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.     

A prospective outcome evaluation of arthroscopic Bankart repairs: minimum 2-year follow-up

BACKGROUND: Arthroscopic treatment of anterior shoulder dislocation has become possible through improvements in instruments and techniques. OBJECTIVE: To prospectively evaluate results of arthroscopic Bankart repairs at a minimum 2-year follow-up for patients with histories of shoulder dislocation and an anterior-inferior labral tear at the time of diagnostic arthroscopy. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A consecutive series of 85 patients (70 men, 15 women; mean age, 26 years) with Bankart lesions were treated with arthroscopic repair using suture anchors; 18 patients (27%) had extension of the labral injury into the superior labrum affecting some or all of the biceps anchor. Anchors were loaded with no. 2 nonabsorbable braided suture and placed 2 mm into the edge of the glenoid surface. A low anterior (5-o'clock) portal through the subscapularis tendon was used in all patients; 72 patients were evaluated at a minimum of 2 years postoperatively (mean, 46 months). RESULTS: Seven patients (10%) experienced recurrent instability after repair. Four patients had redislocations; 3 experienced recurrent subluxations. One patient had pain with the apprehension test without a clear history of recurrent instability. Of 18 collision athletes, 2 had dislocations at 22 and 60 months postoperatively. There were no complications, including no neurologic deficits. Clinical strength testing of the subscapularis muscle was normal in all patients. The mean Rowe score was 88 of 100 points, with 90% excellent or good results. Simple Shoulder Test responses improved from 66% positive preoperatively to 88% positive postoperatively. The American Shoulder and Elbow Surgeons scoring index averaged 92 of 100 points postoperatively. Pain analog scales improved from 5.5 preoperatively to 0.35 postoperatively on a 10-point scale. SF-12 scores improved for physical function. Patient satisfaction was rated 8.9 on a 10-point visual analog scale. CONCLUSION: Bankart repairs performed arthroscopically using properly implanted suture anchors and nonabsorbable sutures and in which associated pathoanatomy is addressed demonstrate low recurrence rates (10%) similar to historical open controls.     

异体骨锚钉双排固定法修复肩袖损伤

目的 探讨异体皮质骨锚钉双排固定法修复肩袖损伤的价值.方法 关节镜监视下,采用同种异体皮质骨锚钉双排同定法修复肩袖损伤16例.其中男10例,女6例;年龄32～58岁,平均44岁.按Bigliani肩袖损伤分类法,小撕裂6例,中度撕裂8例,大撕裂2例.关节镜下肩袖清理和肩峰成形后,采用带线异体骨锚钉植入肱骨大结节肩袖附着处,双根缝线垂直褥式缝合冈上肌腱,分别打结固定后,将缝线交叉牵引到在肱骨大结节预制的骨道处,将缝线穿入另一个骨锚钉孔内并击入骨道内.4根缝线交叉呈网状覆盖撕裂的冈上肌腱由骨锚钉固定.根据撕裂创面大小决定骨锚钉植入数量.结果 所有患者术后得到随访,时间6～23个月,平均14个月.术后疼痛症状均消失,肩关节功能采用美国加州洛杉矶大学(UCLA)功能评分标准评估,术前(20.5±5.6)分,术后(33.4±5.8)分.优10例,良5例,可1例.术后肩关节稳定性良好,无锚钉拔出和损伤复发.结论 异体骨锚钉双排同定法修复肩袖损伤,镜下手术操作方便,骨锚钉嵌入固定牢靠,增加肩袖组织与骨创面的接触面积,有利于肩袖愈合.骨锚钉生物固定,无异物存留,价格低廉.     

