Skip to main content
Top
Published in: International Orthopaedics 5/2015

01-05-2015 | Original Paper

Early anchor displacement after arthroscopic rotator cuff repair

Authors: Gábor Skaliczki, Paolo Paladini, Giovanni Merolla, Fabrizio Campi, Giuseppe Porcellini

Published in: International Orthopaedics | Issue 5/2015

Login to get access

Abstract

Purpose

Arthroscopic rotator cuff repair is a success and became the mainstream method of reconstruction in recent years. Due to the technical development in shoulder surgery, novel suture anchors and high-strength sutures are widely used providing convincing fixation, however anchor pullout still remains a problem. The aim of our study was to observe early anchor movement on a large patient cohort, and identify clinical, biological and technical variables that can lead to this complication.

Methods

A total of 5,327 patients who had arthroscopic rotator cuff reconstruction for full thickness tear were included in the study. Radiographs taken immediately after surgery were observed and occurrent anchor displacement was recorded. Patient-specific, tendon-specific, bone-specific and implant-specific variables were studied. Any possible relationship between these factors and anchor displacement was investigated.

Results

Early anchor movement occurred in six cases (0.1 %). The involvement of two or more tendons, retraction of the tendon by more than 2 cm and the use of four anchors was associated with higher incidence of anchor displacement, however the difference was not significant.

Conclusions

Based on our study, anchor pullout occurring immediately after surgery is a relatively rare complication. Instead of timing the radiologic examination directly after the procedure, assessment of the anchors’ position four to six weeks after surgery should be considered.
Literature
1.
go back to reference Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB (1995) Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am 77:10–15PubMed Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB (1995) Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am 77:10–15PubMed
2.
go back to reference Tempelhof S, Rupp S, Seil R (1999) Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg 8:296–299CrossRefPubMed Tempelhof S, Rupp S, Seil R (1999) Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg 8:296–299CrossRefPubMed
3.
go back to reference Gulotta LV, Nho SJ, Dodson CC, Adler RS, Altchek DW, MacGillivray JD (2011) Prospective evaluation of arthroscopic rotator cuff repairs at 5 years: part I—functional outcomes and radiographic healing rates. J Shoulder Elbow Surg 20(6):934–940CrossRefPubMed Gulotta LV, Nho SJ, Dodson CC, Adler RS, Altchek DW, MacGillivray JD (2011) Prospective evaluation of arthroscopic rotator cuff repairs at 5 years: part I—functional outcomes and radiographic healing rates. J Shoulder Elbow Surg 20(6):934–940CrossRefPubMed
4.
go back to reference Gulotta LV, Nho SJ, Dodson CC, Adler RS, Altchek DW, MacGillivray JD (2011) Prospective evaluation of arthroscopic rotator cuff repairs at 5 years: part II—prognostic factors for clinical and radiographic outcomes. J Shoulder Elbow Surg 20(6):941–946CrossRefPubMed Gulotta LV, Nho SJ, Dodson CC, Adler RS, Altchek DW, MacGillivray JD (2011) Prospective evaluation of arthroscopic rotator cuff repairs at 5 years: part II—prognostic factors for clinical and radiographic outcomes. J Shoulder Elbow Surg 20(6):941–946CrossRefPubMed
5.
go back to reference Bennett WF (2003) Arthroscopic repair of full-thickness supraspinatus tears (small- to-medium): a prospective study with 2- to 4-year follow-up. Arthroscopy 19:249–256CrossRefPubMed Bennett WF (2003) Arthroscopic repair of full-thickness supraspinatus tears (small- to-medium): a prospective study with 2- to 4-year follow-up. Arthroscopy 19:249–256CrossRefPubMed
6.
go back to reference Millett PJ, Horan MP, Maland KE, Hawkins RJ (2011) Long-term survivorship and outcomes after surgical repair of full-thickness rotator cuff tears. J Shoulder Elbow Surg 20(4):591–597CrossRefPubMed Millett PJ, Horan MP, Maland KE, Hawkins RJ (2011) Long-term survivorship and outcomes after surgical repair of full-thickness rotator cuff tears. J Shoulder Elbow Surg 20(4):591–597CrossRefPubMed
7.
go back to reference Bell S, Lim YJ, Coghlan J (2013) Long-term longitudinal follow-up of mini-open rotator cuff repair. J Bone Joint Surg Am 95(2):151–157CrossRefPubMed Bell S, Lim YJ, Coghlan J (2013) Long-term longitudinal follow-up of mini-open rotator cuff repair. J Bone Joint Surg Am 95(2):151–157CrossRefPubMed
8.
go back to reference Miškulin M, Vrgoč G, Sporiš G, Dulic O, Gavrilovic G, Milanović Z (2014) Single-row arthroscopic cuff repair with double-loaded anchors provides good shoulder function in long-term follow-up. Int Orthop. doi:10.1007/s00264-014-2557-x PubMed Miškulin M, Vrgoč G, Sporiš G, Dulic O, Gavrilovic G, Milanović Z (2014) Single-row arthroscopic cuff repair with double-loaded anchors provides good shoulder function in long-term follow-up. Int Orthop. doi:10.​1007/​s00264-014-2557-x PubMed
9.
go back to reference 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(7):895–905CrossRefPubMed 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(7):895–905CrossRefPubMed
10.
go back to reference Barber FA, Herbert MA, Beavis RC (2009) Cyclic load and failure behavior of arthroscopic knots and high strength sutures. Arthroscopy 25(2):192–199CrossRefPubMed Barber FA, Herbert MA, Beavis RC (2009) Cyclic load and failure behavior of arthroscopic knots and high strength sutures. Arthroscopy 25(2):192–199CrossRefPubMed
11.
go back to reference Benson EC, MacDermid JC, Drosdowech DS, Athwal GS (2010) The incidence of early metallic suture anchor pullout after arthroscopic rotator cuff repair. Arthroscopy 26(3):310–315CrossRefPubMed Benson EC, MacDermid JC, Drosdowech DS, Athwal GS (2010) The incidence of early metallic suture anchor pullout after arthroscopic rotator cuff repair. Arthroscopy 26(3):310–315CrossRefPubMed
12.
go back to reference Galland A, Airaudi S, Gravier R, Le Cann S, Chabrand P, Argenson JN (2013) Pullout strength of all suture anchors in the repair of rotator cuff tears: a biomechanical study. Int Orthop 37(10):2017–2023CrossRefPubMedCentralPubMed Galland A, Airaudi S, Gravier R, Le Cann S, Chabrand P, Argenson JN (2013) Pullout strength of all suture anchors in the repair of rotator cuff tears: a biomechanical study. Int Orthop 37(10):2017–2023CrossRefPubMedCentralPubMed
13.
