What Makes Suture Anchor Use Safe in Hip Arthroscopy? A Systematic Review of Techniques and Safety Profile
Bibliographic record
Abstract
Purpose To perform a systematic review that assesses the current literature on suture anchor placement for the purpose of identifying factors that lead to suture anchor perforation and techniques that reduce the likelihood of complications. It was hypothesized that suture anchor placement in hip arthroscopy would generally be safe, with the exception of the complications of articular cartilage violation and psoas tunnel perforation. Perioperative factors, related to patient, surgeon, and technical variables, may influence the safety of suture anchor insertion. Methods Three databases (PubMed, Ovid MEDLINE, and Embase) were searched, and 2 reviewers independently screened the resulting literature. The inclusion criteria were clinical and biomechanical studies examining the use of suture anchors in hip arthroscopy. The methodologic quality of all included articles was assessed using the Methodological Index for Non-Randomized Studies criteria and the Cochrane risk-of-bias assessment tool. Results are presented according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using descriptive statistics. Results We included 14 studies in this review, comprising 4 case series (491 patients; 56.6% female patients; mean age, 33.9 years), 9 controlled cadaveric or laboratory studies (111 cadaveric hips and 12 synthetic acetabular bone blocks; 42.2% female hips; mean age, 60.0 years) with a mean Quality Appraisal for Cadaveric Studies score of 11, and 1 randomized controlled trial (37 hips; 55.6% female hips; mean age, 34.2 years). Anterior cortical perforation into the psoas tunnel by suture anchors led to pain and impingement of pelvic neurovascular structures. The anterior acetabular positions (3- to 4-o’clock position) had the thinnest bone, smallest rim angles, and highest incidence of articular perforation. Drilling angles from 10° to 20° measured off the coronal plane were acceptable. The midanterior and distal anterolateral portals were used successfully, with 1 study reporting difficulty placing anchors at anterior locations through the distal anterolateral portal. One study showed that curved suture anchor drill guides allow for a better trajectory away from the articular cartilage. Small-diameter (≤1.8-mm) all-suture anchors had a lower in vivo incidence of articular perforation with similar stability and pullout strength to other anchor types in biomechanical studies. Conclusions Suture anchors at anterior acetabular rim positions (3- to 4-o’clock position) should be inserted with caution. Large-diameter (≥2.3-mm) suture anchors increase the likelihood of articular perforation without increasing labral stability. Inserting small-diameter (≤1.8-mm) all-suture anchors from 10° to 20° drilling angles may increase safe insertion angles from all cutaneous portals. Direct arthroscopic visualization, the use of fluoroscopy, distal-proximal insertion, and the use of nitinol wire can help prevent articular violation. Level of Evidence Level IV, systematic review of Level I to IV studies. To perform a systematic review that assesses the current literature on suture anchor placement for the purpose of identifying factors that lead to suture anchor perforation and techniques that reduce the likelihood of complications. It was hypothesized that suture anchor placement in hip arthroscopy would generally be safe, with the exception of the complications of articular cartilage violation and psoas tunnel perforation. Perioperative factors, related to patient, surgeon, and technical variables, may influence the safety of suture anchor insertion. Three databases (PubMed, Ovid MEDLINE, and Embase) were searched, and 2 reviewers independently screened the resulting literature. The inclusion criteria were clinical and biomechanical studies examining the use of suture anchors in hip arthroscopy. The methodologic quality of all included articles was assessed using the Methodological Index for Non-Randomized Studies criteria and the Cochrane risk-of-bias assessment tool. Results are presented according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using descriptive statistics. We included 14 studies in this review, comprising 4 case series (491 patients; 56.6% female patients; mean age, 33.9 years), 9 controlled cadaveric or laboratory studies (111 cadaveric hips and 12 synthetic acetabular bone blocks; 42.2% female hips; mean age, 60.0 years) with a mean Quality Appraisal for Cadaveric Studies score of 11, and 1 randomized controlled trial (37 hips; 55.6% female hips; mean age, 34.2 years). Anterior cortical perforation into the psoas tunnel by suture anchors led to pain and impingement of pelvic neurovascular structures. The anterior acetabular positions (3- to 4-o’clock position) had the thinnest bone, smallest rim angles, and highest incidence of articular perforation. Drilling angles from 10° to 20° measured off the coronal plane were acceptable. The midanterior and distal anterolateral portals were used successfully, with 1 study reporting difficulty placing anchors at anterior locations through the distal anterolateral portal. One study showed that curved suture anchor drill guides allow for a better trajectory away from the articular cartilage. Small-diameter (≤1.8-mm) all-suture anchors had a lower in vivo incidence of articular perforation with similar stability and pullout strength to other anchor types in biomechanical studies. Suture anchors at anterior acetabular rim positions (3- to 4-o’clock position) should be inserted with caution. Large-diameter (≥2.3-mm) suture anchors increase the likelihood of articular perforation without increasing labral stability. Inserting small-diameter (≤1.8-mm) all-suture anchors from 10° to 20° drilling angles may increase safe insertion angles from all cutaneous portals. Direct arthroscopic visualization, the use of fluoroscopy, distal-proximal insertion, and the use of nitinol wire can help prevent articular violation.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.006 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".