With the increase in shoulder arthroscopies are increased complications related to shoulder implants frequently used for arthroscopic rotator cuff repair and shoulder stabilisation. The biggest problem is malpositioning of the suture anchor, which might lead to persistent pain, serious cartilage damage, decreased range of motion, and failure of the reconstruction, resulting in revision surgery. Especially in osteoporotic bone, it is important to choose an implant that provides sufficient mechanical strength. Other possible complications are related to the sutures of the anchor. Suture damage or accidental removal of the sutures from the anchor could leave them useless in situ. Tangling of the sutures, especially in massive reconstructions of the rotator cuff, can lead the surgeon to switch to an open technique. Compared with metal implants, bioabsorbable implants have advantages concerning possible revision surgery. However, implant costs, anchor hole enlargement, and possible higher failure rates compared with metallic implants should be considered. A rare but serious complication is allergic reaction to the implant.
All-inside devices have become increasingly popular in reconstructive meniscal surgery since their introduction at the beginning of the 1990s. Although the latest clinical investigations show better results for conventional suture techniques, meniscal devices are an important alternative because of the low risk of neurovascular injury and the easy handling of the instruments. Over the years, many reports on specific complications related to all-inside devices have been published. Especially chondral injuries, implant loosening, device migration and capsular or neural irritations have been described. Furthermore, some authors reported on foreign body reactions and cystic granulomas after the use of meniscal fixation devices. However, there is no evidence for a higher infection rate or for specific infections after the use of intra-articular techniques. Clinical reports on complications along with biomechanical studies on meniscal repair devices have led to the enhancement of all-inside techniques through substantial modifications of established products as well as to the development of new implants. After reviewing the latest literature, the complication rate seems to be decreasing. In many ways, all-inside devices are an interesting alternative to conventional suture techniques. A precise knowledge of their potential complications and the pitfalls during surgery however is crucial to make a risk evaluation in the choice of the right technique for meniscal reconstruction.
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