go back to reference 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 17:31–37CrossRefPubMed 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 17:31–37CrossRefPubMed
14.
go back to reference Downie BK, Miller BS (2012) Treatment of rotator cuff tears in older individuals: a systematic review. J Shoulder Elbow Surg 21(9):1255–1261CrossRefPubMed Downie BK, Miller BS (2012) Treatment of rotator cuff tears in older individuals: a systematic review. J Shoulder Elbow Surg 21(9):1255–1261CrossRefPubMed
15.
go back to reference Cofield RH, Parvizi J, Hoffmeyer PJ, Lanzer WL, Ilstrup DM, Rowland CM (2001) Surgical repair of chronic rotator cuff tears. A prospective long-term study. J Bone Joint Surg Am 83-A(1):71–77PubMed Cofield RH, Parvizi J, Hoffmeyer PJ, Lanzer WL, Ilstrup DM, Rowland CM (2001) Surgical repair of chronic rotator cuff tears. A prospective long-term study. J Bone Joint Surg Am 83-A(1):71–77PubMed
16.
go back to reference Carbonel I, Martinez AA, Calvo A, Ripalda J, Herrera A (2012) Single-row versus double-row arthroscopic repair in the treatment of rotator cuff tears: a prospective randomized clinical study. Int Orthop 36(9):1877–1883CrossRefPubMedCentralPubMed Carbonel I, Martinez AA, Calvo A, Ripalda J, Herrera A (2012) Single-row versus double-row arthroscopic repair in the treatment of rotator cuff tears: a prospective randomized clinical study. Int Orthop 36(9):1877–1883CrossRefPubMedCentralPubMed
17.
go back to reference Tingart MJ, Apreleva M, Lehtinen J, Zurakowski D, Warner JJ (2004) 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? Am J Sports Med 32(6):1466–1473CrossRefPubMed Tingart MJ, Apreleva M, Lehtinen J, Zurakowski D, Warner JJ (2004) 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? Am J Sports Med 32(6):1466–1473CrossRefPubMed
18.
go back to reference Burkhart SS (1995) The deadman theory of suture anchors: observations along a south Texas fence line. Arthroscopy 11(1):119–123CrossRefPubMed Burkhart SS (1995) The deadman theory of suture anchors: observations along a south Texas fence line. Arthroscopy 11(1):119–123CrossRefPubMed
19.
go back to reference Brady PC, Arrigoni P, Burkhart SS (2006) What do you do when you have a loose screw? Arthroscopy 22(9):925–930CrossRefPubMed Brady PC, Arrigoni P, Burkhart SS (2006) What do you do when you have a loose screw? Arthroscopy 22(9):925–930CrossRefPubMed
20.
go back to reference Kim SH, Ha KI (2000) The SMC knot—a new slip knot with locking mechanism. Arthroscopy 16(5):563–565CrossRefPubMed Kim SH, Ha KI (2000) The SMC knot—a new slip knot with locking mechanism. Arthroscopy 16(5):563–565CrossRefPubMed
21.
go back to reference Djurasovic M, Marra G, Arroyo JS, Pollock RG, Flatow EL, Bigliani LU (2001) Revision rotator cuff repair: factors influencing results. J Bone Joint Surg Am 83:1849–1855PubMed Djurasovic M, Marra G, Arroyo JS, Pollock RG, Flatow EL, Bigliani LU (2001) Revision rotator cuff repair: factors influencing results. J Bone Joint Surg Am 83:1849–1855PubMed
22.
go back to reference Dezaly C, Sirveaux F, Philippe R, Wein-Remy F, Sedaghatian J, Roche O, Molé D (2011) Arthroscopic treatment of rotator cuff tear in the over-60s: repair is preferable to isolated acromioplasty-tenotomy in the short term. Orthop Traumatol Surg Res 97(6 Suppl):S125–S130CrossRefPubMed Dezaly C, Sirveaux F, Philippe R, Wein-Remy F, Sedaghatian J, Roche O, Molé D (2011) Arthroscopic treatment of rotator cuff tear in the over-60s: repair is preferable to isolated acromioplasty-tenotomy in the short term. Orthop Traumatol Surg Res 97(6 Suppl):S125–S130CrossRefPubMed
23.
go back to reference Barber FA, Herbert MA, Beavis RC, Barrera Oro F (2008) Suture anchor materials, eyelets, and designs: update 2008. Arthroscopy 24(8):859–867CrossRefPubMed Barber FA, Herbert MA, Beavis RC, Barrera Oro F (2008) Suture anchor materials, eyelets, and designs: update 2008. Arthroscopy 24(8):859–867CrossRefPubMed
24.
go back to reference Kannus P, Leppala J, Lehto M, Sievanen H, Heinonen A (1995) A rotator cuff rupture produces permanent osteoporosis in the affected extremity, but not in those with whom shoulder function has returned to normal. J Bone Miner Res 10:1263–1271CrossRefPubMed Kannus P, Leppala J, Lehto M, Sievanen H, Heinonen A (1995) A rotator cuff rupture produces permanent osteoporosis in the affected extremity, but not in those with whom shoulder function has returned to normal. J Bone Miner Res 10:1263–1271CrossRefPubMed
25.
go back to reference Barber FA (2007) Biodegradable shoulder anchors have unique modes of failure. Arthroscopy 23(3):316–320CrossRefPubMed Barber FA (2007) Biodegradable shoulder anchors have unique modes of failure. Arthroscopy 23(3):316–320CrossRefPubMed
Metadata
Title
Early anchor displacement after arthroscopic rotator cuff repair
Authors
Gábor Skaliczki
Paolo Paladini
Giovanni Merolla
Fabrizio Campi
Giuseppe Porcellini
Publication date
01-05-2015
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 5/2015
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-015-2690-1

Other articles of this Issue 5/2015

International Orthopaedics 5/2015 Go to the issue