Purpose
To evaluate the biomechanical performance of Bankart repair using 1.8-mm knotless
all-suture anchors in comparison to 1.8-mm knotted all-suture anchors with both simple
and horizontal mattress stitch configurations.
Methods
Thirty fresh-frozen human cadaveric shoulders were dissected to the capsule, leaving
the glenoid and humeral capsular insertions intact. A standardized anteroinferior
labral tear was created and repaired using 3 anchors. A 2 × 2 factorial design was
implemented, with 6 matched pairs randomized between knotless and knotted anchor repairs
and 6 matched pairs randomized into simple and horizontal mattress stitch configurations.
In addition, 6 unpaired shoulders were used to evaluate the native capsulolabral state.
First failure load, ultimate load, and stiffness were assessed. Linear mixed-effects
modeling was used to compare endpoints. Digital image correlation was used to evaluate
capsular strain throughout testing. Failure modes were reported qualitatively.
Results
The knotless all-suture anchor repair showed similar biomechanical strength to the
knotted all-suture anchors for first failure load (coefficient, 142 N; 95% confidence
interval [CI], –30 to 314 N; P = .12), ultimate load (coefficient, 11.1 N; 95% CI, –104.9 to 127.2 N; P = .847), and stiffness (coefficient, 3.4 N/mm2; 95% CI, –14.1 to 20.9 N/mm2; P = .697) when stitch configuration was held constant. No statistically significant
differences were found on comparison of simple and mattress stitch configurations
for first failure load (coefficient, –31 N; 95% CI, –205 to 143 N; P = .720), ultimate load (coefficient, 112 N; 95% CI, –321 to 97 N; P = .291), and stiffness (coefficient, –9.6 N/mm2; 95% CI, –27.3 to 8.1 N/mm2; P = .284) when anchor type was held constant. Specimens with knotless anchors and simple
stitch techniques resulted in lower stiffness compared with the native state (P = .030). The knotless-mattress configuration resulted in significantly lower strain
than the knotted-mattress (P = .037) and knotless-simple (P = .019) configurations and was the only configuration that did not result in a significant
increase in strain compared with the intact specimens (P = .216). Fewer instances of suture slippage (loss of loop security) were observed
with knotless anchors versus knotted anchors (11% vs 30%), and less soft-tissue failure
was observed with the mattress stitch configuration versus the simple stitch configuration
(36% vs 47%).
Conclusions
Knotless and knotted all-suture anchor repairs with simple and mattress stitch configurations
showed similar values of ultimate load, first failure load, and stiffness. However,
the horizontal mattress stitch configuration proved to decrease capsular strain more
similarly to the native state compared with the simple stitch configuration. Ultimate
load and first failure load for all repairs were similar to those of the native state.
Clinical Relevance
Knotless all-suture anchors have a smaller diameter than solid anchors, can be inserted
through curved guides, and preserve glenoid bone stock. This study presents knotless,
tensionable all-suture anchor repair for labral tears that displays high biomechanical
fixation strength, similar to the native capsulolabral state.
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Article Info
Publication History
Published online: February 10, 2020
Accepted:
January 17,
2020
Received:
July 7,
2019
Footnotes
See commentary on page 1533
The authors report the following potential conflicts of interest or sources of funding: L.L. receives nonfinancial support from Arthrex and has a position at SPRI supported by Arthrex . B.A. has a position at SPRI supported by Arthrex . P.J.M. receives nonfinancial support, receives grant support, and personal fees from Arthrex; receives personal fees from Medbridge and Springer Publishing; and owns stock and stock options in VuMedi. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2020 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: A New Star Is Born—The Knotless All-Suture AnchorArthroscopyVol. 36Issue 6
- PreviewThe development of all-suture anchors has revolutionized the field of orthopaedic surgery. Biomechanically, these anchors have similar or better strength when compared with conventional solid anchors. All-suture anchors allow the suture to be placed in cortical bone tunnels, with a smaller diameter, thus limiting potential iatrogenic damage. To avoid the inconsistencies of knot tying and eliminate knot stacks, knotless all-suture anchors have been increasingly used in arthroscopic surgery. This may reduce the potential risk of knot abrasion, which can lead to soft-tissue or cartilage damage.
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