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

Abstract

Purpose To compare the clinical outcome of arthroscopic capsulolabral repair for traumatic anterior shoulder instability with PEEK knotless and knotted biodegradable suture anchors. Methods Arthroscopic stabilization was performed in 78 patients with recurrent traumatic anterior shoulder instability. They were divided into 2 groups of 39 patients each, according to suture anchors used: knotless PEEK anchors in group 1, and biodegradable anchors in group 2. Exclusion criteria were: instability without dislocation, posterior or multidirectional instability, glenoid bone loss > 20%, off-track lesions, concomitant rotator cuff tears and previous surgery. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) self-administered questionnaire. Secondary outcomes were: Work-DASH, Sport-DASH, Rowe score, recurrent instability and subsequent surgery. The following independent variables were considered: age, gender, dominance, generalized ligamentous hyperlaxity, duration of symptoms, age at first dislocation, number of dislocations, type of work, type of sport, sports activity level, capsule-labral injury pattern, SLAP lesion and number of anchors. Differences between groups for numerical variables were analyzed by use of the Student’s t-test or Mann–Whitney U-test. Fisher’s exact test was used for analysis of categorical variables. Significance was set at p < 0.05. Results Seven patients (9%) were lost at follow-up, 5 from group 1 and 2 from group 2. Follow-up ranged from 36 to 60 months (median: 44; IQR: 13). Comparison between groups did not show significant differences for each independent variable considered. No differences could be found either for DASH (n.s.) or Rowe (p = n.s.) scores between the two groups. Overall recurrence rate was 7%. Three re-dislocations were reported in group 1 and two in group 2 (n.s.). Only one patient in each group underwent re-operation. Conclusions The study showed no significant differences in clinical outcomes after arthroscopic treatment of traumatic anterior shoulder instability using PEEK knotless or biodegradable knotted anchors at mid-term follow-up. Level of evidence I.

Absorbable implants in sport medicine and arthroscopic surgery: A narrative review of recent development

“…Long-term clinical practice has confirmed that the above-mentioned bioabsorbable suture anchors have comparable mechanical performance to metal or PEEK anchors [ [119] , [120] , [121] ], but there are still some unavoidable complications, such as degradation of fragments into the joint cavity, soft tissue inflammation, cyst formation, and local osteolytic changes [ 122 ]. Among these, cyst formation and osteolytic changes are of particular concern to sport medicine surgeons, as they may affect tendon-bone healing and lead to failure.…”

Knotless Bioabsorbable Anchors Placed on the Glenoid Face for Arthroscopic Bankart Repair

“…With the improvement of anchor materials, fixation mechanisms, and easy surgical techniques, the use of knotless anchors has been increasing in arthroscopic Bankart repair. 34,37 Knotless anchors can reduce the effort to make a secure knot and knot-related complications. 17,23,37 Furthermore, bioabsorbable anchor materials have the advantage of reducing anchor-related complications, including anchor arthropathy, compared with metal or nondegradable anchors.…”