Bioabsorbable tacks improve pain, function in rotator cuff tear patients

Though not experienced in the study, concerns remain over possible synovitis reactions as the tacks dissolve.

Performing arthroscopic rotator cuff repairs using bioabsorbable tacks significantly improves shoulder function and range of movement, a prospective study shows.

Bioabsorbable tacks have been used for instability repairs and superior labral anterior-posterior (SLAP) tears, but not traditionally for rotator cuff repairs, the authors noted in the study, published in the journal Arthroscopy.

“I feel that they definitely have a role to play in certain tear types and, if anything, they actually make the surgery a little easier than using suture anchors, although careful attention to technique is essential for good results,” Julie M. McBirnie, FRCS(Orth), lead author of the study, told Orthopedics Today.

Full-thickness cuff tears

McBirnie, an orthopedic surgeon at the Royal Infirmary of Edinburgh in Edinburgh, Scotland, conducted the study with colleagues at the Cleveland Clinic in Ohio. The researchers evaluated the early and midterm results of arthroscopic full-thickness rotator cuff tear repairs performed using Suretac bioabsorbable tacks (Smith & Nephew Endoscopy). The study included 53 patients (38 men and 15 women) with a mean age 51 years and at least 2 years’ follow-up.

Preoperatively, rotator cuff tears averaged 2.5 cm in size, requiring around two tacks for the repair. Ten of the patients had tears larger than 3 cm, and five patients had tears larger than 5 cm, according to the study.

The researchers could not document whether rotator cuffs healed; financial constraints prevented postoperative MRIs or ultrasounds, McBirnie said. “We therefore don’t know how many cuffs were intact at two years because there is evidence that patients with cuff tears can be symptom-free,” she said.

However, patients showed significant improvement in measures of pain and function following surgery (P<.01).

Postoperatively, patients’ average American Shoulder and Elbow Society (ASES) total score improved to 85 points from 33 points at preop. The mean function score increased from 11 points preoperatively to 25 points, and pain scores improved from 6.9 to 1.3 points, according to the study.

The Constant and Murley score averaged 87 points, which included a 12-point pain component, a 38-point range of movement component and a 21-point power component, according to the study.

The researchers identified two early postoperative complications, which included one superficial infection and one allergic reaction to oral anti-inflammatory medications. There was also one late complication, which involved a patient diagnosed with reflex sympathetic dystrophy of the affected hand at six months follow-up. This patient had a type 2 SLAP lesion repaired with a single tack as well as a 4 cm rotator cuff tear repaired with four tacks, according to the study.

Concerns remain

Based on the results, the researchers concluded that arthroscopic repairs using bioabsorbable tacks produce satisfactory results in terms of subjective pain relief and function.

“I don’t think we were surprised at the results because you tend to get a feel of how your patients are doing after surgery and we felt that this technique was working well. We were obviously delighted that the patients in general did well and we didn't have many complications,” McBirnie said.

Despite the significant improvements, the researchers still have some concerns over using bioabsorbable tacks for rotator cuff repairs. The type of tack used in the study has a rapid hydrolysis time of approximately four to six weeks, McBirnie said. “This is the biggest criticism made with regards to these tacks because the general feeling is that the cuff takes months and not weeks to heal. We still do not have clear data, even now, about how long the cuff takes to heal though,” she said.

Another concern involves reports of synovitis reactions to the tacks as they dissolve in the joint, McBirnie noted. “This has been reported by other authors, but we really didn’t see this at all,” she said.

McBirnie added that she tends to use bioabsorbable suture anchors and sutures more frequently than bioabsorbable tacks, “because the complexity of many rotator cuff tears makes using anchors and sutures essential. I use bioabsorbable devices because I dislike leaving metal near the glenohumeral joint.”

For more information:
McBirnie JM, Miniaci A, Miniaci SL. Arthroscopic repair of full-thickness rotator cuff tears using bioabsorbable tacks. Arthroscopy. 2005;21:1421-1427.