Management of Loose Screw After Rotator Cuff Repair
When encountering a loose screw during rotator cuff repair, use the interference fit technique by inserting a second anchor directly against the loose anchor to create a stable dual-anchor construct. 1
Immediate Intraoperative Management
Primary Technique: Dual-Anchor Interference Fit
- Insert a second 5.0-mm suture anchor directly against the loose anchor to create an interference fit construct 1
- This technique achieved 100% stability in 18 consecutive cases where loose screws were encountered during arthroscopic rotator cuff repair 1
- The dual-anchor interference fit provides the strongest pullout resistance (305 ± 16 N) compared to any single anchor configuration in osteoporotic bone models 1
- All anchors remained stable during knot tying and throughout the procedure with no failures 1
Alternative Single-Anchor Options (If Interference Fit Not Feasible)
If you must use a single anchor replacement, choose in this order of strength:
- 5.5-mm fully threaded anchor (247 ± 12 N pullout strength) 1
- 6.5-mm standard anchor (223 ± 17 N pullout strength) 1
- Standard 5.0-mm anchor is the weakest option (176 ± 13 N) and should be avoided 1
Key Advantages of the Interference Fit Technique
- Provides additional suture pairs for securing the rotator cuff defect, which is particularly valuable given that tendon-suture interface failure is the most common mode of mechanical failure (occurring in 86% of revision cases) 2
- Significantly less cyclic displacement (1.4 mm ± 0.2) compared to larger single anchors 1
- Particularly critical in poor bone quality where anchor purchase is compromised 1
When NOT to Remove the Loose Screw
Do not routinely remove broken or loose screws unless they are causing symptoms 3
- Evidence from syndesmotic screw literature demonstrates that removal of asymptomatic hardware does not improve outcomes and increases infection risk without antibiotic prophylaxis 3
- The same principle applies to rotator cuff repair hardware 3
Critical Technical Principles During Repair
Regardless of anchor configuration chosen:
- Decorticate the bony reattachment site because healing proceeds primarily from bone 4
- Ensure the suture maintains permanent bone-to-tendon contact until healing is complete 4
- Release the cuff adequately to enable reattachment without tension when the elbow is by the side 4
Common Pitfall to Avoid
The weakest link in rotator cuff repairs with suture anchors is the tendon-suture interface, not anchor pullout 2. Therefore, simply replacing a loose anchor with a larger single anchor misses the opportunity to add additional suture pairs that the interference fit technique provides, which directly addresses the most common failure mechanism 2, 1.