Arthroscopic Suture Anchor Repair Research Articles

Arthroscopic suture anchor repair and debridement for refractory lateral epicondylitis show significant clinical improvement

PurposeTo retrospectively compare the clinical outcomes of arthroscopic suture anchor repair of the common extensor tendon (CET) and arthroscopic debridement of CET for the treatment of refractory lateral epicondylitis. MethodsPatients with refractory lateral epicondylitis who underwent arthroscopic surgery between August 2018 and September 2022 with a minimum of 1-year follow-up were included. All patients were divided into two groups based on whether they underwent suture anchor repair. The modified Nirschl technique was used to debride the CET lesions in all patients, and modified anchor repair was used for CET insertion reconstruction in patients after January 2021. In short, suture anchor fixation (single-row) was used in patients with tear areas less than 50% of the CET insertion, and suture-bridge fixation (double-row) was used in patients with tear areas greater than 50%. The outcomes, including the visual analog scale (VAS) score for pain, the Mayo Elbow Performance Score (MEPS), the quick Disabilities of the Arm, Shoulder and Hand (DASH) score, and surgical satisfaction, were measured one day preoperatively and at the latest follow-up. The proportion of patients achieving the minimal clinically important difference (MCID) was compared between the groups. ResultsA total of 62 patients (60% female) were included in the final analysis (30 in the debridement group and 32 in the repair group). The mean age of the cohort was 47.6 ± 7.3 years, with 77% of patients affecting the dominant arm. The follow-up time was 29.3 ± 3.2 (range: 19 - 35) months for the debridement group and 27.2 ± 5.4 (range: 20 - 37) months for the repair group (P = 0.073). Preoperative patient-reported outcomes were comparable between the groups and were significantly improved after surgery. Postoperatively, patients in the repair group had better MEPS score (95.8 ± 6.9 vs 91.2 ± 8.0; P = 0.017) and quick DASH scores (2.2 ± 3.9 vs 4.2 ± 3.9; P = 0.043), while there were no differences between the two groups in terms of VAS scores for pain during rest (0.1 ± 0.4 vs 0.1 ± 0.3; P = 0.933) or during activity (0.3 ± 0.8 vs 0.4 ± 0.6; P = 0.639). MCID achievement of VAS score during rest was similar between the repair group (97%) and the debridement group (93%, P = 0.607), while MCID achievement in the VAS score during activity, MEPS score, and quick-DASH score was 100% in both groups. ( All patients resumed their daily life and work after surgery, for a surgical satisfaction rate of 98.4%. ConclusionArthroscopic suture anchor repair and debridement of the CET insertion resulted in significant clinical improvement in patients with refractory lateral epicondylitis. Level of evidenceRetrospective comparative case series; level 3.

Arthroscopic pullout repair versus suture anchor repair for medial meniscus posterior root tear combined with high tibial osteotomy

BackgroundThe aim of this study was to compare the outcomes of pullout repair with a metal button and suture anchor repair for medial meniscus posterior root tears in patients undergoing high tibial osteotomy with varus alignment. MethodsPatients who underwent arthroscopic pullout repair (P group) and suture anchor repair (SA group) in combination with open-wedge high tibial osteotomy between 2018 and 2021 were retrospectively examined. Patients who received second-look arthroscopy at 1 year and at least 2 years of follow up were included. Structural healing (complete/partial or failed healing) and chondral lesions at the initial surgery and the second-look arthroscopy, radiographic parameters around the knee, Lysholm score, and Tegner activity scale (before and 2 years after surgery) were compared. ResultsA total of 88 patients (68 women/20 men, mean age 61.1 ± 7.9 years old) were included in the analysis. Of these, 51 patients underwent pullout repair, while the other 37 underwent suture anchor repair. The SA group showed a significantly higher rate of complete healing (64.9%) than the P group (21.6%, P < 0.001). The Lysholm score significantly improved after surgery in both treatment groups. At the final follow up, the SA group had a significantly higher Lysholm score (89.6 ± 10.7) than the P group (80.9 ± 17.4, P = 0.011). ConclusionArthroscopic suture anchor repair had superior healing status and Lysholm Score in comparison with pullout repair with a metal button, as it achieved better tension adjustment. This result is meaningful particularly when medial meniscus root repair and high tibial osteotomy are performed simultaneously.

