MRI graduation of osseous reaction and drill hole consolidation after arthroscopic Bankart repair with PLLA anchors and the clinical relevance

Stein, Thomas; Mehling, A.P.; Ulmer, M.; Reck, Corinna; Efe, Turgay; Hoffmann, Reinhard; Jäger, A.; Welsch, F.

doi:10.1007/s00167-011-1721-8

Cited by 15 publications

(13 citation statements)

References 45 publications

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“…Previous studies have demonstrated that it is possible to indirectly estimate the osseous integration of biocomposite implants using MRI [30,33,34]. The narrowing of the tunnels on MRI, from the point of view of the authors, may only have arisen because of true osseous ingrowth in the implants, as this already demonstrates an osseous integration of the anchors.…”

Section: Discussionmentioning

confidence: 94%

Biocomposite Suture Anchors Remain Visible Two Years After Rotator Cuff Repair

Sgroi

Friesz²,

Schocke³

et al. 2019

Clin Orthop Relat Res

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Background Biocomposite suture anchors containing osteoconductive materials have gained popularity in rotator cuff repairs. However, little is known about the influence of the addition of osteoconductive materials on implant resorption, bone reaction, tendon healing, and clinical outcomes scores. Questions/purposes (1) What percentage of suture anchors were not completely resorbed 2 years after implantation? (2) What are the diameters of the bone bed in relation to the implant? (3) Is tendon integrity correlated with bone tunnel diameter? (4) Is there an association between tunnel widening, periimplant fluid film grade, biodegradation grade, and retear with clinical outcomes scores, such as the Western Ontario Rotator Cuff Index (WORC) and the Oxford Shoulder Score (OSS)? Methods Thirty-six patients were enrolled from August 2012 to January 2014. The following inclusion criteria were applied: (1) reparable full-thickness supraspinatus tendon tears, (2) double-row suture bridge techniques applied for supraspinatus repair, (3) use of biocomposites suture anchor implants composed of poly L-lactic acid (PLLA) and b-tricalcium phosphate (TCP) exclusively, and (4) a minimum of 2 years followup. Four patients met the exclusion criteria, and seven of 36 patients (19%) were lost to followup. Thereby, 25 patients (84 implants) were included in this retrospective study. To answer the study's questions, the following methods were applied: (1) The resorption of the implants and periimplant fluid film were assessed on MRI using a four-stage scale system, (2) bone bed diameter was measured on MRI at three different points on the longitudinal central axis of each anchor, (3) tendon integrity was evaluated on MRI according to the Sugaya classification and correlated to bone tunnel diameter, and (4) assessed tunnel diameters, periimplant fluid film grade, biodegradation grade, and tendon condition were related to clinical outcomes scores at the time of followup (2.3 6 0.3 years). The intraobserver reliability was 0.981 (p < 0.001) and interobserver reliability was 0.895 (p < 0.001). Results At 2.3 6 0.3 years, most analyzed suture anchors (76 of 84 [90%]) were, with varying degrees of degradation, still visible. Bone tunnels showed minor widening (0.4 6 1.4 mm) at the base, but osseous ingrowth was detected as narrowing at the middle (0.1 6 1.1 mm) and at the apex (1.4 6 1.7 mm) of the implants. Patients with retears (Sugaya Grades 4-5) had narrower tunnels (3.6 6 1.8 mm) than patients without retears (Sugaya Grades 1-3; 4.4 6 1.6 mm; mean difference, 0.782 [95% confidence interval {CI}: 0.009-1.6]; p = 0.050). WORC and Oxford scores were not associated with the tunnel widening amount, fluid film grade, biodegradation grade, or tendon retear. Conclusions In light of the results of the present study, surgeons should consider in their daily practice that the resorption process of these implants may be slower than Each author certifies that neither he or she, nor any member of his or her immediate family, have funding or commercial a...

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Section: Discussionmentioning

confidence: 94%

Biocomposite Suture Anchors Remain Visible Two Years After Rotator Cuff Repair

Sgroi

Friesz²,

Schocke³

et al. 2019

Clin Orthop Relat Res

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“…To our knowledge, no long-term studies are available of drill-hole changes where CT images were used to classify the degree of bony healing, and therefore the results of the present study are difficult to compare with previously published work. Using MRI scans, Stein et al 32 found evidence of drill-hole consolidation at the drill-hole sites of PLLA anchors 3 years after arthroscopic Bankart repair. Barber et al, 2 examining CT scans, found fibrous healing at the drill-hole sites of PLLA interference screws 5 years after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…This is in accordance with previously published work of the same patient cohort at the 7-year follow-up. 11 Stein et al 32 showed incomplete healing of drill holes 3 years after surgery using PLLA anchors. Elmlund et al 10 found that 24% of drill holes had not healed at 8 years after arthroscopic Bankart repair using PGA tacks.…”

