When it comes to reattaching ligaments, tendons, or other soft tissues in the shoulder what works best? Absorbable sutures? Braided or unbraided? Screw-in tacks? Hooked or knotless anchors and tacks? In this report surgeons at The Johns Hopkins University review use of anchors and tacks for shoulder surgery.
The choice of anchors and tacks depends on the type of surgery being done. The authors say surgeons must choose based on the biomechanics and biology of tissue healing. The rate of healing as the soft tissue knits itself back to the bone depends on these two factors.
Results of animal studies show how healing rates vary depending on different devices used to reattach the soft tissues. It takes at least 12 weeks for a secure fixation of the soft tissue to bone. Surgery can fail if movement puts too much stress on the healing tissue.
Researchers are studying animal models and cadavers to find out how much force can be put on a normal tendon before it pulls away from the bone. The second step in this process is to find out the load it takes to pull away repaired tendon at six weeks and then at 12 weeks. Such information will help the surgeon choose the right anchor or tack to repair each injury.
Each type of implant used to reattach soft tissues in the shoulder is reviewed for the surgeon. Rates of healing are listed when known. It’s unclear how long some sutures stay in the shoulder before dissolving. It’s not clear how long the implants need to stay intact for the tissue to heal enough to resist stress. The authors point out there are still many unknowns.