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Triple labrum tears repaired with the JuggerKnot™ soft anchor: Technique and results.

Agrawal V, Pietrzak WS - Int J Shoulder Surg (2015 Jul-Sep)

Bottom Line: Constant-Murley shoulder score (CS) and Flexilevel scale of shoulder function (FLEX-SF) scores were measured, with preoperative and final postoperative mean scores compared with a paired Student's t-test (P < 0.05).It further demonstrates a meaningful improvement in patient outcomes, a predictable return to activity, and a high rate of patient satisfaction.Level IV case series.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Marian University School of Medicine; The Shoulder Center, Carmel, IN 46032, USA.

ABSTRACT

Purpose: The 2-year outcomes of patients undergoing repair of triple labrum tears using an all-suture anchor device were assessed.

Materials and methods: Eighteen patients (17 male, one female; mean age 36.4 years, range: 14.2-62.3 years) with triple labrum tears underwent arthroscopic repair using the 1.4 mm JuggerKnot Soft Anchor (mean number of anchors 11.5, range: 9-19 anchors). Five patients had prior surgeries performed on their operative shoulder. Patients were followed for a mean of 2.0 years (range: 1.6-3.0 years). Constant-Murley shoulder score (CS) and Flexilevel scale of shoulder function (FLEX-SF) scores were measured, with preoperative and final postoperative mean scores compared with a paired Student's t-test (P < 0.05). Magnetic resonance imaging (MRI) was also performed at final postoperative.

Results: Overall total CS and FLEX-SF scores increased from 52.9 ± 20.4 to 84.3 ± 10.7 (P < 0.0001) and from 29.3 ± 4.7 to 42.0 ± 7.3 (P < 0.0001), respectively. When divided into two groups by whether or not glenohumeral arthrosis was present at the time of surgery (n = 9 each group), significant improvements in CS and FLEX-SF were obtained for both groups (P < 0.0015). There were no intraoperative complications. All patients, including contact athletes, returned to their preinjury level of sports activity and were satisfied. MRI evaluation revealed no instances of subchondral cyst formation or tunnel expansion. Anchor tracts appeared to heal with fibrous tissue, complete bony healing, or combined fibro-osseous healing.

Conclusion: Our results are encouraging, demonstrating a consistent healing of the anchor tunnels through arthroscopic treatment of complex labrum lesions with a completely suture-based implant. It further demonstrates a meaningful improvement in patient outcomes, a predictable return to activity, and a high rate of patient satisfaction.

Level of evidence: Level IV case series.

No MeSH data available.


Related in: MedlinePlus

Completed inferior hemisphere labrum reconstruction
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F3d: Completed inferior hemisphere labrum reconstruction

Mentions: The viewing portal is now changed to the superolateral portal for optimal visualization of the inferior glenoid. Along with the anterolateral working portal, an 8.25 mm cannula converts the posterolateral viewing portal to a working portal. The labrum tear is fully mobilized, followed by light abrasion of the glenoid neck utilizing the shaver only. For the repair of the inferior hemisphere zones, place all of the anchors at once utilizing a combination of approaches to optimize the angle of approach to the glenoid face articular margin. Traditional suture anchors that require fixation within the cortical glenoid and perforation, may significantly compromise the mechanical strength of fixation.[28] The JuggerKnot Soft Anchor achieves fixation strength differently and in our experience, cortical perforation and cortical placement of this anchor enhances fixation strength. Therefore, cortical placement of the anchor is preferred when possible. The anchors are placed via the anterolateral cannula, the posterolateral cannula, or the percutaneous spinal needle localization technique. The anchors were approximately placed 5-10 mm apart and an average of 11.5 anchors was used per case (range: 9-19, mode 12). All the suture limbs are retrieved via the anterolateral cannula. Starting at the 6 o'clock position via the posterolateral cannula, the spectrum suture passer is utilized to pass a solid core shuttle suture to achieve anatomic restoration of the capsule-ligamentous complex. A combination of simple and horizontal mattress sutures is utilized to help restore the labral height and achieve a more uniform rounded bumper cushion.[2930] Each suture is placed and tied, and the sequence is repeated in the posterior and anterior zones until the entire repair is completed. Typically, we complete the posterior inferior zone and a portion of the anterior inferior zone via the posterolateral cannula before retrieving the remaining anterior zone sutures via the posterolateral cannula and completing the anterior zone repair from the anterolateral cannula. After completing the repair and any additional indicated capsular plication, balanced tension in the entire capsule-ligamentous complex combined with a full range of motion and a centralized humeral head is confirmed Figure 3–d. Any remaining indicated procedures were subsequently performed [Table 2]. Following routine closure of the portals with simple sutures, the patient was placed in an abductor pillow immobilizer (Shoulder Abduction Pillow, BREG, Vista CA, USA).


