Complications and Return to Activity After Arthroscopic Repair of Isolated Type II SLAP Lesions: A Systematic Review Comparing Knotted Versus Knotless Suture Anchors

Abstract

Background: Superior labral anterior to posterior (SLAP) tears are one of the most common injuries to the shoulder, with the type II variant representing the most frequently encountered subtype. Purpose: To systematically review the literature to better understand outcomes after arthroscopic repair of isolated type II SLAP lesions using knotted versus knotless anchors based on implant number, implant location, patient position, and portal position. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review investigating all studies in the literature between January 2000 and June 2019 reporting on patients undergoing arthroscopic repair for isolated type II SLAP lesions using knotted versus knotless suture anchors was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the PubMed, BIOSIS Previews, SPORTDiscus, PEDro, and Embase databases. Results: A total of 234 patients undergoing isolated arthroscopic repair of type II SLAP lesions using suture anchors were identified, with 76% (179/234) treated using knotted anchors versus 24% (55/234) treated using knotless anchors. Complications were reported in 12% of patients treated using knotted anchors versus no patients treated using knotless anchors ( P = .008). The incidence of complications for knotted anchor repair was not significantly affected by patient position ( P = .22) or portal position ( P = .19). Using multiple regression analysis, we found no significant association with the incidence of complications when analyzing for anchor design ( R 2 = 0.02; P = .06) or anchor position ( R 2 = 0.02; P = .92). No significant difference in return-to-activity timing was appreciated based on anchor type ( P = .28), patient position ( P = .98), or portal position ( P = .97) in patients treated using knotted anchors. Conclusion: Patients treated using knotted anchors were significantly more likely to experience a postoperative complication compared with patients treated using knotless anchors after arthroscopic repair of isolated type II SLAP lesions. Despite the increased incidence of a postoperative complication after knotted anchor fixation compared with knotless anchor fixation, multiple regression analysis showed that anchor design and anchor position were not significantly predictive of the incidence of complications. Given the increasing popularity of knotless anchor fixation, further study on the long-term outcomes after knotless repair for isolated type II SLAP lesions is warranted.

Arthroscopic Labral Repair Using Knotless Suture Anchors in the Setting of a 270° Labral Tear of the Shoulder

“…13 A systematic review by Knapik et al examined a total of 234 patients who underwent arthroscopic repair of isolated type II SLAP lesions and showed patients treated with knotted anchors were significantly more likely to experience postoperative complications than patients treated with knotless anchors. 12 The current literature supports the use of knotless suture anchors as an effective technique to repair glenoid labral tears. However, there is conflicting evidence on the difference in complications and failure rates between knotless and knotted anchor fixation methods along with a paucity in clinical outcomes published on the use of these techniques to repair extensive labral tears.…”

“…examined a total of 234 patients who underwent arthroscopic repair of isolated type II SLAP lesions and showed patients treated with knotted anchors were significantly more likely to experience postoperative complications than patients treated with knotless anchors. 12 …”

“…While knotted all-suture anchors remain widely utilized, recent research has supported the functional equivalence of knotless allsuture anchors which offer the advantage of potentially quicker application, tensionability, with a lower risk of subsequent soft-tissue and cartilage abrasions. [10][11][12][13] Previously, the senior author has described a technique with knotless suture anchor fixation for addressing recurrent posterior shoulder instability. 14 The purpose of this Technical Note is to outline the expanded application of the knotless suture anchor technique to treat a 270 labral tear in order to address multiplanar instability.…”

“…While knotted all-suture anchors remain widely utilized, recent research has supported the functional equivalence of knotless all-suture anchors which offer the advantage of potentially quicker application, tensionability, with a lower risk of subsequent soft-tissue and cartilage abrasions. 10 , 11 , 12 , 13 …”

Limites da artroscopia na instabilidade anterior do ombro

“…Isso parece ser uma alternativa válida sobretudo nas lesões panlabiais nas quais se utiliza muitos implantes e nas lesões do labrum superior para evitar a abrasão do nó contra a cabeça do úmero durante a abdução e rotação lateral. 47 Após a adequada mobilização labial e cruentização do seu leito ósseo, as âncoras devem ser inseridas na face articular da glenoide. 48 Seu posicionamento medial, mais para o colo da glenoide, constitui um erro técnico que predispõe a recidiva da instabilidade.…”