case report and review of literature

“…Shoulder arthroscopy is a relatively safe and minimally invasive orthopedic procedure, offering good functional results [1]. It has grown in popularity over the past decades specially basing on these highly praised advantages.…”

“…Arthroscopic revision of rotator cuff lesions is an increasingly popular procedure nowadays due to the convenience of its minimally invasive nature, associated with a relatively safe profile [1, 2]. One of the most feared complications of shoulder arthroscopy, although rare, remains deep articular infection, with potentially destructive joint sequelae [2–4].…”