Effect of cyclic loading on new polyblend suture coupled with different anchors

BACKGROUND: Secure tendon-to-bone fixation is essential for successful rotator cuff repair. Biomechanical properties of devices used in rotator cuff repair should be better understood. PURPOSE: To evaluate the response to incremental cyclic loading of 6 different anchor-suture complexes commonly used in rotator cuff repair. STUDY DESIGN: Controlled laboratory study. METHODS: Two absorbable anchors 5 mm and 6.5 mm in diameter and 1 metallic anchor, coupled with Ethibond or FiberWire, were tested on 5 pairs of fresh-frozen human cadaveric shoulders. An incremental cyclic load was applied until failure using a Zwich-Roell Z010 electromechanical testing machine. The ultimate failure load and mode of failure were recorded. An analysis of variance model was used for statistical analysis. RESULTS: The FiberWire suture coupled with both absorbable and metallic anchors provided statistically significantly stronger fixation. However, although the metallic anchors in most cases failed because of slippage of the anchor, absorbable anchors failed because of rupture of the eyelet. CONCLUSIONS: The FiberWire seems to increase the strength of fixation devices under cyclic load using both absorbable and metallic anchors, with relevant differences in failure mode (slippage of the metallic anchor and eyelet failure in the absorbable anchor). CLINICAL RELEVANCE: Use of the FiberWire suture might change the mode of failure of the suture-anchor complexes.     

Sports activity after arthroscopic superior labral repair using suture anchors in overhead-throwing athletes

PURPOSE: To evaluate the results of arthroscopic repair of type II superior labral anterior posterior lesions of the shoulder in overhead athletes. HYPOTHESIS: Such repair is useful for overhead athletes in terms of postoperative sports activity. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The study group was composed of 40 patients with a mean age of 24 years (range, 15-38 years); mean follow-up was 41 months (range, 24-58 months). They were divided into an overuse (n=22) and a trauma group (n=18). The authors used 2 suture anchors loaded with a nonabsorbable suture at the 11-o'clock and 1-o'clock positions through the anterosuperior and lateral trans-rotator cuff portal. A modified Rowe score and postoperative athletic activities were evaluated. RESULTS: After arthroscopic repair, mean modified Rowe scores improved from 27.5 to 92.1 points (P<.0001). Rated on this scale, the results were excellent in 30 (75%), good in 6 (15%), and fair in 4 (10%) athletes; there were no poor results. Satisfactory outcomes were achieved in 36 (90%) of these patients; 30 (75%) experienced a return to the preinjury level. The complete return rate of baseball players in the overuse group was lower than that of other overhead athletes in the trauma group. CONCLUSION: Arthroscopic superior labral repair is a safe and reliable procedure in overhead athletes.     

A clinical and radiographic comparison of absorbable and non-absorbable suture anchors in open shoulder stabilisation

The aim of this study was to compare the clinical and radiographic results using either absorbable or non-absorbable suture anchors in patients with recurrent unidirectional, post-traumatic shoulder dislocations. All patients had a Bankart lesion. One surgeon operated on 33 consecutive patients, 27 males and six females. Group A comprised 15 shoulders and group B 18 shoulders, all of which underwent a standardised open Bankart reconstruction using 3.7-mm TAG suture anchors. In group A, absorbable anchors were used, while in group B, non-absorbable ones were used. There was one re-dislocation in each group. In group A, the Rowe and Constant scores were 89 (69-98) and 89 (76-99) points, respectively. The corresponding values in group B were 87 (44-98) (not significant; NS) and 90 (71-100) points (NS). The strength measurements revealed 8.1 (3.8-12.3) kg in 90 degrees abduction in group A and 10.0 (6.7-12.0) kg in group B. Healthy control shoulders revealed 10.2 (4.5-13.2) kg (NS A and B versus controls). The external rotation in abduction was 70 degrees (40-90) in group A and 80 degrees (40-100) in group B. The value for the controls was 90 degrees (80-120) [P < 0.001 (A versus controls), P < 0.05 (A versus B) and P < 0.001 (B versus controls)]. The radiographs revealed that 9/15 (60%) in group A and 10/15 (66%) in group B had visible drill holes or cystic formations in conjunction with the drill holes (NS). Furthermore, 11/15 (73%) in group A and 10/15 (66%) in group B had signs of minor degeneration (NS). We conclude that, in terms of stability and clinical results, no differences were found between the study groups. Both groups demonstrated a restriction in external rotation as compared with the healthy shoulders in the same cohort. On the radiographs, visible drill holes or cystic formations in conjunction with the drill holes were seen with equal frequency, regardless of whether absorbable or non-absorbable suture anchors were used.     

