Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104-4283, USA.
Arthroscopy. 2011 Oct;27(10):1335-40. doi: 10.1016/j.arthro.2011.06.021. Epub 2011 Sep 3.
This study investigates factors associated with failure and reoperation after glenoid labrum repair.
We studied a nonconcurrent cohort of consecutive patients undergoing arthroscopic superior labrum repair at a single institution by 2 fellowship-trained surgeons over a 10-year period.
There were 348 patients included in this study with a mean age of 33.4 years (95% confidence interval [CI], 32.1 to 35.9) and a mean clinical follow-up of 12.3 months (95% CI, 10.9 to 13.8). The overall reoperation rate was 6.3%, with a revision labrum repair rate of 4.3%. Subsequent surgery and failure after arthroscopic labrum repair were significantly correlated with Workers' Compensation claims (odds ratio [OR], 4.6; P < .001; 95% CI, 1.8 to 11.7), the use of tobacco (OR, 12.0; P = .03; 95% CI, 1.2 to 114.9), and the use of absorbable poly-L/D-lactic acid (PLDLA) anchors (100% correlation, P < .001). The OR for having repeat surgery was 12.7 (95% CI, 4.9 to 32.9; P < .001) with poly-96L/4D-lactic acid (Mini-Revo; Linvatec, Largo, FL) and also increased with the use of poly-70L/30D-lactic acid (Bio-Fastak and Bio-Suturetak; Arthrex, Naples, FL) anchor material (P = .04) after removal of the patients exposed to poly-96L/4D-lactic acid anchors. The rates of repeat surgery with PLDLA anchors from Linvatec and PLDLA anchors from Arthrex were 24% and 4%, respectively. None of the patients treated with nonabsorbable suture anchors (polyether ether ketone or metallic) returned to the operating room (P < .001). After we controlled for associated factors in a multivariate analysis, the use of absorbable anchors, in particular poly-96L/4D-lactic acid anchors (OR, 14.7; P < .001), and having a work-related injury (OR, 8.1; P < .001) remained independent factors associated with both repeat surgery and revision superior labrum repair.
Bioabsorbable PLDLA anchor material led to significantly more SLAP repair failures and reoperations compared with nonabsorbable suture anchors. Our recommendation is that glenoid labrum repairs be performed with nondegradable material and, specifically, that the use of anchors composed of PLDLA material should be avoided.
本研究调查了盂唇修复术后失败和再次手术的相关因素。
我们对一家机构的 2 名 fellowship 培训外科医生在 10 年内连续进行的关节镜上盂唇修复的非同期队列患者进行了研究。
本研究共纳入 348 例患者，平均年龄 33.4 岁（95%置信区间[CI]，32.1 至 35.9），平均临床随访 12.3 个月（95%CI，10.9 至 13.8）。总体再手术率为 6.3%，其中 revision labrum repair 率为 4.3%。关节镜下盂唇修复术后再次手术和失败与工人赔偿索赔（比值比[OR]，4.6；P <.001；95%CI，1.8 至 11.7）、烟草使用（OR，12.0；P =.03；95%CI，1.2 至 114.9）和吸收性聚 L/D-乳酸（PLDLA）锚定物的使用显著相关（100%相关性，P <.001）。再次手术的 OR 为 12.7（95%CI，4.9 至 32.9；P <.001），与聚 96L/4D-乳酸（Mini-Revo；Linvatec，Largo，FL）相关，并且当去除聚 96L/4D-乳酸锚定物暴露的患者后，使用聚 70L/30D-乳酸（Bio-Fastak 和 Bio-Suturetak；Arthrex，Naples，FL）锚定物材料时，再次手术的 OR 也增加（P =.04）。来自 Linvatec 的 PLDLA 锚和来自 Arthrex 的 PLDLA 锚的再次手术率分别为 24%和 4%。没有任何接受不可吸收缝线锚（聚醚醚酮或金属）治疗的患者返回手术室（P <.001）。在多变量分析中控制了相关因素后，可吸收锚，特别是聚 96L/4D-乳酸锚（OR，14.7；P <.001）和与工作相关的损伤（OR，8.1；P <.001）仍然是与再次手术和 revision superior labrum repair 相关的独立因素。
与不可吸收缝线锚相比，生物可吸收的 PLDLA 锚定材料导致明显更多的 SLAP 修复失败和再次手术。我们的建议是，盂唇修复应采用不可降解材料进行，特别是应避免使用由 PLDLA 材料制成的锚定物。
