Mode of failure for rotator cuff repair with suture anchors identified at revision surgery

Cummins, Craig A.; Murrell, George A. C.

doi:10.1067/mse.2003.21

Cited by 340 publications

(252 citation statements)

References 18 publications

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“…Osteoporosis, disuse, fracture, poor bone preparation, cysts in the bone, or prior surgery can leave a bony bed of questionable quality. Previous studies show suture anchors can fail at the anchor-bone interface [5,6,12]. Giori et al showed that anchor fixation can be augmented using PMMA [9].…”

Section: Discussionmentioning

confidence: 99%

“…Retear rates reportedly range from 15% to 90% [1,2,11,20], with approximately 4% of failures being attributed to metal anchor pullout from bone at the time of revision surgery [5,6]. The pullout rates for bioabsorbable anchors reportedly are much higher, with as much as 30% of painful shoulders showing anchor pullout on MRI after cuff repair [12].…”

Section: Introductionmentioning

confidence: 99%

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Bioabsorbable Tricalcium Phosphate Bone Cement Strengthens Fixation of Suture Anchors

Oshtory¹,

Lindsey

Giori

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Failure of suture anchor fixation in rotator cuff repair can occur at different interfaces. Prior studies show fixation at the bone-anchor interface can be augmented using polymethylmethacrylate (PMMA) cement, and screw fixation into bone can be strengthened using bioabsorbable tricalcium phosphate cement. Questions/purposes We wished to determine whether augmentation of suture anchor fixation using bioabsorbable tricalcium phosphate cement would increase pullout strength of suture anchors from bone and the number of cycles to failure, to determine the mode of failure after cement augmentation, and to compare strength and mode of failure with those after augmentation with PMMA.Methods We used 10 matched pairs of cadaveric proximal humeri and implanted a metal screw-type suture anchor in one side and on the other side injected tricalcium phosphate cement into the anchor holes before anchor placement. We tested all specimens to failure using a ramped cyclic loading protocol. Results Tricalcium phosphate cement augmentation increased the final load to failure by 29% and the number of cycles to failure by 20%. Visual inspection confirmed that failure occurred at the cement-bone interface. Conclusions Tricalcium phosphate cement appears to augment suture anchor fixation into bone, reducing the risk of anchor pullout and failure. Clinical Relevance When relying on suture anchor fixation in bone of questionable quality, we suggest considering augmentation of suture anchor fixation with bioabsorbable cement. This method also provides potential for bioabsorbability and may be more amenable to arthroscopic application.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bioabsorbable Tricalcium Phosphate Bone Cement Strengthens Fixation of Suture Anchors

Oshtory¹,

Lindsey

Giori

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…It has been stated that intrinsic factors such as age of the patients, size of the tear, fatty degeneration and retraction of the affected tendons may play a role as predictors for recurrent tears after successful surgery [1][2][3][4][5][6][7]. Regardless, at this point, the only clear predictor that positively correlates with a higher recurrent tear rate seems to be the age of the patient at the moment of surgical intervention [2,5,7,8].…”

Section: Introductionmentioning

confidence: 98%

The acromial index is not predictive for failed rotator cuff repair

Meleán

Lichtenberg²,

Montoya

et al. 2013

International Orthopaedics (SICOT)

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Background The main objective of this study was to evaluate the association between the acromial index (AI) and the incidence of recurrent tears of the rotator cuff (RC) in a cohort of patients with full thickness tears who underwent arthroscopic primary repair. Methods A prognostic study of a prospective case series of 103 patients with full thickness RC tears was undertaken. The average age was 59.5 years (39-74) and follow-up was 30.81-months (12-72). True anterior-posterior X-rays were obtained during the pre-operative evaluation. Pre and post-operative magnetic resonance imaging (MRI) were recorded. Results Eighteen cases with recurrent tears (17.4 %) were seen on post-operative MRI. The average AI for patients with recurrent tears was 0.711±0.065 and for patients without recurrent tears 0.710±0.064 (p<0.05). A positive association between age and recurrent tears of the RC was noted (average ages: recurrent tears group 63±5.9 years; group without recurrent tears 58.8±7.5 years) (r=−0.216; p=0.029). We did not find an association between size of the primary tear and recurrent tears (r=−0.075; p<0.05) or between degrees of retraction of the primary and recurrent tears of the cuff (r=−0.073; p<0.05). We observed that 38.9 % of the recurrent tears cases presented with more than one tendon affected before the arthroscopy. At follow-up, none of these recurrent tears showed more than one tendon affected on MRI evaluation. ConclusionIn this study, we found that the AI radiological measurement is not a predictor for recurrent tears of the RC after primary arthroscopic repair.

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“…The mechanisms of rotator cuff repair failure are believed to be suture cutting through tendon secondary to excessive tension at the repair site and/or poor healing capacity of the involved tissues 2,24,25 . To address these challenges, natural and synthetic devices have been investigated for the reinforcement of rotator cuff repairs.…”

mentioning

confidence: 99%

Rotator Cuff Repair Augmentation in a Canine Model with Use of a Woven Poly-L-Lactide Device

Derwin

Codsi

Milks

et al. 2009

The Journal of Bone and Joint Surgery-American Volume

142

129

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Mode of failure for rotator cuff repair with suture anchors identified at revision surgery

Cited by 340 publications

References 18 publications

Bioabsorbable Tricalcium Phosphate Bone Cement Strengthens Fixation of Suture Anchors

Bioabsorbable Tricalcium Phosphate Bone Cement Strengthens Fixation of Suture Anchors

The acromial index is not predictive for failed rotator cuff repair

Rotator Cuff Repair Augmentation in a Canine Model with Use of a Woven Poly-L-Lactide Device

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