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Bony Ingrowth of Coil-Type Open-Architecture Anchors Compared With Screw-Type PEEK Anchors for the Medial Row in Rotator Cuff Repair: A Randomized Controlled Trial

Published:December 03, 2019DOI:https://doi.org/10.1016/j.arthro.2019.11.119

      Purpose

      To evaluate outcomes of screw-type and coil-type open-architecture suture anchors with respect to bony ingrowth, release of biological markers, and patient-reported outcome measures when used in rotator cuff repair (RCR).

      Methods

      Forty patients undergoing arthroscopic RCR for full-thickness rotator cuff tears were enrolled and prospectively randomized to receive a screw-type (19 patients) or coil-type (21 patients) suture anchor for the medial row during repair. All repairs used a transosseous-equivalent configuration with footprint anchors laterally. Marrow elements released during surgery were evaluated for 9 cytokine markers (insulin-like growth factor 1, fibroblast growth factor 2, bone morphogenetic proteins 7 and 2, platelet-derived growth factors AA and BB, epidermal growth factor, transforming growth factor beta1, and vascular endothelial growth factor). Postoperative computed tomography scans were performed at 6 months. Range of motion, strength, and validated patient-reported outcome measures (Simple Shoulder Test, Single Assessment Numeric Evaluation, visual analog scale, and American Shoulder and Elbow Surgeons scores) were gathered before the operation and at 6 months and 1 year postoperatively.

      Results

      Bone mineral density surrounding the coil-type anchor was significantly greater than that surrounding the screw-type anchor (P = .005). Bone mineral density values within the coil-type and screw-type anchors were comparable (P = .527); however, a larger amount of total bone mineral mass (in milligrams) was shown within the coil-type anchor owing to its larger volume (P < .01). Marrow elements released at the repair site were similar between groups (P > .05). Postoperatively, no statistically significant difference was found between groups for clinical outcome measures at 6 months or 1 year. Retear and complication rates were similar between groups (P > .05).

      Conclusions

      Both the coil-type and screw-type anchors can be reliably used for RCR and produce similar clinical outcomes. The coil-type anchor resulted in superior bony growth surrounding the anchor and a larger total bone mineral mass within the anchor owing to its larger volume.

      Level of Evidence

      Level II, randomized prospective comparative study.
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      References

