Clinical and Radiologic Outcomes of Combined Use of Biocomposite and PEEK Suture Anchors during Arthroscopic Rotator Cuff Repair: A Prospective Observational Study

Abstract

The aim of the current study was to evaluate the functional and radiologic outcomes of biocompatible non-absorbable PEEK (polyetheretherketone) and biocomposite (poly-L-lactic acid/poly(lactic-co-glycolic acid) 70% + β-tricalcium phosphate) anchors, especially in terms of perianchor cyst formation during the first six months postoperatively. We prospectively analysed 29 patients who underwent arthroscopic rotator cuff repair between March and May 2019. Both PEEK and biocomposite suture anchors were used as lateral anchors in one body. Clinical outcomes were assessed using the shoulder range of motion (ROM), visual analogue scale (VAS) for pain and satisfactory score, American Shoulder and Elbow Surgeons (ASES) score, and Simple Shoulder Test (SST). All these were obtained in patients preoperatively at 3 and 6 months after surgery. The imaging evaluation included perianchor cyst formation, anchor absorption, repaired cuff integrity, and retear pattern. All functional outcomes significantly improved over time. The biocomposite anchor had a statistically significant tendency to form higher grades of fluid collection at 3 months after surgery. However, the perianchor cyst reduced by the sixth postoperative month. Six months postoperatively, the functional outcomes were improved after rotator cuff repair and similar degrees of perianchor cyst formation were observed, regardless of the suture anchor material used.

A Retrospective Study on the Efficacy, Safety, and Clinical and Radiological Outcomes of PEEK Anchors (CEPTRE® Knotted Suture Anchor and VIPLOK® Knotless Anchor) in the Treatment of Rotator Cuff Repairs

“…Even though the perianchor cysts are noted in PEEK anchor use, the biological effect on cuff healing and subsequent clinical outcomes appears to be largely unaffected. In a study by Lee et al, the functional and radiologic outcomes of PEEK and biocomposite (PLLA/poly(lactic-co-glycolic acid) 70% + β-tricalcium phosphate) anchors were evaluated, especially in terms of perianchor cyst formation during the first three and six months postoperatively [ 14 ]. Although the PEEK anchor had a significantly lower grade of perianchor cyst formation during the third postoperative month of follow-up, the degree of cyst formation was similar in both anchors at six months.…”

“…Despite the initial increase in fluid collection during the early stages of rotator cuff healing, caused by the formation of perianchor cysts around the biocomposite anchor, these cysts gradually diminished over time. Importantly, this reduction in perianchor cysts did not have any detrimental effects on the integrity of the repaired rotator cuff or the functional outcomes of patients within the first six months [ 14 ]. The authors postulate that the high prevalence of perianchor fluid collection in the early phase of repair is probably due to anchor micromotion from the tensile load of the repaired rotator cuff [ 14 ].…”

“…Since the 1990s, PEEK-based orthopedic implants have been widely used in various spine and trauma procedures. However, there is a paucity of literature on the clinical and radiological implications of using PEEK suture anchors in rotator cuff repairs [ 12 - 14 ].…”

Knotless PEEK and double-loaded biodegradable suture anchors ensure comparable clinical outcomes in the arthroscopic treatment of traumatic anterior shoulder instability: a prospective randomized study

“…Theoretically, safe, reliable and effective fixation devices for arthroscopic Bankart repair should consist of a combination of inert material with the most suitable design. Although several ex-vivo studies compared mechanical behavior of different suture anchors available on the market [ 1 , 14 , 23 ], few clinical trials compared safety and efficacy of suture anchors having different composition and design [ 4 , 18 , 22 ].…”

New Trends in Shoulder Surgery from Biomechanics to the Operating Room

“…Lee et al [ 1 ] evaluated the functional and radiologic outcomes of biocompatible non-absorbable PEEK and biocomposite anchors used during rotator cuff repair, focusing on the rate of perianchor cyst formation during the first six months postoperatively. This paper demonstrated that the biocomposite anchor has a statistically significant tendency to form higher grades of fluid collection at 3 months after surgery, though this is usually reduced by the sixth postoperative month.…”