A Comparison of Permanent Anchors Versus Biodegradable Anchors and Tacks for Arthroscopic Shoulder Stabilization

Abstract

To determine the clinical outcomes of arthroscopic stabilization of patients with anterior glenohumeral instability using knotless devices made from 4 different materials. A prospective cohort study was performed on patients who had an arthroscopic anterior shoulder stabilization for unidirectional anterior instability by a single surgeon using one of 4 devices: Suretac resorbable tac made of PGA (n=41), BioKnotless resorbable suture anchor made of PLLA (n=52), the OPUS Labrafix knotless anchor made from stainless steel (n=18), and the Pushloc knotless anchor made from PEEK (n=44). Standardized patient-determined and examiner-determined outcomes were obtained before operation and 6, 12, 24 weeks, and up to 10-year follow-up. Kaplan-Meier analysis for redislocation showed a fall in survival curves from 1 year (90% stable) to 3 years (40% stable) in the Suretac group then a plateau to 10 years; and a fall in stability survivorship for the Bioknotless group from 1 year (90% stable) to 5 years (60% stable). Survivorship curves for the 2 nonresorbable anchors were more encouraging with over 90% stable out to 3 years (Pushloc) and 4 years (Labrafix) (P<0.001). Arthroscopic stabilization for traumatic anterior instability leads to excellent outcomes when using nonresorbable knotless devices (6% and 5% recurrence at 3 to 5 y). The resorbable suture anchors and tacs in this study showed a higher recurrence rate (40% and 60%, respectively) at 5 years.