Posterosuperior suture granuloma impingement after arthroscopic SLAP repair using suture anchors: a case report

Arthroscopic refixation of the glenoid labrum has become a standard treatment of type II SLAP lesions although postoperative results are not uniformly good due to factors which are yet unclear. We present the case of an active overhead athlete with an intraarticular posterosuperior impingement syndrome arising from a suture granuloma formation complicating the postoperative course after arthroscopic SLAP repair. The symptoms resolved completely following revision arthroscopy during which the granuloma and the permanent sutures were removed. Implant related complications should be considered when patients present with recurrent pain after arthroscopic SLAP repair using suture anchors, in particular during overhead activity.     

A meta-analysis of open versus arthroscopic Bankart repair using suture anchors

Purpose of this study is to conduct a meta-analysis comparing the results of open and arthroscopic Bankart repair using suture anchors in recurrent traumatic anterior shoulder instability. Using Medline Pubmed, Cochrane and Embase databases we performed a search of all published articles. We included only studies that compared open and arthroscopic repair using suture anchors. Statistical analysis was performed using chi-square test. Six studies met the inclusion criteria. The total number of patients was 501, 234 suture anchors and 267 open. The rate of recurrent instability in the arthroscopic group was 6% versus 6.7% in the open group; rate of reoperation was 4.7% in the arthroscopic group vs. 6.6% in open (difference not statistically significant). The difference was statistically significant only in the studies after 2002 (2.9% of recurrence in the arthroscopic group vs. 9.2% in open; 2.2% of reoperation in the arthroscopic group vs. 9.2% in open). Results regarding function couldn’t be combined because of non-homogeneous scores reported in the original articles, but the arthroscopic treatment led to better functional results. Arthroscopic repair using suture anchors results in similar redislocation and reoperation rate compared to open Bankart repair; however, we need larger and more homogeneous prospective studies to confirm these findings.     

Arthroscopic Bankart repair using suture anchors in athletes: patient selection and postoperative sports activity

PURPOSE: The purpose of this study was to evaluate the results in selected high-risk patients who underwent arthroscopic stabilization of shoulders with recurrent anterior instability. HYPOTHESIS: Arthroscopic stabilization using suture anchors is useful for athletes younger than 25 years or for contact athletes without a large bone loss of glenohumeral articulation. STUDY DESIGN: Prospective cohort study. METHODS: The study group comprised 55 patients, with a mean follow-up of 42 months (range, 25-72 months). Thirty-two patients had recurrent dislocations, 14 had recurrent subluxations, and 9 had recurrent subluxations after a single dislocation. Rowe score, range of motion, recurrence, and sports activities were evaluated. RESULTS: Mean Rowe score improved from 30.1 to 92.3 points; 45 scores (82%) were excellent, 5 (9%) good, 1 fair (2%), and 4 (7%) poor. Patients had lost a mean of 4 degrees of external rotation in adduction. Four (7%) had recurrence. The recurrence rate in contact athletes (9.5%, 2 of 21) was not statistically different from that in noncontact athletes (6%, 2 of 34). Forty-four (80%) returned at the same levels. The complete return rate in overhead-throwing athletes (68%, 17 of 25) was lower than that in nonoverhead athletes (90%, 27 of 30) (P = .0423). Five patients had unsatisfactory results. CONCLUSION: Arthroscopic stabilization is a reliable procedure in selected high-risk patients.     

No difference between knotless sutures and suture anchors in arthroscopic repair of Bankart lesions in collision athletes

The purpose of this study was to compare the clinical results of knotless and knot-tying suture anchors in arthroscopic Bankart repair of collision athletes. Thirty-eight athletes underwent arthroscopic Bankart repairs. The mean age of the patients at the time of surgery was 23 years. Bio-Knot-tying anchors were used in 18 patients, and Bio-Knotless suture anchors were used in 20 patients. Preoperative and postoperative evaluations were performed by Rowe scores. At the end of 40 months follow-up, both the knot-tying and the knotless suture anchor groups had similar postoperative results. There were no differences between Knot-Tying and Knotless repair about late disengagement and re-dislocation in this patient group. Knotless repair provided secure and low-profile repair without introducing complexities to the procedure of arthroscopic knot tying one.     

Return to sports after arthroscopic capsulolabral repair using knotless suture anchors for anterior shoulder instability in soccer players: minimum 5-year follow-up study

Purpose

To report the return to sports and recurrence rates in competitive soccer players after arthroscopic capsulolabral repair using knotless suture anchors at a minimum of 5 years of follow-up.

