Broken or dislodged poly-L-lactic acid bioabsorbable tacks in patients after SLAP lesion surgery.
OBJECTIVE
To document the complication of bioabsorbable poly-L-lactic acid (PLLA) tack breakage and repair failure after arthroscopic stabilization of SLAP lesions.


METHODS
Six patients (average age, 38 years) were referred to the senior author because of persistent postoperative pain and disability after arthroscopic stabilization of an unstable SLAP lesion was performed with bioabsorbable PLLA tacks. A total of eight tacks were used in the six patients, and the time from index procedure to evaluation at our facility averaged 9.5 months (range, 8 to 12 months). Three patients experienced an identifiable reinjury an average of 4 months after the index procedure was performed. Magnetic resonance imaging (MRI) revealed a broken or dislodged tack in all cases. All patients were taken to the operating room for arthroscopic evaluation of the biceps anchor, tack fragment removal, and restabilization of the SLAP lesion as needed.


RESULTS
At repeat arthroscopy, all shoulders were found to have minimal healing of the SLAP lesion with failure of the bioabsorbable tack. Chondral injury was noted in 2 cases. In all cases, revision SLAP repair was performed with the use of arthroscopic suture repair. At an average follow-up of 14 months (range, 8 to 17 months), all patients reported alleviation of symptoms. Five patients had returned to work with no or minimal symptoms. One patient experienced significant improvement in function and range of motion but did not return to work.


CONCLUSIONS
Bioabsorbable PLLA tack breakage or dislodgement is a potential postoperative complication after SLAP lesions are arthroscopically stabilized. This event may result in postoperative reports of pain or mechanical symptoms. Surgeons who use these devices must be aware of the potential complications when they evaluate postoperative patients with persistent complaints. MRI may be helpful in identifying tack fragments. Subsequent arthroscopy to evaluate biceps anchor healing, remove tack fragments, and restabilize the labral lesion may be indicated.


METHODS
Level IV, case series.
Sassmannshausen
Greg
G
Division of Orthopaedic Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA.
Sukay
Michael
M
Mair
Scott D
SD
D020341:Absorbable Implants; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D001858:Bone Nails / Q000009:adverse effects*; D020878:Device Removal; D004868:Equipment Failure; D006801:Humans; D019344:Lactic Acid; D008279:Magnetic Resonance Imaging; D010149:Postoperative Pain / Q000209:etiology / Q000503:physiopathology; D011091:Polyesters; D011108:Polymers; D012086:Reoperation; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000473:pathology / Q000503:physiopathology; D013536:Suture Techniques; D016896:Treatment Outcome; D014945:Wound Healing; D014947:Wounds and Injuries / Q000601:surgery
D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide)