Advertisement

The Arthroscopic Treatment of Shoulder Instability: Bioabsorbable and Standard Metallic Anchors Produce Equivalent Clinical Results

      Purpose

      To investigate whether there are any differences in clinical outcomes and complications between absorbable and nonabsorbable suture anchors in the treatment of shoulder instability.

      Methods

      We performed a comprehensive search of Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, and the Cochrane Central Registry of Controlled Trials, from inception of the databases, using various combinations of keywords. Only studies focusing on clinical outcomes of patients who underwent arthroscopic shoulder stabilization with suture anchors were selected. Two authors (R.P. and L.D.B.) then evaluated the methodologic quality of each article using the Coleman Methodology Score.

      Results

      Ten articles were included. Four were prospective randomized studies, 2 were prospective cohort studies, and 4 were case series. The mean modified Coleman Methodology Score was 76.2.

      Conclusions

      Given the overall good results reported after arthroscopic stabilization of the shoulder using different suture anchors, it is not possible to draw a definite and solid suggestion on which class of device is better advised for routine use. Thus the decision to use one of the anchor systems available may mostly depend on its cost-effectiveness, which should be the focus of future comprehensive research.

      Level of Evidence

      Level IV, systematic review of Level I to IV studies.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Biz C.
        • Vinanti G.B.
        • Rossato A.
        • Arnaldi E.
        • Aldegheri R.
        Prospective study of three surgical procedures for long head biceps tendinopathy associated with rotator cuff tears.
        Muscles Ligaments Tendons J. 2012; 2: 133-136
        • Lewis A.
        • Kitamura T.
        • Bayley J.I.L.
        The classification of shoulder instability: New light through old windows. Mini symposium: Shoulder instability.
        Curr Orthop. 2004; 18: 97-108
        • Abrams J.S.
        Arthroscopic approach to massive rotator cuff tears.
        Instr Course Lect. 2006; 55: 59-66
        • Barber F.A.
        • Cawley P.
        • Prudich J.F.
        Suture anchor failure strength—An in vivo study.
        Arthroscopy. 1993; 9: 647-652
        • Barber F.A.
        • Deck M.A.
        The in vivo histology of an absorbable suture anchor: A preliminary report.
        Arthroscopy. 1995; 11: 77-81
        • McFarland E.G.
        • Park H.B.
        • Keyurapan E.
        • Gill H.S.
        • Selhi H.S.
        Suture anchors and tacks for shoulder surgery, part 1: Biology and biomechanics.
        Am J Sports Med. 2005; 33: 1918-1923
        • Shall L.M.
        • Cawley P.W.
        Soft tissue reconstruction in the shoulder. Comparison of suture anchors, absorbable staples, and absorbable tacks.
        Am J Sports Med. 1994; 22: 715-718
        • Barber F.A.
        Biodegradable shoulder anchors have unique modes of failure.
        Arthroscopy. 2007; 23: 316-320
        • Jeong J.H.
        • Shin S.J.
        Arthroscopic removal of proud metallic suture anchors after Bankart repair.
        Arch Orthop Trauma Surg. 2009; 129: 1109-1115
        • Kaar T.K.
        • Schenck Jr., R.C.
        • Wirth M.A.
        • Rockwood Jr., C.A.
        Complications of metallic suture anchors in shoulder surgery: A report of 8 cases.
        Arthroscopy. 2001; 17: 31-37
        • Ozbaydar M.
        • Elhassan B.
        • Warner J.J.
        The use of anchors in shoulder surgery: A shift from metallic to bioabsorbable anchors.
        Arthroscopy. 2007; 23: 1124-1126
        • Silver M.D.