Methods

All competitive soccer players with anterior glenohumeral instability treated by arthroscopic capsulolabral repair using knotless suture anchors between 2002 and 2009 were retrospectively identified through the medical records. Inclusion criteria were: no previous surgical treatment of the involved shoulder, absence of glenoid or tuberosity fractures, absence of large Hill–Sachs or glenoid bone defect, minimum follow-up of 5 years, instability during soccer practice or games, and failure of non-surgical treatment. The charts of included players were reviewed, and a phone call was performed in a cross-sectional manner to obtain information on: current soccer, return to soccer, recurrence of instability, shoulder function (Rowe score), and disability [Quick-Disability of the Arm, Shoulder, and Hand (DASH) score and Quick-DASH Sports/Performing Arts Module].

Results

Fifty-seven young male soccer players were finally included with a median (range) follow-up of 8 (5–10) years. Forty-nine (86 %) of the soccer players were able to return to soccer and 36 of them (73 %) at the same pre-injury level. There were 6 (10.5 %) re-dislocations in the 57 players, all of them of traumatic origin produced during soccer and other unrelated activities. The main reasons to not return to soccer were: knee injuries (two players), changes in personal life (two players), and job-related (three players). None of the players quit playing soccer because of their shoulder instability injury. The median (range) Rowe score, Quick-DASH score, and Quick-DASH sports score were 80 (25–100), 2.3 (0–12.5), and 0 (0–18.8), respectively.

Conclusions

Competitive soccer players undergoing arthroscopic capsulolabral repair with knotless suture anchors for shoulder instability without significant bone loss demonstrate excellent return to play at mid-to-long-term follow-up, with a 10.5 % chances of re-dislocating.

Level of evidence

IV.

     

Outcomes of combined arthroscopic rotator cuff and labral repair

BACKGROUND: Rotator cuff tears, Bankart lesions, and superior labral anterior posterior lesions commonly occur in isolation, but there is a subgroup of patients who experience combined injuries. Prior studies have excluded such patients as confounding groups. HYPOTHESIS: In patients with combined lesions of the labrum and rotator cuff, arthroscopic repair of both lesions will restore range of motion and stability and provide good clinical results. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We retrospectively evaluated the clinical outcomes of a series of patients with combined rotator cuff and labral (Bankart or superior labral anterior posterior) lesions treated arthroscopically. RESULTS: Thirty patients (average age, 47.8 years) with combined rotator cuff and labral lesions were evaluated at a mean follow-up of 2.7 years (range, 24-54 months). Sixteen patients had Bankart lesions and 14 patients had SLAP lesions. Significant improvements in forward flexion (20.5 degrees, P = .005), external rotation (9.0 degrees, P = .008), and internal rotation (2 vertebral levels, P = .016) were observed. The mean L'Insalata and American Society of Shoulder and Elbow Surgeons scores for all patients were 92.9 and 94.3, respectively. Twenty-seven (90%) patients reported satisfaction as good to excellent, and 23 of 30 (77%) returned to their preinjury level of athletics. Two patients suffered recurrent rotator cuff tears. CONCLUSION: In patients with rotator cuff and labral lesions, arthroscopic treatment of both lesions yields good clinical outcomes, restoration of motion, and a high degree of patient satisfaction.     

Stress distribution in the supraspinatus tendon after tendon repair: suture anchors versus transosseous suture fixation

BACKGROUND: The stress concentration at the site of supraspinatus tendon repair, either by suture anchor fixation or by transosseous suture fixation, has not been fully clarified. HYPOTHESIS: Suture anchor fixation showed higher stress concentrations in the tendon than did transosseous suture fixation. STUDY DESIGN: Controlled laboratory study. METHODS: Three finite element models were developed based on a previously published model of normal supraspinatus tendon (0 degrees abduction). Single-row fixation, double-row fixation, and transosseous suture fixation were simulated. A tensile force was applied to the proximal end of the supraspinatus tendon to simulate its contraction force. RESULTS: In the single-row model, the stress appeared from the site of the anchor and extended into the proximal tendon. The highest stress concentration was observed on the bursal surface of the tendon. The double-row model showed a similar pattern to the single-row model except that the stress concentration was observed only around the medial anchor. In the transosseous model, the stress appeared from the attachment site to a bony trough, which extended proximally into the tendon substance. No significant stress concentration was observed inside the tendon. CONCLUSION: Both single-row and double-row fixations showed higher stress concentration inside the tendon than did transosseous suture fixation. CLINICAL RELEVANCE: A high stress concentration might be a cause of the rerupture often observed after arthroscopic cuff repair using suture anchors.     