Risk Factors and Corresponding Management for Suture Anchor Pullout during Arthroscopic Rotator Cuff Repair.

Due to the aging of the population, the incidence of rotator cuff tears is growing. For rotator cuff repair, arthroscopic suture-anchor repair has gradually replaced open transosseous repair, so suture anchors are now considered increasingly important in rotator cuff tear reconstruction. There are some but limited studies of suture anchor pullout after arthroscopic rotator cuff repair. However, there is no body of knowledge in this area, which makes it difficult for clinicians to predict the risk of anchor pullout comprehensively and manage it accordingly. The literature search included rotator cuff repair as well as anchor pullout strength. A review of the literature was performed including all articles published in PubMed until September 2021. Articles of all in vitro biomechanical and clinical trial levels in English were included. After assessing all abstracts (n = 275), the full text and the bibliographies of the relevant articles were analyzed for the questions posed (n = 80). Articles including outcomes without the area of interest were excluded (n = 22). The final literature research revealed 58 relevant articles. Narrative synthesis was undertaken to bring together the findings from studies included in this review. Based on the presented studies, the overall incidence of anchor pullout is not low, and the incidence of intraoperative anchor pullout is slightly higher than in the early postoperative period. The risk factors for anchor pullout are mainly related to bone quality, insertion depth, insertion angle, size of rotator cuff tear, preoperative corticosteroid injections, anchor design, the materials used to produce anchors, etc. In response to the above issues, we have introduced and evaluated management techniques. They include changing the implant site of anchors, cement augmentation for suture anchors, increasing the number of suture limbs, using all-suture anchors, using an arthroscopic transosseous knotless anchor, the Buddy anchor technique, Steinmann pin anchoring, and transosseous suture repair technology. However, not many of the management techniques have been widely used in clinical practice. Most of them come from in vitro biomechanical studies, so in vivo randomized controlled trials with larger sample sizes are needed to see if they can help patients in the long run.

Does the immediate repair of Bankart lesion following first dislocation reduce the chances of recurrence after arthroscopic repair in soldiers?

The study attempted to compare the effects of immediate and delayed arthroscopic Bankart repair on the shoulder dislocation recurrence. In total, 465 soldiers with first-time anterior shoulder dislocation were included in the study. Of the total, 285 soldiers underwent a quick arthroscopic Bankart repair procedure, whether 180 soldiers underwent a delayed repair procedure. The initial dislocation was traumatic in both groups and operated using the standard arthroscopic suture anchor repair technique. Patient's age, repair time since the first dislocation, number of dislocations before surgery, number of suture anchors used during the repair, duration of surgical procedure, duration from surgery to return to work, and recurrence of dislocation after surgery were recorded. Rowe score, Constant score, and American Shoulder and Elbow Surgeons score were used for clinical assessment. The operating time and recurrence rate were higher in the group subjected to delayed repair procedure than in the group subjected to immediate repair procedure. Repair timing was found to be crucial for a successful outcome. The findings suggest that Bankart repair must be performed immediately to minimize recurrence and other degenerative changes, which may require an additional surgical procedure for satisfactory repair. More studies are required to reach a definitive conclusion. Level III.

Arthroscopic Knotless, Tensionable All-Suture Anchor Bankart Repair

Surgical management for glenohumeral instability has advanced to provide stronger fixation and to be less invasive. Arthroscopic suture anchor repair has been the gold standard for isolated capsulolabral tears over the years. Despite the ability of the solid suture anchors to handle physiologic load, they can present challenges such as chondral damage due to anchor size and imperfect angulation, osteolysis, anchor breakage, revision drilling, difficulty of revision surgery with accompanied bone loss, and compromised postoperative magnetic resonance imaging quality. Recently, knotless all-suture anchors have been introduced as a technique to overcome these challenges. These anchors lack a rigid component and can be placed in a tunnel of smaller diameter, thereby allowing for maintenance of glenoid bone stock. The purpose of this Technical Note is to describe our preferred surgical technique with a minimally invasive approach for the fixation of capsulolabral tears using a knotless all-suture anchor construct.

