Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China.
Department of Orthopedics, Banan People's Hospital of Chongqing, Chongqing, China.
Knee Surg Sports Traumatol Arthrosc. 2021 Jan;29(1):162-169. doi: 10.1007/s00167-020-05897-7. Epub 2020 Feb 14.
To assess the natural evolution of the osseous reaction following arthroscopic double-row rotator cuff repair with PEEK anchors and to analyze its correlation with clinical shoulder function.
Between 2015 and 2017, 159 patients received arthroscopic double-row rotator cuff repair with PEEK anchors and underwent serial clinical and radiological follow-up (3, 6, 12, and 24 months). Radiological results were analyzed by tendon integrity, bone marrow edema, and peri-implant osteolysis. Clinical shoulder function was evaluated with the Constant score.
One-hundred and seventeen patients were enrolled; among them, 63% demonstrated bone marrow edema around the anchors on postoperative 3-month MRI. The edema area percentage was 41% ± 7%. At 6 months, edema was only seen in 12% of cases, with an area percentage of 18% ± 5%. At 12 and 24 months, edema was rarely present. Fluid signals around the anchor were observed in 17.6%, 42.7%, 33.3%, and 21.0% of patients at 3, 6, 12, and 24 months, respectively; the tunnel widening values were 1.1 ± 0.4 mm, 1.8 ± 0.5 mm, 2.3 ± 0.6 mm, and 2.2 ± 0.7 mm at each follow-up, respectively. The sign of osteolysis was significantly more obvious around the lateral anchor than around the medial anchor. The presence of an osseous reaction was not correlated with worse clinical outcome.
Osseous reactions following arthroscopic rotator cuff repair are common and significant even with PEEK anchors. Bone marrow edema does not last more than 6 months in patients without complications. Peri-implant osteolysis is more evident around the lateral anchor than around the medial anchor and improves gradually over time. The sign of osteolysis is not correlated with clinical shoulder function. Based on these findings, surgeons should be cautious about bone marrow edema lasting more than 6 months following arthroscopic rotator cuff repair.
Level IV.
评估关节镜下双排 PEEK 锚定修复肩袖后的骨反应自然演变，并分析其与临床肩部功能的相关性。
2015 年至 2017 年，159 例患者接受关节镜下双排 PEEK 锚定修复肩袖，并进行连续的临床和影像学随访（3、6、12 和 24 个月）。通过肌腱完整性、骨髓水肿和植入物周围溶骨来分析影像学结果。采用 Constant 评分评估肩部临床功能。
共纳入 117 例患者，其中 63%的患者在术后 3 个月 MRI 上显示锚钉周围骨髓水肿。水肿面积百分比为 41%±7%。6 个月时，仅 12%的病例出现水肿，面积百分比为 18%±5%。12 个月和 24 个月时，水肿很少见。术后 3、6、12 和 24 个月时，分别有 17.6%、42.7%、33.3%和 21.0%的患者出现锚钉周围液性信号；隧道增宽值分别为 1.1±0.4mm、1.8±0.5mm、2.3±0.6mm 和 2.2±0.7mm。外侧锚钉周围的溶骨征象明显比内侧锚钉周围明显。骨反应的存在与临床结果不佳无关。
即使使用 PEEK 锚钉，关节镜肩袖修复后也会出现明显的骨反应。无并发症患者的骨髓水肿不会持续超过 6 个月。植入物周围的溶骨在外侧锚钉周围比在内侧锚钉周围更明显，并随时间逐渐改善。溶骨的迹象与肩部临床功能无关。根据这些发现，外科医生应谨慎对待关节镜肩袖修复后持续超过 6 个月的骨髓水肿。
IV 级。
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