Postoperative bone marrow edema lasts no more than 6 months after uncomplicated arthroscopic double-row rotator cuff repair with PEEK anchors.

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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 OF EVIDENCE: Level IV.

A Retrospective Study on the Efficacy, Safety, and Clinical and Radiological Outcomes of PEEK Anchors (CEPTRE® Knotted Suture Anchor and VIPLOK® Knotless Anchor) in the Treatment of Rotator Cuff Repairs.

BACKGROUND: Rotator cuff tears are a common cause of disability in the shoulder of the aging population. Rotator cuff repair is performed to address disability arising from rotator cuff tears, which fails to improve by conservative treatment. The present retrospective study was undertaken to explore the efficacy, safety, clinical, and radiological outcomes of PEEK suture anchors (Ceptre® suture anchor and Viplok® knotless anchor; Sironix, Healthium MedTech, India) in the treatment of arthroscopic rotator cuff repairs. METHOD: This is a retrospective cohort study of arthroscopic rotator cuff repair of posterosuperior tears, which was performed between January 2019 and December 2020 with a minimum follow-up of one year. The demographic data, history, preoperative clinical, magnetic resonance imaging report, and intraoperative details of each patient operated on were obtained from medical records. Post-operative clinical assessments of patients were done based on American Shoulder and Elbow Score (ASES) and Single Sssessment Numeric Evaluation (SANE) scores. Ultrasonography (USG) was done to assess any anchor pull-out and structural healing of the cuff. X-rays were performed to look for the anchor's metallic tip migration. RESULTS: A total of 65 patients were included in the study. There were 43 males (66.2%) and 22 females (33.8%). The mean age was 55.98 (±7.9) years (range: 40-69 years). The mean follow-up was 21.9 months (range: 12-46). Mean (±SD) postoperative ASES and SANE scores at the end of one year were 81.5 (±14.27) and 83.55 (±13.83), respectively. There was significant improvement with respect to the preoperative scores (p<0.0001). USG revealed complete healing in 80% of cases, partial tears in 10.8 %, and full-thickness tears in 9.2% of cases. No anchor pull-outs were noted on USG. X-rays did not reveal unusually large cystic areas in the humeral head or metallic tip migration from the humeral head at their last follow-up. CONCLUSIONS: The results of this study suggest that PEEK suture anchors (Ceptre® knotted suture anchor and Viplok® knotless anchor; Sironix, Healthium MedTech, India) are a viable option for successful surgery in the treatment of arthroscopic rotator cuff repairs without any major anchor related complications.

Biomechanical comparison of different suture anchors used in rotator cuff repair surgery-all-suture anchors are equivalent to other suture anchors: a systematic review and network meta-analysis.

PURPOSE: Suture anchors are commonly used to repair rotator cuff tendons in arthroscopy surgery, and several anchor materials have been created to maximize pull-out strength and minimize iatrogenic damage. We hypothesized that all-suture anchors have biomechanical properties equivalent to those of conventional anchors. Our purpose is to compare the biomechanical properties of different anchors used for rotator cuff repair. METHODS: The Embase, PubMed, Cochrane, and Scopus databases were searched for biomechanical studies on various suture anchors. The search keywords included rotator cuff tears and suture anchors, and two authors conducted study a selection, risk of bias assessment, and data extraction. The failure load, stiffness, and displacement were calculated using the mean differences with 95% confidence intervals (CIs). Failure modes were estimated using summary odds ratios with 95% CIs. The surface under the cumulative ranking curve was used for the relative ranking probabilities. A sensitivity analysis was performed by excluding studies using synthetic bones. RESULTS: The polyetheretherketone (PEEK) (p < 0.001) and all-suture anchors (p < 0.001) had higher failure loads than the biocomposite anchors, whereas no significant difference was observed in stiffness among the anchors. The all-suture (p = 0.006) and biocomposite anchors (p < 0.001) had displacements higher than the metal anchors. The relative ranking of the included anchors in failure loads and displacement changed in sensitivity analysis. The meta-analysis did not find significant differences, but the relative ranking probabilities suggested that all-suture anchor had a higher rate of anchor pull-out and a lower rate of eyelet or suture breakage. In contrast, the metal anchors were associated with a higher number of eyelet breakage episodes. CONCLUSIONS: All-suture anchors showed significantly higher failure loads than the biocomposite anchors and similar cyclic displacements to the biocomposite and PEEK anchors. There were no significant differences in stiffness between all-suture and conventional suture anchors. The relative ranking of biomechanical properties changed in sensitivity analysis, suggesting the potential effect of bone marrow density. LEVEL OF EVIDENCE: Level IV.

Clinical and Radiologic Outcomes of Combined Use of Biocomposite and PEEK Suture Anchors during Arthroscopic Rotator Cuff Repair: A Prospective Observational Study.

The aim of the current study was to evaluate the functional and radiologic outcomes of biocompatible non-absorbable PEEK (polyetheretherketone) and biocomposite (poly-L-lactic acid/poly(lactic-co-glycolic acid) 70% + ß-tricalcium phosphate) anchors, especially in terms of perianchor cyst formation during the first six months postoperatively. We prospectively analysed 29 patients who underwent arthroscopic rotator cuff repair between March and May 2019. Both PEEK and biocomposite suture anchors were used as lateral anchors in one body. Clinical outcomes were assessed using the shoulder range of motion (ROM), visual analogue scale (VAS) for pain and satisfactory score, American Shoulder and Elbow Surgeons (ASES) score, and Simple Shoulder Test (SST). All these were obtained in patients preoperatively at 3 and 6 months after surgery. The imaging evaluation included perianchor cyst formation, anchor absorption, repaired cuff integrity, and retear pattern. All functional outcomes significantly improved over time. The biocomposite anchor had a statistically significant tendency to form higher grades of fluid collection at 3 months after surgery. However, the perianchor cyst reduced by the sixth postoperative month. Six months postoperatively, the functional outcomes were improved after rotator cuff repair and similar degrees of perianchor cyst formation were observed, regardless of the suture anchor material used.