Single versus double row suture anchor fixation for greater tuberosity fractures \u2013 a biomechanical study

BackgroundFractures of the humeral greater tuberosity (GT) are a frequent injury progressively treated with arthroscopic suture anchor repair. Yet, no biomechanical study has been performed comparing fixation strength of arthroscopic single- (SR) vs. double row (DR) fixation.MethodsStandardized fractures of the greater tuberosity were created in 12 fresh frozen proximal humeri. After random assignation to the SR or DR group the fixed humeri were tested applying cyclic loading to the supraspinatus and infraspinatus tendon. Load to failure and fragment displacement were assessed by means of an electrodynamic material testing machine using an optical tracking system.ResultsLoad to failure values were higher in the DR group (649 N; ±176) than in the SR group (490 N; ±145) however without statistical significance (p = .12). In greater tuberosity displacement of 3–5 mm surgical treatment is recommended. The fixing constructs in this study did not reach displacement landmarks of 3 or 5 mm before construct failure as shown in previous studies. Thus the applied traction force (N) at 1 mm displacement was analyzed. In the SR group the load at 1 mm displacement was 277 N; ±46 compared to 260 N; ±62 in the DR group (p = .65).ConclusionThe results suggest that both techniques are viable options for refixation of greater tuberosity fractures.Level of Evidence: Laboratory study.

Arthroscopic Repair of Subscapularis Tendon Tears.

The subscapularis is the largest and strongest muscle of the rotator cuff, and it plays an essential role in global shoulder function. Beyond its primary function as an internal rotator, the subscapularis also acts to pull the humeral head posteriorly on the glenoid and is an important dynamic and static anterior stabilizer of the glenohumeral joint. In comparison with tears of the tendons of the rest of the rotator cuff, isolated tears of the subscapularis have a tendency for both early retraction and fatty infiltration. Consequently, full-thickness tears of the subscapularis tendon generally require surgical management. Arthroscopic suture-anchor repair allows anatomic reconstruction of the anterior aspect of the rotator cuff, with all of the benefits of arthroscopic surgery. The principal steps of this procedure include (1) verifying the subscapularis tear and identifying any concomitant lesions during diagnostic arthroscopy, (2) exposing the subscapularis tendon, (3) releasing tendon adhesions and so enabling anatomic reduction, (4) placing suture anchors at the anatomic subscapularis footprint on the lesser tuberosity and anatomically repairing the subscapularis tendon to its anatomic insertion, and (5) performing biceps tenodesis or tenotomy, if indicated. Postoperatively, patients with an isolated subscapularis tear are managed with immobilization in a sling for 6 weeks, while those with combined anterosuperior rotator cuff tears are managed with an abduction pillow. Arthroscopic subscapularis reconstruction provides a good structural repair, substantially restores shoulder mobility and strength, reduces pain, and results in high levels of patient satisfaction and return of shoulder function as measured by functional outcome scores.

Arthroscopic Double-Row Suture Anchor Repair of Acute Posterior Bony Bankart Lesion

The treatment of anterior shoulder instability is well described with various techniques, including arthroscopic double-row repair, an alternative to open stabilization procedures in high-risk groups. The surgical management of posterior instability in high-risk and athletic populations is a less-explored entity. We describe our technique for an all arthroscopic double-row suture anchor repair of a large posterior bony Bankart lesion. We prefer this technique over percutaneous cannulated screw fixation because the double-row suture technique allows for incorporation of capsular plication with bony fixation in an effort to better restore normal anatomy for capsulolabral complex. Double-row repair capsulolabral repair or fixation of the bony Bankart is performed via a suture-bridge technique. Medial row anchors are placed down the glenoid neck and shuttled around the bony fragment and labrum. The lateral-row anchor is placed at the rim of the native glenoid. This repair technique has been shown to increase the surface area for healing and more closely reconstruct the native anatomic capsulolabral complex footprint, improve force distribution, and potentially impart enhanced posterior stability to the glenohumeral joint.

