Purpose
This study compared the status of suture knots immediately after repair and after
shoulder motion to evaluate the possibility of movement-induced knot migration to
a location nearer the glenoid.
Methods
We included 10 shoulders from 5 cadavers in the study. After posterior capsulotomy,
a Bankart lesion was created. A capsulolabral repair was then performed with 3 knot-tying
suture anchors. All knots were positioned on the capsular side, far from the articular
surface. After the repair was complete, a photograph was taken with a metal rod placed
to reference absolute distance. After passive pendulum motion was applied, another
photograph was taken. The length of the suture strand from the knot base to the anchor
insertion site was measured during both the initial repair and post-motion periods.
Results
Initial distances were 4.83 ± 1.09 mm for the inferior knot, 4.70 ± 0.97 mm for the
middle knot, and 3.84 ± 1.25 mm for the superior knot. After motion, the distances
were 3.52 ± 1.21 mm (P = .01), 3.07 ± 0.81 mm (P < .001), and 2.69 ± 1.18 mm (P = .016), respectively. Additional observations showed changes in direction and security
of the knot. The change in knot direction from an initial orientation facing the capsular
side to a new orientation facing the glenoid was observed in 5 of 10 inferior, 7 of
10 middle, and 6 of 10 superior knots. In addition, knot loosening was noted for the
last half-hitches in 4 inferior knots and 1 middle knot.
Conclusions
Intentional placement of suture knots away from the joint surface was not maintained
after motion at the shoulder.
Clinical Relevance
Movement-induced knot migration may be detrimental to articular cartilage in the event
that a knot becomes interposed between the glenoid and humeral head.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A knotless suture anchor. Design, function, and biomechanical testing.Am J Sports Med. 2001; 29: 646-649
- Restoring the labral height for treatment of Bankart lesions: A comparison of suture anchor constructs.Arthroscopy. 2010; 26: 587-591
- Biomechanical comparison of knotless anchor repair versus simple suture repair for type II SLAP lesions.Arthroscopy. 2009; 25: 1085-1092
- Incorporating evidence-based medicine in arthroscopic knot preferences: A survey of American Orthopaedic Society for Sports Medicine members.Am J Orthop (Belle Mead NJ). 2010; 39: 577-581
- A biomechanical analysis of anterior Bankart repair using suture anchors.Am J Sports Med. 2010; 38: 1405-1412
- Optimization of stacked half-hitch knots for arthroscopic surgery.Arthroscopy. 2001; 17: 752-759
- Arthroscopic knot tying.in: Angelo R.L. Esch J.C. Ryu R.K.N. AANA advanced arthroscopy: The shoulder. Ed 1. Saunders/Elsevier, Philadelphia2010: 44-52
- Arthroscopic treatment of traumatic anterior shoulder instability.in: Angelo R.L. Esch J.C. Ryu R.K.N. AANA advanced arthroscopy: The shoulder. Ed 1. Saunders/Elsevier, Philadelphia2010: 106-113
- Arthroscopic treatment of shoulder instability.in: Ed 4. The shoulder. Vol 2. Saunders/Elsevier, Philadelphia2009: 940-960
- In vitro comparison of standard and Knotless metal suture anchors.Arthroscopy. 2004; 20: 517-520
- Modes of failure of knotted and knotless suture anchors in an arthroscopic Bankart repair model with the capsulolabral tissues intact.Am J Orthop (Belle Mead NJ). 2011; 40: 134-138
- Clinical and radiologic outcomes of arthroscopic glenoid labrum repair with the BioKnotless suture anchor.Am J Sports Med. 2009; 37: 2340-2348
- No difference between knotless sutures and suture anchors in arthroscopic repair of Bankart lesions in collision athletes.Knee Surg Sports Traumatol Arthrosc. 2009; 17: 844-849
- Arthroscopic Bankart repair using knotless or BioKnotless suture anchors: 2- to 7-year results.Arthroscopy. 2007; 23: 367-375
- Clinical results of arthroscopic Bankart repair with knot-tying and knotless suture anchors.Arthroscopy. 2006; 22: 1276-1282
- Osteolysis and arthropathy of the shoulder after use of bioabsorbable knotless suture anchors. A report of four cases.J Bone Joint Surg Am. 2006; 88: 1840-1845
- Use of bioabsorbable knotless suture anchors and associated accelerated shoulder arthropathy: Report of 3 cases.Am J Sports Med. 2009; 37: 1429-1433
Article info
Publication history
Published online: January 14, 2013
Accepted:
October 15,
2012
Received:
April 3,
2012
Footnotes
The authors report the following source of funding: Grant-in-Aid No. 0620112910 for Seoul National University Hospital. The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
