Joo Han Oh, Department of Orthopedic Surgery, Seoul National University College of Medicine, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam 463-707, Korea.
Am J Sports Med. 2014 Mar;42(3):552-7. doi: 10.1177/0363546513517538. Epub 2014 Jan 15.
Bioabsorbable anchors may lead to osteolysis and cyst formation. However, the prevalence of these outcomes is not known for rotator cuff repairs.
To evaluate cyst formation after placement of bioabsorbable anchors for rotator cuff repairs and to verify whether bioabsorbable anchors degraded as intended and preserved bone stock for possible revision compared with metal anchors. The null hypothesis was that the rate and severity of cyst formation around the anchor are negligible.
Case series; Level of evidence, 4.
Between April 2008 and November 2011, a total of 209 patients (85 men, 124 women) underwent rotator cuff repair with bioabsorbable suture anchors (113 with polylactic acid enantiomers [PLLA] and 96 with poly-D,L-lactide from L-lactide and D-lactide [PLDLA]); the patients underwent magnetic resonance imaging (MRI) evaluation more than 10 months after surgery. The fluid signal around the anchor on T2-weighted MRI scans was graded as follows: grade 0, no fluid around anchor; grade 1, minimal fluid around anchor; grade 2, local fluid around anchor; grade 3, fluid collection around entire length of anchor with cyst diameter less than twice the anchor diameter; and grade 4, cyst diameter larger than grade 3. The integrity of repairs was also evaluated.
Cysts were observed in 97 instances (46.4%). There were 41 grade 1 cases (19.6%), 16 grade 2 (7.7%), 22 grade 3 (10.5%), and 18 grade 4 (8.6%). Healing of repaired tendon was observed in 131 patients (62.7%). There was no statistical difference in healing rate between patients with and without cyst formation (66.1% vs 58.8%; P = .276). Altered anchor shape and absorption were not observed in most of the patients. However, in 12 patients (6 with PLLA and 6 with PLDLA anchors), T2-weighted scans showed that the signal intensity of anchors had changed since surgery, which could indicate that absorption had taken place; nonetheless, even in these 12 patients, anchors were clearly visible on T1-weighted scans.
Osteolysis and cyst formation are common complications following the use of bioabsorbable anchors in rotator cuff repairs. Considering that adequate absorption of anchors and preservation of bone stock are the reasons for using bioabsorbable anchors, use of these anchors should be reconsidered because of possible interference with revision surgery.
可吸收锚钉可能导致骨质溶解和囊肿形成。然而，目前尚不清楚这些结果在肩袖修复中的发生率。
评估可吸收锚钉固定肩袖修复术后囊肿形成的情况，并验证与金属锚钉相比，可吸收锚钉是否按预期降解并保留了骨量以备可能的翻修。零假设是锚钉周围的囊肿形成率和严重程度可以忽略不计。
病例系列；证据水平，4 级。
2008 年 4 月至 2011 年 11 月，共有 209 例患者（85 例男性，124 例女性）接受了可吸收缝线锚钉修复肩袖（113 例使用聚乳酸对映体[PLLA]，96 例使用聚-D，L-乳酸由 L-乳酸和 D-乳酸[PLDLA]）；患者在手术后 10 个月以上接受了磁共振成像（MRI）评估。T2 加权 MRI 扫描中锚钉周围的液体信号分级如下：0 级，无锚钉周围液体；1 级，锚钉周围有少量液体；2 级，锚钉周围有局部液体；3 级，整个锚钉长度周围有液体聚集，囊肿直径小于锚钉直径的两倍；4 级，囊肿直径大于 3 级。还评估了修复的完整性。
97 例（46.4%）观察到囊肿。41 例为 1 级（19.6%），16 例为 2 级（7.7%），22 例为 3 级（10.5%），18 例为 4 级（8.6%）。131 例（62.7%）患者的修复肌腱愈合。有囊肿形成和无囊肿形成的患者的愈合率无统计学差异（66.1%比 58.8%；P=.276）。大多数患者未观察到锚钉形状改变和吸收。然而，在 12 例患者（6 例 PLLA 锚钉和 6 例 PLDLA 锚钉）中，T2 加权扫描显示术后锚钉的信号强度发生了变化，这可能表明已经发生了吸收；尽管如此，即使在这 12 例患者中，T1 加权扫描仍能清楚地显示锚钉。
肩袖修复术后使用可吸收锚钉可导致骨质溶解和囊肿形成。考虑到吸收锚钉和保留骨量是使用可吸收锚钉的原因，可能会干扰翻修手术，因此应重新考虑使用这些锚钉。
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