In Vivo Randomized Controlled Study of the Bone Response of All-Suture Anchors and Biocomposite Anchors

Abstract

Background: Suture anchors are widely used for labral reconstruction surgery. However, there has been some concern over the development of osteolysis around the anchor. This has been reported for both biocomposite and all-suture anchors, but they have not been compared directly in vivo. Purpose: To compare the bone response to 2 common suture anchors: a traditional biocomposite push-fit anchor and an all-suture anchor. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Included in this study were 17 patients with a total of 37 unique suture anchors. Magnetic resonance imaging scans were performed at 3 weeks and 6 months postoperatively. A total of 38 senior radiologists and shoulder surgeons evaluated the images using a previously validated system for grading the bone response around suture anchors. The mean difference in grading at 3 weeks and 6 months was calculated using unpaired t tests, and the interrater reliability was evaluated with an intraclass correlation coefficient (ICC). Results: At 3 weeks, there was no statistically significant difference in the degree of osteolysis surrounding each suture anchor type ( P = .258), with little bone response. However, on the 6-month scans, there was a significantly lower level of osteolysis seen in the all-suture anchors compared with the biocomposite anchors ( P = .040). Interrater reliability was excellent, with an ICC value of 0.975 (95% CI, 0.962-0.985). Conclusion: All-suture anchors cause significantly less osteolysis in glenoid bone at 6 months compared with biocomposite anchors.

Arthroscopic Bankart repair with knotless all-suture anchors

“…All-suture anchors might have several advantages over traditional polymer-or bioabsorbable-based anchor constructs including the potential for small sizes allowing for bone preservation, reduced The repair suture (white-blue) is separated from the shuttling suture (white-black) by retrieving it through the anterosuperior portal using an atraumatic arthroscopic grasping instrument risk of anchor arthropathy, and reduced bone reactions (e.g., osteolysis) around the implant when compared with solid biocomposite anchors [4]. Concerns about limited failure load, anchor displacement, and anchor pull-out were recently addressed by Lacheta et al [2], who demonstrated high loads to failure for both knotted and knotless all-suture anchor repairs, with superior loop security of knotless repairs.…”

“…Knotless, all-suture anchors are a valuable alternative to solid anchors for arthroscopic Bankart repairs with a strong biomechanical profile and promising clinical short-term results [1,2,5]. The benefits of knotless, all-suture anchors include the small size, allowing for more points of fixation per unit area, improved access due to the ability to insert through curved drill guides, artifactreduced postoperative imaging, bone stock preservation, less risk of erosion of the humeral head or soft tissue such as the rotator cuff, and time efficiency due to the knotless construct [1][2][3][4][5].…”