        • Daigneault J.P.
        Symptomatic interarticular migration of glenoid suture anchors.
        Arthroscopy. 2000; 16: 102-105
        • Tan C.K.
        • Guisasola I.
        • Machani B.
        • et al.
        Arthroscopic stabilization of the shoulder: A prospective randomized study of absorbable versus nonabsorbable suture anchors.
        Arthroscopy. 2006; 22: 716-720
        • Marquardt B.
        • Witt K.A.
        • Gotze C.
        • Liem D.
        • Steinbeck J.
        • Potzl W.
        Long-term results of arthroscopic Bankart repair with a bioabsorbable tack.
        Am J Sports Med. 2006; 34: 1906-1910
        • Bos R.R.
        • Rozema F.R.
        • Boering G.
        • et al.
        Degradation of and tissue reaction to biodegradable poly(L-lactide) for use as internal fixation of fractures: A study in rats.
        Biomaterials. 1991; 12: 32-36
        • Clavert P.
        • Warner J.J.
        Panacryl synovitis: Fact or fiction?.
        Arthroscopy. 2005; 21: 200-203
        • Rhee Y.G.
        • Ha J.H.
        Knot-induced glenoid erosion after arthroscopic fixation for unstable superior labrum anterior-posterior lesion: Case report.
        J Shoulder Elbow Surg. 2006; 15: 391-393
        • Coleman B.D.
        • Khan K.M.
        • Maffulli N.
        • Cook J.L.
        • Wark J.D.
        Studies of surgical outcome after patellar tendinopathy: Clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group.
        Scand J Med Sci Sports. 2000; 10: 2-11
        • Ee G.W.
        • Mohamed S.
        • Tan A.H.
        Long term results of arthroscopic Bankart repair for traumatic anterior shoulder instability.
        J Orthop Surg Res. 2011; 6: 28
        • Milano G.
        • Grasso A.
        • Santagada D.A.
        • Saccomanno M.F.
        • Deriu L.
        • Fabbriciani C.
        Comparison between metal and biodegradable suture anchors in the arthroscopic treatment of traumatic anterior shoulder instability: A prospective randomized study.
        Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1785-1791
        • Monteiro G.C.
        • Ejnisman B.
        • Andreoli C.V.
        • de Castro Pochini A.
        • Cohen M.
        Absorbable versus nonabsorbable sutures for the arthroscopic treatment of anterior shoulder instability in athletes: A prospective randomized study.
        Arthroscopy. 2008; 24: 697-703
        • Barber F.A.
        • Snyder S.J.
        • Abrams J.S.
        • Fanelli G.C.
        • Savoie III, F.H.
        Arthroscopic Bankart reconstruction with a bioabsorbable anchor.
        J Shoulder Elbow Surg. 2003; 12: 535-538
        • Kim K.C.
        • Shin H.D.
        • Cha S.M.
        • Kim J.H.
        Arthroscopic double-loaded single-row repair in chronic traumatic anterior shoulder dislocation. Archives of orthopaedic and trauma surgery.
        Arch Orthop Trauma Surg. 2012; 132: 1515-1520
        • Carreira D.S.
        • Mazzocca A.D.
        • Oryhon J.
        • Brown F.M.
        • Hayden J.K.
        • Romeo A.A.
        A prospective outcome evaluation of arthroscopic Bankart repairs: Minimum 2-year follow-up.
        Am J Sports Med. 2006; 34: 771-777
        • Castagna A.
        • Markopoulos N.
        • Conti M.
        • Delle Rose G.
        • Papadakou E.
        • Garofalo R.
        Arthroscopic Bankart suture-anchor repair: Radiological and clinical outcome at minimum 10 years of follow-up.
        Am J Sports Med. 2010; 38: 2012-2016
        • Kim S.H.
        • Ha K.I.
        • Cho Y.B.
        • Ryu B.D.
        • Oh I.
        Arthroscopic anterior stabilization of the shoulder: Two to six-year follow-up.
        J Bone Joint Surg Am. 2003; 85: 1511-1518
        • Sedeek S.M.
        • Tey I.K.
        • Tan A.H.
