Osteolysis after rotator cuff repair with bioabsorbable anchors

Pilge, Hakan; Spang, Jeffrey T.; Rose, Tim; Wolter, H.; Woertler, Klaus; Imhoff, Andreas B.

doi:10.1007/s00402-011-1369-3

Cited by 30 publications

(40 citation statements)

References 24 publications

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“…Osteolysis was diagnosed when the normal marrow fat around the suture anchors was replaced by tissue whose signal was hypointense to water on T2-weighted images (T2WI). 6 The postoperative cuff condition was classified as described by Sugaya et al . 3 We also made a note of any abnormal signals in the proximal humerus in the preoperative MRI so as not to falsely label the findings in postoperative MRI.…”

Section: Aterials and M Ethodsmentioning

confidence: 99%

Magnetic resonance appearance of bioabsorbable anchor screws for double row arthroscopic rotator cuff repairs

Pawaskar

Kekatpure

Cho

et al. 2015

IJOO

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Background:Little is known about the bioabsorbable, anchor related postoperative changes in rotator cuff surgery, which has become more popular recently. The purpose of the present study was to use magnetic resonance imaging (MRI) to analyze the degradation of bioabsorbable anchors and to determine the incidences and characteristics of early postoperative reactions around the anchors and their mechanical failures.Materials and Methods:Postoperative MRIs of 200 patients who underwent arthroscopic rotator cuff repair were retrospectively analyzed. The tissue reactions around the bioanchors included fluid accumulations around the anchor, granulation tissue formation and changes in the condition of the surrounding osseous structure. The condition of the bioanchor itself was also examined, including whether the bioanchor failed mechanically. In the case of mechanical failure, the location of the failure was noted. Serial MRIs of 18 patients were available for analysis.Results:The total number of medial row bioanchors was 124, while that of the lateral row was 338. A low signal intensity rim suggestive of sclerosis surrounded all lateral row bioanchors. Ninety three lateral row bioanchors (27%) showed a rim with signal intensity similar to or less than that of surrounding bone, which was granulation tissue or foreign body reaction (FBR). Similar signal intensity was seen around nine medial row bioanchors (7%). Fluid accumulation was seen around 4 lateral row bioanchors (1%) and around 14 medial row bioanchors (11%). Five lateral row bioanchors showed the breakage, while there was none in the medial row bioanchors. There were nine cases with a cuff re-tear (4.5%). There was no evidence of affection of glenohumeral articular surfaces or of osteolysis around any bioanchor. In serial MRI, there was no change in appearance of the bioanchors, but the granulation tissue or FBR around four bioanchors and the fluid around one bioanchor showed a decrease in successive MRI.Conclusion:This study highlights the normal and adverse reactions to Bioabsorbable anchors that surgeons can expect to see on MRI after rotator cuff repairs.

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Section: Aterials and M Ethodsmentioning

confidence: 99%

Magnetic resonance appearance of bioabsorbable anchor screws for double row arthroscopic rotator cuff repairs

Pawaskar

Kekatpure

Cho

et al. 2015

IJOO

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“…However there are also some reports that osteolysis occurred at the site of insertion of the anchor after rotator cuff repair. 7,8) Glueck et al 7) reported a case of rotator cuff repair with development of extensive osteolysis in the humeral head. At postoperative 8 and 16 months, there were findings suggestive of significant osteolysis at the site of insertion of the anchor.…”

Section: )mentioning

confidence: 99%

“…6) The authors suggested that subtle differences in the manufacturing processes of PLDLA, oxidative degradation during or after manufacturing, and different isomer compositions between manufacturers may contribute to the different chemical properties of the final products and could have resulted in the differences in reoperation rate, loss of fixation or osteolysis. Pilge et al 8) reported a high rate of osteolysis after rotator cuff repair with PLDLA suture anchors. Of a total of 70 PLDLA anchors, 22 showed osteolytic changes on MRI scans without affecting the clinical outcomes after rotator cuff repair.…”

Section: )mentioning

confidence: 99%

“…There are some controversies regarding whether the cause of osteolysis is mechanical or biological. 7,8) It is not known whether the difference in the polymer contents may be more or less likely to cause an osteolytic reaction. Also in our cases, the exact role of premature anchor degradation through the process of anchor displacement is still inconclusive as there are no serial images showing the change of anchor insertion site.…”

Section: )mentioning

confidence: 99%

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Two Cases of Biodegradable Suture Anchor Displacement Diagnosed with Ultrasonography following Arthroscopic Rotator Cuff Repair

