Sliding or Nonsliding Arthroscopic Knots for Shoulder Surgery: A Systematic Review

Abstract

Background: Knot tying is a crucial component of successful arthroscopic shoulder surgery. It is currently unknown whether sliding or nonsliding techniques result in superior clinical outcomes. Purpose: To assess the clinical outcomes of arthroscopic sliding knot (SK)– versus nonsliding knot (NSK)–tying techniques during arthroscopic shoulder surgery, including rotator cuff repair, Bankart repair, and superior labral anterior-posterior (SLAP) repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of the PubMed, Embase, and Cochrane Library databases was performed using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. All English-language literature published between 2000 and 2018 reporting clinical outcomes utilizing SK- or NSK-tying techniques during rotator cuff repair, Bankart repair, and SLAP repair with a minimum 24-month follow-up was reviewed by 2 independent reviewers. Information on type of surgery, knot used, failure rate, patient satisfaction, and patient-reported outcomes was collected. Patient-reported outcome measures included the Constant-Murley score, Rowe score, and visual analog scale for pain. Study quality was evaluated using the modified Coleman Methodology Score. Results: Overall, 9 studies (6 level 3 and 3 level 4) with a total of 671 patients (mean age, 52.8 years [range, 16-86 years]; 65.7% male; 206 SK and 465 NSK) were included. There were 4 studies that reported on Bankart repair in 148 patients (63 SK and 85 NSK), 3 on SLAP repair in 59 patients (59 SK), and 2 on rotator cuff repair in 464 patients (84 SK and 380 NSK). Also, 6 studies compared knot-tying with knotless techniques (3 Bankart repair studies and 3 SLAP repair studies), while the studies reporting the outcomes of SLAP repair evaluated SK-tying techniques only. The failure rate for Bankart repair was 3.2% (2/63) for SKs and 4.7% (4/85) for NSKs. The failure rate for rotator cuff repair was 2.4% (2/84) for SKs and 6.3% (24/380) for NSKs. The failure rate for SLAP repair was 11.9% (7/59). Because of inconsistencies in outcomes and procedures, no quantitative analysis was possible. The mean modified Coleman Methodology Score for all studies was 65.1 ± 8.77, indicating adequate methodology. Conclusion: The literature on clinical outcomes using SKs or NSKs for shoulder procedures is limited to level 4 evidence. Future studies should be prospective and focus on comparing the use of SKs and NSKs for shoulder procedures to elucidate which arthroscopic knot results in superior clinical outcomes.

No Difference in Recurrent Instability Between Knotted and Knotless Repair Techniques in Arthroscopic Treatment of Isolated Posterior Labral Tears: A Systematic Review

“…There are multiple described techniques for arthroscopic management of posterior labral tears to include the use of suture-based capsulolabral plication to an intact labrum vs glenoid-based anchor fixation. 14 , 15 , 16 Within suture anchor repair, there are both knotted and knotless techniques described, yet there is a paucity of high-level evidence supporting one preferred technique leading to superior clinical outcomes. An ideal arthroscopic implant must withstand the greatest amount of stress early during postoperative recovery while also maintaining a low profile, as well as provide optimal tension for healing and ease of knot tying.…”

“…An ideal arthroscopic implant must withstand the greatest amount of stress early during postoperative recovery while also maintaining a low profile, as well as provide optimal tension for healing and ease of knot tying. 15 , 17 Advantages of traditional knot-tying have been shown to be biomechanically superior ex vivo but are technically challenging and highly dependent on knot security with the risk of migration, loosening, or prominence over time and may also lead to prolonged operative time. 16 , 18 , 19 With the advancement of arthroscopic implants, knotless suture anchors have shown improved efficiency without risk of knot prominence, but at the risk of gap formation and need for retensioning of the repair.…”