Open reconstruction of anterior glenoid rim fractures

The present study evaluates the clinical and radiological results of patients with anterior glenoid rim fractures treated with two different open surgical techniques depending on the size of the bony fragment. In patients with displaced glenoid rim fractures involving less than 25% of the glenoid surface (Type I, II and IIIA fractures) suture anchor repair was performed. Patients with a bony defect involving more than 25% of the glenoid surface (Type IIIB fractures) underwent open reduction and internal fixation using cannulated screws. After a mean follow-up of 22 months, 15 patients (mean age 42.2 years) treated with suture anchor repair achieved an average Constant Score of 85.5 points (range 67.1–100) and an average Rowe Score of 94 points (range 70–100). In six patients the bony fragment was located in an unimproved medial position compared to the preoperative X-ray. In another six patients the fragment was consolidated medially to the level of the glenoid rim, and in three cases an anatomic situation was found. Patients treated with cannulated screws (ten cases, mean age 46.6 years) had a mean follow-up of 30 months and achieved a mean Constant Score of 81.9 points (range 61.7–96.1) and a mean Rowe Score of 90 points (range 70–100). Radiologically, the bony fragment was consolidated in an anatomic position in nine out of ten cases. Three patients suffered from screw impingement and one patient had screw loosening. No recurrent subluxations or dislocations were observed in either group. Three patients in group one and one patient in group two had glenohumeral osteoarthritic changes. In cases of small glenoid-rim fractures (Type I, II and IIIA fractures), suture anchor repair resulted in an excellent clinical outcome; however, the radiological results of chronic Type I fractures revealed in many cases a non-anatomical glenoidal reconstruction. For Type IIIB fractures with significant loss of glenoid concavity, open reduction and internal fixation with cannulated screws gave good clinical and radiological results; however the early complication rate was higher.     

Prospective Evaluation of Absorbable Gastropexy Anchor Indwelling Time in 33 Patients

PurposeTo evaluate the time to absorbable suture gastropexy anchor release and gastropexy-related complications in patients receiving percutaneous image-guided transabdominal gastrostomy or gastrojejunostomy tube placement.Materials and MethodsThirty-three consecutive patients (16 women; mean age, 63.5 y; range, 25–92 y) undergoing fluoroscopically guided (n = 32) or computed tomography–guided (n = 1) percutaneous transabdominal gastrostomy (n = 26) or gastrojejunostomy (n = 7) were prospectively enrolled in a single-center study. Each patient had three synthetic absorbable suture T-fasteners inserted and were followed until all gastropexy button-locks released naturally, were cut by a health care provider, or were lost to follow-up. Patients or caregivers were contacted weekly to determine timing of gastropexy button-lock release and assess for postprocedural complications.ResultsAll three T-fastener button-type suture locks released naturally in 14 of 33 patients (42.4%) at a median of 29.5 days (mean, 26.7 d; range, 8–40 d). One or more T-fastener sutures were cut in 10 of 33 patients (30.3%), and nine patients (27.3%) were lost to follow-up. Accounting for patient censorship, T-fasteners in all 33 patients remained intact for a median of 35 days. Local infections developed in three patients (9%) on days 22, 25, and 34.ConclusionsRelative to nonabsorbable gastropexy sutures, absorbable suture gastropexy anchors offer the potential to reduce complications associated with long gastropexy indwelling times. However, absorbable gastropexy anchor buttons usually remain intact for longer than 3 weeks after insertion. A postprocedural plan for gastropexy inspection and removal within 3 weeks should continue to be emphasized to avoid local complications, even for absorbable suture kits.     

