TY - JOUR
T1 - Biomechanical Studies for Glenoid Based Labral Repairs With Suture Anchors Do Not Use Consistent Testing Methods
T2 - A Critical Systematic Review
AU - Hohmann, Erik
AU - Glatt, Vaida
AU - Tetsworth, Kevin
AU - Paschos, Nikolaos
N1 - Publisher Copyright:
© 2021 Arthroscopy Association of North America
PY - 2022/3
Y1 - 2022/3
N2 - Purpose: The purpose of this systematic review was to investigate variability in biomechanical testing protocols for laboratory-based studies using suture anchors for glenohumeral shoulder instability and SLAP lesion repair. Methods: A systematic review of Medline, Embase, Scopus, and Google Scholar using Covidence software was performed for all biomechanical studies investigating labral-based suture anchor repair for shoulder instability and SLAP lesions. Clinical studies, technical notes or surgical technique descriptions, or studies treating glenoid bone loss or capsulorrhaphy were excluded. Risk of bias (ROB) was assessed with the ROBINS-I tool. Study quality was assessed with the Quality Appraisal for Cadaveric Studies. Heterogeneity was assessed with the I2 statistic. Results: A total of 41 studies were included. ROB was serious and critical in 27 studies, moderate in 13, and low in 1; 6 studies had high quality, 21 good quality, 10 moderate quality, 2 low quality, and 2 very low quality. Thirty-one studies used and 22 studies included cyclic loading. Angle of anchor insertion was reported by 33 studies. The force vector for displacement varied. The most common directions were perpendicular to the glenoid (n = 9), and anteroinferior or anterior (n = 8). The most common outcome measures were load to failure (n = 35), failure mode (n = 23), and stiffness (n = 21). Other outcome measures included load at displacement, displacement at failure, tensile load at displacement, translation, energy absorbed, cycles to failure, contact pressure, and elongation. Conclusion: This systematic review demonstrated a clear lack of consistency in those cadaver studies that investigated biomechanical properties after surgical repair with suture anchors for shoulder instability and SLAP lesions. Testing methods between studies varied substantially with no universally applied standard for preloading, load to failure and cyclic loading protocols, insertion angles of suture anchors, or direction of loading. To allow comparability between studies standardization of testing protocols is strongly recommended.
AB - Purpose: The purpose of this systematic review was to investigate variability in biomechanical testing protocols for laboratory-based studies using suture anchors for glenohumeral shoulder instability and SLAP lesion repair. Methods: A systematic review of Medline, Embase, Scopus, and Google Scholar using Covidence software was performed for all biomechanical studies investigating labral-based suture anchor repair for shoulder instability and SLAP lesions. Clinical studies, technical notes or surgical technique descriptions, or studies treating glenoid bone loss or capsulorrhaphy were excluded. Risk of bias (ROB) was assessed with the ROBINS-I tool. Study quality was assessed with the Quality Appraisal for Cadaveric Studies. Heterogeneity was assessed with the I2 statistic. Results: A total of 41 studies were included. ROB was serious and critical in 27 studies, moderate in 13, and low in 1; 6 studies had high quality, 21 good quality, 10 moderate quality, 2 low quality, and 2 very low quality. Thirty-one studies used and 22 studies included cyclic loading. Angle of anchor insertion was reported by 33 studies. The force vector for displacement varied. The most common directions were perpendicular to the glenoid (n = 9), and anteroinferior or anterior (n = 8). The most common outcome measures were load to failure (n = 35), failure mode (n = 23), and stiffness (n = 21). Other outcome measures included load at displacement, displacement at failure, tensile load at displacement, translation, energy absorbed, cycles to failure, contact pressure, and elongation. Conclusion: This systematic review demonstrated a clear lack of consistency in those cadaver studies that investigated biomechanical properties after surgical repair with suture anchors for shoulder instability and SLAP lesions. Testing methods between studies varied substantially with no universally applied standard for preloading, load to failure and cyclic loading protocols, insertion angles of suture anchors, or direction of loading. To allow comparability between studies standardization of testing protocols is strongly recommended.
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U2 - 10.1016/j.arthro.2021.08.035
DO - 10.1016/j.arthro.2021.08.035
M3 - Review article
C2 - 34506885
AN - SCOPUS:85115973976
SN - 0749-8063
VL - 38
SP - 1003
EP - 1018
JO - Arthroscopy - Journal of Arthroscopic and Related Surgery
JF - Arthroscopy - Journal of Arthroscopic and Related Surgery
IS - 3
ER -