We thank Dr. Steinmann for his interest in our article and were interested to read about his experience with similar cases.
From an engineering point of view, the creation of any defect (such as a drill hole) within a structure will tend to cause stress concentration around the defect, particularly if that defect lies close to the margin of the structure. If several defects lie in close proximity, a “postage stamp” effect may be created, where cracks may propagate between defects and coalesce.
We agree that the use of suture anchors necessarily incurs this risk, and whether the drill hole is initially filled with metal, polymer, or absorbable material probably does not matter. The extra concern with some absorbable implants is that the defects may enlarge unpredictably beyond their original dimensions because of osteolysis and make matters worse.
Ideally, newer materials that fully resorb and are replaced by host bone seem the best solution to restoring stress distribution across the glenoid face, but reconstitution may take several years and it is not feasible to expect athletes in collision sports to avoid competition during this process. Until we have a better solution, patients should be advised of the risk of glenoid rim fracture, irrespective of the type of anchor used.
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© 2009 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
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- Cause of Glenoid Rim FractureArthroscopyVol. 25Issue 10
- PreviewI read with interest the article by Banerjee et al.1 entitled “Glenoid Rim Fracture in Contact Athletes With Absorbable Suture Anchor Reconstruction” in the May 2009 issue of Arthroscopy. They very eloquently describe 3 patients who sustained a glenoid rim fracture caused by cysts that had developed around absorbable implants. Theoretically, however, as the authors point out, development of a cyst or any loss of bone could cause weakness in the glenoid, predisposing toward fracture if the stress is great enough.
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