        Arthroscopic Bankart repair for traumatic anterior shoulder instability with the use of suture anchors.
        Singapore Med J. 2008; 49: 676-681
        • Freedman K.B.
        • Smith A.P.
        • Romeo A.A.
        • Cole B.J.
        • Bach Jr., B.R.
        Open Bankart repair versus arthroscopic repair with transglenoid sutures or bioabsorbable tacks for recurrent anterior instability of the shoulder: A meta-analysis.
        Am J Sports Med. 2004; 32: 1520-1527
        • Green M.R.
        • Christensen K.P.
        Arthroscopic Bankart procedure: Two- to five-year followup with clinical correlation to severity of glenoid labral lesion.
        Am J Sports Med. 1995; 23: 276-281
        • Castagna A.
        • Conti M.
        • Borroni M.
        • et al.
        Posterior shoulder pain and anterior instability: A preliminary clinical study.
        Chir Organi Mov. 2008; 91: 79-83
        • Bacilla P.
        • Field L.D.
        • Savoie III, F.H.
        Arthroscopic Bankart repair in a high demand patient population.
        Arthroscopy. 1997; 13: 51-60
        • Bottoni C.R.
        • Smith E.L.
        • Berkowitz M.J.
        • Towle R.B.
        • Moore J.H.
        Arthroscopic versus open shoulder stabilization for recurrent anterior instability: A prospective randomized clinical trial.
        Am J Sports Med. 2006; 34: 1730-1737
        • Cole B.J.
        • L'Insalata J.
        • Irrgang J.
        • Warner J.J.
        Comparison of arthroscopic and open anterior shoulder stabilization. A two to six-year follow-up study.
        J Bone Joint Surg Am. 2000; 82: 1108-1114
        • Fabbriciani C.
        • Milano G.
        • Demontis A.
        • Fadda S.
        • Ziranu F.
        • Mulas P.D.
        Arthroscopic versus open treatment of Bankart lesion of the shoulder: A prospective randomized study.
        Arthroscopy. 2004; 20: 456-462
        • Hobby J.
        • Griffin D.
        • Dunbar M.
        • Boileau P.
        Is arthroscopic surgery for stabilisation of chronic shoulder instability as effective as open surgery? A systematic review and meta-analysis of 62 studies including 3044 arthroscopic operations.
        J Bone Joint Surg Br. 2007; 89: 1188-1196
        • Hovelius L.
        • Augustini B.G.
        • Fredin H.
        • Johansson O.
        • Norlin R.
        • Thorling J.
        Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study.
        J Bone Joint Surg Am. 1996; 78: 1677-1684
        • Horsley I.G.
        • Herrington L.C.
        • Rolf C.
        Does a SLAP lesion affect shoulder muscle recruitment as measured by EMG activity during a rugby tackle?.
        J Orthop Surg Res. 2010; 5: 12
        • Kirkley A.
        • Griffin S.
        • Richards C.
        • Miniaci A.
        • Mohtadi N.
        Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder.
        Arthroscopy. 1999; 15: 507-514
        • Wolf E.M.
        Arthroscopic capsulolabral repair using suture anchors.
        Orthop Clin North Am. 1993; 24: 59-69
        • Coughlin L.
        • Rubinovich M.
        • Johansson J.
        • White B.
        • Greenspoon J.
        Arthroscopic staple capsulorrhaphy for anterior shoulder instability.
        Am J Sports Med. 1992; 20: 253-256
        • Lane J.G.
        • Sachs R.A.
        • Riehl B.
        Arthroscopic staple capsulorrhaphy: A long-term follow-up.
        Arthroscopy. 1993; 9: 190-194
        • Matthews L.S.
        • Vetter W.L.
        • Oweida S.J.
        • Spearman J.
        • Helfet D.L.
        Arthroscopic staple capsulorrhaphy for recurrent anterior shoulder instability.
        Arthroscopy. 1988; 4: 106-111
        • Hecker A.T.
        • Shea M.
        • Hayhurst J.O.
        • Myers E.R.
        • Meeks L.W.
        • Hayes W.C.
