Abstract
Purpose
The aim of this study was to analyse the osseous reaction after arthroscopic double-row rotator cuff repair using bio-absorbable poly-l-lactic acid (PLLA) and non-absorbable polyetheretherketone (PEEK) suture anchors. Focus of interest was the appearance of peri-implant fluid and anchor tunnel widening.
Methods
Thirty-six patients were evaluated at final follow-up (16 PLLA and 20 PEEK). Clinical results were acquired by use of the subjective shoulder value, the Constant score and the Western Ontario Rotator Cuff Index. Radiological results were analysed by supraspinatus tendon integrity, footprint coverage, muscular atrophy and fatty infiltration. Furthermore, anchor tunnel expansion was measured, anchor structure and peri-implant fluids graduated.
Results
At 28.4 ± 8.9-month follow-up, clinical outcome was similar (n.s.). MRI investigation revealed osseous reaction in both groups; tunnel widening was 0.9 ± 0.7 mm in PLLA and 0.8 ± 0.6 mm in PEEK anchors (n.s.). Peri-implant fluid was pronounced in PLLA anchors (p < 0.05). Tunnel widening was significantly higher in lateral anchors irrespectively of the material used. Tendon integrity, muscular atrophy, fatty infiltration and footprint coverage were not significantly different (n.s.).
Conclusion
Both materials lead to osseous reaction in this study, whereas consequences of pronounced fluid in PLLA patients remain unclear. Pronounced tunnel widening in lateral anchors leads to the assumption that other causes such as mechanical stress potentially have to be considered when analysing osseous reaction.
Level of evidence
III.
Similar content being viewed by others
References
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 88:1840–1845
Barber FA, Dockery WD (2006) Long-term absorption of poly-l-lactic acid interference screws. Arthroscopy 22:820–826
Barber FA, Herbert MA, Beavis RC, Barrera Oro F (2008) Suture anchor materials, eyelets, and designs: update 2008. Arthroscopy 24:859–867
Barber FA, Herbert MA, Hapa O, Rapley JH, Barber CA, Bynum JA, Hrnack SA (2011) Biomechanical analysis of pullout strengths of rotator cuff and glenoid anchors: 2011 update. Arthroscopy 27:895–905
Bateman JE (1963) The diagnosis and treatment of ruptures of the rotator cuff. Surg Clin North Am 43:1523–1530
Boden RA, Burgess E, Enion D, Srinivasan MS (2009) Use of bioabsorbable knotless suture anchors and associated accelerated shoulder arthropathy: report of 3 cases. Am J Sports Med 37:1429–1433
Bostman OM, Laitinen OM, Tynninen O, Salminen ST, Pihlajamaki HK (2005) Tissue restoration after resorption of polyglycolide and poly-laevo-lactic acid screws. J Bone Joint Surg Br 87:1575–1580
Burkhart SS (2005) Case report by Drs. Glueck, Wilson, and Johnson entitled “Extensive osteolysis after rotator cuff repair with a bioabsorbable suture anchor” (May 2005, pp. 742–744). Am J Sports Med 33:1768
Busfield BT, Glousman RE, McGarry MH, Tibone JE, Lee TQ (2008) A biomechanical comparison of 2 technical variations of double-row rotator cuff fixation: the importance of medial row knots. Am J Sports Med 36:901–906
Castagna A, Garofalo R, Conti M, Borroni M, Snyder SJ (2007) Arthroscopic rotator cuff repair using a triple-loaded suture anchor and a modified Mason-Allen technique (Alex stitch). Arthroscopy 23(440):e441–e444
Cho NS, Lee BG, Rhee YG (2011) Arthroscopic rotator cuff repair using a suture bridge technique: is the repair integrity actually maintained? Am J Sports Med 39:2108–2116
Chu T, McDonald E, Tufaga M, Kandemir U, Buckley J, Ma CB (2011) Comparison of completely knotless and hybrid double-row fixation systems: a biomechanical study. Arthroscopy 27:479–485
Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164
Dhawan A, Ghodadra N, Karas V, Salata MJ, Cole BJ (2012) Complications of bioabsorbable suture anchors in the shoulder. Am J Sports Med 40:1424–1430
Franceschi F, Ruzzini L, Longo UG, Martina FM, Zobel BB, Maffulli N, Denaro V (2007) Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: a randomized controlled trial. Am J Sports Med 35:1254–1260
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 31:643–647
Gerhardt C, Hug K, Pauly S, Marnitz T, Scheibel M (2012) Arthroscopic single-row modified mason-allen repair versus double-row suture bridge reconstruction for supraspinatus tendon tears: a matched-pair analysis. Am J Sports Med 40:2777–2785
Gilbart MK, Gerber C (2007) Comparison of the subjective shoulder value and the constant score. J Should Elbow Surg 16:717–721
Glueck D, Wilson TC, Johnson DL (2005) Extensive osteolysis after rotator cuff repair with a bioabsorbable suture anchor: a case report. Am J Sports Med 33:742–744
Gonzalez-Lomas G, Cassilly RT, Remotti F, Levine WN (2011) Is the etiology of pretibial cyst formation after absorbable interference screw use related to a foreign body reaction? Clin Orthop Relat Res 469:1082–1088