Arthroscopic Suture Anchor Fixation of Bony Bankart Lesions: Clinical Outcome, Magnetic Resonance Imaging Results, and Return to Sports

The purpose of this study was to evaluate the outcome, return to sporting activity, and postoperative articular cartilage and bony morphology of shoulders that underwent arthroscopic suture anchor repair of bony Bankart lesions. The inclusion criteria for this retrospective study were anterior glenoid rim fractures after traumatic shoulder instability that were treated with arthroscopic suture anchor repair. Patients were surveyed by a questionnaire including sport-specific outcome, Rowe score, Western Ontario Shoulder Instability Index, and Oxford Instability Score. Three-tesla magnetic resonance imaging could be performed in 30 patients to assess osseous integration, glenoid reconstruction, and signs of osteoarthritis. From November 1999 to April 2010, 81 patients underwent an anterior bony Bankart repair in our department (50 arthroscopic suture anchor repairs, 5 arthroscopic screw fixations, and 26 open repairs). The 55 arthroscopic repairs comprised a consecutive cohort of patients treated by a single surgeon. Of the 50 patients in the suture anchor group, 45 (90%) were available for evaluation. At 82 ± 31 months postoperatively, the mean Rowe score was 85.9 ± 20.5 points, the mean Western Ontario Shoulder Instability Index score was 89.4% ± 14.7%, and the mean Oxford Instability Score was 13.6 ± 5.4 points. Compared with the contralateral shoulder, all scores showed a significantly reduced outcome (P < .001, P < .001, and P < .001, respectively). A redislocation occurred in 3 patients (6.6%). Regarding satisfaction, 35 patients (78%) were very satisfied, 9 (20%) were satisfied, and 1 was partly satisfied. Overall, 95% of patients returned to any sporting activity after surgery. The number of sports disciplines (P < .001), duration (P= .005), level (P= .02), and risk category (P= .013) showed a significant reduction compared with the pretrauma condition. However, only 19% of patients reported that shoulder complaints were the reason for the reduction in activity. Nonunion occurred in 16.6%, with a higher frequency in patients with chronic lesions (P= .031). Anatomic reduction was achieved in 72%, the medial step-off in patients with nonanatomic reduction averaged 1.8 ± 0.9 mm, and the remaining glenoid defect size averaged 6.8% ± 7.3%. Full-thickness cartilage defects of the anterior glenoid were detected in 70% of patients. Arthroscopic suture anchor repair may enable an anatomic reduction of bony Bankart lesions with no or only minimal articular steps and provides successful midterm outcomes concerning clinical scores, recurrence, and patient satisfaction. The return to activity is limited for various, mostly non-shoulder-related causes. Chronic lesions may have an inferior healing potential; therefore early surgical stabilization of acute Bankart fragments is suggested to avoid possible nonunion. Level IV, therapeutic case series.

Ultrasonic evaluation of the repair integrity can predict functional outcomes after arthroscopic double-row rotator cuff repair.

Despite proven accuracy of US for the evaluation of rotator cuff integrity, there is no US-based classification for this purpose. This study aimed to assess US for the evaluation of rotator cuff repair integrity in accordance with a well-established MRI classification. The authors retrospectively reviewed 257 patients who underwent arthroscopic double-row suture anchor repair for rotator cuff tears. Post-operative function was rated using the Constant score, the UCLA rating and the SSV, whereas repair integrity was assessed using US as described in the MRI classification of Sugaya et al. A total of 212 patients aged 55.6 ± 9.8 years had complete functional and radiographic assessments at a mean follow-up of 36.8 ± 11.6 months. Using all three ratings, repairs of Type I had highest scores, repairs of Type II had discernibly lower scores, whereas repairs of Types III, IV and V had similar intermediate scores. Comparison of the UCLA scores with those of Sugaya et al. revealed similar scores for repairs of Type I and of Type V. The scores are less comparable for repairs of Types II, III and IV, because US does not allow identification of partial tears if shielded by bony structures and because partial tears correspond to minimal impairment. The study reveals that US is an adequate imaging modality to classify rotator cuff repair integrity, which could reduce economic and practical burdens of CTA, MRI or MRA. The results also confirm that post-operative repair integrity and functional outcome depend on pre-operative tear size and fatty infiltration, which provides clinicians with reasoning for early surgical repair and warning of the risks of strenuous activity for patients with larger tears. Prognostic study, Level IV.