        • Tashjian R.Z.
        Epidemiology, natural history, and indications for treatment of rotator cuff tears.
        Clin Sports Med. 2012; 31: 589-604
        • Huang A.L.
        • Thavorn K.
        • van Katwyk S.
        • MacDonald P.
        • Lapner P.
        Double-row arthroscopic rotator cuff repair is more cost-effective than single-row repair.
        J Bone Joint Surg Am. 2017; 99: 1730-1736
        • Piper C.C.
        • Hughes A.J.
        • Ma Y.
        • Wang H.
        • Neviaser A.S.
        Operative versus nonoperative treatment for the management of full-thickness rotator cuff tears: A systematic review and meta-analysis.
        J Shoulder Elbow Surg. 2018; 27: 572-576
        • Shen C.
        • Tang Z.H.
        • Hu J.Z.
        • Zou G.Y.
        • Xiao R.C.
        Incidence of retear with double-row versus single-row rotator cuff repair.
        Orthopedics. 2014; 37: e1006-e1013
        • Millett P.J.
        • Espinoza C.
        • Horan M.P.
        • et al.
        Predictors of outcomes after arthroscopic transosseous equivalent rotator cuff repair in 155 cases: A propensity score weighted analysis of knotted and knotless self-reinforcing repair techniques at a minimum of 2 years.
        Arch Orthop Trauma Surg. 2017; 137: 1399-1408
        • Guo Q.
        • Li C.
        • Qi W.
        • et al.
        A novel suture anchor constructed of cortical bone for rotator cuff repair: A biomechanical study on sheep humerus specimens.
        Int Orthop. 2016; 40: 1913-1918
        • Pietschmann M.F.
        • Gulecyuz M.F.
        • Fieseler S.
        • et al.
        Biomechanical stability of knotless suture anchors used in rotator cuff repair in healthy and osteopenic bone.
        Arthroscopy. 2010; 26: 1035-1044
        • Barber F.A.
        • Herbert M.A.
        • Hapa O.
        • et al.
        Biomechanical analysis of pullout strengths of rotator cuff and glenoid anchors: 2011 Update.
        Arthroscopy. 2011; 27: 895-905
        • Efird C.
        • Traub S.
        • Baldini T.
        • et al.
        Knotless single-row rotator cuff repair: A comparative biomechanical study of 2 knotless suture anchors.
        Orthopedics. 2013; 36: e1033-e1037
        • Barber F.A.
        • Dockery W.D.
        • Cowden III, C.H.
        The degradation outcome of biocomposite suture anchors made from poly L-lactide-co-glycolide and beta-tricalcium phosphate.
        Arthroscopy. 2013; 29: 1834-1839
        • Cobaleda Aristizabal A.F.
        • Sanders E.J.
        • Barber F.A.
        Adverse events associated with biodegradable lactide-containing suture anchors.
        Arthroscopy. 2014; 30: 555-560
        • Sano H.
        • Tokunaga M.
        • Noguchi M.
        • et al.
        Comparison of fixation properties between coil-type and screw-type anchors for rotator cuff repair: A virtual pullout testing using 3-dimensional finite element method.
        J Orthop Sci. 2016; 21: 452-457
        • Jeong J.Y.
        • Chung P.K.
        • Yoo J.C.
        Effect of sodium hyaluronate/carboxymethyl cellulose (Guardix-sol) on retear rate and postoperative stiffness in arthroscopic rotator cuff repair patients: A prospective cohort study.
        J Orthop Surg (Hong Kong). 2017; 25 (2309499017718908)
        • Rodeo S.A.
        • Delos D.
        • Williams R.J.
        • Adler R.S.
        • Pearle A.
        • Warren R.F.
        The effect of platelet-rich fibrin matrix on rotator cuff tendon healing: A prospective, randomized clinical study.
        Am J Sports Med. 2012; 40: 1234-1241
        • Hernigou P.
        • Flouzat Lachaniette C.H.
        • Delambre J.
        • et al.
        Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: A case-controlled study.
        Int Orthop. 2014; 38: 1811-1818
        • Ebert J.R.
        • Wang A.
        • Smith A.
        • et al.
        A midterm evaluation of postoperative platelet-rich plasma injections on arthroscopic supraspinatus repair: A randomized controlled trial.
        Am J Sports Med. 2017; 45: 2965-2974
        • Charles M.D.
        • Christian D.R.
        • Cole B.J.
        The role of biologic therapy in rotator cuff tears and repairs.
        Curr Rev Musculoskelet Med. 2018; 11: 150-161
        • Greenspoon J.A.
        • Moulton S.G.
        • Millett P.J.
        • Petri M.
        The role of platelet rich plasma (PRP) and other biologics for rotator cuff repair.
        Open Orthop J. 2016; 10: 309-314
        • Simon P.
        • Gupta A.
        • Pappou I.
        • et al.
        Glenoid subchondral bone density distribution in male total shoulder arthroplasty subjects with eccentric and concentric wear.
        J Shoulder Elbow Surg. 2015; 24: 416-424
        • Rho J.Y.
        • Hobatho M.C.
        • Ashman R.B.
        Relations of mechanical properties to density and CT numbers in human bone.
        Med Eng Phys. 1995; 17: 347-355
        • Cvetanovich G.L.
        • Gowd A.K.
        • Liu J.N.
        • et al.
        Establishing clinically significant outcome after arthroscopic rotator cuff repair.
        J Shoulder Elbow Surg. 2019; 28: 939-948
        • Zuke W.A.
        • Leroux T.S.
        • Gregory B.P.
        • et al.
        Establishing maximal medical improvement after arthroscopic rotator cuff repair.
        Am J Sports Med. 2018; 46: 1000-1007
        • Tiaka E.K.
        • Papanas N.
        • Manolakis A.C.
        • Georgiadis G.S.
        Epidermal growth factor in the treatment of diabetic foot ulcers: An update.
        Perspect Vasc Surg Endovasc Ther. 2012; 24: 37-44
        • Tokunaga T.
        • Shukunami C.
        • Okamoto N.
        • et al.
        FGF-2 stimulates the growth of tenogenic progenitor cells to facilitate the generation of tenomodulin-positive tenocytes in a rat rotator cuff healing model.
        Am J Sports Med. 2015; 43: 2411-2422
        • Wang L.L.
        • Yin X.F.
        • Chu X.C.
        • Zhang Y.B.
        • Gong X.N.
        Platelet-derived growth factor subunit B is required for tendon-bone healing using bone marrow-derived mesenchymal stem cells after rotator cuff repair in rats.
        J Cell Biochem. 2018; 119: 8897-8908
        • Liu X.N.
        • Yang C.J.
        • Kim J.E.
        • et al.
        Enhanced tendon-to-bone healing of chronic rotator cuff tears by bone marrow aspirate concentrate in a rabbit model.
        Clin Orthop Surg. 2018; 10: 99-110
        • Foster T.E.
        • Puskas B.L.
        • Mandelbaum B.R.
        • Gerhardt M.B.
        • Rodeo S.A.
        Platelet-rich plasma: From basic science to clinical applications.
        Am J Sports Med. 2009; 37: 2259-2272
        • Holtby R.
        • Christakis M.
        • Maman E.
        • et al.
        Impact of platelet-rich plasma on arthroscopic repair of small- to medium-sized rotator cuff tears: A randomized controlled trial.
        Orthop J Sports Med. 2016; 4 (2325967116665595)
        • Pandey V.
        • Bandi A.
        • Madi S.
        • et al.
        Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial.
        J Shoulder Elbow Surg. 2016; 25: 1312-1322
        • Chung S.W.
        • Oh J.H.
        • Gong H.S.
        • Kim J.Y.
        • Kim S.H.
        Factors affecting rotator cuff healing after arthroscopic repair: Osteoporosis as one of the independent risk factors.
        Am J Sports Med. 2011; 39: 2099-2107