Novel and reproducible technique coping with intraoperative anchor pullout during arthroscopic rotator cuff repair

To evaluate the incidence of intraoperative anchor pullout during arthroscopic rotator cuff repair, to compare the outcomes of different methods of managing anchor pullout, and to introduce a new technique for anchor pullout.

1076 patients who underwent arthroscopic rotator cuff repair using a single-row repair technique were included. In 483 patients, rotator cuff repair was performed using a screw-in type anchor, and in 593 patients, soft anchors were used. When intraoperative anchor pullout occurred, it was managed by buddy screwing, anchor insertion in a different location, cement augmentation, or by bar anchoring using a threaded Steinmann pin. Plain radiography and sonography were used to check anchor locations and healing.

Fifty-two patients experienced anchor pullout intra- or postoperatively (48 and four patients, respectively). Anchor pullouts were more frequently observed for larger tears, women, older patients, and in patients with preoperative stiffness (limitations of both active and passive movements of the affected shoulder joint). For screw-in type anchors, pullout during surgery occurred in 16 patients (3.3%, 16/483), and all were managed using the buddy screwing technique. For soft anchor cases, pullout occurred in 32 patients (5.4%, 32/593) and was managed by anchor insertion in a different location (17 patients), cement augmentation (two patients), or bar anchoring using a threaded Steinmann pin (13 patients). Three patients managed by buddy screwing and two patients managed by anchor insertion in a different location had anchor failure after repair. Tendon healing at 6 months was observed in 12/16 patients treated by buddy screwing, 11/17 treated by anchor insertion in a different location, 2/2 treated by cement augmentation, and 12/13 treated by bar anchoring with a threaded Steinmann pin.

Intraoperative anchor pullout during arthroscopic rotator cuff repair is an uncommon but cumbersome complication. There are some techniques already introduced to deal with this complication. In comparison, not one technique is overwhelmingly superior to others; however, our new technique which is bar anchoring with a threaded Steinmann pin could be another solution, since it could utilize primary anchor sites and results appear to be acceptable. Level of evidence III.