Complications of Bioabsorbable Suture Anchors in the Shoulder

Abstract

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.

Pullout strength of all suture anchors in the repair of rotator cuff tears: a biomechanical study

“…The pullout strength obtained in that study was lower, but this is probably related to the nature of the support (bovine tuberosity in our study; porcine femoral diaphysis in the Barber et al [9,17] studies). During SA failure (anchor detachment or eyelet rupture), the release of intra-articular foreign bodies (anchor fragments) can have adverse effects, especially on cartilage [10][11][12][13][14]. For ASAs, it is likely that the complications of failure are mild and comparable with those of a transosseous suture.…”

“…Anchors require surgical preparation of the bone insertion site (drilling or punching), and their size (up to 6.5 mm) limits the number of anchors on the insertion site, which can lead to bone loss and result in imprecise tendon reinsertion. Finally, interarticular migration (of the entire anchor or fragments), prominent intra-articular portions and resorption granuloma fractures have been described in anchor failures [10][11][12][13][14]. Due to the volume and reported complications of anchors, some surgeons prefer to repair the rotator cuff with transosseus points, allowing a very small gap between attachment points without using anchors [15].…”

Arthroscopic Bankart Repair for the Management of Anterior Shoulder Instability: Indications and Outcomes

“…Implant selection plays an important role in potential complications. Anchor usage can lead to significant pain, decreased ROM, and failure if they are not positioned properly during the initial procedure [40]. Degenerative joint conditions, such as chondrolysis and osteoarthritis (OA), have also been reported as long-term complications of arthroscopic Bankart repair, primarily due to intra-articular pain pumps, which have since fallen out of favor.…”

Revolutionizing orthopaedic biomaterials: The potential of biodegradable and bioresorbable magnesium-based materials for functional tissue engineering

“…Additionally, arthroscopic repair of torn acetabular labrum is on the rise and suture anchors are used to re-approximate the torn tissue. The majority of suture anchors for these applications are currently made of polymers, and it has been shown that these devices may cause osteolysis leading to osseous cyst formation (Dhawan et al, 2012). Excellent biocompatibility and osteoinductivity of Mg and its alloys may allow better bone healing.…”