Poly-L/D-Lactic Acid Anchors Are Associated With Reoperation and Failure of SLAP Repairs

• Published in: Arthroscopy Vol. 27; no. 10; pp. 1335 - 1340
• Main Authors: Park, Min Jung, M.D., M.M.Sc, Hsu, Jason E., M.D, Harper, Carl, M.D, Sennett, Brian J., M.D, Huffman, G. Russell, M.D., M.P.H
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2011; Elsevier
• Subjects: Absorbable Implants - adverse effects; Adult; Arthroscopy; Biological and medical sciences; Endoscopy; Equipment Failure; Female; Fibrocartilage - injuries; Fibrocartilage - surgery; Follow-Up Studies; Glenoid Cavity; Humans; Investigative techniques, diagnostic techniques (general aspects); Ketones; Lactic Acid; Male; Materials Testing; Medical sciences; Orthopedic surgery; Orthopedics; Polyesters; Polyethylene Glycols; Polymers; Reoperation - statistics & numerical data; Retrospective Studies; Shoulder Joint - injuries; Shoulder Joint - surgery; Smoking - adverse effects; Smoking - epidemiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Suture Anchors - adverse effects; Titanium; Workers' Compensation - statistics & numerical data; Reoperation; Arthroscopy; Orthopedic surgery; Treatment; Endoscopy; Lactic acid; Repair; Failure
• ISSN: 0749-8063; 1526-3231
• DOI: 10.1016/j.arthro.2011.06.021

Purpose This study investigates factors associated with failure and reoperation after glenoid labrum repair. Methods We studied a nonconcurrent cohort of consecutive patients undergoing arthroscopic superior labrum repair at a single institution by 2 fellowship-trained surgeons over a 10-year period. Results There were 348 patients included in this study with a mean age of 33.4 years (95% confidence interval [CI], 32.1 to 35.9) and a mean clinical follow-up of 12.3 months (95% CI, 10.9 to 13.8). The overall reoperation rate was 6.3%, with a revision labrum repair rate of 4.3%. Subsequent surgery and failure after arthroscopic labrum repair were significantly correlated with Workers' Compensation claims (odds ratio [OR], 4.6; P < .001; 95% CI, 1.8 to 11.7), the use of tobacco (OR, 12.0; P = .03; 95% CI, 1.2 to 114.9), and the use of absorbable poly-L/D-lactic acid (PLDLA) anchors (100% correlation, P < .001). The OR for having repeat surgery was 12.7 (95% CI, 4.9 to 32.9; P < .001) with poly-96L/4D-lactic acid (Mini-Revo; Linvatec, Largo, FL) and also increased with the use of poly-70L/30D-lactic acid (Bio-Fastak and Bio-Suturetak; Arthrex, Naples, FL) anchor material ( P = .04) after removal of the patients exposed to poly-96L/4D-lactic acid anchors. The rates of repeat surgery with PLDLA anchors from Linvatec and PLDLA anchors from Arthrex were 24% and 4%, respectively. None of the patients treated with nonabsorbable suture anchors (polyether ether ketone or metallic) returned to the operating room ( P < .001). After we controlled for associated factors in a multivariate analysis, the use of absorbable anchors, in particular poly-96L/4D-lactic acid anchors (OR, 14.7; P < .001), and having a work-related injury (OR, 8.1; P < .001) remained independent factors associated with both repeat surgery and revision superior labrum repair. Conclusions Bioabsorbable PLDLA anchor material led to significantly more SLAP repair failures and reoperations compared with nonabsorbable suture anchors. Our recommendation is that glenoid labrum repairs be performed with nondegradable material and, specifically, that the use of anchors composed of PLDLA material should be avoided. Level of Evidence Level III, retrospective comparative study.