Factors associated with needle breakage of antegrade suture passer and effect of intratendinous remnant needle tip on clinical outcomes after arthroscopic rotator cuff repair

Abstract

Objective The aim of this study was to evaluate factors associated with the needle breakage of antegrade suture passer and the effect of intratendinous remnant needle tip on clinical outcomes after rotator cuff repair. Methods We retrospectively reviewed 283 patients (138 men and 145 women; mean age: 59.7 ± 9.3 years) who underwent arthroscopic repair for full-thickness rotator cuff tear. We evaluated the characteristics of 16 patients in whose needle tip had been broken and embedded and remained in the rotator cuff (remnant needle group) and compared them with the remaining 267 patients (control group). Afterwards, another 64 patients were selected from control group (1:4 matching) after propensity score matching (PSM). The groups were compared anatomically with MRI or ultrasonography and functionally (serial pain VAS and ROM; ASES, Constant, UCLA and SST scores) at a minimum follow-up of 1 year. Results The remnant needle group showed preoperative thicker tendon (6.72 mm vs 5.33 mm, p = 0.047), higher tendinosis (mean grade, 1.88 vs. 1.43, p = 0.029), and more frequent delaminated tears (p = 0.035) compared with control group. When we compare the clinical outcomes after PSM, the initial pain VAS of the remnant needle tip group was higher up to 3 months (pain VAS: 4.13 ± 2.07 vs 2.48 ± 1.61 (p = 0.032) at 5 weeks and 3.79 ± 2.12 vs 2.25 ± 1.76 (p = 0.044) at 3 months), however the difference disappeared after 6 months postoperatively. In final evaluation, there was no significant differences in every outcome parameters (all p > 0.05). Conclusion Breakage of the needle of the antegrade suture passer occurred more frequently in the thicker tendon, higher tendinosis, and delaminated tears. The retained broken needle tip was associated with higher pain scores during the early postoperative period, but revealed no difference in final outcomes by using PSM. Level of Evidence Level III, Therapeutic Study

Broken Needle Embedded in the Body during Vascular Puncture

“…The incidence of a broken needle or needle breakage is not unknown. Broken needles have been reported during dental procedures [ 2 , 3 ], laparoscopy [ 4 ], surgical operation [ 1 ], percutaneous needle biopsy [ 5 ], endobronchial ultrasound-guided-transbronchial needle aspiration [ 6 ], antegrade suture passer of shoulder [ 7 ], bone biopsy [ 8 ], acupunctures [ 9 ], spinal anesthesia [ 10 , 11 ], and the injection of drugs [ 12 , 13 ]. Seven case reports of broken needles during various procedures were reported in 2021 from a PubMed ® search.…”

“…The potential reasons for needle detachment could be syringe defects, fault in handling by the operator, or the patient. Risk factors associated with needle breakage of antegrade suture passer are thicker tendon, higher tendinosis, and delaminated tears [ 7 ]. Saurin et al reported that emergency procedures, morbid obesity and multiple puncture attempts, redirection without introducer, poorly differentiated landmarks, and resistance to needle advancement increase the risk of a broken needle during spinal anesthesia [ 11 ].…”

Mechanical mechanism of suture passer needle break in rotator cuff repair

“…However, it is too late for the postoperative observation of broken needle tips, and reoperation is unacceptable for patients and may result in more serious injuries in patients, which is also a source of medical dispute. A few literature studies have discussed about the suture passer needle breakage issue recently (9)(10)(11)(12)(13). The phenomenon of a broken suture passer needle was first described by Song and Ramsey in a case report in 2008 (11).…”

“…However, the notch at the tip of the needle often causes problems during the surgery. When the needle tip penetrates through thick tendon or the acromion in the narrow subacromial space, the needle is vulnerable to break at the notch site ( 9 ). Broken needle tips are tiny metal pieces, so that they cannot be observed easily during surgery and can only be identified by postoperative radiography.…”

“…Although they founded that intratendinous needle remnants do not influence the range of motion of the shoulder 2 years postoperatively ( 11 ), clinical observations indicate that these remnants may be the source of pain in patients when they actively try to reach toward the upper back ( 11 ). Recently, Chung et al pointed that needle remnants seemed to be associated with higher visual analog score in the early postoperative period ( 9 ). Therefore, the problem about broken suture passer needle remnants cannot be ignored and needs to be resolved.…”