Bone Response to Suture Anchor Classification Training Document

Health & Medicine

Training document for grading
suture anchors
Haseem Raja
Professor Bhatti

Proposed grading system by Bhatti and Ahmed

Grading system
Grade 0
• Normal high signal T1W
• Uniformly low signal pdfat
sat
Tibia
Cor T1W
Cor Pdfs
Humerus Glenoid
Humerus Glenoid

Grading system
Grade 0
• Normal high signal T1W
• Uniformly low signal pdfat
sat
Tibia
Cor T1W
Cor Pdfs

Grading system
Grade I
• T1- Normal
• T2 FS/STIR Minimal bony
oedema
Tibia
Cor T1W
Cor Pdfs
Humerus Glenoid
Humerus Glenoid

Grading system
Grade 2
• T1- Patchy low
• T2 FS/STIR Mild bony
oedema
Tibia
Cor T1W
Cor Pdfs
Humerus Glenoid
Humerus Glenoid

Grading system
Grade 3
• T1- Low
• T2 FS/STIR Bony oedema
and cystic change
Tibia
Cor T1W
Cor Pdfs
Humerus Glenoid
Humerus Glenoid

Grading system
Grade 4
• T1- Larger region of low
signal
• T2 FS/STIR Fluid surround
anchor Tibia
Cor T1W
Cor Pdfs
Humerus Glenoid
Humerus Glenoid

Significance
Normal
Post surgical
change
Upto 6 months
Potential
unstable

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Presentation at ISAKOS, 2019 There were 442 primary arthroscopic labral repair procedures performed over the three-year period. The total cohort had a mean age of 25.91±9.09 years (range, 14-67 years) and consisted of 89.6% males. There was no significant difference in mean age or gender between the isolated anterior, posterior or combined groups (p=0.383 and p=0.541, respectively). • Of the 442 patients who underwent a shoulder labral repair, isolated anterior labral pathology occurred in 52.9% (n=234), with posterior and combined labral tears accounting for 16.3% (n=72) and 30.8%, respectively (n=136) (Table 3). • Patients were stratified as either sporting or non-sporting; 74.9% of patients were categorised as sporting (n=331) and had a mean age of 24.91±5.69 years, which was significantly lower than the mean age of 35.40±11.94 years in the non-sporting population (p<0.001). In the non-sporting population 68.5% (n=76) of patients had isolated anterior labral tears with 12.6% (n=14) posterior and 18.9% (n=21) combined. In the sporting population isolated anterior labral tears accounted for 47.7% (n=158), posterior 17.5% (n=58) and combined labral tears 34.7% (n=115). The sporting population had a significantly greater proportion of posterior and combined labral tears with the non-sporting population a significantly greater proportion of anterior labral tears (p=0.013). • Rugby players had the greatest incidence of shoulder instability within the sporting cohort accounting for 231 cases. Of the 231 cases, 47.2% were isolated anterior labral tears, 12.6% isolated posterior and 40.3% combined lesions. Posterior and combined shoulder labral tears are more prevalent than previously reported in the civilian population. The rates are higher in young, sporting populations and especially in contact sports such as rugby.

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Presentation at ISAKOS, 2019 We performed a total of 142 pectoralis major repairs over a ten year period, of which 19 required allograft reconstruction. Of these 19 patients, 11 were available for response. All 11 patients were male with a mean age of 38.3 years (21 to 48 years). The mean time between injury and surgery was 12.2 months (4 to 30 months). Ten patients (91%) were unable to perform their previous level of work pre-operatively, with all patients returning to pre-injury occupation levels post-operatively. The main complaint prior to surgery was pain on pushing and moving the affected arm across the body, which improved in nine patients (82%), with no improvement reported in two patients. Strength improved significantly post-operatively, with only three patients reporting no improvement (paired t-test p=0.01). Six patients reported an improvement in cosmesis (50%).

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Hydrodistention is a treatment for frozen shoulder (FS) that is gaining popularity again. However, no large, long-term outcome data has been published yet. Our aims were to evaluate hydrodistension for the treatment of primary frozen shoulder (FS) in a large cohort of patients with long follow-up period. We present a case series of eighty-nine patients (36 males and 53 females) with a mean age of 52 years (33-73). Eleven (12.4%) had disease associations. We excluded post-operative secondary stiff shoulders. The mean volume injected was 33.7ml (16-66). 36/89 (40%) had capsular rupture. Six (6.7%) had adverse effects. The mean follow-up was 104.5 weeks (8-238). Mean improvement in forward flexion was 165.4, abduction 111.6, external rotation was hand above head with elbow back (and internal rotation in extension to T12. Mean improvement in quickDASH score was 17.1 (p<0.001) and Constant Score was 70.0 (p<0.001). Mean improvement in VAS was 7.3 (p<0.001). No patients had night pain (p<0.001). Eighty-eight (99%) returned to their previous occupation. Seventy-six (85%) returned to their previous level of sport. Gender, previous intra-articular steroid injection, volume of the injectate, type of steroid used, capsular rupture and underlying aetiology had no impact on outcome.

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Adolescents are neither children, nor adults. The ages 12 to 18 years are a time of rapid growth and body changes. These vary significantly between individuals. At the same time the the intensity and pressures of competitive sport are increasing in this age group. This is the time when athletes are competing for school, clubs and national level. It is also the time when they are being scouted and signed for professional contracts. In my practice of 15 years so far, I have seen large changes in the pattern, frequency, intensity and complexity of shoulder injuries in adolescent contact athletes. We have studied this over the years and in this lecture I will present our data showing the increasing frequency and complexity over the years, as well as the difficult diagnosis and decision-making processes. I will also present our published outcomes of surgical management and question the future of managing this key group of athletes.

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Suture anchors are routinely used for shoulder labral reconstruction procedures. There is paucity of literature on how the response of bone to suture anchor should be measured following labral reconstruction. A new system, based on the use of magnetic resonance (MR) imaging, has been developed by Professor Bhatti and his trainee which grades bone signal changes around suture anchors using a five-point scale. This system, however, has not yet been tested on a clinical dataset. We tested the reliability of the grading system in an independent dataset. This validation study demonstrates that the grading system is feasible and has generally moderate reliability. And, although results could be improved if a training document is added at the beginning of the study, this grading system should undergo further validation testing for use in clinical trials.

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