Huber W, Hofstaetter JG, Hanslik-Schnabel B, Posch M, Wurnig C (2005) Translation and psychometric testing of the Western Ontario Rotator Cuff Index (WORC) for use in Germany. Z Orthop Ihre Grenzgeb 143:453–460
Jost B, Pfirrmann CW, Gerber C, Switzerland Z (2000) Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am 82:304–314
Kim KC, Shin HD, Lee WY (2012) Repair integrity and functional outcomes after arthroscopic suture-bridge rotator cuff repair. J Bone Joint Surg Am 94:e48
Kim KC, Shin HD, Lee WY, Han SC (2012) Repair integrity and functional outcome after arthroscopic rotator cuff repair: double-row versus suture-bridge technique. Am J Sports Med 40:294–299
Kurtz SM, Devine JN (2007) PEEK biomaterials in trauma, orthopedic, and spinal implants. Biomaterials 28:4845–4869
Lorbach O, Tompkins M (2012) Rotator cuff: biology and current arthroscopic techniques. Knee Surg Sports Traumatol Arthrosc 20:1003–1011
Ma HL, Chiang ER, Wu HT, Hung SC, Wang ST, Liu CL, Chen TH (2012) Clinical outcome and imaging of arthroscopic single-row and double-row rotator cuff repair: a prospective randomized trial. Arthroscopy 28:16–24
Marchant MH Jr, Willimon SC, Vinson E, Pietrobon R, Garrett WE, Higgins LD (2010) Comparison of plain radiography, computed tomography, and magnetic resonance imaging in the evaluation of bone tunnel widening after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1059–1064
McCarty LP, Buss DD, Datta MW, Freehill MQ, Giveans MR (2013) Complications observed following labral or rotator cuff repair with use of poly-l-lactic acid implants. J Bone Joint Surg Am 95(6):507–511
Nusselt T, Freche S, Klinger HM, Baums MH (2010) Intraosseous foreign body granuloma in rotator cuff repair with bioabsorbable suture anchor. Arch Orthop Trauma Surg 130:1037–1040
Papalia R, Franceschi F, Zampogna B, D’Adamio S, Maffulli N, Denaro V (2013) Augmentation techniques for rotator cuff repair. Br Med Bull 105:107–138
Park MJ, Hsu JE, Harper C, Sennett BJ, Huffman GR (2011) Poly-l/d-lactic acid anchors are associated with reoperation and failure of SLAP repairs. Arthroscopy 27:1335–1340
Patte D (1990) Classification of rotator cuff lesions. Clin Orthop Relat Res 254:81–86
Pauly S, Gerhardt C, Chen J, Scheibel M (2010) Single versus double-row repair of the rotator cuff: does double-row repair with improved anatomical and biomechanical characteristics lead to better clinical outcome? Knee Surg Sports Traumatol Arthrosc 18:1718–1729
Pauly S, Kieser B, Schill A, Gerhardt C, Scheibel M (2010) Biomechanical comparison of 4 double-row suture-bridging rotator cuff repair techniques using different medial-row configurations. Arthroscopy 26:1281–1288
Pilge H, Spang J, Rose T, Wolter H, Woertler K, Imhoff AB (2012) Osteolysis after rotator cuff repair with bioabsorbable anchors. Arch Orthop Trauma Surg 132:305–310
Scheibel M, Nikulka C, Dick A, Schroeder RJ, Popp AG, Haas NP (2007) Structural integrity and clinical function of the subscapularis musculotendinous unit after arthroscopic and open shoulder stabilization. Am J Sports Med 35:1153–1161
Stein T, Mehling AP, Ulmer M, Reck C, Efe T, Hoffmann R, Jager A, Welsch F (2012) MRI graduation of osseous reaction and drill hole consolidation after arthroscopic Bankart repair with PLLA anchors and the clinical relevance. Knee Surg Sports Traumatol Arthrosc 20:2163–2173
Sugaya H, Maeda K, Matsuki K, Moriishi J (2005) Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthroscopy 21:1307–1316
Thomazeau H, Rolland Y, Lucas C, Duval JM, Langlais F (1996) Atrophy of the supraspinatus belly. Assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand 67:264–268
Trantalis JN, Boorman RS, Pletsch K, Lo IK (2008) Medial rotator cuff failure after arthroscopic double-row rotator cuff repair. Arthroscopy 24:727–731
Tsuda E, Ishibashi Y, Tazawa K, Sato H, Kusumi T, Toh S (2006) Pretibial cyst formation after anterior cruciate ligament reconstruction with a hamstring tendon autograft. Arthroscopy 22(691):e691–e696
Webster TJ, Patel AA, Rahaman MN, Sonny Bal B (2012) Anti-infective and osteointegration properties of silicon nitride, poly(ether ether ketone), and titanium implants. Acta Biomater 8:4447–4454
Weiler A, Hoffmann RF, Stahelin AC, Helling HJ, Sudkamp NP (2000) Biodegradable implants in sports medicine: the biological base. Arthroscopy 16:305–321
Yakacki CM, Poukalova M, Guldberg RE, Lin A, Saing M, Gillogly S, Gall K (2010) The effect of the trabecular microstructure on the pullout strength of suture anchors. J Biomech 43:1953–1959
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Haneveld, H., Hug, K., Diederichs, G. et al. Arthroscopic double-row repair of the rotator cuff: a comparison of bio-absorbable and non-resorbable anchors regarding osseous reaction. Knee Surg Sports Traumatol Arthrosc 21, 1647–1654 (2013). https://doi.org/10.1007/s00167-013-2510-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-013-2510-3