Thursday, November 26, 2015

Suture anchors - never out of the woods

These are the films of a patient having a suture anchor Bankart repair 20 years ago that successfully managed the anterior instability. However, two years ago the shoulder became increasingly painful and stiff. Radiographs suggested at least one prominent suture anchor.

The patient requested a total shoulder arthroplasty. At our surgery we found a prominent metal suture anchor in the inferior center of the glenoid that was abrading the humeral head.


Removal of the suture anchor left a substantial defect in the center of the inferior glenoid surface so that it was necessary to prepare the glenoid so that the two peg holes were in the superior rather than the usual inferior aspect of the glenoid.

 This provided secure fixation for the glenoid component and allowed our usual postoperative early assisted motion to 150 degrees before hospital discharge.
 An anteriorly eccentric humeral head component nicely managed a tendency for excessive posterior translation.

Comment: Presumably the suture anchor was initially covered with a thin layer of cartilage that, when it wore away, exposed the suture anchor that then led to anchor arthropathy.

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