Osteolysis and Arthropathy of the Shoulder After Use of Bioabsorbable Knotless Suture Anchors

Abstract

Recently, bioabsorbable suture anchors have been utilized for many applications in shoulder surgery, including rotator cuff repair and capsulolabral repair1. Bioabsorbable anchors were developed to provide secure reattachment of avulsed soft tissues to their osseous insertions while allowing eventual implant degradation and replacement by autogenous tissue2. Although bioabsorbable materials offer some advantages, their use is not without complications. Foreign-body reactions, osteolysis, and synovitis have been described after use of biodegradable polyglycolic acid implants in the shoulder3-5. The next-generation, poly(L-lactide) polymer implants were initially described as being well tolerated without apparent complications of lysis, loosening, or synovitis1,6,7. Poly(L-lactide) was also found to degrade much more slowly than polyglycolic acid, with the time to complete degradation estimated to be more than three years in animal models8. Furthermore, poly(L-lactide) implants were thought to have better biocompatibility than polyglycolic acid implants1,6. In 2003, Freehill et al.9 reported similar complications, consisting of glenohumeral synovitis and chondral damage, with poly(L-lactide) tacks. The Bioknotless suture anchor (Mitek, Norwood, Massachusetts), which is constructed of poly(L-lactide) polymer, has been reported to be a secure, reliable, and efficient means of fixation for superior labrum anterior-posterior (SLAP) lesions and Bankart lesions7. The senior author (S.W.O'D.) implanted Bioknotless anchors in twenty-five shoulders in twenty-five patients for repair of SLAP and/or Bankart lesions. The purpose of this study is to report on four of these patients, who had failure of the Bioknotless device that led to destructive glenoid osteolysis, anchor pull-out, and subsequent severe damage of the articular cartilage. The patients were informed that data concerning their cases would be submitted for publication. Case 1. A forty-year-old right-hand-dominant female registered nurse underwent repair of a right type-II SLAP lesion, …