What Makes Suture Anchor Use Safe in Hip Arthroscopy? A Systematic Review of Techniques and Safety Profile

Shah, Ajay; Kay, Jeffrey; Memon, Muzammil; Coughlin, Ryan P.; Simunovic, Nicole; Nho, Shane J.; Ayeni, Olufemi R.

doi:10.1016/j.arthro.2018.10.118

Cited by 28 publications

(35 citation statements)

References 42 publications

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“…Noncomparative studies were categorized a priori as follows: 0-4, very low quality; 5-7, low quality; 8-12, fair quality; and ≥13, high quality. 48 For comparative studies, the categorization was as follows: 0-6, very low quality; 7-10, low quality; 11-15, fair quality; and ≥16, high quality. 48 The risk of bias in randomized controlled trials was assessed using the Cochrane risk of bias tool.…”

Section: Methodsmentioning

confidence: 99%

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Iliopsoas Tenotomy During Hip Arthroscopy: A Systematic Review of Postoperative Outcomes

et al. 2020

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Background: Arthroscopic iliopsoas tendon release is a surgical treatment option for painful snapping hips, although it has been associated with controversy surrounding potential complications including decreased hip flexion strength, iatrogenic hip instability, and iliopsoas atrophy. Purpose: To systematically assess the efficacy and safety of arthroscopic iliopsoas tenotomy during hip arthroscopic surgery as an intervention for painful snapping hips. Study Design: Systematic review; Level of evidence, 4. Methods: A total of 3 online databases (Embase, PubMed, and MEDLINE) were searched from database inception until September 2019 for studies investigating iliopsoas tenotomy during hip arthroscopic surgery. Studies were screened by 2 reviewers independently and in duplicate, and studies investigating arthroscopic iliopsoas tendon release were included. Demographic data as well as data on treatment success, functional outcome scores, and radiological outcomes were recorded. A risk of bias assessment was performed for all included studies. Results: Overall, 21 studies were identified with a total of 824 patients (875 hips). These patients were 82.5% female (680/824), with a mean age of 28.1 years (range, 12-62 years) and mean follow-up of 32.1 months (range, 3-73 months). Arthroscopic iliopsoas tenotomy was performed at the level of the labrum in 811 hips (92.7%) or the lesser trochanter in 64 hips (7.3%). The overall reported success rate of the procedure in resolving snapping hips was 93.0% (266/286), and all studies reported an improvement in functional outcome scores. Only 6 studies (93 hips) discussed postoperative hip flexion strength, with complete recovery of strength reported in 4 studies (47 hips) and mild decreases reported in the other 2 studies (46 hips). Iliopsoas atrophy was evaluated radiologically (3 studies; 66 hips) and was found postoperatively in 92.4% (61/66) of hips. No major complications were reported. Conclusion: Arthroscopic release of the iliopsoas tendon was effective in alleviating pain and persistent clicking associated with a snapping hip. Although patients demonstrated some early postoperative weakness and iliopsoas atrophy on radiological imaging, the results from studies to date showed satisfactory clinical function and return to sports/activities. High-quality comparative studies are needed to further assess arthroscopic iliopsoas tendon release to determine the optimal technique and location of tendon release.

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Section: Methodsmentioning

confidence: 99%

“…48 For comparative studies, the categorization was as follows: 0-6, very low quality; 7-10, low quality; 11-15, fair quality; and ≥16, high quality. 48 The risk of bias in randomized controlled trials was assessed using the Cochrane risk of bias tool. 25…”

Section: Methodsmentioning

confidence: 99%

Iliopsoas Tenotomy During Hip Arthroscopy: A Systematic Review of Postoperative Outcomes

et al. 2020

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“…11 However, the availability of glenoid anchors in conjunction with their track record of clinical success and the potential advantages for using smaller suture anchors in the hip advocate for further ex vivo and clinical assessments to determine optimal suture anchor characteristics for use in the acetabulum. [12][13][14] For use in acetabular labral repair, the use of small knotless anchors may allow for suitable placement through a direct anterior portal and obviate the need for a mid-anterior or distal anterolateral accessory portal to obtain the desired trajectory for insertion. In addition, small knotless anchors may reduce the chance for implant perforation into the psoas tunnel.…”

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Knotless Suture Anchors: A Comparative Biomechanical Study of Acetabular Rim Anchor Fixation with Implications for Hip Labral Repair

