Large Drill Holes Are Still Present in the Long Term After Arthroscopic Bankart Repair With Absorbable Tacks: An 18-Year Randomized Prospective Study

Abstract

Background: Studies have demonstrated the development of an osseous reaction at the drill sites of anchors after arthroscopic shoulder surgery. Purpose: To investigate the drill-hole size at 18 years after arthroscopic Bankart repair using either fast polygluconate acid (PGA) or slow polylevolactic acid (PLLA) absorbable tacks and to compare the functional outcomes and development of osteoarthritis. Study design: Randomized controlled trial; Level of evidence, 2. Methods: 40 patients with unidirectional anterior shoulder instability, treated with arthroscopic Bankart repair, were randomized into the PGA group (n = 20) or the PLLA group (n = 20). Plain radiographs of both shoulders, as well as computed tomography (CT) images of the operated shoulder, were used to evaluate the drill-hole size, volume, and degenerative changes. Functional outcomes were assessed by use of the Rowe score, Constant score, and Western Ontario Shoulder Instability (WOSI) index. Results: Of the 40 patients, 32 patients returned for the follow-up (15 PGA and 17 PLLA). No significant differences were found in the population characteristics between the study groups. The mean follow-up time was 18 years for both groups. No significant differences were seen in range of motion, strength in abduction, or Constant, Rowe, and WOSI scores between the groups. Recurrence rate was 33% in the PGA group and 6% in the PLLA group during the follow-up period ( P = .07). The drill-hole appearance on plain radiographs (invisible/hardly visible/visible/cystic) was 11/2/2/0 and 6/5/5/1 for the PGA and PLLA groups, respectively ( P = .036). The mean ± SD drill-hole volume as estimated on CT images was 89 ± 94 and 184 ± 158 mm3 in the PGA and PLLA groups, respectively ( P = .051). Degenerative changes (normal/minor/moderate/severe) on plain radiographs were 7/4/4/0 and 3/8/5/1 for the PGA and PLLA groups, respectively ( P = .21), and on CT images were 5/7/3/0 and 2/6/6/3 for the PGA and PLLA groups, respectively ( P = .030). Conclusion: This long-term follow-up study demonstrated that the PLLA group had significantly more visible drill holes than the PGA group on plain radiographs. However, this difference was not evident on CT imaging, with both groups having several visible cystic drill holes and a substantial drill-hole volume defect. No significant differences were found between the study groups in terms of clinical outcomes.

High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review

“…On the Coleman methodology score, one scored poor, 11 43 studies scored fair, 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 37 scored good, 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 ...…”

“… 42 15 26 + + Prospective + + 1,2,3 1,3,4 1,2 62 Constantinou et al. 75 32 217 + + RCT + − 1,2,3 1,2,3,4 1 79 De Giorgi et al. 43 22 56 + + Retrospective + + 1,2,3 2,3,4 1,2 68 Salomonsson et al.…”

“…(continued) e6 71 DS 10 (11) Boileau et al 72 DS 6 (7) 8 ( 9) 9 (10) 14 ( 15) Calvo et al 73 DS 11 (18) Kim et al 97 DSA 0 (0) 0 (0) 4 ( 6) 4 (6) Kim et al 74 167 DSA 1 (1) 2 (1) 4 (2) 7 (4) Sperber et al 38 DS 0 7 (23) Nakagawa et al 39 257 DS 42 (16) Nakagawa et al 40 DS 22 (24) Chechik et al 41 DS 9 (11) 7 ( 8) 16 ( 19) Cole et al 98 DSA 3 (8) 9 (24) Anderl et al 42 DSA 0 (0) 0 (0) 0 (0) 0 (0) Constantinou et al 75 DS 6 (19) De Giorgi et al 43 DS 4 (19) 1 ( 5) 3 ( 14 48 Recurrent dislocation, symptomatic subluxation or instability preventing return to full active duties or necessitating an additional surgical stabilization procedure. 2).…”

“…Definition of dislocation Dislocation needing reduction (by medical professional or third party) 12,16,19,26,31,33,34,37,57,58,68,70,[72][73][74]87,91,102 Objective documentation of a dislocation either radiologically or clinically 24,32,59,62,71,75,92 Increased translation of the humerus relative to the glenoid to the point of complete separation of articular surfaces 96 More than 1 episode of instability which needed manual reduction by other people 97…”

“…Instability without the need of reduction 12,13,16,26,31,33,34,45,57,58,68,70,72,87,91,97,102 Subjective sense of subluxation/instability 24,37,44,60,69,71,99 Sense of dislocation with a positive anterior apprehension test 59 Transient instability event that did not require reduction but demonstrated a positive apprehension and relocation sign with radiographic or magnetic resonance imaging evidence of a Bankart or Hill-Sachs 19 Symptomatic self-reported subluxation 62 "Dead-arm" phenomenon or instability which spontaneously reduced 73,75 Symptomatic translation of the humeral head relative to the glenoid articular surface without a dislocation 96 Subluxation at the time of the clinical assessment or through a history of at least 1 episode of dead arm syndrome 84 with signs of a sustained dislocation in further radiographs, such as Hill-Sachs or bony Bankart lesion in comparison with the preoperative situation, could be categorized as a confirmed dislocation. For subluxations, we advise using the definition of the feeling of a dislocation that can be (spontaneously) reduced without the need for a radiographically confirmed dislocation.…”