Triple labrum tears repaired with the JuggerKnot™ soft anchor: Technique and results.

Agrawal V, Pietrzak WS - Int J Shoulder Surg (2015 Jul-Sep)

Completed inferior hemisphere labrum reconstruction
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4528288&req=5

F3d: Completed inferior hemisphere labrum reconstruction
Mentions: The viewing portal is now changed to the superolateral portal for optimal visualization of the inferior glenoid. Along with the anterolateral working portal, an 8.25 mm cannula converts the posterolateral viewing portal to a working portal. The labrum tear is fully mobilized, followed by light abrasion of the glenoid neck utilizing the shaver only. For the repair of the inferior hemisphere zones, place all of the anchors at once utilizing a combination of approaches to optimize the angle of approach to the glenoid face articular margin. Traditional suture anchors that require fixation within the cortical glenoid and perforation, may significantly compromise the mechanical strength of fixation.[28] The JuggerKnot Soft Anchor achieves fixation strength differently and in our experience, cortical perforation and cortical placement of this anchor enhances fixation strength. Therefore, cortical placement of the anchor is preferred when possible. The anchors are placed via the anterolateral cannula, the posterolateral cannula, or the percutaneous spinal needle localization technique. The anchors were approximately placed 5-10 mm apart and an average of 11.5 anchors was used per case (range: 9-19, mode 12). All the suture limbs are retrieved via the anterolateral cannula. Starting at the 6 o'clock position via the posterolateral cannula, the spectrum suture passer is utilized to pass a solid core shuttle suture to achieve anatomic restoration of the capsule-ligamentous complex. A combination of simple and horizontal mattress sutures is utilized to help restore the labral height and achieve a more uniform rounded bumper cushion.[2930] Each suture is placed and tied, and the sequence is repeated in the posterior and anterior zones until the entire repair is completed. Typically, we complete the posterior inferior zone and a portion of the anterior inferior zone via the posterolateral cannula before retrieving the remaining anterior zone sutures via the posterolateral cannula and completing the anterior zone repair from the anterolateral cannula. After completing the repair and any additional indicated capsular plication, balanced tension in the entire capsule-ligamentous complex combined with a full range of motion and a centralized humeral head is confirmed Figure 3–d. Any remaining indicated procedures were subsequently performed [Table 2]. Following routine closure of the portals with simple sutures, the patient was placed in an abductor pillow immobilizer (Shoulder Abduction Pillow, BREG, Vista CA, USA).

Bottom Line: Constant-Murley shoulder score (CS) and Flexilevel scale of shoulder function (FLEX-SF) scores were measured, with preoperative and final postoperative mean scores compared with a paired Student's t-test (P < 0.05).It further demonstrates a meaningful improvement in patient outcomes, a predictable return to activity, and a high rate of patient satisfaction.Level IV case series.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Marian University School of Medicine; The Shoulder Center, Carmel, IN 46032, USA.

ABSTRACT

Purpose: The 2-year outcomes of patients undergoing repair of triple labrum tears using an all-suture anchor device were assessed.

Materials and methods: Eighteen patients (17 male, one female; mean age 36.4 years, range: 14.2-62.3 years) with triple labrum tears underwent arthroscopic repair using the 1.4 mm JuggerKnot Soft Anchor (mean number of anchors 11.5, range: 9-19 anchors). Five patients had prior surgeries performed on their operative shoulder. Patients were followed for a mean of 2.0 years (range: 1.6-3.0 years). Constant-Murley shoulder score (CS) and Flexilevel scale of shoulder function (FLEX-SF) scores were measured, with preoperative and final postoperative mean scores compared with a paired Student's t-test (P < 0.05). Magnetic resonance imaging (MRI) was also performed at final postoperative.

Results: Overall total CS and FLEX-SF scores increased from 52.9 ± 20.4 to 84.3 ± 10.7 (P < 0.0001) and from 29.3 ± 4.7 to 42.0 ± 7.3 (P < 0.0001), respectively. When divided into two groups by whether or not glenohumeral arthrosis was present at the time of surgery (n = 9 each group), significant improvements in CS and FLEX-SF were obtained for both groups (P < 0.0015). There were no intraoperative complications. All patients, including contact athletes, returned to their preinjury level of sports activity and were satisfied. MRI evaluation revealed no instances of subchondral cyst formation or tunnel expansion. Anchor tracts appeared to heal with fibrous tissue, complete bony healing, or combined fibro-osseous healing.

Conclusion: Our results are encouraging, demonstrating a consistent healing of the anchor tunnels through arthroscopic treatment of complex labrum lesions with a completely suture-based implant. It further demonstrates a meaningful improvement in patient outcomes, a predictable return to activity, and a high rate of patient satisfaction.

Level of evidence: Level IV case series.

No MeSH data available.


Related in: MedlinePlus