Rowan

Cook

Bezold

et al. 2021

The Journal of Hip Surgery

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The purpose of this study was to analyze relevant initial-implantation biomechanical properties of five knotless suture anchors available for use in acetabular labral repair. Five knotless suture anchor constructs were tested: Arthrex PushLock 2.9, Arthrex PushLock 2.4, Arthrex SutureTak 3.0, Stryker CinchLock SS 2.4, and Stryker CinchLock Flex 2.4. Anchors were placed in synthetic bone blocks and in acetabular bone of cadaveric specimens. Constructs were subjected to cyclic and load-to-failure (LTF) testing. Displacement at 1, 100, 250, and 500 cycles, yield load, ultimate load, and failure mode were compared with statistically significant (p < 0.005) differences. PushLock 2.9 mm and CinchLock SS 2.4 anchor constructs had significantly less displacement than PushLock 2.4 mm after 1 cycle (p = 0.017) and 500 cycles (p = 0.043). Excluding “tare” displacement after the first cycle, all anchor constructs were associated with less than 2.0 mm of displacement after 500 cycles. Arthrex PushLock 2.4 and SutureTak 3.0 had the highest number of failures prior to completing cyclic loading. Arthrex PushLock 2.9 was associated with the highest LTF in cadaver (p = 0.00013) and synthetic (p = 0.009) bone models. Most common failure mode in cadaver bone was eyelet failure for all anchor types. Knotless suture anchors used for arthroscopic hip surgery (2.9 mm PushLock, 2.4 mm PushLock, 3.0 mm SutureTak, 2.4 mm CinchLock SS, and 2.4 mm CinchLock Flex) were associated with material properties that met or exceeded the reported thresholds for successful periarticular soft tissue repair surgeries. Based on cyclic and LTF testing in synthetic bone blocks and cadaveric acetabulums, 2.9 mm PushLocks and 2.4 mm CinchLock SS anchors may have potential biomechanical advantages over the other constructs tested. Further functional ex vivo and preclinical animal model studies are recommended to further characterize suture anchor constructs designed for acetabular labrum repair. These results provide novel and relevant biomechanical testing data that contribute to assessing knotless suture anchor constructs for use in acetabular labral repair.

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“…63 Appropriate techniques for safe acetabular anchor drilling and placement to avoid complications, such as acetabular cartilage penetration or psoas irritation, have been described and analyzed. 15,53,74 Shah et al 68 performed a systematic review on the anchor safety profile in hip arthroscopic surgery and found that large-diameter suture anchors were more likely to violate articular cartilage at vulnerable positions (3-to 4-o'clock position at the acetabular rim). In general, smaller suture anchors and smaller diameters for labral penetrator devices are currently the trend.…”

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Prospective Analysis of Arthroscopic Hip Anatomic Labral Repair Utilizing Knotless Suture Anchor Technology: The Controlled-Tension Anatomic Technique at Minimum 2-Year Follow-up

Maldonado

Chen

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Labral tears are the most common abnormalities in patients undergoing hip arthroscopic surgery. Appropriate management is crucial, as it has been shown that better overall outcomes can be achieved with labral restoration. Purpose: To report the patient-reported outcomes (PROs) at minimum 2-year follow-up of patients who underwent hip arthroscopic surgery for labral tear repair using the knotless controlled-tension anatomic technique in the setting of femoroacetabular impingement syndrome (FAIS). Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected for patients who underwent hip arthroscopic surgery for FAIS for labral tear repair using the knotless controlled-tension anatomic technique. Patients were excluded if they had prior hip conditions, prior ipsilateral surgery, Tönnis grade >1, a lateral center-edge angle (LCEA) <25°, or workers’ compensation claims. Preoperative and postoperative scores at minimum 2-year follow-up were recorded for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain. The proportion of patients who achieved the minimal clinically important difference (MCID) or patient acceptable symptomatic state (PASS) for the mHHS, HOS-SSS, and iHOT-12 were also reported. Results: A total of 309 hips were included. The mean patient age was 36.2 years (range, 12.8-75.9 years). The mean preoperative LCEA and alpha angle were 31.9° and 57.1°, respectively. A significant improvement on the mHHS (62.6 ± 15.7 preoperatively vs 86.9 ± 16.2 at 2-year follow-up), NAHS (63.1 ± 16.7 vs 86.1 ± 16.7), and HOS-SSS (39.8 ± 22.0 vs 74.2 ± 27.3) was found ( P < .001 for all). A significant decrease was shown for VAS scores ( P < .001). Also, 78.6% and 82.2% of patients achieved the MCID and PASS for the mHHS, respectively; 60.8% and 69.9% of patients met the MCID and PASS for the HOS-SSS, respectively; and the MCID for the iHOT-12 was met by 77.3% of patients. Conclusion: In the setting of FAIS and labral tears, patients who underwent hip arthroscopic surgery for labral tear repair using the knotless controlled-tension anatomic technique demonstrated significant improvement in several validated PRO measures, the VAS pain score, and patient satisfaction at a minimum 2 years of follow-up. Based on this evidence, labral tear repair using the knotless controlled-tension anatomic technique seems to be a safe option.

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What Makes Suture Anchor Use Safe in Hip Arthroscopy? A Systematic Review of Techniques and Safety Profile

Cited by 28 publications

References 42 publications

Iliopsoas Tenotomy During Hip Arthroscopy: A Systematic Review of Postoperative Outcomes

Iliopsoas Tenotomy During Hip Arthroscopy: A Systematic Review of Postoperative Outcomes

Knotless Suture Anchors: A Comparative Biomechanical Study of Acetabular Rim Anchor Fixation with Implications for Hip Labral Repair

Prospective Analysis of Arthroscopic Hip Anatomic Labral Repair Utilizing Knotless Suture Anchor Technology: The Controlled-Tension Anatomic Technique at Minimum 2-Year Follow-up

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