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Bioabsorbable suture anchor migration to the acromioclavicular joint: how far can these implants go?

Medina G, Garofo G, D'Elia CO, Bitar AC, Castropil W, Schor B - Case Rep Orthop (2014)

Bottom Line: What motivated this case report was the unusual location of the anchor, found in the acromioclavicular joint which, to our knowledge, has never been reported so far.A suspicion of retear of the RC led to request of a magnetic resonance image, in which the implant was found located in the acromioclavicular joint.Since the use of bioabsorbable suture anchors is increasing, it is important to know the possible complications associated with these devices.

View Article: PubMed Central - PubMed

Affiliation: Shoulder and Elbow Service, Vita Institute, Rua Mato Grosso, 306 1 Andar, Higienopolis, 01239-040 São Paulo, SP, Brazil.

ABSTRACT
Few complications regarding the use of bioabsorbable suture anchors in the shoulder have been reported. What motivated this case report was the unusual location of the anchor, found in the acromioclavicular joint which, to our knowledge, has never been reported so far. A 53-year old male with previous rotator cuff (RC) repair using bioabsorbable suture anchors presented with pain and weakness after 2 years of surgery. A suspicion of retear of the RC led to request of a magnetic resonance image, in which the implant was found located in the acromioclavicular joint. The complications reported with the use of metallic implants around the shoulder led to the development of bioabsorbable anchors. Advantages are their absorption over time, minimizing the risk of migration or interference with revision surgery, less artifacts with magnetic resonance imaging, and tendon-to-bone repair strength similar to metallic anchors. Since the use of bioabsorbable suture anchors is increasing, it is important to know the possible complications associated with these devices.

No MeSH data available.


Related in: MedlinePlus

Arthroscopic images confirmed the MRI findings. (a) View through the posterior portal: it is able to see the bioabsorbable anchor in the ACJ (white arrow). We used a spinal needle inserted through the skin superiorly through the ACJ joint, to push the anchor down ((b) white arrow) and retrieve it from the lateral working portal. (c) The retear of the rotator cuff was repaired with double row technique (d) using 2 medial and 1 lateral bioabsorbable anchors.
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fig2: Arthroscopic images confirmed the MRI findings. (a) View through the posterior portal: it is able to see the bioabsorbable anchor in the ACJ (white arrow). We used a spinal needle inserted through the skin superiorly through the ACJ joint, to push the anchor down ((b) white arrow) and retrieve it from the lateral working portal. (c) The retear of the rotator cuff was repaired with double row technique (d) using 2 medial and 1 lateral bioabsorbable anchors.

Mentions: The patient was then submitted to surgical treatment and all these findings were confirmed with arthroscopy. During the procedure the anchor localized in the ACJ was not overt because of fibrous tissue covering the implant. After removing the soft tissue with a shaver, the bioabsorbable anchor was exposed inside the ACJ joint (Figure 2(a)). The surgeon grasped the small device with a grasper and, to assist in removing it from the joint, a 14G needle was inserted through the ACJ using an outside-in technique. This needle pushed the anchor downward and the surgeon was able to remove it (Figure 2(b)). The second anchor was visible, attached to the tendon stump, and a large retear of the RC was seen (Figure 2(c)). We removed the anchor from the tendon and performed a new double row repair with bioabsorbable anchors and LHB tenodesis with bioabsorbable interference screw (tendon repair seen in Figure 2(d)). No procedure was performed at the ACJ after anchor removal. The patient remained in a sling for six weeks and followed a more restricted rehabilitation program, with passive range of motion only. After twelve weeks he started active exercises and, by the end of the sixth month after surgery, patient was symptom-free and achieved near normal forward elevation of the arm (150°) with good abduction strength against resistance. External rotation with the arm at the side of the body was 50 degrees and internal rotation reached the tenth thoracic vertebra. A new MRI one year after the procedure showed RC healing with implants in place.


