Early pullout of lateral row knotless anchor in rotator cuff repair

Tsiouri, Chrysi; Mok, D.

doi:10.4103/0973-6042.59972

Cited by 7 publications

(10 citation statements)

References 8 publications

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“…6 Although application of the rotator cuff onto the footprint using sustained pressure has been regarded as an important part of the suture bridge type technique, there is some concern that this may cause reduction of perfusion in the tendon margin that may then ultimately lead to compromised healing. 11,26 Tendon perfusion may not be regarded as particularly critical to the outcome of the surgery by many surgeons; however, the high reported rate of repair failure is a concern. 4 The recent article by Urita et al 27 has shown convincingly that the transosseous technique achieves better blood flow in the healing margin of the tendon, compared with the transosseous equivalent option.…”

Section: Discussionmentioning

confidence: 99%

“…4,17 There is however concern that the suture bridge, or transosseous equivalent approach, may interfere with blood supply to the healing tendon. 26 Further, the use of anchors in patients who are elderly, and who may be osteoporotic, 28 can potentially increase the likelihood of anchor pullout. Although such a displacement has not been commonly reported, various techniques have been described to address this technical issue.…”

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confidence: 99%

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Arthroscopic rotator cuff repair using a transosseous knotless anchor (ATOK)

Sandow

Schutz

2020

Journal of Shoulder and Elbow Surgery

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Background: This article reviews the clinical and radiographic outcomes in a noninferiority trial use of a transosseous knotless anchor to perform arthroscopic rotator cuff repairs in a patient cohort that have an increased incidence of osteoporosis. Methods: Patients aged over 60 with a documented rotator cuff tear and who failed a rehab program underwent repair using an arthroscopic transosseous knotless (ATOK) anchor. Patients were prospectively reviewed using shoulder functional assessments (age-adjusted Constant score, Oxford Shoulder Score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES], visual analog scale [VAS] pain scores), and underwent preoperative as well as 1-, 3-, and 12-month postoperative magnetic resonance imaging. Results: 15 patients had undergone rotator cuff repair using the ATOK and were followed for a minimum of 24 months (range 24-30 months). From preoperative to 24 months post repair, median scores improved for ASES (61-89), Oxford (26-44), Constant (62-91), and VAS Pain (5-0.5). Four patients developed a partial retear of their repair, but only 1 patient sustained a complete retear: Sugaya type I, 10; type II, 1; type III, 2; type IV, 1; and type V, 1. No anchors were displaced, and there were no osteolysis, neurologic, or technique-related complications. Conclusions: Arthroscopic rotator cuff repairs using a transosseous knotless technique has achieved a satisfactory outcome in this group of patients, who typically have poor bone quality, increasing the risk of antegrade anchor pullout. This approach would appear to combine the potential biomechanical and biological advantages of a transosseous repair technique, with the benefits of the lower morbidity arthroscopic surgical approach. Level of evidence: Level IV; Case Series; Treatment Study Ó 2019 The Authors. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Arthroscopic rotator cuff repair using a transosseous knotless anchor (ATOK)

Sandow

Schutz

2020

Journal of Shoulder and Elbow Surgery

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“…26 An older patient population is associated with decreased bone mass and strength, and postmenopausal females have decreased bone quality; these factors are associated with higher rotator cuff failure rates due to poor tendon healing, with anchor fixation failure also playing a role. [27][28][29] Therefore, it is critically important to develop methods for augmenting implant and tendon fixation to bone to achieve functional healing. The results of this study suggest that OsteoCrete provides a valid method for accomplishing this goal based on the observation that proximal humeral anchor fixation was improved by 50% in load-to-failure 15 minutes post-injection with an even more profound impact on the anchors placed in poor-quality bone (99% increased load-to-failure 15 minutes post-injection).…”

Section: Discussionmentioning

confidence: 99%

Use of a Novel Magnesium-Based Resorbable Bone Cement for Augmenting Anchor and Tendon Fixation

Roller

Kuroki²,

Bozynski³

et al. 2018

Am J Orthop

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The aim of this study was to assess the efficacy and safety of a novel magnesium-based resorbable bone cement (OsteoCrete, Bone Solutions Incorporated) for anchor and tendon fixation. Cadaveric humeral testing involved straight pull-to-failure of rotator cuff suture anchors; OsteoCrete was injected through one anchor, and a second anchor served as the uninjected control. Testing was conducted 15 minutes post-injection. A canine preclinical model was used to evaluate the safety of the following parameters: Rotator cuff repair: A double-row technique was used to repair transected infraspinatus tendons; OsteoCrete was injected through both anchors in one limb, and the contralateral limb served as the uninjected control. Biceps tenodesis: The transected biceps tendon was implanted into a proximal humeral socket with a transcortical button; OsteoCrete was injected into the socket of one limb, and a screw was used for final fixation in the contralateral control limb. Nondestructive biomechanical testing and histologic assessment were performed after 12 weeks. OsteoCrete-augmented anchors showed significantly higher load-to-failure compared to that with uninjected controls. In cadaveric humeri with reduced bone quality, OsteoCrete increased the mean load-to-failure by 99%. Within the preclinical model, there were no complications or statistically significant biomechanical/histologic differences between the techniques. OsteoCrete has the potential for safely providing improved suture anchor and tissue fixation in patients with poor bone or tissue quality.

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“…This case may also be related to the number of used anchors used: a single medial anchor and two lateral anchors. A previous report [ 8 ] suggested that, after a mattress repair to the torn tendon, which placed four strands of sutures from the single medial anchor to be carried by the lateral row anchor, all traction forces on the medial anchor were then transmitted across to the lateral anchor. They proposed that this tension might be beyond the level of tension that the bone of the lateral cortex can withstand.…”

Section: Discussionmentioning

confidence: 99%

Delayed Lateral Row Anchor Failure in Suture Bridge Rotator Cuff Repair: A Report of 3 Cases

Jeong

Park

2018

Clin Shoulder Elbow

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Compared to single row repair, use of lateral row anchors in suture bridge rotator cuff repair enhances repair strength and increases footprint contact area. If a lateral knotless anchor (push-in design) is inserted into osteoporotic bone, pull-out of the lateral row anchor can developed. However, failures of lateral row anchors have been reported at several months after surgery. In our cases, even though complete cuff healing occurred, delayed pull-out of the lateral row anchor in the suture bridge repair occurred. In comparison to a conventional medial anchor, further biomechanical evaluation of the pull-out force, design, and insertion angle of the lateral anchor is needed in future studies. We report three cases with delayed pull-out of lateral row anchor in suture bridge rotator cuff repair with a literature review.

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Early pullout of lateral row knotless anchor in rotator cuff repair

Cited by 7 publications

References 8 publications

Arthroscopic rotator cuff repair using a transosseous knotless anchor (ATOK)

Arthroscopic rotator cuff repair using a transosseous knotless anchor (ATOK)

Use of a Novel Magnesium-Based Resorbable Bone Cement for Augmenting Anchor and Tendon Fixation

Delayed Lateral Row Anchor Failure in Suture Bridge Rotator Cuff Repair: A Report of 3 Cases

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