Concise Review Bioabsorbable Anchors in Glenohumeral Shoulder Surgery Shane J. Nho, M.D., M.S., LCDR Matthew T. Provencher, M.D., MC, USN, Shane T. Seroyer, M.D., and Anthony A. Romeo, M.D. Abstract: The use of implants to provide glenohumeral soft tissue fixation has changed dramatically over the past few decades, from point tack fixation to metallic suture anchors to bioabsorbable suture anchors. Bioabsorbable suture anchors have largely replaced metallic anchors because of concerns of implant loosening, migration, and chondral injury. Although the safety and efficacy of bioabsorbable anchors has been well documented, there are numerous reports regarding the early failure related to implant bioabsorbable implant breakage or premature degradation. Patients with anchor-related complications generally present with pain and/or stiffness, and the surgeon should have a high index of suspicion if a patient does not progress as expected. Glenohumeral synovitis, glenoid osteolysis, loose bodies, and chondral injury are some of the notable complications that have been reported. Careful attention to proper anchor insertion techniques can limit the potential for complications. Newer materials, such as polyetheretherketone and other composites, have recently been introduced. These materials may address concerns of biocompatibility and material strength, but additional rigorous in vitro and in vivo trials need to be conducted before their use becomes widespread. Key Words: Bioabsorbable anchors—Metallic anchors—Shoulder arthroscopy—Suture anchors. T he suture anchor is arguably the most important innovation in arthroscopic glenohumeral shoul- der surgery. The ability to provide fixation of soft tissue to bone dramatically changed shoulder surgery from open repair to arthroscopic repair techniques. Before the suture anchor, there were a number of devices that attempted to repair the glenoid labrum, including metallic staple capsulorrhaphy, removable rivet capsulorrhaphy, cannulated screw fixation, the transglenoid suture technique, and glenoid tacks. 1 Metallic devices implanted in the glenohumeral joint have historically performed very well. To achieve opti- mal success with metallic anchors, careful attention to proper insertion depth, in an area of adequate glenoid bone stock, and with optimal angle of insertion are all paramount to the prevention of devastating glenohu- meral joint complications. However, metallic anchor mi- gration, loosening, and breakage all have been described, which can result in severe premature degenerative changes of the glenohumeral joint. Because of concerns with metallic devices, a bioabsorbable alternative was first developed with a tack fixation device (Suretac; Smith & Nephew, Andover, MA), which provides point fixation of labral tissue to the glenoid. 2 Suture anchors were introduced thereafter and since then have essen- tially replaced tissue tack devices. 3 EVOLUTION OF SUTURE ANCHOR MATERIALS Metallic suture anchors (G1; DePuy Mitek, Rayn- ham, MA) loaded with simple braided polyester su- tures were the first to be introduced and widely used in From the Section of Shoulder and Elbow Surgery, Division of Sports Medicine, Department of Orthopedic Surgery (S.J.N., S.T.S., A.A.R.), Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois; and the Division of Sports Surgery, Department of Orthopaedic Surgery (M.T.P.), Naval Medical Center San Diego, San Diego, California, U.S.A. The authors report no conflict of interest. Address correspondence and reprint requests to Shane J. Nho, M.D., M.S., Rush University Medical Center, 1725 W Harrison St, Suite 1063, Chicago, IL 60612, U.S.A. E-mail: snho@hotmail.com © 2009 by the Arthroscopy Association of North America 0749-8063/09/xx0x-8454$36.00/0 doi:10.1016/j.arthro.2008.08.018 1 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol xx, No x (Month), 2009: pp xxx ARTICLE IN PRESS