Download PDF
Sportverletz Sportschaden 2012; 26(1): 33-38
DOI: 10.1055/s-0031-1281868
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Visualisierung bioresorbierbarer Fadenanker-Implantate mit digitaler Projektionsradiografie und Magnetresonanztomografie

Visualisation of Bioabsorbable Suture Anchors with Digital Projection Radiography and Magnetic Resonance Imaging
H. Steckel
1   MVZ-VITALIS, Orthopädisch-Chirurgisches Zentrum, Berlin
,
A. Krönke
2   Zentrum Radiologie, Universitätsklinikum, Göttingen
,
M. Funke
3   Klinikum Mittelbaden Stadtklinik, Baden-Baden
,
H. Klinger
4   Orthopädische Klinik, Universitätsklinikum, Göttingen
› Author Affiliations
Further Information

Publication History

Publication Date:
29 February 2012 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Hintergrund: Neben metallhaltigen Refixationsankern haben sich in den letzten Jahren zunehmend Anker aus bioresorbierbarem Material in der orthopädischen Chirurgie etabliert. Bei der Beurteilung der postoperativen Situation nach Einbringung von Refixationsankern ergeben sich jedoch diverse Probleme. Das Ziel der vorliegenden Arbeit war es, die Visualisierbarkeit bioresorbierbarer Refixationsanker mit der digitalen Projektionsradiografie und der Magnetresonanztomografie zu untersuchen.

Material und Methoden: Hierfür wurden 10 Mitek-Anker-Panalok® aus Polylaktidsäure in ein Ex-vivo-Tiermodell implantiert. Das Präparat wurde anschließend mit digitaler Projektionsradiografie und MRT untersucht. Die Bildauswertung erfolgte unter Berücksichtigung der Darstellbarkeit des Ankermaterials sowie der angrenzenden ossären Strukturen.

Ergebnisse: In den eingesetzten Untersuchungstechniken waren die durch die Einbringung der Anker resultierenden Knochendefekte abgrenzbar, das Ankermaterial selbst war nicht direkt zu visualisieren.

Schlussfolgerung: Die Ergebnisse unserer Studie zeigen, dass Projektionsradiografie und MRT als Methoden zur Detektion des postoperativen Befunds nur bedingt geeignet sind. Auf den angefertigten Bildern gelingt eine gute Beurteilung der durch die Implantation der Anker resultierenden Knochendefekte. Das Ankermaterial selbst ist aber nicht zu visualisieren. Die bildgebende Darstellung bioresorbierbarer Fadenanker stellt weiterhin eine große Herausforderung dar.

Abstract

Background: During the last few years bioabsorbable suture anchors have become widely established along side metallic suture anchors in orthopaedic surgery. However, there are still some difficulties in evaluating the postoperative situation after implanting bioabsorbable suture anchors. The aim of this study was to examine the visualisation of bioabsorbable suture anchors with digital projection radiography and magnetic resonance imaging.

Materials and Methods: Ten Mitek-Anchor-Panalok® suture anchors made of polylactic acid were implanted in an ex-vivo animal study design. After implantation the specimens were examined with digital projection radiography and MRI. The analysis was performed with regard to the bony defects and the anchor material itself.

Results: With digital projection radiography and MRI, it was possible to detect the bony defects after implantation of the anchors. The anchor material could not be visualised.

Conclusion: The results of this study demonstrate that neither digital projection radiography nor MRI is well suited for the detection of the bioabsorbable suture anchors in the postoperative situation. Whereas the bony defects can be well described, the anchors cannot be directly visualised. The visualisation of bioabsorbable anchors remains a clinical problem in orthopaedic surgery.

Schlüsselwörter

bioresorbierbare Anker - Projektionsradiografie - Magnetresonanztomografie

Key words

bioabsorbable suture anchors - digital projection radiography - magnetic resonance imaging
 

