Saturday, November 9, 2013

Shoulder Arthritis in Athletes Following the use of Suture Anchors

Shoulder Arthroplasty in Athletes Following Metallic Suture Anchor. A 2-Year Follow-up Investigation after Removal of the Implants and Physiotherapy

One of our first shoulder articles (30 years ago) was on the complications of metal around the shoulder. 

These authors point to the risks associated with the use of suture anchors. While they emphasize complications associated with metallic anchors, similar complications can be associated with other anchor materials. 

They note that complications resulting from the use of suture anchors are typically due to a malpositioning of the implant within the joint, but they can also result from implant loosening, breakage,  migration, or osteolysis. These complications can cause damage to the glenohumeral joint surface. They underscore what we have repeatedly observed in patients referred to us with post arthroscopic arthritis, "the learning curve for the use of metallic suture anchors to correct shoulder instability is high and the effects of associated complications are extensive".

The authors report 20 patients who developed chondral injuries after metallic suture anchors were used to repair labral lesions. There were four patients with Superior Labral Anterior Posterior (SLAP) lesions, 13 with anterior shoulder instability, one with multidirectional instability, and two requiring rotator cuff repair. Radiographs revealed that in 100% of the cases, at least one of the suture anchors was malpositioned.

The patients were treated with suture anchor removal and rehabilitation. Many improved.

Noting that of the 20 patients presented in this study, only 1 patient with metal suture anchor-associated complications was recognized in the early postoperative period (5 weeks) while the remaining 19 patients were recognized after 3 months, the authors emphasize the need for close monitoring and early diagnosis of this problem so that timely intervention can prevent major damage.
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