Metal artefacts severely hamper magnetic resonance imaging of the rotator cuff tendons after rotator cuff repair with titanium suture anchors

TECHNIQUES AND MATERIALS TO TREAT SHOULDER PATHOLOGIES BY ARTHROSCOPY: A SURVEY IN MEMBERS OF THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY

Objective

To evaluate the preferences of shoulder and elbow surgeons from the Brazilian Society of Shoulder and Elbow Surgery to treat rotator cuff injuries, glenohumeral instability, and acromioclavicular dislocations considering a current and an ideal scenarios.

Methods

A nationwide survey included 314 specialists who answered a 20-question questionnaire on treating shoulder pathologies.

Results

This study included 314 specialists. Most (96%) perform rotator cuff repair arthroscopically and 74% use metallic anchors as a fixation method. In open surgery, most specialists reported using anchors (75%) instead of transosseous sutures. In treating glenohumeral instability via arthroscopic Bankart repair, 86% used three or more fixation anchors and 87%, bioabsorbable anchors. In Latarjet cases, 57% used cannulated screws. In treating acute acromioclavicular dislocations, 88% used the open route. Regarding fixation, 70% chose high-resistance wires; 65%, anchors; and 61%, Kirschner wires.

Conclusion

The current Brazilian scenario has limited availability of ideal instruments and materials so specialists can treat shoulder pathologies. However, specialists' preferences agree with the latest medical literature. Level of evidence V, Expert opinion.

My Approach to Failed Rotator Cuff Repair

Failed rotator cuff repairs pose several challenges due to the high incidence rate, complexity, and range of symptoms. We propose an overview for assessing and treating failed rotator cuff repairs. For active young patients, attempt revision repair with patch augmentation if possible. When anatomic revision is not viable, but muscle is retained, consider partial repair with interposition bridging. Isolated, irreparable supraspinatus tears may benefit from superior capsule reconstruction. Tendon transfer is suitable for patients with significant atrophy and multiple irreparable cuff tears. Low-demand elderly patients or those with substantial glenohumeral arthritis may consider reverse total shoulder arthroplasty if conservative management fails. There are a variety of reported outcomes in the literature but long-term studies with larger cohorts are needed to improve the management of failed rotator cuff repair.

3D-Printed Double-Helical Biodegradable Iron Suture Anchor: A Rabbit Rotator Cuff Tear Model

Suture anchors are extensively used in rotator cuff tear surgery. With the advancement of three-dimensional printing technology, biodegradable metal has been developed for orthopedic applications. This study adopted three-dimensional-printed biodegradable Fe suture anchors with double-helical threads and commercialized non-vented screw-type Ti suture anchors with a tapered tip in the experimental and control groups, respectively. The in vitro study showed that the Fe and Ti suture anchors exhibited a similar ultimate failure load in 20-pound-per-cubic-foot polyurethane foam blocks and rabbit bone. In static immersion tests, the corrosion rate of Fe suture anchors was 0.049 ± 0.002 mm/year. The in vivo study was performed on New Zealand white rabbits and SAs were employed to reattach the ruptured supraspinatus tendon. The in vivo ultimate failure load of the Fe suture anchors was superior to that of the Ti suture anchors at 6 weeks. Micro-computed tomography showed that the bone volume fraction and bone surface density in the Fe suture anchors group 2 and 6 weeks after surgery were superior, and the histology confirmed that the increased bone volume around the anchor was attributable to mineralized osteocytes. The three-dimensional-printed Fe suture anchors outperformed the currently used Ti suture anchors.

J, Mathai NJ, Madi S, Karegowda LH, Willems J. Five Year Follow up of Retrospective Cohort Comparing Structural and Functional Outcome of Arthroscopic Single-row ersus Double-row Suture Bridge Repair of Large Posterosuperior Rotator Cuff Tear in Patients Less than or Equal to 70 Years

BACKGROUND

High re-tear rates after repairing large-sized posterosuperior rotator cuff tears remain a significant concern which may affect the clinical outcome. The most optimal type of repair (single versus double-row suture bridge) suited for large size tear remains debatable.

METHODS

In a retrospective cohort study with a minimum of five years follow up, the structural and functional outcome of 103 patients with large size cuff tear repaired with single row (SR) or double row suture bridge (DRSB) were evaluated. The structural outcome was assessed with ultrasonography whereas functional outcome was evaluated with Constant Murley (CM) and American shoulder elbow score (ASES).

RESULTS

There were 55 patients in the SR group and 48 patients in the DRSB group with a mean follow-up of 74.2 months (range, 60-96 months). While comparing the structural integrity in two groups, we found significantly lower re-tear rates in the DRSB group as compared to the SR group (10.4% vs. 32.7%; P=0.006). Also, there were more focal defects in the SR group (25.4%) than the DRSB group (8.3%). Overall, there was no significant difference in CM and ASES scores when the SR group was compared to DRSB. However, subgroup analysis between those with intact and retorn tendon revealed significant difference (P=0.0001) in the clinical scores.

CONCLUSION

At a minimum of five years follow-up, the DRSB repair of large posterosuperior cuff tear resulted in superior structural healing over SR repair. Nevertheless, overall there was no significant functional difference between both the techniques. However, the functional outcome of the healed tendon subgroup was superior to retear tendon subgroup.

Biomechanical Evaluation of Proximal Hamstring Repair: All-Suture Anchor Versus Titanium Suture Anchor

Background:

Proximal hamstring avulsions are severe tendon injuries and are commonly sports-related. Open and endoscopic techniques as well as different anchor configurations have already been described for proximal hamstring repair. Novel all-suture anchors have been developed to provide decreased bone loss during placement and reduced occupied bone volume when compared with titanium suture anchors.

Hypothesis:

Complete proximal hamstring avulsions repaired with all-suture anchors will demonstrate equal load to failure and comparable displacement under cyclic loading when compared with titanium suture anchors.

Study Design:

Controlled laboratory study.

Methods:

Complete proximal hamstring avulsions were created in 18 paired cadaveric specimens (mean ± SD age, 63.0 ± 10.4 years). Either all-suture anchors or titanium suture anchors were used for repair. Cyclic loading from 10 to 125 N at 1 Hz was performed for 1500 cycles with a material testing machine. Displacement was assessed along anterior and posterior aspects of the tendon repair with optical tracking. Specimens were loaded to failure at a rate of 120 mm/min. Displacement, load to failure, and repair construct stiffness were compared between matched pairs with the Wilcoxon signed-rank test. Correlations were determined by Spearman rho analysis.

Results:

The all-suture anchors showed significantly higher load-to-failure values when compared with the titanium anchor repairs (799.64 ± 257.1 vs 573.27 ± 89.9 N; P = .008). There was no significant difference in displacement between all-suture anchors and titanium suture anchors at the anterior aspect (6.60 ± 2.2 vs 5.49 ± 1.1 mm; P = .26) or posterior aspect (5.87 ± 2.08 vs 5.23 ± 1.37 mm; P = .678) of the repaired hamstring tendons.

Conclusion:

All-suture anchors demonstrated similar displacement and superior load to failure when compared with titanium suture anchors.

Clinical Relevance:

The results of this study suggest that all-suture anchors are an equivalent alternative to titanium suture anchors for proximal hamstring avulsion repair.