The surgical outcome of immediate arthroscopic Bankart repair for first time anterior shoulder dislocation in young active patients

This study evaluated the surgical outcomes of young active patients with arthroscopic Bankart repair within 1 month after first-time anterior shoulder dislocation. From July 2002–October 2004, patients presented with first-time traumatic anterior shoulder dislocation and treated with arthroscopic stabilization within 1 month of injury were retrospectively reviewed. Magnetic resonance imaging and computed tomography were performed before the operation in all cases. Cases with contralateral shoulder multidirectional instability or glenoid bone loss of more than 30% on preoperative computed tomography on the injury side were excluded. All patients were treated with arthroscopic Bankart repair, using metallic suture anchors or soft tissue bio-absorbable anchors by a same group of surgeons and followed the same rehabilitation protocol. Recurrence, instability signs, range of motion, WOSI score, Rowe score and complications were assessed. Thirty-eight patients were recruited: the average age was 21 (16–30). All patients had definite trauma history. Radiologically, all patients had Bankart/Hill-Sachs lesion. All the operations were done within 1 month after injury (6–25 days). The average hospital stay was 1.2 days (1–5 days). The average follow-up was 28 months (24–48 months). There were two cases of posttraumatic re-dislocation (5.2%). The average external rotation lag was 5° (0–15) in 90° shoulder abduction when compared with contralateral side. 95% of patients had excellent or good Rowe score. The average WOSI score was 83%. There was one case of transient ulnar nerve palsy and one case of superficial wound infection. This study concluded that immediate arthroscopic Bankart repair with an accelerated rehabilitation program is an effective and safe technique for treating young active patients with first-time traumatic anterior shoulder dislocation. This study complies with the current laws of the Hong Kong Special Administration Region Government.     

Complications of bioabsorbable suture anchors in the shoulder

The development of the suture anchor has played a pivotal role in the transition from open to arthroscopic techniques of the shoulder. Various suture anchors have been manufactured that help facilitate the ability to create a soft tissue to bone repair. Because of reported complications of loosening, migration, and chondral injury with metallic anchors, bioabsorbable anchors have become increasingly used among orthopaedic surgeons. In this review, the authors sought to evaluate complications associated with bioabsorbable anchors in or about the shoulder and understand these in the context of the total number of bioabsorbable anchors placed. In 2008, 10 bioabsorbable anchor-related complications were reported to the US Food and Drug Administration. The reported literature complications of bioabsorbable anchors implanted about the shoulder include glenoid osteolysis, synovitis, and chondrolysis. These potential complications should be kept in mind when forming a differential diagnosis in a patient in whom a bioabsorbable anchor has been previously used. These literature reports, which amount to but a fraction of the total bioabsorbable anchors implanted in the shoulder on a yearly basis, underscore the relative safety and successful clinical results with use of bioabsorbable suture anchors. Product development continues with newer composites such as PEEK (polyetheretherketone) and calcium ceramics (tricalcium phosphate) in an effort to hypothetically create a mechanically stable construct with and improve biocompatibility of the implant. Bioabsorbable anchors remain a safe, reproducible, and consistent implant to secure soft tissue to bone in and about the shoulder. Meticulous insertion technique must be followed in using bioabsorbable anchors and may obviate many of the reported complications found in the literature. The purpose of this review is to provide an overview of the existing literature as it relates to the rare complications seen with use of bioabsorbable suture anchors in the shoulder.     