Arthroscopic repair of type II SLAP lesions: Clinical and anatomic follow-up.

Aims:The aim was to evaluate the clinical and anatomic outcome of arthroscopic repair of type II SLAP lesions.Materials and Methods:The senior author performed isolated repairs of 25 type II SLAP lesions in 25 patients with a mean age of 40.0 ± 12 years. All tears were repaired using standard arthroscopic suture anchor repair to bone. All patients were reviewed using a standardized clinical examination by a blinded, independent observer, and using several shoulder outcome measures. Patients were evaluated by magnetic resonance imaging arthrogram at a minimum of 1-year postoperatively.Statistical Analysis Used:Two-tailed paired t-test were used to determine significant differences in preoperative and postoperative clinical outcomes scores. In addition, a Fisher's exact test was used.Results:At a mean follow-up of 54-month, the mean American Shoulder and Elbow Surgeons Shoulder Index (ASES) scores improved from 52.1 preoperatively to 86.1 postoperatively (P < 0.0001) and the Simple Shoulder Test (SST) scores from 7.7 to 10.6 (P < 0.0002). Twenty-two out of the 25 patients (88%) stated that they would have surgery again. Of the 21 patients who had postoperative magnetic resonance imaging arthrographys (MRAs), 9 patients (43%) demonstrated dye tracking between the labrum bone interface suggestive of a recurrent tear and 12 patients (57%) had a completely intact repair. There was no significant difference in ASES, SST, and patient satisfaction scores in patients with recurrent or intact repairs.Conclusions:Arthroscopic repair of type II SLAP lesions demonstrated improvements in clinical outcomes. However, MRA imaging demonstrated 43% of patients with recurrent tears. MRA results do not necessarily correlate with clinical outcome.

Arthroscopic Suture Anchor Repair of the Lateral Ligament Ankle Complex

Background: Operative treatment of mechanical ankle instability is indicated for patients with multiple sprains and continued episodes of instability. Open repair of the lateral ankle ligaments involves exposure of the attenuated ligaments and advancement back to their anatomic insertions on the fibula using bone tunnels or suture implants. Hypothesis: Open and arthroscopic fixation are equal in strength to failure for anatomic Broström repair. Study Design: Controlled laboratory study. Methods: Seven matched pairs of human cadaveric ankle specimens were randomized into 2 groups of anatomic Broström repair: open or arthroscopic. The calcaneofibular ligament and anterior talofibular ligament were excised from their origin on the fibula. In the open repair group, 2 suture anchors were used to reattach the ligaments to their anatomic origins. In the arthroscopic repair group, identical suture anchors were used for repair via an arthroscopic technique. The ligaments were cyclically loaded 20 times and then tested to failure. Torque to failure, degrees to failure, initial stiffness, and working stiffness were measured. A matched-pair analysis was performed. Power analysis of 0.8 demonstrated that 7 pairs needed to show a difference of 30%, with a 15% standard error at a significance level of α = .05. Results: There was no difference in the degrees to failure, torque to failure, or stiffness for the repaired ligament complex. Nine of 14 specimens failed at the suture anchor. Conclusion: There is no statistical difference in strength or stiffness of a traditional open repair as compared with an arthroscopic anatomic repair of the lateral ligaments of the ankle. Clinical Relevance: An arthroscopic technique can be considered for lateral ligament stabilization in patients with mild to moderate mechanical instability.

