title: Panacryl synovitis: fact or fiction?
abstract: OBJECTIVE
  It has been suggested from anecdotal experience that Panacryl suture (Ethicon, Johnson & Johnson, Westwood, MA) may be responsible for an exaggerated inflammatory response. Our goal was to test the null hypothesis that Panacryl causes aseptic synovitis when used on anchors in the case of arthroscopic Bankart and rotator cuff repair.
  
  
  METHODS
  Retrospective review of the postoperative outcome, specifically looking for clinical criteria that are associated with aseptic synovitis.
  
  
  METHODS
  Eighty-three arthroscopic Bankart and 33 arthroscopic rotator cuff repairs were performed using anchors loaded with Panacryl. The clinical factors associated with synovitis that we assessed were motion, pain, hyperthermia, and swelling.
  
  
  RESULTS
  There was no hyperthermia. Two patients had transient swelling and 10 patients had initial transient postoperative pain. One patient had chronic pain and a second arthroscopy was performed 5 months after the initial procedure, which revealed obvious synovitis. Biopsy examinations were performed and these showed typical foreign-body reaction. Two anterior redislocations occurred after new traumas, 2 failed rotator cuff repairs were observed, due to early active motion, and 2 underwent an open revision repair; synovitis was not observed in any of these cases. After 6 months, the loss of external rotation was a mean of 6.7 degrees (Bankart) and 3.3 degrees (rotator cuff repair). The loss of forward elevation was a mean of 5.8 degrees (Bankart) and of 3.3 degrees (rotator cuff repair).
  
  
  CONCLUSIONS
  In only 1 of 116 cases of arthroscopic repair was there direct evidence of synovitis. Even in the cases undergoing revision surgery, there was no indication that Panacryl caused aseptic synovitis. Clinical course after these repairs appeared to be similar to historical experience using nonabsorbable braided suture material. Failure rates in each series appeared to be more related to new trauma and use of other implants than to Panacryl suture.
  
  
  METHODS
  Level IV.
authors.affiliation: Harvard Shoulder Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: Philippe
authors.initials: P
authors.lastname: Clavert
authors.forename: Jon J P
authors.initials: JJ
authors.lastname: Warner
mesh_terms: D001182:Arthroscopy / Q000009:adverse effects* / Q000379:methods*; D004487:Edema / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D005549:Foreign-Body Reaction / Q000150:complications*; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D008297:Male; D010149:Postoperative Pain; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000601:surgery; D013536:Suture Techniques / Q000009:adverse effects*; D013585:Synovitis / Q000209:etiology*; D016896:Treatment Outcome