Contact area and pressure in suture bridge rotator cuff repair using knotless lateral anchors

Purpose

To evaluate whether the use of knotless lateral anchors in a suture bridge construct produces better contact area and pressure parameters than a suture bridge construct with standard lateral anchors that require knots or a double-row repair. The hypothesis was that knotless lateral anchors would produce better contact area and pressure parameters than the other two constructs.

Methods

A total of fifteen matched pairs of cadaveric shoulders were divided into three groups. In Group 1, a suture bridge using knotless anchors for the lateral row was performed on five shoulders. A suture bridge using standard lateral row anchors that require knots was performed on the contralateral shoulders. In Group 2, suture bridge with knotless lateral row anchors was compared with double-row repair. In Group 3, suture bridge using standard lateral row anchors was compared with double-row repair. The contact conditions of the rotator cuff footprint were measured using pressure-sensitive film.

Results

There were no statistically significant differences between any of the techniques regarding contact area F(2, 15.7) = 3.09, P = 0.07 or mean contact pressure F(2, 15.1) = 2.35, P = 0.12. A post hoc power analysis suggests differences between techniques are likely less than 91–113 mm² for area and 0.071-0.089 N for pressure.

Conclusions

The use of knotless anchors in the lateral row of a suture bridge repair did not increase the footprint contact area or contact pressure when compared to a suture bridge repair requiring knots laterally or to a double-row repair.     

Periacetabular osteotomy and arthroscopic labral repair after failed hip arthroscopy due to iatrogenic aggravation of hip dysplasia

Hip arthroscopy can be a successful surgery when properly indicated and performed properly. In the setting of dysplasia, arthroscopy of the hip can lead to devastating consequences. This case presents a patient who underwent hip arthroscopy despite having significant hip dysplasia. The surgery failed and was subsequently revised with a concomitant arthroscopic labral repair and periacetabular osteotomy with good results at 2-year follow-up. Level of evidence Case report, Level IV.     

Glenohumeral translations are only partially restored after repair of a simulated type II superior labral lesion

BACKGROUND: The effect on joint stability of repair of type II superior labrum and biceps anchor lesions is unknown. HYPOTHESIS: Increased translations of the glenohumeral joint after a simulated type II lesion will be reduced after the lesion is repaired. STUDY DESIGN: Controlled laboratory study. METHODS: A robotic/universal force-moment testing system was used to simulate load-and-shift and apprehension tests on eight cadaveric shoulders to determine joint kinematics of the shoulder after venting, creation of a type II lesion, and repair of the lesion. RESULTS: At 30 degrees of abduction, anterior translation of the vented joint in response to an anterior load was 18.7 +/- 8.5 mm and was significantly increased to 26.2 +/- 6.5 mm after simulation of a type II lesion. Repair did not restore anterior translation (23.9 +/- 8.6 mm) to that of the vented joint. The inferior translation that also occurred during application of an anterior load was 3.8 +/- 4.0 mm in the vented joint and increased significantly to 8.5 +/- 5.4 mm with a simulated type II lesion. After repair, the inferior translation decreased significantly to 6.7 +/- 5.3 mm. CONCLUSIONS: Repair of a type II lesion only partially restored glenohumeral translations to that of the vented joint. CLINICAL RELEVANCE: Surgical techniques including improved repair of passive stabilizers injured in the type II lesion should be considered.     

Noncontrast magnetic resonance imaging of superior labral lesions. 102 cases confirmed at arthroscopic surgery

Previous studies report that noncontrast magnetic resonance imaging is limited in the evaluation of the superior glenoid labrum. From our magnetic resonance imaging database of 2552 patients, we prospectively identified 104 patients with superior labral lesions who subsequently went on to arthroscopic surgery. Magnetic resonance images were assessed to identify fraying, flap tears, bucket-handle tears, or displaced flap of fibrocartilage. The biceps tendon was also evaluated. Patients were categorized according to Snyder's classification, and the findings on the magnetic resonance images were correlated with surgical findings. One hundred of the 104 tears suspected on the images were confirmed at surgery. There were four false-positives and two false-negatives, the former reflecting one normal labrum, two meniscoid-type labra, and one sublabral foramen. With arthroscopic surgery as the standard, magnetic resonance imaging had a sensitivity of 98.0% (100 of 102), a specificity of 89.5% (34 of 38), and an accuracy of 95.7% (134 of 140) for detection of superior labral lesions. We concluded that high-resolution noncontrast magnetic resonance imaging can accurately diagnose superior labral lesions and aid in surgical management.