Bioabsorbable suture anchor migration to the acromioclavicular joint: how far can these implants go?

Medina G, Garofo G, D'Elia CO, Bitar AC, Castropil W, Schor B - Case Rep Orthop (2014)

Arthroscopic images confirmed the MRI findings. (a) View through the posterior portal: it is able to see the bioabsorbable anchor in the ACJ (white arrow). We used a spinal needle inserted through the skin superiorly through the ACJ joint, to push the anchor down ((b) white arrow) and retrieve it from the lateral working portal. (c) The retear of the rotator cuff was repaired with double row technique (d) using 2 medial and 1 lateral bioabsorbable anchors.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4120899&req=5

fig2: Arthroscopic images confirmed the MRI findings. (a) View through the posterior portal: it is able to see the bioabsorbable anchor in the ACJ (white arrow). We used a spinal needle inserted through the skin superiorly through the ACJ joint, to push the anchor down ((b) white arrow) and retrieve it from the lateral working portal. (c) The retear of the rotator cuff was repaired with double row technique (d) using 2 medial and 1 lateral bioabsorbable anchors.
Mentions: The patient was then submitted to surgical treatment and all these findings were confirmed with arthroscopy. During the procedure the anchor localized in the ACJ was not overt because of fibrous tissue covering the implant. After removing the soft tissue with a shaver, the bioabsorbable anchor was exposed inside the ACJ joint (Figure 2(a)). The surgeon grasped the small device with a grasper and, to assist in removing it from the joint, a 14G needle was inserted through the ACJ using an outside-in technique. This needle pushed the anchor downward and the surgeon was able to remove it (Figure 2(b)). The second anchor was visible, attached to the tendon stump, and a large retear of the RC was seen (Figure 2(c)). We removed the anchor from the tendon and performed a new double row repair with bioabsorbable anchors and LHB tenodesis with bioabsorbable interference screw (tendon repair seen in Figure 2(d)). No procedure was performed at the ACJ after anchor removal. The patient remained in a sling for six weeks and followed a more restricted rehabilitation program, with passive range of motion only. After twelve weeks he started active exercises and, by the end of the sixth month after surgery, patient was symptom-free and achieved near normal forward elevation of the arm (150°) with good abduction strength against resistance. External rotation with the arm at the side of the body was 50 degrees and internal rotation reached the tenth thoracic vertebra. A new MRI one year after the procedure showed RC healing with implants in place.

Bottom Line: What motivated this case report was the unusual location of the anchor, found in the acromioclavicular joint which, to our knowledge, has never been reported so far.A suspicion of retear of the RC led to request of a magnetic resonance image, in which the implant was found located in the acromioclavicular joint.Since the use of bioabsorbable suture anchors is increasing, it is important to know the possible complications associated with these devices.

View Article: PubMed Central - PubMed

Affiliation: Shoulder and Elbow Service, Vita Institute, Rua Mato Grosso, 306 1 Andar, Higienopolis, 01239-040 São Paulo, SP, Brazil.

ABSTRACT
Few complications regarding the use of bioabsorbable suture anchors in the shoulder have been reported. What motivated this case report was the unusual location of the anchor, found in the acromioclavicular joint which, to our knowledge, has never been reported so far. A 53-year old male with previous rotator cuff (RC) repair using bioabsorbable suture anchors presented with pain and weakness after 2 years of surgery. A suspicion of retear of the RC led to request of a magnetic resonance image, in which the implant was found located in the acromioclavicular joint. The complications reported with the use of metallic implants around the shoulder led to the development of bioabsorbable anchors. Advantages are their absorption over time, minimizing the risk of migration or interference with revision surgery, less artifacts with magnetic resonance imaging, and tendon-to-bone repair strength similar to metallic anchors. Since the use of bioabsorbable suture anchors is increasing, it is important to know the possible complications associated with these devices.

No MeSH data available.


Related in: MedlinePlus