Long-Term Outcomes After Bankart Shoulder Stabilization

The purposes of this study were (1) to analyze long-term outcomes in patients who have undergone open or arthroscopic Bankart repair and (2) to evaluate study methodologic quality through validated tools. We performed a systematic review of Level I to IV Evidence using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Clinical outcome studies after open or arthroscopic Bankart repair with a minimum of 5 years' follow-up were analyzed. Clinical and radiographic outcomes were extracted and reported. Study methodologic quality was evaluated with Modified Coleman Methodology Scores and Quality Appraisal Tool scores. We analyzed 26 studies (1,781 patients). All but 2 studies were Level III or IV Evidence with low Modified Coleman Methodology Scores and Quality Appraisal Tool scores. Patients analyzed were young (mean age, 28 years) male patients (81%) with unilateral dominant shoulder (61%), post-traumatic recurrent (mean of 11 dislocations before surgery) anterior shoulder instability without significant glenoid bone loss. The mean length of clinical follow-up was 11 years. There was no significant difference in recurrence of instability with arthroscopic (11%) versus open (8%) techniques (P = .06). There was no significant difference in instability recurrence with arthroscopic suture anchor versus open Bankart repair (8.5% v 8%, P = .82). There was a significant difference in rate of return to sport between open (89%) and arthroscopic (74%) techniques (P < .01), whereas no significant difference was observed between arthroscopic suture anchor (87%) and open repair (89%) (P = .43). There was no significant difference in the rate of postoperative osteoarthritis between arthroscopic suture anchor and open Bankart repair (26% and 33%, respectively; P = .059). There was no significant difference in Rowe or Constant scores between groups (P > .05). Surgical treatment of anterior shoulder instability using arthroscopic suture anchor and open Bankart techniques yields similar long-term clinical outcomes, with no significant difference in the rate of recurrent instability, clinical outcome scores, or rate of return to sport. No significant difference was shown in the incidence of postoperative osteoarthritis with open versus arthroscopic suture anchor repair. Study methodologic quality was poor, with most studies having Level III or IV Evidence. Level IV, systematic review of studies with Level I through IV Evidence.

Suture anchors or transglenoidal sutures for arthroscopic repair of isolated SLAP-2 lesions? A matched-pair comparison of functional outcome and return to sports

Presumably, the technique of SLAP refixation has significant influence on outcome. This study analyzes and compares functional outcome and return to sports after arthroscopic suture anchor (SA) and arthroscopic transglenoidal suture (TS) repair of isolated SLAP-2 lesions. Twenty-four competitive amateur athletes constituted the two treatment groups of this retrospective matched-pair analysis. In the SA group (n = 12), the mean age was 39.1 years (±12.0) and the mean follow-up period was 4.0 years (±0.6). In the TS group (n = 12), the mean age was 33.8 years (±12.0) and the mean follow-up period was 3.7 years (±0.9). The minimum follow-up period was 2.0 years. Primary outcome measures were the absolute constant-score (CS), the subjective shoulder value (SSV) as well as the ability to return to sports. The mean CS in the SA group was 91.6 (±5.5) compared to 81.3 (±15.5) in the TS group (p = 0.04). The mean SSV after SA repair was 96.9 (±4.6) compared to 80.0 (±20.8) after TS repair (p = 0.01). Both scores showed significantly higher standard deviations within the TS group (p < 0.05). Twelve of eighteen patients (67 %) were able to return to their overhead sports without restrictions (5/9 in the SA group and 7/9 in the TS group; p > 0.05). Fourteen of twenty-four patients (58 %) achieved their preinjury sports levels (8/12 in the SA group and 6/12 in the TS group; p > 0.05). Superior objective and subjective shoulder function was obtained following arthroscopic SA repair compared to arthroscopic TS repair of isolated SLAP-2 lesions. In addition, results of SA repair were more predictable. However, nearly half of the athletes did not achieve full return to sports regardless of the applied technique of refixation.

Paper 34: Functional and MR Arthrography Imaging Evaluation After Arthroscopic Single Row and Double Row Suture Anchor Repair

Paper 34: Functional and MR Arthrography Imaging Evaluation After Arthroscopic Single Row and Double Row Suture Anchor Repair

Paper 60: Arthroscopic Suture Anchor Repair for Shoulder Instability: A Prospective Study Comparing Absorbable and Non Absorbable Sutures

Paper 60: Arthroscopic Suture Anchor Repair for Shoulder Instability: A Prospective Study Comparing Absorbable and Non Absorbable Sutures

鏡視下腱板修復術：triple row法の術後早期成績

鏡視下腱板修復術：triple row法の術後早期成績

Arthroscopic Suture Anchor Repair Versus Pullout Suture Repair in Posterior Root Tear of the Medial Meniscus: A Prospective Comparison Study

