Impingement syndrome of the shoulder following double row suture anchor technique for arthroscopic rotator cuff repair: a case report
© Rambani and Hackney; licensee Cases Network Ltd. 2009
Received: 27 September 2008
Accepted: 12 March 2009
Published: 12 June 2009
Arthroscopic repair of the rotator cuff is a demanding surgery. Accurate placement of anchors is key to success.
A 38-year-old woman received arthroscopic repair of her rotator cuff using a double row suture anchor technique. Postoperatively, she developed impingement syndrome which resulted from vertical displacement of a suture anchor once the shoulder was mobilised. The anchor was removed eight weeks following initial surgery and the patient had an uneventful recovery.
Impingement syndrome following arthroscopic repair of the rotator cuffs using double row suture anchor has not been widely reported. This is the first such case where anchoring has resulted in impingement syndrome.
Arthroscopic repair of a rotator cuff tear is a demanding technique. Arthroscopic repairs of rotator cuff tears have become more popular than open or mini-open repairs [1, 2]. The use of double row suture anchor technique has become the standard technique among many arthroscopic shoulder surgeons . Recent reports have suggested high percentages of good to excellent results even for large or massive tears with 1-3 years follow up. But the literature is still not clear about the long-term results comparing open repairs with arthroscopic repairs [2, 4]. The influence of the repair technique on the failure rates and functional outcomes after open or arthroscopic rotator cuff repair remains controversial .
Acute impingement syndrome following rotator cuff repair has been reported to occur due to heterotopic ossification . There have been no reports of acute impingement syndrome resulting from arthroscopic repair of rotator cuff from a suture anchor.
The main causes of postoperative shoulder pain include frozen shoulder , failure of repair , reflex sympathetic dystrophy  and subcoracoid impingement syndrome . Many papers have discussed the readmission and reoperation rate after rotator cuff repairs  but the incidence of subacromial impingement is not documented in patients with no impingement preoperatively or intra-operatively.
The shoulder's subacromial space is of significant clinical interest due to its association with rotator cuff disease. Recent trials have suggested that subacromial decompression did not seem to significantly affect the outcome of arthroscopic rotator cuff repair on shorter follow-ups . Post-operative diagnosis is usually inconclusive using ultrasonography when postoperative impingement is suspected because of inflammatory changes in the subacromial space because of surgery.
The introduction of rotator cuff MITEK anchors brought forth a fairly exclusive procedure for refixation of rotator cuff ruptures . The reinsertion of the rotator cuff to their bony footprints has been suggested to have stronger and quicker healing [11, 12]. Bay et al. reported an in vivo increase in subacromial space after rotator cuff repair .
Impingement syndrome due to Quick-T suture anchors has not been reported in the literature. We report an interesting and unusual case of impingement syndrome following double row suture anchor technique.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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