Purpose
To compare biomechanical and clinical outcomes between knotless and knotted anchors
in arthroscopic labral repair, specifically in (1) Bankart repair, (2) SLAP repair,
(3) posterior labral repair, and (4) remplissage augmentation of Bankart repair.
Methods
MEDLINE, EMBASE, and the Cochrane Library were searched according to the PRISMA (Preferred
Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to find biomechanical
and clinical studies comparing knotted and knotless anchors using the search term
“knotless anchor.”
Results
Overall, 17 studies met inclusion criteria. There were 7 studies evaluating the biomechanical
outcomes, of which 5 found mixed results between knotted and knotless anchors for
arthroscopic Bankart repair, 1 demonstrated a difference for SLAP repair favoring
knotless anchors, and 2 showed no significant difference for Remplissage in terms
of ultimate load-to-failure. Four studies evaluated knotless labral anchors compared
with knotted anchors in patients undergoing arthroscopic Bankart repair with no significant
differences in outcomes reported between the 2 anchor types, except in one study that
found an improved visual analog scale score and a lower recurrence and revision rate
with knotted anchors. Five studies evaluated knotless anchors compared with knotted
anchors in patients undergoing SLAP repair, and none of the included studies found
any significant differences in the patient reported outcome measures or revision rates.
Of the 5 studies comparing operative time, 4 found a reduced time with knotless anchors.
Conclusions
The clinical results show no significant differences in outcomes between knotless
and knotted anchors for labral repair in the shoulder, including Bankart repair, SLAP
repair, and posterior labral repair. However, there was conflicting evidence supporting
knotless or knotted anchors in the biomechanical studies. However, operative times
may be reduced with the use of knotless anchors.
Level of Evidence
III, A Systematic Review of Level II and III studies.
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Article info
Publication history
Published online: December 08, 2020
Accepted:
November 28,
2020
Received:
April 10,
2020
Footnotes
See commentary on page 1322
The authors report the following potential conflicts of interest or sources of funding: L.M.J. reports grants from Arthrex, outside the submitted work. M.V. reports grants from Exactech, outside the submitted work. E.J.S. reports grants and personal fees from Arthrex, grants from CartiHeal and Fidia, personal fees from Flexion Therapeutics, grants from Joint Restoration Foundation and NuTech, personal fees from Organogenesis, and personal fees from Smith & Nephew and Vericel, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2020 by the Arthroscopy Association of North America