        Pull-out strength of suture anchors for rotator cuff and Bankart lesion repairs.
        Am J Sports Med. 1993; 21: 874-879
        • Gaenslen E.S.
        • Satterlee C.C.
        • Hinson G.W.
        Magnetic resonance imaging for evaluation of failed repairs of the rotator cuff. Relationship to operative findings.
        J Bone Joint Surg Am. 1996; 78: 1391-1396
        • Ticker J.B.
        • Lippe R.J.
        • Barkin D.E.
        • Carroll M.P.
        Infected suture anchors in the shoulder.
        Arthroscopy. 1996; 12: 613-615
        • Burkhart S.S.
        • Brady P.C.
        Arthroscopic subscapularis repair: Surgical tips and pearls A to Z.
        Arthroscopy. 2006; 22: 1014-1027
        • van Oostveen D.P.
        • Schild F.J.
        • van Haeff M.J.
        • Saris D.B.
        Suture anchors are superior to transglenoid sutures in arthroscopic shoulder stabilization.
        Arthroscopy. 2006; 22: 1290-1297
        • Edwards D.J.
        • Hoy G.
        • Saies A.D.
        • Hayes M.G.
        Adverse reactions to an absorbable shoulder fixation device.
        J Shoulder Elbow Surg. 1994; 3: 230-233
        • Speer K.P.
        • Warren R.F.
        • Pagnani M.
        • Warner J.J.
        An arthroscopic technique for anterior stabilization of the shoulder with a bioabsorbable tack.
        J Bone Joint Surg Am. 1996; 78: 1801-1807
        • Barber F.A.
        Biology and clinical experience of absorbable materials in ACL fixation.
        Tech Orthop. 1999; 14: 34-42
        • Bostman O.M.
        Intense granulomatous inflammatory lesions associated with absorbable internal fixation devices made of polyglycolide in ankle fractures.
        Clin Orthop Relat Res. 1992; : 193-199
        • Bostman O.M.
        • Pihlajamaki H.K.
        Adverse tissue reactions to bioabsorbable fixation devices.
        Clin Orthop Relat Res. 2000; : 216-227
        • Freehill M.Q.
        • Harms D.J.
        • Huber S.M.
        • Atlihan D.
        • Buss D.D.
        Poly-L-lactic acid tack synovitis after arthroscopic stabilization of the shoulder.
        Am J Sports Med. 2003; 31: 643-647
        • Bardana D.D.
        • Burks R.T.
        • West J.R.
        • Greis P.E.
        The effect of suture anchor design and orientation on suture abrasion: An in vitro study.
        Arthroscopy. 2003; 19: 274-281
        • Warme W.J.
        • Arciero R.A.
        • Savoie III, F.H.
        • Uhorchak J.M.
        • Walton M.
        Nonabsorbable versus absorbable suture anchors for open Bankart repair. A prospective, randomized comparison.
        Am J Sports Med. 1999; 27: 742-746
        • Papalia R.
        • Franceschi F.
        • Zampogna B.
        • D'Adamio S.
        • Maffulli N.
        • Denaro V.
        Augmentation techniques for rotator cuff repair.
        Br Med Bull. 2013; 105: 107-138
        • Denaro V.
        • Papalia R.
        • Di Martino A.
        • Denaro L.
        • Maffulli N.
        The best surgical treatment for type II fractures of the dens is still controversial.
        Clin Orthop Relat Res. 2011; 469: 742-750
        • Papalia R.
        • Del Buono A.
        • Zampogna B.
        • Maffulli N.
        • Denaro V.
        Sport activity following joint arthroplasty: A systematic review.
        Br Med Bull. 2012; 101: 81-103
        • Tallon C.
        • Coleman B.D.
        • Khan K.M.
        • Maffulli N.
        Outcome of surgery for chronic Achilles tendinopathy. A critical review.
        Am J Sports Med. 2001; 29: 315-320
        • Papalia R.
        • Franceschi F.
        • Diaz Balzani L.
        • D'Adamio S.
        • Maffulli N.
        • Denaro V.
        Scaffolds for partial meniscal replacement: An updated systematic review.
        Br Med Bull. 2013; 107: 19-40