Open Bankart repair with suture anchors for traumatic recurrent anterior shoulder instability: comparison of results between small and large Bankart lesions

This retrospective study was to demonstrate the clinical outcome of open Bankart repair with suture anchors for recurrent anterior shoulder instability, and to compare surgical results of small (<3 clock units) and large (>3 clock units) Bankart lesions. With an average follow-up of 55.6 months (2–8 years), there were 82 patients (60 right, 22 left shoulders) with the mean age of 27 years accepting open Bankart repair with suture anchors and capsular shift procedure by the same team. According to surgical findings, these patients were grouped into small (<3 clock units) and large (>3 clock units) Bankart lesions. Subjective outcomes were recorded according to the Bankart scoring system of Rowe. Rowe scores averaged 85.9±12.9 (range 25–100). The patients, 92–7 %, had objectively excellent or good results. Twenty nine patients (35.4%) had small Bankart lesions and 53 patients had large Bankart lesions. The Rowe scores in small Bankart lesions were better than that in large Bankart lesions (93.5±6.8 vs.81.8±13.6, Wilcoxon rank sum test, P<0.001). Mean scores of stability (Wilcoxon rank sum test, P=0.043), motion (Wilcoxon rank sum test, P=0.037), and function (Wilcoxon rank sum test, P<0.001) in small lesions also had superior outcomes than in large lesions. Four patients (4.9%) got fair results and two (2.4%) patients got poor results at the end of follow-up. The average loss of external rotation is 10°. Open Bankart repair with the aid of suture anchors still got satisfactory results in the treatment of traumatic recurrent anterior instability of the shoulder. The size of the Bankart lesion was a factor affecting surgical outcome. Small Bankart lesions usually got better results than large Bankart lesions.     

A radiographic investigation to determine the safety of suture anchor systems for pediatric modified Broström ankle ligament reconstruction

BACKGROUND: The modified Brostr?m ligament reconstruction using anchor sutures has been performed in adults with clinical success; however, the safety parameters for the use of suture anchors in adolescent lateral ankle ligament reconstruction have not been established. PURPOSE: To perform a radiographic analysis comparing the depth of penetration of suture anchors in adult ankle ligament reconstruction with the average distance of the physis from the tip of the fibula in adolescents. STUDY DESIGN: Cross-sectional study, Level of evidence, 4. METHODS: Forty postoperative ankle radiographs of adult patients who had a modified Brostr?m procedure were compared with 40 normal adolescent ankle radiographs. In the adult group, the distance of the suture anchor penetration from the distal tip of the fibula was measured; in the adolescent group, the distance of the physis from the distal tip of the fibula was measured. RESULTS: The mean depth of the suture anchors was 17 mm (range, 14-21 mm) from the tip of the fibula in the adult group, and the mean distance of the growth plate was 23 mm (range, 18-29 mm) in the adolescent group. Eight radiographs from the adolescent group (20%) had a physis measurement of <22 mm on the anteroposterior or mortise view. CONCLUSIONS: Using careful preoperative planning and intraoperative technique, it is possible to safely perform lateral ankle ligament repair in the skeletally immature patient using suture anchors.     

Biomechanical evaluation of a new technique for rotator cuff repair

BACKGROUND: In recent studies, investigators have used a cyclic loading model to investigate the efficacy of rotator cuff fixation modalities. HYPOTHESIS: A bioabsorbable poly-D-lactic acid screw and toothed washer implant will provide more stable fixation of rotator cuff repairs than standard suture anchor techniques. STUDY DESIGN: Controlled laboratory study. METHODS: Forty bovine shoulders (ages 3 to 6 months) had 1 x 2 cm defects created in the infraspinatus tendon. There were five repair groups (eight specimens per group) consisting of either two screw and washer implants or two suture anchors. Four suture techniques were tested: single-loaded anchors with simple sutures, double-loaded anchors with simple sutures, single-loaded anchors with horizontal mattress sutures, or single-loaded anchors with modified Mason-Allen sutures. Repairs were loaded at 5-second cycles from 10 to 180 N with use of a hydraulic testing machine. The number of cycles to gap formation of 5 and 10 mm was recorded. RESULTS: Gap formation of 5 and 10 mm occurred significantly later for the screw repair group than for any of the suture anchor groups. There was no significant difference between suture groups. CONCLUSIONS: The bioabsorbable screw and washer provided more stable fixation than suture anchor techniques under isometric cyclic loading conditions. Clinical Relevance: This is a time-zero study of implant performance. The results indicate that the implant may decrease clinical failures in the early postoperative period under standard rehabilitation protocols.     

