Foreign-body reaction to the bioabsorbable Suretac device

Arthroscopic shoulder stabilization with the bioabsorbable Suretac device ( Acufex Microsurgical, Mansfield, MA) offers some technical advantages compa red with other approaches. However,: in 4 patients (3 men, 1 woman; between 20 and 35 years of age) with 3 SLAP lesions grades 2 and 1 post-traumatic anterior shoulder instability, breakage and early loosening of the Suretac device was observed. All patients complained about shoulder pain and loss o f active and passive motion. The arthroscopic examination revealed a massiv e synovitis without positive cultures. Loose fragments of the Suretac devic e spread in the joint cavity and induced a foreign-body reaction. Histologi cally, there was a massive infiltration of phagocytic cells (histiocytes, m ultinucleated giant cells) and birefringent polymeric particles surrounded by:or within histiocytes and multinucleated giant cells. All patients under went arthroscopic synovectomy. Because of instability, 2 of them required r estabilization. which was performed with suture anchors (Fastak [Arthrex, N aples, FL], Mitek [Mitek Division, Ethicon, Norder-stedt, Germany]). Postop eratively all patients were:pain; free, progressing to full active and pass ive range of motion. Our patients suffered from a mechanical failure rather than from a predisposition to exaggerated inflammatory response. According to this observation, the Suretac device seems to be prone to early failure in patients with SLAP lesions because of its biodegradability.