Thursday, March 21, 2013

Suture anchor complications - a cautionary tale

Suture anchors are used to fix soft tissue to bone. While they are handy, they can be associated with a wide range of complications. If they are loose or prominent, they can damage the joint surface and lead to arthritis. Metal anchors have been found to be particularly problematic if they contact the joint surface. This led to the advent of absorbable suture anchors. However, the authors point to the problems experienced with rapid hydrolysis, breakage, premature degradation, and sterile abscess formation related to polyglycolic acid suture anchors.  This gave rise to the pursuit of anchors made from polylactic acid.

This report concerns a series of 44 patients with complications of PLLA implants to treat either labral or rotator cuff pathology. These patients had undergone secondary arthroscopic exploration because of  pain and loss of shoulder motion following prior labral or rotator cuff repair with PLLA implants.

Macroscopic pieces of anchor, giant cell reaction, polarizing crystalline material, papillary synovitis, and chondral damage were found in the majority of the cases.  The degree of chondral damage appeared to increase with longer elapsed times since the index surgery.  All patients having had a rotator cuff repair had recurrent cuff defects larger than the tear documented at the index procedure.

This article suggests that these implants can degrade in a manner that releases particulate debris into the joint creating the risk of joint damage. 

In the meanwhile, we continue to fix rotator cuffs with the tried and true transosseous repair to a trough without any form of suture anchor.

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