Bone Response to Suture Anchor Classification Training Document

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Lennard Funk

Health & Medicine

Training document for grading
suture anchors
Haseem Raja
Professor Bhatti

Proposed grading system by Bhatti and Ahmed

Grading system
Grade 0
• Normal high signal T1W
• Uniformly low signal pdfat
sat
Tibia
Cor T1W
Cor Pdfs
Humerus Glenoid
Humerus Glenoid

Grading system
Grade 0
• Normal high signal T1W
• Uniformly low signal pdfat
sat
Tibia
Cor T1W
Cor Pdfs

Grading system
Grade I
• T1- Normal
• T2 FS/STIR Minimal bony
oedema
Tibia
Cor T1W
Cor Pdfs
Humerus Glenoid
Humerus Glenoid

Grading system
Grade 2
• T1- Patchy low
• T2 FS/STIR Mild bony
oedema
Tibia
Cor T1W
Cor Pdfs
Humerus Glenoid
Humerus Glenoid

Grading system
Grade 3
• T1- Low
• T2 FS/STIR Bony oedema
and cystic change
Tibia
Cor T1W
Cor Pdfs
Humerus Glenoid
Humerus Glenoid

Grading system
Grade 4
• T1- Larger region of low
signal
• T2 FS/STIR Fluid surround
anchor Tibia
Cor T1W
Cor Pdfs
Humerus Glenoid
Humerus Glenoid

Significance
Normal
Post surgical
change
Upto 6 months
Potential
unstable

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Hydrodistention is a treatment for frozen shoulder (FS) that is gaining popularity again. However, no large, long-term outcome data has been published yet. Our aims were to evaluate hydrodistension for the treatment of primary frozen shoulder (FS) in a large cohort of patients with long follow-up period. We present a case series of eighty-nine patients (36 males and 53 females) with a mean age of 52 years (33-73). Eleven (12.4%) had disease associations. We excluded post-operative secondary stiff shoulders. The mean volume injected was 33.7ml (16-66). 36/89 (40%) had capsular rupture. Six (6.7%) had adverse effects. The mean follow-up was 104.5 weeks (8-238). Mean improvement in forward flexion was 165.4, abduction 111.6, external rotation was hand above head with elbow back (and internal rotation in extension to T12. Mean improvement in quickDASH score was 17.1 (p<0.001) and Constant Score was 70.0 (p<0.001). Mean improvement in VAS was 7.3 (p<0.001). No patients had night pain (p<0.001). Eighty-eight (99%) returned to their previous occupation. Seventy-six (85%) returned to their previous level of sport. Gender, previous intra-articular steroid injection, volume of the injectate, type of steroid used, capsular rupture and underlying aetiology had no impact on outcome.

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Adolescents are neither children, nor adults. The ages 12 to 18 years are a time of rapid growth and body changes. These vary significantly between individuals. At the same time the the intensity and pressures of competitive sport are increasing in this age group. This is the time when athletes are competing for school, clubs and national level. It is also the time when they are being scouted and signed for professional contracts. In my practice of 15 years so far, I have seen large changes in the pattern, frequency, intensity and complexity of shoulder injuries in adolescent contact athletes. We have studied this over the years and in this lecture I will present our data showing the increasing frequency and complexity over the years, as well as the difficult diagnosis and decision-making processes. I will also present our published outcomes of surgical management and question the future of managing this key group of athletes.

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Suture anchors are routinely used for shoulder labral reconstruction procedures. There is paucity of literature on how the response of bone to suture anchor should be measured following labral reconstruction. A new system, based on the use of magnetic resonance (MR) imaging, has been developed by Professor Bhatti and his trainee which grades bone signal changes around suture anchors using a five-point scale. This system, however, has not yet been tested on a clinical dataset. We tested the reliability of the grading system in an independent dataset. This validation study demonstrates that the grading system is feasible and has generally moderate reliability. And, although results could be improved if a training document is added at the beginning of the study, this grading system should undergo further validation testing for use in clinical trials.

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