Arthroscopic remplissage with all-suture anchors causes cystic lesions in the humerus: a volumetric CT study of 55 anchors

Abstract

Purpose To evaluate with computed tomography (CT) the incidence of implant-related osteolysis after implantation of two types of all-suture anchors during remplissage for the management of Hill-Sachs lesions in shoulder instability. Methods Single-cohort, observational study with a minimum of 12 months follow-up. Twenty-ive participants (19 males and 6 females; mean age 37.4 years [SD: 11.6]) with Hill-Sachs lesions requiring remplissage were evaluated with a CT performed a mean of 14.1 [3.74] months after surgery. Fifty-ive all-suture anchors (19 2.3 mm Iconix and 36 1.7 mm Sutureix) were used. The volume of the bone defects was measured in the CT. Every anchor was classiied into one of four groups: (1) no bone defect. (2) Partial bone defect (bone defects smaller than the drill used for anchor placement). (3) Tunnel enlargement (bone defect larger than the drill volume but smaller than twice that volume). (4) Cystic lesion (bone defect larger twice the drill volume). Results No bone defect was identiied in only two anchors (3.6%, 95% CI 0.4-12.5%). A partial bone defect was found in eight anchors (14.5%, 95% CI 6.5-26.7%). In 35 anchors (63.6%, 95% CI 49.6-76.2%), there was enlargement of the bone defect that was smaller than 200% the size of the drill used. Ten anchors caused bone defects larger than twice the size of the drill used (18.2%, 95% CI 9.1-30.9%). The defect size was a mean of 89 mm 3 (SD: 49 mm 3 , minimum 0 mm 3 , maximum 230 mm 3 ). Conclusion When using all-suture anchors in arthroscopic remplissage during instability surgery, relevant bone osteolytic defects are common at 1-year-follow-up. Cystic defects larger than twice the volume of the resected bone during implantation develop in one in six anchors and signiicant tunnel widening will develop in another three out of ive anchors. This bone loss efectively increases the size and depth of the Hill-Sachs lesions but does not seem to afect short-term clinical outcomes. Level of evidence Level IV.

No Difference Between Anchorless and Traditional Suture Anchors in Arthroscopic Bankart Repair: A Clinical Comparison

“…On the other hand, Iban et al did find a high rate of peri-anchor cystic changes in a retrospective study of 55 all-suture anchors at one year of use for remplissage. However, this study did not provide a control group for comparison [29]. Further investigation with standardized groups and more common instability patterns, particularly anterior instability, is needed.…”

Clinical and radiological outcome of all-suture anchors in shoulder and elbow surgery

“…Cyst formation and statistically significant increased tunnel expansion was seen in postoperative CT imaging, but it did not influence clinical outcomes. 39,[43][44][45] MRI studies showed various bone reactions, such as tunnel widening, cyst formation and rims of fluid around the anchors, but these reactions were considered as not statistically significant. 36,41 However, one MRI study executed by Ro et al 40 did show a peri-anchor cystic bone reaction being associated with a higher rate of rotator cuff retears.…”

Editorial Commentary: All-Suture Anchors Are Evidence-Based and Biomechanically Sound but Require Additional Clinical Outcomes Evaluation

“…There are still doubts raised by reported cyst formations and potential secondary anchor failure. 18,19 Corresponding clinical outcomes studies are rare, 18,[20][21][22][23][24][25] and there is a lack of evidence for the clinical advantages of ASA compared to established implants.…”