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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

  • SHOULDER
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To assess the natural evolution of the osseous reaction following arthroscopic double-row rotator cuff 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 cuff 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 significantly 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 cuff repair are common and significant 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 findings, surgeons should be cautious about bone marrow edema lasting more than 6 months following arthroscopic rotator cuff repair.

Level of evidence

Level IV.

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References

  1. Chung SW, Lee YS, Kim JY, Lee JH, Ki SY, Oh KS, Yoon JP, Kim JY (2019) Changes in perianchor cyst formation over time after rotator cuff repair: influential factors and outcomes. Am J Sports Med 47:165–172

    Article  Google Scholar 

  2. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    Google Scholar 

  3. 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

    Article  Google Scholar 

  4. 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

    Article  Google Scholar 

  5. Haneveld H, Hug K, Diederichs G, Scheibel M, Gerhardt C (2013) 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

    Article  Google Scholar 

  6. Kim JH, Kim YS, Park I, Lee HJ, Han SY, Jung S, Shin SJ (2019) A comparison of open-construct PEEK suture anchor and non-vented biocomposite suture anchor in arthroscopic rotator cuff repair: a prospective randomized clinical trial. Arthroscopy. https://doi.org/10.1016/j.arthro.2019.08.049

    Article  PubMed  Google Scholar 

  7. Kim SH, Kim DY, Kwon JE, Park JS, Oh JH (2015) Perianchor cyst formation around biocomposite biodegradable suture anchors after rotator cuff repair. Am J Sports Med 43:2907–2912

    Article  Google Scholar 

  8. Kim SH, Oh JH, Lee OS, Lee HR, Hargens AR (2014) Postoperative imaging of bioabsorbable anchors in rotator cuff repair. Am J Sports Med 42:552–557

    Article  Google Scholar 

  9. Kim SH, Yang SH, Rhee SM, Lee KJ, Kim HS, Oh JH (2019) The formation of perianchor fluid associated with various suture anchors used in rotator cuff repair: all-suture, polyetheretherketone, and biocomposite anchors. Bone Joint J 101(12):1506–1511

    Article  Google Scholar 

  10. 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

    Article  CAS  Google Scholar 

  11. Nho SJ, Provencher MT, Seroyer ST, Romeo AA (2009) Bioabsorbable anchors in glenohumeral shoulder surgery. Arthroscopy 25:788–793

    Article  Google Scholar 

  12. Park JY, Jang SH, Oh KS, Li YJ (2017) Radiolucent rings around bioabsorbable anchors after rotator cuff repair are not associated with clinical outcomes. Arch Orthop Trauma Surg 137:1539–1546

    Article  Google Scholar 

  13. Pfalzer F, Huth J, Sturmer E, Endele D, Kniesel B, Mauch F (2017) Serial clinical and MRI examinations after arthroscopic rotator cuff reconstruction using double-row technique. Knee Surg Sports Traumatol Arthrosc 25:2174–2181

    Article  CAS  Google Scholar 

  14. 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

    Article  CAS  Google Scholar 

  15. Ro K, Pancholi S, Son HS, Rhee YG (2019) Perianchor cyst formation after arthroscopic rotator cuff repair using all-suture-type, bioabsorbable-type, and PEEK-type anchors. Arthroscopy 35:2284–2292

    Article  Google Scholar 

  16. Saridakis P, Jones G (2010) Outcomes of single-row and double-row arthroscopic rotator cuff repair: a systematic review. J Bone Joint Surg Am 92:732–742

    Article  Google Scholar 

  17. Sgroi M, Friesz T, Schocke M, Reichel H, Kappe T (2019) Biocomposite suture anchors remain visible two years after rotator cuff repair. Clin Orthop Relat Res 477:1469–1478

    Article  Google Scholar 

  18. Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428

    Article  CAS  Google Scholar 

  19. Smith MV, Calfee RP, Baumgarten KM, Brophy RH, Wright RW (2012) Upper extremity-specific measures of disability and outcomes in orthopaedic surgery. J Bone Joint Surg Am 94:277–285

    Article  Google Scholar 

  20. Stahnke K, Nikulka C, Diederichs G, Haneveld H, Scheibel M, Gerhardt C (2016) Serial MRI evaluation following arthroscopic rotator cuff repair in double-row technique. Arch Orthop Trauma Surg 136:665–672

    Article  Google Scholar 

  21. 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

    Article  CAS  Google Scholar 

  22. 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

    Article  Google Scholar 

  23. Van der Bracht H, Van den Langenbergh T, Pouillon M, Verhasselt S, Verniers P, Stoffelen D (2018) Rotator cuff repair with all-suture anchors: a midterm magnetic resonance imaging evaluation of repair integrity and cyst formation. J Shoulder Elbow Surg 27:2006–2012

    Article  Google Scholar 

  24. 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

    Article  Google Scholar 

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Funding

This study was funded by the Natural Science Foundation of China (No.81600615).

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Author notes

  1. Sinan Chen and Yao He have contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China

    Sinan Chen, Ning Hu, Xi Liang, Wei Huang & Hong Chen

  2. Department of Orthopedics, Banan People’s Hospital of Chongqing, Chongqing, China

    Yao He

  3. Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Dandong Wu

  4. Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Dianming Jiang

Authors
  1. Sinan Chen
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  2. Yao He
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  4. Ning Hu
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  5. Xi Liang
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  7. Wei Huang
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  8. Hong Chen
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Corresponding author

Correspondence to Hong Chen.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this retrospective study were in accordance with the ethical standards of the First Affiliated Hospital of Chongqing Medical University, and this study was performed after obtaining approval from our institutional review board (IRB, No. 20194701).

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Chen, S., He, Y., Wu, D. et al. Postoperative bone marrow edema lasts no more than 6 months after uncomplicated arthroscopic double-row rotator cuff repair with PEEK anchors. Knee Surg Sports Traumatol Arthrosc 29, 162–169 (2021). https://doi.org/10.1007/s00167-020-05897-7

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