Purpose
To describe the key clinical, imaging, and arthroscopic characteristics of anchor
arthropathy after arthroscopic shoulder stabilization procedures and, secondarily,
to define risk factors for the development of anchor-induced arthropathy.
Methods
A total of 23 patients who underwent revision arthroscopic shoulder surgery and were
diagnosed with glenohumeral arthropathy were retrospectively identified from prospectively
collected data registries between January 2000 and May 2018. Data included initial
diagnosis and index procedure performed, presenting arthropathy symptoms including
duration, and examination findings before revision surgery. Pre-revision imaging was
used to assess presence of glenohumeral osteoarthritis and chondromalacia, anchors/sutures,
loose bodies, and labral pathology. The same parameters were recorded intraoperatively
during revision surgery. Descriptive statistics were performed for demographic data
and means with standard deviations were calculated for continuous data. A McNemar–Bowker
test was used to analyze marginal homogeneity between preoperative imaging and intraoperative
findings.
Results
Mean age at presentation was 33.4 ± 11.7 years (range 16-59, 17 male patients; 6 female
patients). More than one half (13/23) developed symptoms within 10 months after index
arthroscopic procedure (mean 32.2 ± 59.9 months, range <1 to 165.2 months) with 87%
presenting with pain and 100% presenting with loss of motion on examination. Plain
radiographs demonstrated humeral osteoarthritis in 57% (13/23) of patients, magnetic
resonance imaging (MRI) revealed recurrent labral pathology in 19 of 23 (83%) patients,
potential proud implants in 12 of 23 (52%), and loose bodies in 12 of 23 (52%). Intraoperatively,
all had evidence of osteoarthritis; 22 of 23 (96%) had prominent implants. Humeral
head chondromalacia was present in 21 of 23 patients (91%), the majority of which
was linear stripe wear, and 6 of 23 (26%) had severe global glenohumeral osteoarthritis.
Statistical analysis revealed a 54.5% (95% confidence interval 0.327-0.749) sensitivity
of MRI identification of proud implants with a specificity of 100% (95% confidence
interval 0.055-1). The ability of MRI to accurately assess chondromalacia of the humeral
head (P = .342) or glenoid (P = .685) was not statistically significant.
Conclusions
Anchor arthropathy is characterized by symptoms of pain and stiffness on examination
and in many cases develops early after stabilization surgery (<10 months). Implants
were implicated in the majority of cases of humeral head chondromalacia. MRI scans
may produce false-negative identification of proud implants and can be a poor predictor
of the severity of chondromalacia and intra-articular pathology; thus, a high index
of clinical suspicion is necessary in patients with motion loss and pain postoperatively.
Level of Evidence
Level IV, case series.
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References
- Dislocation arthropathy of the shoulder.J Bone Joint Surg Am. 1983; 65: 456-460
- Prevalence of and risk factors for dislocation arthropathy: Radiological long-term outcome of arthroscopic Bankart repair in 100 shoulders at an average 13-year follow-up.Am J Sports Med. 2015; 43: 1084-1090
- Glenohumeral arthrosis in anterior instability before and after surgical treatment: Incidence and contributing factors.Am J Sports Med. 2004; 32: 1165-1172
- Glenohumeral osteoarthritis after arthroscopic Bankart repair for anterior instability.Am J Sports Med. 2011; 39: 1653-1659
- Arthrosis of glenohumeral joint after arthroscopic Bankart repair: A long-term follow-up of 13 years.J Shoulder Elbow Surg. 2012; 21: 350-355
- Arthroscopic Bankart suture-anchor repair: Radiological and clinical outcome at minimum 10 years of follow-up.Am J Sports Med. 2010; 38: 2012-2016
- Fixation methods and implants in shoulder stabilization: A historical perspective.J Orthop. 2018; 15: 630-635
- Complications about the glenohumeral joint related to the use of screws and staples.J Bone Joint Surg Am. 1984; 66: 175-180
- Long-term results of staple capsulorrhaphy for anterior instability of the shoulder [published correction appears in J Bone Joint Surg Am 1993;75:791].J Bone Joint Surg Am. 1993; 75: 249-258
- Osteolysis and arthropathy of the shoulder after use of bioabsorbable knotless suture anchors. A report of four cases.J Bone Joint Surg Am. 2006; 88: 1840-1845
- Arthroscopic removal of proud metallic suture anchors after Bankart repair.Arch Orthop Trauma Surg. 2009; 129: 1109-1115
- Use of bioabsorbable knotless suture anchors and associated accelerated shoulder arthropathy: Report of 3 cases.Am J Sports Med. 2009; 37: 1429-1433
- Severe chondrolysis after shoulder arthroscopy: A case series.J Shoulder Elbow Surg. 2009; 18: 742-747
- Glenohumeral chondrolysis after arthroscopy: A systematic review of potential contributors and causal pathways.Arthroscopy. 2009; 25: 1329-1342
- Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study.J Bone Joint Surg Am. 1996; 78: 1677-1684
- Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. a prospective twenty-five-year follow-up.J Bone Joint Surg Am. 2008; 90: 945-952
- Radiographic classification of glenohumeral arthrosis.Acta Orthop Scand. 2003; 74: 186-189
- Classifications in brief: Outerbridge classification of chondral lesions.Clin Orthop Relat Res. 2018; 476: 2101-2104
- Glenohumeral arthropathy after arthroscopic anterior shoulder stabilization.Arthroscopy. 2004; 20: 402-406
- Broken or dislodged poly-L-lactic acid bioabsorbable tacks in patients after SLAP lesion surgery.Arthroscopy. 2006; 22: 615-619
- Complications of bioabsorbable suture anchors in the shoulder.Am J Sports Med. 2012; 40: 1424-1430
- Perianchor radiolucency after knotless anchor repair for shoulder instability: Correlation with clinical results of 69 cases.Am J Sports Med. 2009; 37: 360-370
Article info
Publication history
Published online: May 26, 2021
Accepted:
May 11,
2021
Received:
December 28,
2020
Footnotes
The authors report the following potential conflicts of interest or sources of funding: P.J.M. reports grants and personal fees from Arthrex; personal fees from Springer Publishing and MedBridge; and other from VuMedi, ProofPoint Biologics, Steadman Philippon Research Institute, Smith & Nephew, Siemens, and Ossur, outside the submitted work. M.T.P. reports personal fees from Arthrex, JRF Ortho, SLACK, and Arthrosurface, during the conduct of the study; and is a board or committee member for Arthroscopy Association of North America, American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, the San Diego Shoulder Institute, and the Society of Military Orthopaedic Surgeons. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2021 Published by Elsevier on behalf of the Arthroscopy Association of North America
