Perianchor Cyst Formation After Arthroscopic Rotator Cuff Repair Using All-Suture–Type, Bioabsorbable-Type, and PEEK-Type Anchors

Ro, Kyung Han; Pancholi, Samyak; Son, Hyuck Sung; Rhee, Yong Girl

doi:10.1016/j.arthro.2019.03.032

Arthroscopy: The Journal of Arthroscopic & Related Surgery

2019

DOI: 10.1016/j.arthro.2019.03.032

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Perianchor Cyst Formation After Arthroscopic Rotator Cuff Repair Using All-Suture–Type, Bioabsorbable-Type, and PEEK-Type Anchors

Kyung Han Ro

Samyak Pancholi

Hyuck Sung Son

et al.

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Cited by 39 publications

(115 citation statements)

References 28 publications

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“…7 Therefore, from the perspectives of clinical outcome and rate of cyst occurrence, I think that it is safe to say that allsuture anchors are no more baleful than other anchors. The findings of Ro et al 5 are similar to those of other studies in that perianchor cysts do not negatively affect clinical outcomes. 6,8,9 Reported rates of cyst appearance vary widely among studies (10.8%-56.6%).…”

supporting

confidence: 84%

“…The incidence of perianchor bone cysts was 8.8%, 16.7%, and 12.5% for all-sutureetype, bioabsorbable-type, and PEEK-type anchors, respectively, and did not differ statistically. Ro et al 5 found no significant differences in terms of visual analog scale scores, Constant scores, retear rates, and perianchor cyst rates among all-sutureetype, bioabsorbable-type, and PEEK-type anchors.…”

mentioning

confidence: 96%

“…Given the concerns regarding all-suture anchors causing the formation of wider cavities around the anchors due to micromotion, 3,7 Ro et al 5 showed that the rate and size of the cysts caused by all-suture anchors were not significantly different from those of biocomposite and PEEK anchors. Lee et al 7 reported that the increment in tunnel diameter with all-suture anchors was significantly greater than that with biodegradable suture anchors at the 1-year computed tomography follow-up after arthroscopic Bankart repair.…”

mentioning

confidence: 99%

“…6,8,9 Reported rates of cyst appearance vary widely among studies (10.8%-56.6%). 5,6,8,9 This is probably because of the different definitions of perianchor cysts and different methods of detecting the cysts (plain radiographs, computed tomography, and magnetic resonance imaging). There are hypotheses regarding why cysts occur around the anchors, including foreign-body reaction, synovitis, and inflammation.…”

mentioning

confidence: 99%

“…In their article, using multiple regression analysis, Ro et al 5 have associated retears with a greater perianchor cystic reaction and larger tear size. I believe that this needs to be read with some scrutiny.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Editorial Commentary: Perianchor Cysts—We Need More Worries After Rotator Cuff Repair Like We Need Holes in the Head

Jang

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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supporting

confidence: 84%

mentioning

confidence: 96%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Editorial Commentary: Perianchor Cysts—We Need More Worries After Rotator Cuff Repair Like We Need Holes in the Head

Jang

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Postoperative bone marrow edema lasts no more than 6 months after uncomplicated arthroscopic double-row rotator cuff repair with PEEK anchors