Section: Discussionmentioning

confidence: 99%

Large Drill Holes Are Still Present in the Long Term After Arthroscopic Bankart Repair With Absorbable Tacks: An 18-Year Randomized Prospective Study

et al. 2020

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Background: Studies have demonstrated the development of an osseous reaction at the drill sites of anchors after arthroscopic shoulder surgery. Purpose: To investigate the drill-hole size at 18 years after arthroscopic Bankart repair using either fast polygluconate acid (PGA) or slow polylevolactic acid (PLLA) absorbable tacks and to compare the functional outcomes and development of osteoarthritis. Study design: Randomized controlled trial; Level of evidence, 2. Methods: 40 patients with unidirectional anterior shoulder instability, treated with arthroscopic Bankart repair, were randomized into the PGA group (n = 20) or the PLLA group (n = 20). Plain radiographs of both shoulders, as well as computed tomography (CT) images of the operated shoulder, were used to evaluate the drill-hole size, volume, and degenerative changes. Functional outcomes were assessed by use of the Rowe score, Constant score, and Western Ontario Shoulder Instability (WOSI) index. Results: Of the 40 patients, 32 patients returned for the follow-up (15 PGA and 17 PLLA). No significant differences were found in the population characteristics between the study groups. The mean follow-up time was 18 years for both groups. No significant differences were seen in range of motion, strength in abduction, or Constant, Rowe, and WOSI scores between the groups. Recurrence rate was 33% in the PGA group and 6% in the PLLA group during the follow-up period ( P = .07). The drill-hole appearance on plain radiographs (invisible/hardly visible/visible/cystic) was 11/2/2/0 and 6/5/5/1 for the PGA and PLLA groups, respectively ( P = .036). The mean ± SD drill-hole volume as estimated on CT images was 89 ± 94 and 184 ± 158 mm3 in the PGA and PLLA groups, respectively ( P = .051). Degenerative changes (normal/minor/moderate/severe) on plain radiographs were 7/4/4/0 and 3/8/5/1 for the PGA and PLLA groups, respectively ( P = .21), and on CT images were 5/7/3/0 and 2/6/6/3 for the PGA and PLLA groups, respectively ( P = .030). Conclusion: This long-term follow-up study demonstrated that the PLLA group had significantly more visible drill holes than the PGA group on plain radiographs. However, this difference was not evident on CT imaging, with both groups having several visible cystic drill holes and a substantial drill-hole volume defect. No significant differences were found between the study groups in terms of clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

“…20 The literature remains contradictory (with some of these studies utilizing in vitro or animal models) when determining the clinical relevance of potentially heightened inflammation and foreign body reaction secondary to absorbable poly-l-lactic acid-derived implants, which seem to have varying propensities to elicit an inflammatory response based on their composition. [21][22][23][24][25] To date, this technique has been performed in a small series by the authors for revision lateral ankle stabilization or for primary lateral ankle stabilization in larger patients with significant instability. All patients had returned to meaningful weight-bearing activities at early follow-up without recurrent instability or pain.…”

Section: Techniquementioning

confidence: 99%

All-Inside, Anatomical Lateral Ankle Stabilization for Revision and Complex Primary Lateral Ankle Stabilization

Prissel

Roukis

2014

Foot & Ankle Specialist

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Lateral ankle instability is a common mechanical problem that often requires surgical management when conservative efforts fail. Historically, myriad open surgical approaches have been proposed. Recently, consideration for arthroscopic management of lateral ankle instability has become popular, with promising results. Unfortunately, recurrent inversion ankle injury following lateral ankle stabilization can occur and require revision surgery. To date, arthroscopic management for revision lateral ankle stabilization has not been described. We present a novel arthroscopic technique combining an arthroscopic lateral ankle stabilization kit with a suture anchor ligament augmentation system for revision as well as complex primary lateral ankle stabilization.

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MRI graduation of osseous reaction and drill hole consolidation after arthroscopic Bankart repair with PLLA anchors and the clinical relevance

Abstract: IV.

Cited by 15 publications

References 45 publications

Biocomposite Suture Anchors Remain Visible Two Years After Rotator Cuff Repair

Biocomposite Suture Anchors Remain Visible Two Years After Rotator Cuff Repair

Large Drill Holes Are Still Present in the Long Term After Arthroscopic Bankart Repair With Absorbable Tacks: An 18-Year Randomized Prospective Study

All-Inside, Anatomical Lateral Ankle Stabilization for Revision and Complex Primary Lateral Ankle Stabilization

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