Clinical Results of Arthroscopic Bankart Repair with Knot-Tying and Knotless Suture Anchors

Su Cho N, Lubis AMT, Han Ha J, Rhee YG.
Arthroscopy: The Journal of Arthroscopic and Related Surgery. 2006;22(12):1276-1282.

The goal of a Bankart repair is to restore the normal anatomical attachment of the capsulo-labral ligaments to the anterior/inferior glenoid rim following shoulder dislocations. If the repair is performed adequately then the shoulder results in a stable and painless shoulder. An arthroscopic suture anchor repair can produce identical clinical results to those of an open procedure.

Arthroscopic knot-tying anchors can be technically difficult for some and can increase operating times. Knotless anchors were therefore developed to overcome these issues, however some authors have suggested that knotless anchors can weaken the quality of the repair and lead to recurrence of shoulder instability.

There are no studies comparing the clinical results of these two types of anchors. This paper studied the difference in outcome between a knotless (Knotless anchor,Mitek,Norwood,MA) and a knot-tying anchor (Linvatec,Largo,FL). All the procedures were performed by one surgeon and a total of 82 subjects were retrospectively followed up (61 knot-tying and 21 knotless).All patients were followed up for at least 24 months and scored with:VAS (visual ana

logue), Constant-Murley and Rowe scores. This unique analysis demonstrated an improvement in postoperative shoulder scores compared to the preoperative conditions. There was no difference in postoperative limitation of motion between the two groups. The knot-tying group had significantly better results than the knotless group in terms of postoperative pain (p=0.007), patient satisfaction score (p=0.007) and a significantly lower redislocation rate (4.9 % compared to 23.8 %).

The authors discuss the mechanical weaknesses of knotless anchors but a longer follow up and a larger number in the knotless group may allow a better evaluation of knotless anchors.


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