Comparable clinical outcomes using knotless and knot-tying anchors for arthroscopic capsulolabral repair in recurrent anterior glenohumeral instability at mean 5-year follow-up

Abstract

Purpose To compare rates of recurrent instability, revision surgery and functional outcomes following arthroscopic anterior capsulolabral repair for recurrent anterior instability using knot-tying versus knotless suture anchor techniques. Methods Patients who had undergone arthroscopic anterior labrum and capsular repair for recurrent anterior glenohumeral instability using knotless anchors were identiied. Those with minimum 2-year follow-up were matched (1:2) to knot-tying anchor repair patients. Rates of failure and recurrent instability were compared, as well as Visual Analog Scale (VAS), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), University of California Los Angeles (UCLA) and Rowe scores. Results One hundred and two patients (89 males, 13 females) with a mean age of 24.3 ± 9.6 were included. Repair was performed with knotless anchors in 34 and knot-tying anchors in 68 shoulders. At mean follow-up of 4.8 ± 2.5 years, redislocation rates between groups were not signiicantly diferent (knotless anchor: 9% versus knot-tying group: 15%, n.s.), but the knot-tying group showed a higher re-subluxation rate (p = 0.039). 12 (18%) revisions were performed in the knottying group at a mean 2.9 years after surgery and 1 (3%) revision in the knotless anchors group at 1.4 years (n.s.). There was no diference in mean VAS with use (1.3 ± 1.9 versus 0.8 ± 1.

Arthroscopic Bankart repair with knotless suture anchors: A comparison of the permanent and absorbable types

“…[21][22][23][24] Some studies have reported superior outcomes using KSA, but the difference in these series did not reach statistical significance. 23,24 Absorbable anchors were introduced to reduce the complications of implant loosening, migration and articular damage. With absorption over time, they minimise the interference with further revision surgery.…”

“…20 Clinical studies comparing ABR using TSA and KSA have generally revealed comparable outcomes in terms of functional outcomes, recurrence of instability, return to pre-injury level and restriction of range of motion, in particular ER. 21 –24 Some studies have reported superior outcomes using KSA, but the difference in these series did not reach statistical significance. 23,24…”

“…21 –24 Some studies have reported superior outcomes using KSA, but the difference in these series did not reach statistical significance. 23,24…”

“…11,[21][22][23] Recent ABR studies reported recurrence rates between 4% and 11%; our finding of a 9.4% recurrence rate is in concert with these reports. 8,24,32 KSA failure due to migration, loosening, insufficiency or breakage has been reported. 29 We had few incidents of intraoperative anchor breakage of both types without any noticeable predilection for either.…”

Excellent Functional Outcomes and Low Complication Rates Following Knotless Arthroscopic Bankart Repair: A Systematic Review of Clinical and Biomechanical Studies

“…Knot configurations used in knot-tying repair included horizontal mattress, 8 sliding hangman's knot with alternating half-stitches, 9,10 and nonsliding Revo knot with alternating half-stitches. 11 Most knotless anchors used are PEEK (polyether ether ketone) anchors manufactured by Arthrex (Push-Lock) [8][9][10]12 or Depuy (Mitek Bioknotless). 11,13,14 Three case series on knotless repair used metallic knotless anchors manufactured by Depuy.…”