Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 18, Issue 12, pp 1785–1791 | Cite as

Comparison between metal and biodegradable suture anchors in the arthroscopic treatment of traumatic anterior shoulder instability: a prospective randomized study

  • Giuseppe MilanoEmail author
  • Andrea Grasso
  • Domenico A. Santagada
  • Maristella F. Saccomanno
  • Laura Deriu
  • Carlo Fabbriciani



The purpose of this study was to compare the clinical outcome of arthroscopic treatment of shoulder instability with metal and biodegradable suture anchors.


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: metal anchors in group 1, and biodegradable anchors in group 2. Results were evaluated by use of the Disabilities of the Arm, Shoulder and Hand (DASH) self-administered questionnaire; Rowe score; Constant score normalized for age and gender, and recurrence of dislocation.


On analyzing the results at a 2-year follow-up, we considered the following independent variables: age; gender; arm dominance; duration of symptoms, age at first dislocation, number of dislocations, type of work; type of sport; sports activity level; lesion of the anterior labrum and anterior-inferior gleno-humeral ligament; SLAP lesion, and number of suture anchors. Comparison between groups did not show significant differences for each variable considered. Overall, according to the results, median DASH scores were 4.5 points (range 0–27) in group 1 and 7 points (range 0–25) in group 2 (n.s.); median Rowe scores were 100 points (range 60–100) and 100 points (range 25–100), respectively (n.s.); and median Constant scores were 98 points (range 81–107) and 98 points (range 87–121), respectively (n.s.). Recurrence was observed in 1 patient (2.8%) in group 1 and in 2 patients (5.9%) in group 2. Overall recurrence rate was 4.3%. Univariate and multivariate analysis showed that age, duration of symptoms, number of dislocations, type of work, and type of sports significantly and independently influenced the outcomes. Differences between groups 1 and 2 were not significant.


At a short-term follow-up, differences between arthroscopic shoulder stabilization with metal and biodegradable suture anchors were not statistically significant. Clinical relevance of the study is that there is no difference in the use of metal or biodegradable suture anchors for the arthroscopic treatment of shoulder instability.