Oh¹,

Song²,

Rhie³

2015

Clinics in Shoulder and Elbow

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With the advancement of shoulder arthroscopy, use of biodegradable suture anchors in the surgical repair of rotator cuff tears has increased. Because of the radiolucency of these anchors, radiography is not appropriate for early detection of anchor failure. Ultrasonography is an advantageous modality in visualizing biodegradable, radiolucent anchors on a real-time basis without risk of radiation exposure. We report on two cases of displacement of a biodegradable suture anchor diagnosed on ultrasonography during the postoperative follow-up, which has not been previously reported. Because this displacement could be missed in the postoperative follow up ultrasonography, we describe the ultrasonographic features of the displaced biodegradable anchors. Surgeons and radiologists should pay special attention to the possibility of displacement of the suture anchor in patients who underwent rotator cuff repairs using suture anchors. With the advancement of shoulder arthroscopy, use of biodegradable suture anchors has increased. Biodegradable fixation devices were originally developed for the alternative use of the metal that produces complications including incarceration of the metal implant within the joint with migration, chondral damage and the imaging artifact on magnetic resonance imaging (MRI) scans.1) Their biodegradable property may reduce complications from metal anchors. However it is probable that various types of complications may occur in association with their biodegradability; these include foreign body reactions, osteolysis, synovitis, chondrolysis, and implant failure.2) Due to the radiolucency, however, radiography is limited in making a diagnosis of cuff healing and displacement of biodegradable suture anchors. Due to its relatively higher cost, MRI may not be available in a usual clinical setting as an imaging modality for a mid-term follow-up. Ultrasonography (USG) has recently become a popular, valid modality for use in diagnosis of patients with shoulder pathology. However, to the best of our knowledge, there are no reports on the usefulness of USG in detecting the displacement of the anchor. We experienced two cases of displacement of a biodegradable suture anchor diagnosed on USG during the postoperative follow-up. We report our cases with a review of literature. Case Report Case 1A 61-year-old right-handed man presented with a more than 3-month history of left shoulder pain. The patient underwent MRI at another hospital, which showed a full-thickness rotator cuff tear of 1.1×1.5 cm (anteroposterior dimension/retraction) in size. The patient underwent arthroscopic rotator cuff repair for treatment of severe activity-related pain in the left shoulder. While undergoing arthroscopic surgery, a supraspinatus tendon tear measuring approximately 1.5×2.2 cm was detected. Two 5.0-mm biodegradable suture anchors (Paladin ® ; ConMed Linvatec, Largo, FL, USA) were inserted in the medial row, followed by placement of four mattress transtendon sutures. We also used two lateral suture anchors (Versalok ® ; DeP...

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“…7 These suture anchors have elicited some concern regarding the response that the glenoid bone appears to show postsurgery. Several studies 1,4,8,11,12 have found that various types of suture anchors can lead to osteolysis and cyst formation after labral reconstruction, and it is believed that these lytic changes can contribute to glenoid rim fracture, anchor pullout, or subsequent articular cartilage damage. 1,6 This study aimed to compare the glenoid bone response and osteolytic changes in 2 different types of commercially available suture anchors: traditional push-fit biocomposite suture anchor (Osteoraptor; Smith & Nephew), and a 1.9-mm all-suture anchor (Suturefix Ultra; Smith & Nephew).…”

mentioning

confidence: 99%

In Vivo Randomized Controlled Study of the Bone Response of All-Suture Anchors and Biocomposite Anchors

Stewart

Raja

Torrance³

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Suture anchors are widely used for labral reconstruction surgery. However, there has been some concern over the development of osteolysis around the anchor. This has been reported for both biocomposite and all-suture anchors, but they have not been compared directly in vivo. Purpose: To compare the bone response to 2 common suture anchors: a traditional biocomposite push-fit anchor and an all-suture anchor. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Included in this study were 17 patients with a total of 37 unique suture anchors. Magnetic resonance imaging scans were performed at 3 weeks and 6 months postoperatively. A total of 38 senior radiologists and shoulder surgeons evaluated the images using a previously validated system for grading the bone response around suture anchors. The mean difference in grading at 3 weeks and 6 months was calculated using unpaired t tests, and the interrater reliability was evaluated with an intraclass correlation coefficient (ICC). Results: At 3 weeks, there was no statistically significant difference in the degree of osteolysis surrounding each suture anchor type ( P = .258), with little bone response. However, on the 6-month scans, there was a significantly lower level of osteolysis seen in the all-suture anchors compared with the biocomposite anchors ( P = .040). Interrater reliability was excellent, with an ICC value of 0.975 (95% CI, 0.962-0.985). Conclusion: All-suture anchors cause significantly less osteolysis in glenoid bone at 6 months compared with biocomposite anchors.

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Osteolysis after rotator cuff repair with bioabsorbable anchors

Cited by 30 publications

References 24 publications

Magnetic resonance appearance of bioabsorbable anchor screws for double row arthroscopic rotator cuff repairs

Magnetic resonance appearance of bioabsorbable anchor screws for double row arthroscopic rotator cuff repairs

Two Cases of Biodegradable Suture Anchor Displacement Diagnosed with Ultrasonography following Arthroscopic Rotator Cuff Repair

In Vivo Randomized Controlled Study of the Bone Response of All-Suture Anchors and Biocomposite Anchors

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