  • Literatur

  • 1 Ambrose CG, Clanton TO. Bioabsorbable implants: Review of clinical experience in orthopedic surgery. Annu Biomed Eng 2004; 32: 171-177
    CrossrefPubMedGoogle Scholar
  • 2 Barber FA, Herbert MA, Coons DA et al. Sutures and suture anchors – Update 2006. Arthroscopy 2006; 22: 1063-1069
    CrossrefPubMedGoogle Scholar
  • 3 Cole BJ, ElAttrache NS, Anbari A. Arthroscopic rotator cuff repairs: an anatomic and biomechanical rationale for different suture-anchor repair configurations. Arthroscopy 2007; 23: 662-669
    CrossrefPubMedGoogle Scholar
  • 4 Fuchs B, Weishaupt D, Zanetti M et al. Fatty degeneration of the muscles of the rotator cuff: Assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 1999; 8: 599-605
    CrossrefPubMedGoogle Scholar
  • 5 Knudsen HB, Gelineck J, Sojberg JO et al. Functional and magnetic resonance imaging evaluation after single-tendon rotator cuff reconstruction. J Shoulder Elbow Surg 1999; 8: 242-246
    CrossrefPubMedGoogle Scholar
  • 6 Bencardino JT, Beltran J, Rosenberg ZS et al. Superior labrum anterior-posterior lesions: diagnosis with MR arthrography of the shoulder. Radiology 2000; 214: 267-271
    CrossrefPubMedGoogle Scholar
  • 7 Chandnani VP, Gagliardi JA, Murnane TG et al. Glenohumeral ligaments and shoulder capsular mechanism: Evaluation with MR arthrography. Radiology 1995; 196: 27-32
    CrossrefPubMedGoogle Scholar
  • 8 Fritzsche S, Thull R, Haase A. Reduction of artifacts in magnetic resonance imaging by using optimized materials for diagnostc devices and implants. Biomed Tech 1994; 39: 42-46
    PubMedGoogle Scholar
  • 9 Sugimoto H, Suzuki K, Mihara KI et al. MR Arthrography of Shoulders after Suture-Ancho Bankart Repair. Radiology 2002  224: 105-111
    PubMedGoogle Scholar
  • 10 Balch OK, Collier MA, DeBault LE et al. Bioabsorbable suture anchor (co-polymer 85/15 D,L lactide/glycolide) implanted in bone: correlation of physical/mechanical properties, magnetic resonance imaging, and histological response. Arthroscopy 1999; 15: 691-708
    CrossrefPubMedGoogle Scholar
  • 11 Herold T, Caro WC, Heers G et al. Abhängigkeit der Artefaktgröße vom Sequenztyp in der MRT-Präparatstudie zur Beurteilung der postoperativen Schulter nach Labrumfixation. Fortschr Röntgenstr 2004; 176: 1296-1301
    PubMedGoogle Scholar
  • 12 Cummings CA, Strickland S, Appleyard RC et al. Rotator cuff repair with bioabsorbable screws; an in vivo and ex vivo investigation. Arthroscopy 2003; 19: 239-248
    CrossrefPubMedGoogle Scholar
  • 13 Ejerhed L, Kartus J, Funck E et al. A clinical and radiographic comparison of absorbable and non-absorbabla suture anchors in open shoulder stabilisation. Knee Surg Sports Traumatol Arthroscopy 2000; 8: 349-355
    CrossrefPubMedGoogle Scholar
  • 14 Speer KP, Warren RF. Arthroscopic shoulder stabilization. A role for biodegradable materials. . Clin Orthop 1993; 291: 67-74
    PubMedGoogle Scholar
  • 15 Steinbeck J, Jerosch J. The open Bankart repair using suture anchors in posttraumatic shoulder instability: 2- to 5-year results. Unfallchirurg 1997; 12: 938- 942
    PubMedGoogle Scholar
  • 16 Kulkarni RK, Pani KC, Neumann C et al. Polylactic acid for surgical implants. Arch Surg 1966; 93: 839-843
    CrossrefPubMedGoogle Scholar
  • 17 Kulkarni RK, Moore EG, Hegyeli AF et al. Biodegradable poly(lactic acid) polymers. J Biomed Mater Res 1971; 5: 169-181
    PubMedGoogle Scholar
  • 18 Kääb MJ, Rahn BA, Weiler A et al. Osseous integration of poly-(L-co-D/L-Lactide) 70/30 and titanium suture anchors: An experimental study in sheep cancellous bone. Injury 2006; 33: 37-42
    PubMedGoogle Scholar
  • 19 Bostman OM. Metallic or absorbable fracture fixation devices: A cost minimization analysis. Clin Orthop 1996; 329: 233-239
    PubMedGoogle Scholar
  • 20 Pister H, Gutwald R, Ordung R et al. A long-term degradation study in vivo. Part 1: Biological results. Biomaterials 1993; 14: 671-677
    CrossrefPubMedGoogle Scholar
  • 21 Tan CK, Guisasola I, Machani B et al. Arthroscopic stabilization of the shoulder: a prospective randomized study of absorbable versus nonabsorbable suture anchors. Arthroscopy 2006; 22: 716-20
    CrossrefPubMedGoogle Scholar
  • 22 Chandnani VP, Yeager TD, DeBerardino T et al. Glenoid labral tears: Prospective evaluation with MRI imaging, MR arthrography, and CT arthrography. AJR 1993; 161: 1229-1235
    PubMedGoogle Scholar
  • 23 Herold T, Caro WC, Heers G et al. Influence of sequence type on the extent of the susceptibility artifact in MRI – a shoulder specimen study after suture anchor repair. Fortschr Röntgenstr 2004; 176: 1296-1301
    PubMedGoogle Scholar
  • 24 Yoo JC, Lee YS, Tae SK et al. Magnetic resonance imaging appearance of a repaired capsulolabral complex after arthroscopic bankart repair. Am J Sports Med 2008; 36: 2310-2316
    CrossrefPubMedGoogle Scholar
  • 25 Gaenslen ES, Satterlee CC, Hinson GW. Magnetic resonance imaging for evaluation of failed repairs of the rotator cuff. J Bone Joint Surg Am 1996; 78: 1391-1396
    PubMedGoogle Scholar