Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

目的

为了评估关节镜下袖套修复术中锚拔的发生率，比较不同方法处理锚拔的效果，并介绍一种新的锚拔技术。

方法

包括1076例使用单行修复技术进行关节镜下肩袖修复的患者。在483例患者中，使用旋入式锚钉进行了肩袖修复，在593例患者中，使用了软锚钉。发生术中锚定拔出时，可以通过伙伴拧紧螺钉，将锚钉插入不同位置，进行骨水泥填充或使用带螺纹的Steinmann销的钢筋锚固来进行管理。普通放射线照相和超声检查可检查锚点的位置和愈合情况。

结果

52例患者在术中或术后经历了锚栓拔除术（分别为48和4例患者）。对于较大的眼泪，女性，老年患者以及术前僵硬（受影响的肩关节主动和被动运动均受限）的患者，更经常观察到锚拔出。对于旋入式锚，手术中有16位患者（3.3％，16/483）拔出，所有操作均使用伙伴螺钉技术进行。对于软锚病例，有32例（5.4％，32/593）发生拔出，并通过在不同位置插入锚（17例），骨水泥隆起（2例）或使用带螺纹的Steinmann销钉进行锚固来解决（13耐心）。3例通过伙伴螺钉固定治疗的患者和2例通过在不同位置插入锚钉的患者在修复后发生了锚钉衰竭。

结论

关节镜转子袖修复术中术中拔除术是一种罕见但繁琐的并发症。已经引入了一些技术来处理这种并发症。相比之下，没有一种技术比其他技术具有压倒性的优势。但是，我们的新技术是使用带螺纹的Steinmann销进行钢筋锚固，这可能是另一种解决方案，因为它可以利用主要锚固部位，结果似乎可以接受。

证据级别III。