Chen

He²,

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To assess the natural evolution of the osseous reaction following arthroscopic double-row rotator cuf repair with PEEK anchors and to analyze its correlation with clinical shoulder function. Methods Between 2015 and 2017, 159 patients received arthroscopic double-row rotator cuf repair with PEEK anchors and underwent serial clinical and radiological follow-up (3, 6, 12, and 24 months). Radiological results were analyzed by tendon integrity, bone marrow edema, and peri-implant osteolysis. Clinical shoulder function was evaluated with the Constant score. Results One-hundred and seventeen patients were enrolled; among them, 63% demonstrated bone marrow edema around the anchors on postoperative 3-month MRI. The edema area percentage was 41% ± 7%. At 6 months, edema was only seen in 12% of cases, with an area percentage of 18% ± 5%. At 12 and 24 months, edema was rarely present. Fluid signals around the anchor were observed in 17.6%, 42.7%, 33.3%, and 21.0% of patients at 3, 6, 12, and 24 months, respectively; the tunnel widening values were 1.1 ± 0.4 mm, 1.8 ± 0.5 mm, 2.3 ± 0.6 mm, and 2.2 ± 0.7 mm at each follow-up, respectively. The sign of osteolysis was signiicantly more obvious around the lateral anchor than around the medial anchor. The presence of an osseous reaction was not correlated with worse clinical outcome. Conclusion Osseous reactions following arthroscopic rotator cuf repair are common and signiicant even with PEEK anchors. Bone marrow edema does not last more than 6 months in patients without complications. Peri-implant osteolysis is more evident around the lateral anchor than around the medial anchor and improves gradually over time. The sign of osteolysis is not correlated with clinical shoulder function. Based on these indings, surgeons should be cautious about bone marrow edema lasting more than 6 months following arthroscopic rotator cuf repair. Level of evidence Level IV.

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Arthroscopic remplissage with all-suture anchors causes cystic lesions in the humerus: a volumetric CT study of 55 anchors

Ibán

Rodriguez

Díaz

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate with computed tomography (CT) the incidence of implant-related osteolysis after implantation of two types of all-suture anchors during remplissage for the management of Hill-Sachs lesions in shoulder instability. Methods Single-cohort, observational study with a minimum of 12 months follow-up. Twenty-ive participants (19 males and 6 females; mean age 37.4 years [SD: 11.6]) with Hill-Sachs lesions requiring remplissage were evaluated with a CT performed a mean of 14.1 [3.74] months after surgery. Fifty-ive all-suture anchors (19 2.3 mm Iconix and 36 1.7 mm Sutureix) were used. The volume of the bone defects was measured in the CT. Every anchor was classiied into one of four groups: (1) no bone defect. (2) Partial bone defect (bone defects smaller than the drill used for anchor placement). (3) Tunnel enlargement (bone defect larger than the drill volume but smaller than twice that volume). (4) Cystic lesion (bone defect larger twice the drill volume). Results No bone defect was identiied in only two anchors (3.6%, 95% CI 0.4-12.5%). A partial bone defect was found in eight anchors (14.5%, 95% CI 6.5-26.7%). In 35 anchors (63.6%, 95% CI 49.6-76.2%), there was enlargement of the bone defect that was smaller than 200% the size of the drill used. Ten anchors caused bone defects larger than twice the size of the drill used (18.2%, 95% CI 9.1-30.9%). The defect size was a mean of 89 mm 3 (SD: 49 mm 3 , minimum 0 mm 3 , maximum 230 mm 3 ). Conclusion When using all-suture anchors in arthroscopic remplissage during instability surgery, relevant bone osteolytic defects are common at 1-year-follow-up. Cystic defects larger than twice the volume of the resected bone during implantation develop in one in six anchors and signiicant tunnel widening will develop in another three out of ive anchors. This bone loss efectively increases the size and depth of the Hill-Sachs lesions but does not seem to afect short-term clinical outcomes. Level of evidence Level IV.

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Perianchor Cyst Formation After Arthroscopic Rotator Cuff Repair Using All-Suture–Type, Bioabsorbable-Type, and PEEK-Type Anchors

Cited by 39 publications

References 28 publications

Editorial Commentary: Perianchor Cysts—We Need More Worries After Rotator Cuff Repair Like We Need Holes in the Head

Editorial Commentary: Perianchor Cysts—We Need More Worries After Rotator Cuff Repair Like We Need Holes in the Head

Postoperative bone marrow edema lasts no more than 6 months after uncomplicated arthroscopic double-row rotator cuff repair with PEEK anchors

Arthroscopic remplissage with all-suture anchors causes cystic lesions in the humerus: a volumetric CT study of 55 anchors

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