Shoulder instability Repair Arthroscopy Suture anchors Biodegradable 


  1. 1.
    Athwal GS, Shridharani SM, O’Driscoll SW (2006) Osteolysis and arthropathy of the shoulder after use of bioabsorbable knotless suture anchors. A report of four cases. J Bone Joint Surg Am 88:1840–1845CrossRefPubMedGoogle Scholar
  2. 2.
    Banerjee S, Weiser L, Connell D, Wallace AL (2009) Glenoid rim fracture in contact athletes with absorbable suture anchor reconstruction. Arthroscopy 25:560–562CrossRefPubMedGoogle Scholar
  3. 3.
    Barber FA (2007) Biodegradable shoulder anchors have unique modes of failure. Arthroscopy 23:316–320CrossRefPubMedGoogle Scholar
  4. 4.
    Barber FA, Coons DA, Ruiz-Suarez M (2008) Cyclic load testing and ultimate failure strength of biodegradable glenoid anchors. Arthroscopy 24:224–228CrossRefPubMedGoogle Scholar
  5. 5.
    Barber FA, Herbert MA, Click JN (1997) Internal fixation strength of suture anchors–update. Arthroscopy 13:355–362CrossRefPubMedGoogle Scholar
  6. 6.
    Barber FA, Herbert MA, Coons DA, Boothby M (2006) Sutures and suture anchors–update. Arthroscopy 22:1063.e1–1063.e9Google Scholar
  7. 7.
    Barber FA, Snyder SJ, Abrams JS, Fanelli GC, Savoie FH III (2003) Arthroscopic Bankart reconstruction with a bioabsorbable anchor. J Shoulder Elbow Surg 12:535–538CrossRefPubMedGoogle Scholar
  8. 8.
    Baudi P, Righi P, Bolognesi D, Rivetta S, Rossi Urtoler E, Guicciardi N, Carrara M (2005) How to identify and calculate glenoid bone deficit. Chir Organi Mov 90:145–152PubMedGoogle Scholar
  9. 9.
    Burkart A, Imhoff AB, Roscher E (2000) Foreign-body reaction to the bioabsorbable suretac device. Arthroscopy 16:91–95CrossRefPubMedGoogle Scholar
  10. 10.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMedGoogle Scholar
  11. 11.
    Cooke SJ, Starks I, Kathuria V (2009) The results of arthroscopic anterior stabilisation of the shoulder using the bioknotless anchor system. Sports Med Arthrosc Rehabil Ther Technol 19(1):2CrossRefGoogle Scholar
  12. 12.
    Ejerhed L, Kartus J, Funck E, Köhler K, Sernert N, Karlsson J (2000) A clinical and radiographic comparison of absorbable and non-absorbable suture anchors in open shoulder stabilisation. Knee Surg Sports Traumatol Arthrosc 8:349–355CrossRefPubMedGoogle Scholar
  13. 13.
    Elmlund AO, Kartus J, Rostgård-Christensen L, Sernert N, Magnusson L, Ejerhed L (2009) A 7-year prospective, randomized, clinical, and radiographic study after arthroscopic Bankart reconstruction using 2 different types of absorbable tack. Am J Sports Med 37:1930–1937CrossRefPubMedGoogle Scholar
  14. 14.
    Flinkkilä T, Hyvönen P, Ohtonen P, Leppilahti J (2010) Arthroscopic Bankart repair: results and risk factors of recurrence of instability. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-010-1105-5
  15. 15.
    Freehill MQ, Harms DJ, Huber SM, Atlihan D, Buss DD (2003) Poly-l-lactic acid tack synovitis after arthroscopic stabilization of the shoulder. Am J Sports Med 31:643–647PubMedGoogle Scholar
  16. 16.
    Gerber C (1993) Integrated scoring systems for the functional assessment of the shoulder. In: Matsen FA, Fu FH, Hawkins RJ (eds) The shoulder: a balance of mobility and stability, AAOS, pp 531–550Google Scholar
  17. 17.
    Gummesson C, Atroshi I, Ekdahl C (2003) The Disabilities of the Arm, Shoulder and Hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord 4:11CrossRefPubMedGoogle Scholar
  18. 18.
    Hobby J, Griffin D, Dunbar M, Boileau P (2007) Is arthroscopic surgery for stabilisation of chronic shoulder instability as effective as open surgery? A systematic review and meta-analysis of 62 studies including 3044 arthroscopic operations. J Bone Joint Surg Br 89:1188–1196CrossRefPubMedGoogle Scholar
  19. 19.
    Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608CrossRefPubMedGoogle Scholar
  20. 20.
    Jeong JH, Shin SJ (2009) Arthroscopic removal of proud metallic suture anchors after Bankart repair. Arch Orthop Trauma Surg 129:1109–1115CrossRefPubMedGoogle Scholar
  21. 21.
    Kaar TK, Schenck RC Jr, Wirth MA, Rockwood CA Jr (2001) Complications of metallic suture anchors in shoulder surgery: a report of 8 cases. Arthroscopy 17:31–37CrossRefPubMedGoogle Scholar
  22. 22.
    Magnusson L, Ejerhed L, Rostgård-Christensen L, Sernert N, Eriksson R, Karlsson J, Kartus JT (2006) A prospective, randomized, clinical and radiographic study after arthroscopic Bankart reconstruction using 2 different types of absorbable tacks. Arthroscopy 22:143–151CrossRefPubMedGoogle Scholar
  23. 23.
    Meyer DC, Gerber C (2004) Failure of anterior shoulder instability repair caused by eyelet cutout of absorbable suture anchors. Arthroscopy 20:521–523CrossRefPubMedGoogle Scholar
