Arthroscopy: The Journal of Arthroscopic & Related Surgery
Glenohumeral arthropathy after arthroscopic anterior shoulder stabilization
Section snippets
Methods
Five patients who experienced severe pain with crepitus during motion were referred to our institution for further evaluation after a previous arthroscopic stabilization for traumatic anterior shoulder instability, performed at other hospitals. Subnormal symptoms, including a sharp aching pain and catching sensation, were noticed with increased motion, and the degree of these symptoms increased with time. Cases were reviewed using records of the index surgery, and patients were examined using a
Results
At the initial physical examination in our institution, a marked limited range of motion with a sharp pain and loud crepitus during midrange abduction and rotation occurred. VAS for pain was an average of 1.4 at rest and 7 during motion, and VAS for instability was, on average, 7 for abduction and external rotation. The mean preoperative range of motion was 130° (range, 100° to 170°) of elevation, 30° (range, 20° to 60°) of external rotation, and internal rotation to the spinous process of the
Discussion
The metallic suture anchor is a common device used in the stabilization of shoulder instability, in both open and arthroscopic surgery, and complications from this hardware have been well documented.12 However, the majority of the literature concerns interarticular migration of hardware about the glenohumeral joint. Zuckerman and Matsen9 reported on 37 patients with complications of the glenohumeral joint related to the use of a screw or staple after open surgery. Ten of 37 patients (27%) had
Conclusions
The causative factor for arthropathy after using a metallic suture anchor was presumed to be misplacement of the hardware, which had not been loosened. If a patient complains of unusual symptoms such as sharp pain and catching sensation, or of an unexpected marked motion limitation during early rehabilitation after anchor implantation, the surgeon should consider the possibility of a malpositioned anchor. Clinicians should check radiographs if unexpected symptoms develop and misplacement of a
References (13)
- et al.
Stability
- et al.
Arthroscopic shoulder stabilization with suture anchorsTechnique, technology, and pitfalls
Clin Orthop
(2001) - et al.
Arthroscopic treatment of anterior-inferior glenohumeral instabilityTwo to five-year follow-up
J Bone Joint Surg Am
(2000) - et al.
Comparison of arthroscopic and open anterior shoulder stabilizationA two- to six-year follow-up study
J Bone Joint Surg Am
(2000) - et al.
Two- to five-year follow up of arthroscopic Bankart reconstruction using a suture anchor technique
Am J Sports Med
(1997) Cartilage injuries in the shoulder caused by migration of suture anchors or mini screw
J Shoulder Elbow Surg
(1998)
Cited by (35)
Cyst formation and bony ingrowth inside coil-type open-architecture anchors used for arthroscopic remplissage: a volumetric computed tomographic study of 50 anchors
2023, Journal of Shoulder and Elbow SurgeryCitation Excerpt :A variety of anchors can be used for arthroscopic remplissage, including metallic,19 resorbable,15 and all-suture25 anchors; these anchors have been used successfully with few anchor-related complications.1,16 Metallic anchors in instability surgery are an option from which most surgeons shy away, as chondral lesions associated with malpositioned or exposed anchors can be fearsome.20 The use of absorbable anchors in the humerus has been associated with osteolysis and bone cyst formation in 10%-30% of cases,7,13,17 probably because of a combination of giant cell reaction and synovitis.
Anchor Arthropathy of the Shoulder Joint After Instability Repair: Outcomes Improve With Revision Surgery
2021, Arthroscopy - Journal of Arthroscopic and Related SurgeryPostoperative Stiffness and Pain After Arthroscopic Labral Stabilization: Consider Anchor Arthropathy
2021, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :We found pain (87%) in combination with loss of motion to be the most reliable predictors of anchor arthropathy. Several previous studies have concluded that if a patient complains of pain, stiffness, mechanical symptoms and/or catching sensation, the surgeon should consider implant arthropathy as a possible etiology.8,19 Our study validates this in a larger cohort of 23 patients.
Long-term outcomes of the arthroscopic Bankart repair: a systematic review of studies at 10-year follow-up
2019, Journal of Shoulder and Elbow SurgeryCitation Excerpt :In addition, Aboalata et al1 found that the severity of osteoarthritis was substantially correlated to the number of preoperative dislocations, age of the patient at the time of the initial instability episode and surgery, and number of anchors used. However, Rhee et al28 did not find a direct relationship between arthropathy and misplaced sutures. Further focus and study on the patients who are most at risk of progressive arthropathy and development of strategies to reduce this risk are still needed to improve the long-term outcome of shoulder stabilization surgery and halt progression of instability arthropathy.
Shoulder Arthroscopy
2016, Rockwood and Matsen’s The ShoulderThe painful labral repair
2015, Shoulder and Elbow Trauma and its Complications: The Shoulder: Volume 1