title: MRI graduation of osseous reaction and drill hole consolidation after arthroscopic Bankart repair with PLLA anchors and the clinical relevance.
abstract: OBJECTIVE
  Conventionally, radiography studies revealed prolonged glenoidal drill hole visibilities with an unclear influence to the clinical outcome after arthroscopic Bankart repair using Poly-Laevo-Lactic-Acid (PLLA) anchors. The primary aim of the present study was the separated assessment of drill hole consolidation (DHC) and the concomitant osseous reaction (OR) of the glenoidal bio-degradation process in new specific magnetic resonance grading systems. In accordance with the specific DHC and the OR graduation, the clinical relevance was the secondary focus.
  
  
  METHODS
  Twenty-eight patients with arthroscopic Bankart repair using knotless PLLA anchors were prospectively followed and analyzed using a clinical scoring system (3, 6, 15 and 32 months). The T2-weighted OR and T1-weighted DHC were assessed using specific magnetic resonance imaging grading protocols (15 and 32 months).
  
  
  RESULTS
  Longitudinal assessments revealed successive clinical status improvements over time (32 months: Rowe 95.7 ± 3.8; Walch-Duplay 93.8 ± 6.6; Constant 93.9 ± 4.5; ASES 93.8 ± 6.9; DASH 28.6 ± 7.2; NAS(pain) 1.1 ± 1.3; NAS(function) 1.3 ± 1.4). The initial OR level regressed over the 15-32 month period while the DHC showed significant drill hole reductions (P < 0.05). The inferior glenoid revealed a significantly increased bio-degradation capacity (P < 0.05) with drill hole enlargements in 14.3%. Neither the OR nor the drill hole enlargements influenced the clinical status. In no case were clinical or radiologic signs for a foreign body reaction.
  
  
  CONCLUSIONS
  Knotless bio-anchors provide secure glenoidal fixation for Bankart repair without any specific clinical or MR evidence of an inflammatory response. The clinical status remained unaffected by the bio-degradation process.
  
  
  METHODS
  IV.
authors: Department of Sporttraumatology-Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany. thomas.stein@gmx.ch
authors: T
authors: T
authors: Stein
authors: A P
authors: AP
authors: Mehling
authors: M
authors: M
authors: Ulmer
authors: C
authors: C
authors: Reck
authors: T
authors: T
authors: Efe
authors: R
authors: R
authors: Hoffmann
authors: A
authors: A
authors: Jäger
authors: F
authors: F
authors: Welsch
mesh_terms: D020341:Absorbable Implants; D001182:Arthroscopy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D019344:Lactic Acid / Q000031:analogs & derivatives; D008279:Magnetic Resonance Imaging; D016348:Osseointegration; D010000:Osteitis / Q000145:classification / Q000473:pathology*; D010147:Pain Measurement; D011108:Polymers; D011446:Prospective Studies; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000473:pathology / Q000601:surgery*; D053441:Suture Anchors / Q000009:adverse effects*
chemical_list: D011108:Polymers; C445939:polylevolactic acid; D019344:Lactic Acid