To evaluate functional and radiographic results of arthroscopic suture anchor repair for posterior root tear of the medial meniscus (PRTMM) and compare with pullout suture repair. From December 2006 to August 2008, 51 consecutive patients underwent arthroscopic repair of PRTMM at our hospital. The repair technique was switched over time from pullout suture repair (group 1) to suture anchor repair (group 2). Of the patients, 6 were lost to follow-up, leaving a study population of 45 patients, with 22 menisci (48.9%) in group 1 and 23 (51.1%) menisci in group 2. The mean follow-up duration was 25.9 months (range, 24 to 27 months) in group 1 and 26.8 months (range, 24 to 28 months) in group 2. Compared variables included International Knee Documentation Committee criteria, Kellgren-Lawrence grade, gap distance at PRTMM, structural healing, meniscal extrusion, and cartilage degeneration of the medial femoral condyle. At 2 years postoperatively, both groups showed significant improvements in function (P < .05) and did not show significant differences in Kellgren-Lawrence grade (P > .05) compared with preoperatively. On magnetic resonance imaging, the gap distance at PRTMM was 3.2 ± 1.1 mm in group 1 and 2.9 ± 0.9 mm in group 2 preoperatively (P > .05). Complete structural healing was seen in 11 cases in group 1 and 12 cases in group 2 (P > .05). Mean meniscal extrusion of 4.3 ± 0.9 mm (group 1) and 4.1 ± 1.0 mm (group 2) preoperatively was significantly decreased to 2.1 ± 1.0 mm (group 1) and 2.2 ± 0.8 mm (group 2) postoperatively (P < .05). Regardless of repair technique, incompletely healed cases showed progression of cartilage degeneration (4 cases in group 1 and 2 cases in group 2). For PRTMM, our results show significant functional improvement in both the suture anchor repair and pullout suture repair groups. Reduction of meniscal extrusion seems to be appropriate to preserve its protective role against progression of cartilage degeneration after complete healing at PRTMM. Level III, prospective therapeutic comparative study.

Arthroscopic Bankart repair: results and risk factors of recurrence of instability

The purpose of this study was to discover the recurrence rate of instability after arthroscopic Bankart repair and to assess risk factors for recurrence, with special interest in bone defects seen on preoperative plain radiographs. Consecutive unselected patients (182; 186 shoulders) with recurrent instability (redislocation or subluxation) after initial traumatic anteroinferior shoulder dislocation were operated on using arthroscopic suture-anchor repair at our institution during 2000-2005. Demographic data and details of the operation were retrospectively reviewed from case records, and glenoid and Hill-Sachs lesions were assessed from preoperative radiographs. The primary outcome measure was recurrence of instability (redislocation or subluxation). Functional results were assessed via Oxford instability scores and subjective shoulder values (SSVs), using postal questionnaires. One hundred and seventy-four shoulders (170 patients) were assessed after a median of 51 (range 24-95) months' follow-up. The recurrence rate of instability was 19% (redislocation 9% and subluxation 10%). Eighteen patients (10%) needed further surgery. The mean Oxford instability score was 21 and the mean SSV 84%. The recurrence rate among patients aged 20 or less was 44% and among patients over 20, 12%. Multivariate logistic regression analysis showed that age ≤20 (OR 8.8), Hill-Sachs lesion (OR 3.3), glenoid erosion (OR 2.7) and length of follow-up (OR 1.5) were the most important risk factors for recurrence. Young age is the most important risk factor for recurrence of instability after arthroscopic suture-anchor Bankart repair. Bone defects seen in preoperative plain radiographs are less important and more accurate imaging is needed to reveal their true role for recurrence of instability.

Arthroscopic suture anchor repair for lateral patellar instability

Several all-arthroscopic techniques have been described to address patellar instability. Most arthroscopic procedures focus on soft tissue plication or "tightening" of the medial retinacular structures to correct lateral patellar instability. We found these techniques to be ineffective when the medial stabilizers were avulsed from the patella. As a result, we have developed an arthroscopic technique to repair medial patellofemoral ligament avulsions to the patella using suture anchors.