Failure mode of suture anchors as a function of insertion depth

BACKGROUND: Surgeons can control not only the angle but also the depth of suture anchor placement during arthroscopic rotator cuff repair, although the tendency may be to place suture anchors on the deep side to avoid damage from prominent anchor eyelets. However, little information is available regarding possible effects of suture anchor depth on construct failure mechanisms. HYPOTHESIS: Anchor depth affects the mode of suture failure with physiologically relevant cyclic loads. STUDY DESIGN: Controlled laboratory study. METHODS: Metallic screw-in suture anchors loaded with No. 2 braided polyester sutures were inserted into the bovine infra-spinatus footprint with the eyelet proud, standard, or deep. Sutures were hand tied to create a closed loop. Constructs were cyclically loaded from 10 to 90 N and, if still intact at 500 cycles, taken to ultimate failure (maximum load). RESULTS: When clinical failure was defined as greater than 3-mm construct elongation, anchors placed with the eyelet deep experienced statistically earlier clinical failure via cutting of the suture through the bone (P < .02). However, anchors placed at this level did not experience catastrophic failure during cyclic loading. The standard and proud anchors experienced 3 mm of elongation at a greater number of cycles, but the suture material degraded at the anchor eyelet, and a majority of these constructs broke during cyclic physiologic loading. At failure testing, the deep anchors had a significantly increased failure load (164 N) compared to standard (133 N) (P < .04) and proud (113 N) anchors (P < .005). CONCLUSION: Varying the depth of suture anchor insertion changes the mechanical properties and mode of failure of suture anchor constructs. CLINICAL RELEVANCE: Surgeons should be aware of the effects of suture anchor depth and abrasive eyelet wear on construct failure during arthroscopic rotator cuff repair.     

Operative stabilization of posterior shoulder instability

BACKGROUND: Symptomatic, traumatic posterior shoulder instability is often the result of a posteriorly directed blow to an adducted, internally rotated, and forward-flexed upper extremity. Operative repair has been shown to provide favorable results. Current arthroscopic techniques with suture anchors and the ability to plicate the capsule using a nonabsorbable suture may provide favorable outcomes with reduced morbidity. PURPOSE: To evaluate the results of operative shoulder stabilization in patients with traumatic posterior shoulder instability. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A consecutive series of patients who underwent arthroscopic or open posterior stabilization for traumatic posterior shoulder instability were evaluated using subjective assessments, physical examinations, the Single Assessment Numeric Evaluation, Rowe score, Simple Shoulder Test, and the Western Ontario Shoulder Instability Index.Results: Between May 1996 and February 2002, 31 shoulders (30 patients) underwent posterior stabilization (19 arthroscopically, 12 open). There were 29 men and 1 woman (mean age, 23 years). Preoperatively, all patients had a distinct traumatic cause for the instability. On physical examination, all patients had posterior apprehension and increased (2+, 3+) posterior load-shift testing. Preoperative radiographs and/or magnetic resonance imaging revealed posterior rim calcification or reverse Bankart lesions in 29 cases (94%). At arthroscopy, posterior labral injuries, reverse Bankart lesions, or humeral head defects were identified. Follow-up averaged 40 months, and the mean duration between injury and surgery was 21 months. The mean Single Assessment Numeric Evaluation, Rowe score, Simple Shoulder Test, and Western Ontario Shoulder Instability Index scores, respectively, for the entire group were 89, 87, 11, and 346; for the open group, they were 81, 80, 10.5, and 594; for the arthroscopic group, they were 92, 92, 11.4, and 190. The Western Ontario Shoulder Instability Index (P < .03) and Rowe score (P < .04) outcomes scores for the arthroscopic group were statistically better than those of the open group. Twenty-nine of 31 shoulders were rated as excellent or good. CONCLUSION: In the case of traumatic posterior shoulder subluxation, posterior lesions of the labrum ("reverse Bankart"), articular edge, and capsule are observed. Surgical treatment addressing these lesions led to satisfactory results for both the open and arthroscopic treated groups. In this study, an arthroscopic technique utilizing suture anchor repair with capsular placation provided the most favorable outcomes.     

Open Bankart repair versus arthroscopic repair with transglenoid sutures or bioabsorbable tacks for Recurrent Anterior instability of the shoulder: a meta-analysis

BACKGROUND: In published comparative studies, it remains unknown if arthroscopic techniques for performing Bankart repair for anterior shoulder instability equal the success of open repair. HYPOTHESIS: The current literature supports a lower rate of recurrent instability after open Bankart repair compared to arthroscopic repair with bioabsorbable tacks or transglenoid sutures. STUDY DESIGN: Meta-analysis. METHODS: A Medline search identified all randomized controlled trials or cohort studies that directly compared open repair to arthroscopic techniques of Bankart repair for traumatic, unilateral, recurrent anterior instability. Data collected from each study included patient demographics, surgical technique, rehabilitation, outcome, and complications. RESULTS: Six studies met all inclusion criteria. There were 172 patients in the arthroscopic group (90 patients with transglenoid sutures, 77 patients with arthroscopic tacks, and 5 patients with suture anchors) and 156 patients in the open group. The groups were similar in demographic characteristics. When comparing the arthroscopic to the open group, there was a significantly higher rate of recurrent dislocation (12.6% vs 3.4%; P = .01) and total recurrence (recurrent dislocation or subluxation) (20.3% vs 10.3%; P = .01). In addition, there was a higher proportion of patients with an excellent or good postoperative Rowe score in the open group (88%) than in the arthroscopic group (71%) (P = .01). CONCLUSIONS: Arthroscopic Bankart repair using transglenoid sutures or bioabsorbable tacks results in a higher rate of recurrence of instability compared to open techniques. Studies comparing open repair to newer arthroscopic techniques using suture anchor fixation and capsular plication are necessary.     

A knotless suture anchor. Design, function, and biomechanical testing

The development of a unique Knotless suture anchor for soft tissue repair to bone is described. This device allows for soft tissue repair to bone using a suture anchor without the need for knot tying. This provides a particular advantage for arthroscopic repairs, where knot tying can be difficult. The Knotless suture anchor has a short loop of suture secured to the tail end of the anchor. A channel located at the tip of the anchor functions to capture the loop of suture after it has been passed through the soft tissue. The soft tissue is tensioned as the anchor is inserted into bone to the appropriate depth. Biomechanical testing demonstrated increased suture strength in the Knotless suture anchor compared with standard suture anchors. This is because of the doubled-suture configuration that is created with the Knotless suture anchor loop. To the author's knowledge, this paper describes the first knotless suture anchor. A secure, low-profile repair can be created without knot tying.     

Anchor design and bone mineral density affect the pull-out strength of suture anchors in rotator cuff repair: which anchors are best to use in patients with low bone quality?

BACKGROUND: Different metal and biodegradable suture anchors are available for rotator cuff repair. Poor bone quality may result in anchor loosening and tendon rerupture. HYPOTHESES: Higher bone mineral density is associated with higher pull-out strength of suture anchors. Depending on anchor placement, pull-out strengths of anchors are different within the greater tuberosity. STUDY DESIGN: Cadaveric biomechanical study. METHODS: Trabecular and cortical bone mineral densities were determined for different regions within the greater tuberosity. Metal screw-type and biodegradable hook-type anchors were cyclically loaded. RESULTS: Mean failure load of metal and biodegradable anchors was 273 N and 162 N, respectively, for the proximal part (P < .01) and 184 N and 112 N, respectively, for the distal part (P < .01). Both types of anchors showed higher failure loads in the proximal-anterior and -middle parts of the greater tuberosity than in the distal part (P < .01). A significant positive correlation was found between cortical bone mineral density and failure load of metal anchors (P < .01). CONCLUSION: Bone quality, anchor type, and anchor placement have a significant impact on anchor failure loads. CLINICAL RELEVANCE: Suture anchors should be placed in the proximal-anterior and -middle parts of the greater tuberosity. In the distal parts, biodegradable hook-like anchors should be used with caution.     

