Fewer anchors achieves successful arthroscopic shoulder stabilization surgery: 114 patients with 4 years of follow-up

Department of Orthopaedics, Dewsbury and District Hospital, West Yorkshire, UK. Electronic address: .
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] (Impact Factor: 2.29). 11/2013; 23(3). DOI: 10.1016/j.jse.2013.08.010
Source: PubMed


The shoulder is the most frequently dislocated joint, with an incidence of 10 to 20 per 100,000 each year. The optimum number of anchors to use in arthroscopic stabilization is a topic of growing interest; most surgeons use 3. Our stabilization technique is to commonly use only a single suture anchor to purse-string the capsulolabral tissue up and toward the glenoid. This study aimed to ascertain whether successful stabilization can be achieved with fewer than 3 anchors.
Our study comprised 114 consecutive patients with anterior instability and a Bankart lesion undergoing arthroscopic stabilization with 4 years of follow-up. Outcome was measured by Oxford Instability Score (OIS) and recurrence of instability or dislocation. Patient demographics were 86.8% male, 13.2% female, mean age of 31 years, 76.3% Hill-Sachs lesions, 13.2% bony Bankart lesions, 13.2% glenoid defects, and 9.6% SLAP lesions. The majority of patients, 71 patients (62.3%), received only 1 anchor; 40 patients (35.1%) received 2 anchors, and 3 patients (2.6%) had 3 anchors.
The mean OIS was 44.3 preoperatively and 17.3 postoperatively (P < .0001). There was no difference in OIS improvement between the patients who received a single anchor and those who received 2 or 3 anchors (P > .05). Even with minor bony Bankart lesions and glenoid defects, a single suture anchor can be sufficient. Our failure rate of 6.1% is comparable with that of other published series.
Successful shoulder stabilization can be achieved with fewer than 3 anchors, and a single anchor is usually sufficient.

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    ABSTRACT: We studied the incidence of postoperative glenoid rim fractures and analysed the relationships of glenoid rim fracture with osteolysis, fracture pattern, number of anchors and postoperative activity after arthroscopic Bankart repair with suture anchor fixation. Among 570 patients of the Bankart repair group, nine patients who had undergone revision arthroscopy for glenoid rim fracture after initial Bankart repair with at least two years post-revision follow-up were enrolled. Mean age was 28.8 years (range, 18-49 years), and mean follow-up was 36.4 months (range, 25-64 months). The mean time from Bankart repair to failure of initial surgery following trauma was 27.3 months (range, four to-84 months). Initial suture anchors were made of bioabsorbable composites (poly-D-L-lactic acid, PDLLA) without ceramic osteo-filler (seven cases) and metals (two cases). PDLLA without ceramic osteo-filler suture anchors were used for revision surgery. We reviewed 570 patients for relationship between osteolysis and glenoid rim fracture. Five patients including three and two with bioabsorbable and metal suture anchors, respectively, experienced glenoid rim fracture at more than two years postoperatively. Osteolysis around initial suture anchors groups showed higher glenoid rim fracture incidence compared with the control group (odd ratio =4.186 [95 % CI, 1.108-15.818]; p = 0.037). Osteolysis related to insertion of metal or PLDDA suture anchors may lead to glenoid rim fracture. Remnant metal or bioabsorbable suture anchors without ceramic composite could be a stress riser at two years postoperatively.
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    ABSTRACT: Background Resorbable anchors are widely used in arthroscopic stabilization of the shoulder as a means of soft tissue fixation to bone. Their function is to ensure repair stability until they are replaced by host tissue. Complications include inflammatory soft tissue reactions, cyst formation, screw fragmentation in the joint, osteolytic reactions, and enhanced glenoid rim susceptibility to fracture.
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