  24. 24.
    Mohtadi NG, Hollinshead RM, Ceponis PJ, Chan DS, Fick GH (2006) A multi-centre randomized controlled trial comparing electrothermal arthroscopic capsulorrhaphy versus open inferior capsular shift for patients with shoulder instability: protocol implementation and interim performance: lessons learned from conducting a multi-centre RCT [ISRCTN68224911; NCT00251160]. Trials 2(7):4CrossRefGoogle Scholar
  25. 25.
    Müller M, Kääb MJ, Villiger C, Holzach P (2002) Osteolysis after open shoulder stabilization using a new bio-resorbable bone anchor: a prospective, non-randomized clinical trial. Injury 33(Suppl 2):B30–B36CrossRefPubMedGoogle Scholar
  26. 26.
    Mueller MB, Fredrich HH, Steinhauser E, Schreiber U, Arians A, Imhoff AB (2005) Biomechanical evaluation of different suture anchors for the stabilization of anterior labrum lesions. Arthroscopy 21:611–619CrossRefPubMedGoogle Scholar
  27. 27.
    Oh JH, Lee HK, Kim JY, Kim SH, Gong HS (2009) Clinical and radiologic outcomes of arthroscopic glenoid labrum repair with the BioKnotless suture anchor. Am J Sports Med 37:2340–2348CrossRefPubMedGoogle Scholar
  28. 28.
    Owens BD, DeBerardino TM, Nelson BJ, Thurman J, Cameron KL, Taylor DC, Uhorchak JM, Arciero RA (2009) Long-term follow-up of acute arthroscopic Bankart repair for initial anterior shoulder dislocations in young athletes. Am J Sports Med 37:669–673CrossRefPubMedGoogle Scholar
  29. 29.
    Ozbaydar M, Elhassan B, Warner JJ (2007) The use of anchors in shoulder surgery: a shift from metallic to bioabsorbable anchors. Arthroscopy 23:1124–1126CrossRefPubMedGoogle Scholar
  30. 30.
    Padua R, Padua L, Ceccarelli E, Romanini E, Zanoli G, Amadio PC, Campi A (2003) Italian version of the disability of the arm, shoulder and hand (DASH) questionnaire. Cross-cultural adaptation and validation. J Hand Surg Br 28:179–186CrossRefPubMedGoogle Scholar
  31. 31.
    Park JY, Lhee SH, Park HK, Jeon SH, Oh JH (2009) Perianchor radiolucency after knotless anchor repair for shoulder instability: correlation with clinical results of 69 cases. Am J Sports Med 37:360–370CrossRefPubMedGoogle Scholar
  32. 32.
    Porcellini G, Campi F, Pegreffi F, Castagna A, Paladini P (2009) Predisposing factors for recurrent shoulder dislocation after arthroscopic treatment. J Bone Joint Surg Am 91:2537–2542CrossRefPubMedGoogle Scholar
  33. 33.
    Rowe CR, Patel D, Southmayd WW (1978) The Bankart procedure: a long-term end-result study. J Bone Joint Surg Am 60:1–16PubMedGoogle Scholar
  34. 34.
    Silver MD, Daigneault JP (2000) Symptomatic interarticular migration of glenoid suture anchors. Arthroscopy 16:102–105CrossRefPubMedGoogle Scholar
  35. 35.
    Spoliti M (2007) Glenoid osteolysis after arthroscopic labrum repair with a bioabsorbable suture anchor. Acta Orthop Belg 73:107–110PubMedGoogle Scholar
  36. 36.
    Takubo Y, Morihara T, Namura T, Nakagawa H, Takeshita H, Horii M, Kurokawa M, Kubo T (2008) Anchor hole enlargement after arthroscopic Bankart repair using absorbable suture anchors: a report of three cases. J Shoulder Elbow Surg 17:e16–e18CrossRefPubMedGoogle Scholar
  37. 37.
    Tan CK, Guisasola I, Machani B, Kemp G, Sinopidis C, Brownson P, Frostick S (2006) Arthroscopic stabilization of the shoulder: a prospective randomized study of absorbable versus nonabsorbable suture anchors. Arthroscopy 22:716–720CrossRefPubMedGoogle Scholar
  38. 38.
    Thal R, Nofziger M, Bridges M, Kim JJ (2007) Arthroscopic Bankart repair using Knotless or BioKnotless suture anchors: 2- to 7-year results. Arthroscopy 23:367–375CrossRefPubMedGoogle Scholar
  39. 39.
    Voos JE, Livermore RW, Feeley BT, Altchek DW, Williams RJ, Warren RF, Cordasco FA, Allen AA (2010) Prospective evaluation of arthroscopic Bankart repairs for anterior instability. Am J Sports Med 38:302–307CrossRefPubMedGoogle Scholar
  40. 40.
    Warme WJ, Arciero RA, Savoie FH III et al (1999) Nonabsorbable versus absorbable suture anchors for open Bankart repair. A prospective, randomized comparison. Am J Sports Med 27:742–746PubMedGoogle Scholar
  41. 41.
    Weber SC, Kauffman JI (2006) Distant migration of a bioabsorbable implant in the shoulder. J Shoulder Elbow Surg 15:e48–e53CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Giuseppe Milano
    • 1
    Email author
  • Andrea Grasso
    • 2
  • Domenico A. Santagada
    • 1
  • Maristella F. Saccomanno
    • 1
  • Laura Deriu
    • 1
  • Carlo Fabbriciani
    • 1
  1. 1.Department of Orthopaedics and TraumatologyCatholic UniversityRomeItaly
  2. 2.Villa Valeria ClinicRomeItaly

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