Is the transglenoid suture technique recommendable for recurrent shoulder dislocation? A minimum 5-year follow-up in 59 non-athletic shoulders

The aim of this retrospective study is to compare the clinical outcomes following arthroscopic Bankart repair employing the transglenoid technique versus suture anchors in non-athletic shoulders of patients 30 years or older at the time of surgery. Fifty-nine consecutive patients who were available for a minimum of 5 years follow-up after arthroscopic Bankart repair were included. The transglenoid technique was employed in 27 patients whose age and follow-up period were 37 years (range 30–58) and 82 (range 61–109) months. Suture anchor was used in 32 patients whose age and follow-up period were 38 years (range 30–62) and 72 months (range 65–89). The Rowe scores of the transglenoid and suture anchor groups were 90 (range 35–100) and 90 (range 35–100), respectively, and there was no statistically significant difference between the two groups (p > 0.05). The Constant score of both groups was 92 (range 64–100) and 95 (range 62–100) without a significant difference (p > 0.05). Moreover, there were no significant differences between the recurrence rates (7%-transglenoid, 6%-suture anchor) (p > 0.05) and positive apprehension signs (7%-transglenoid, 3%-suture anchor) (p > 0.05). In non-athletes over 30-years-old, the results of the transglenoid technique in arthroscopic Bankart repair were comparable to those of the suture anchor. We suggest that the transglenoid technique is a viable alternative for older, non-athletic shoulder if the suture anchors are not available.     

Pullout strength of suture anchors in comparison with transosseous sutures for rotator cuff repair

Suture anchors are increasingly gaining importance in rotator cuff surgery. This means they will be gradually replacing transosseous sutures. The purpose of this study was to compare the stability of transosseous sutures with different suture anchors with regard to their pullout strength depending on bone density. By means of bone densitometry (CT scans), two groups of human humeral head specimens were determined: a healthy and a osteopenic bone group. Following anchor systems were being tested: SPIRALOK™ 5.0 mm (resorbable, DePuy Mitek), Super Revo 5 mm (titanium, Linvatec), UltraSorb (resorbable, Linvatec) and the double U-sutures with Orthocord™ USP 2 (partly resorbable, DePuy Mitek) and Ethibond Excel 2 (non-resorbable, Ethicon). The suture anchors/double U-sutures were inserted in the greater tuberosity 12 times. An electromechanical testing machine was used for cyclic loading with power increasing in stages. We recorded the ultimate failure loads, the system displacements and the modes of failure. The suture anchors tended to bring about higher ultimate failure loads than the transosseous double U-sutures. This difference was significant in the comparison of the Ethibond suture and the SPIRALOK 5.0 mm—both in healthy and osteopenic bone. Both the suture materials and the SPIRALOK 5.0 mm showed a significant difference in pullout strength on either healthy or osteopenic bone; the titanium anchor SuperRevo 5 mm and the tilting anchor UltraSorb did not show any significant difference in healthy or osteopenic bone. There was no significant difference concerning system displacement (healthy and osteopenic bone) between the five anchor systems tested. The pullout strength of transosseous sutures is neither on healthy nor on osteopenic bone higher than that of suture anchors. Therefore, even osteopenic bone does not constitute a valid reason for the surgeon to perform open surgery by means of transosseous sutures. The choice of sutures in osteopenic bone is of little consequence anyway since it is mostly the bone itself which is the limiting factor.