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Comparable clinical outcomes using knotless and knot-tying anchors for arthroscopic capsulolabral repair in recurrent anterior glenohumeral instability at mean 5-year follow-up

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To compare rates of recurrent instability, revision surgery and functional outcomes following arthroscopic anterior capsulolabral repair for recurrent anterior instability using knot-tying versus knotless suture anchor techniques.

Methods

 Patients who had undergone arthroscopic anterior labrum and capsular repair for recurrent anterior glenohumeral instability using knotless anchors were identified. Those with minimum 2-year follow-up were matched (1:2) to knot-tying anchor repair patients. Rates of failure and recurrent instability were compared, as well as Visual Analog Scale (VAS), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), University of California Los Angeles (UCLA) and Rowe scores.

Results

One hundred and two patients (89 males, 13 females) with a mean age of 24.3 ± 9.6 were included. Repair was performed with knotless anchors in 34 and knot-tying anchors in 68 shoulders. At mean follow-up of 4.8 ± 2.5 years, re-dislocation rates between groups were not significantly different (knotless anchor: 9% versus knot-tying group: 15%, n.s.), but the knot-tying group showed a higher re-subluxation rate (p = 0.039). 12 (18%) revisions were performed in the knot-tying group at a mean 2.9 years after surgery and 1 (3%) revision in the knotless anchors group at 1.4 years (n.s.). There was no difference in mean VAS with use (1.3 ± 1.9 versus 0.8 ± 1.5, n.s.), SANE scores (91.8 ± 12.7 versus 92.0 ± 11.0, n.s.), QuickDASH scores (4.1 ± 5.5 versus 3.0 ± 6.5, n.s.), UCLA Shoulder Score (32.5 ± 3.6 versus 33.2 ± 3.1, n.s.), or Rowe scores (90.5 ± 18.5 versus 92.2 ± 16.6, n.s.) between knotless and knot-tying groups, respectively. VAS at rest was higher in the knotless group (0.7 ± 1.5 vs 0.1 ± 0.4, p = 0.021).

Conclusions

Knotless anchors demonstrated similar rates of re-dislocation and revision surgery, and lower rates of recurrent subluxation, compared to knot-tying anchors. Patients achieved good-to-excellent functional outcomes. This supports the efficacy of knotless anchors as an alternative to knot-tying anchors for arthroscopic anterior labral repair of recurrent anterior shoulder dislocation.

Level of evidence

III.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA

    Isabella T. Wu, Vishal S. Desai, Devin R. Mangold, Christopher L. Camp, Jonathan D. Barlow MD, MS, Joaquin Sanchez-Sotelo, Diane L. Dahm & Aaron J. Krych

Authors
  1. Isabella T. Wu
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  2. Vishal S. Desai
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  3. Devin R. Mangold
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  4. Christopher L. Camp
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  5. Jonathan D. Barlow MD, MS
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  6. Joaquin Sanchez-Sotelo
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  7. Diane L. Dahm
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  8. Aaron J. Krych
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Contributions

All eight authors listed on this manuscript met the ICMJE criteria for authorship as follows: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Specifically: ITW: data curation; formal analysis; investigation; methodology; validation; writing—original draft; writing—review and editing, VSD: data curation; formal analysis; investigation; methodology; validation; writing—original draft; writing—review and editing, DRM: data curation; formal analysis; investigation; methodology; project administration; resources; validation; writing—review and editing, CLC: conceptualization; formal analysis; investigation; methodology; resources; supervision; validation; writing—review and editing, JDB: formal analysis; investigation; methodology; resources; supervision; validation; writing—review and editing, JSS: formal analysis; methodology; project administration; resources; supervision; validation; writing—review and editing, DLD: conceptualization; formal analysis; methodology; project administration; resources; supervision; validation; writing—review and editing, AJK: conceptualization; formal analysis; investigation; methodology; project administration; resources; supervision; validation; writing—original draft; writing—review and editing.

Corresponding author

Correspondence to Aaron J. Krych.

Ethics declarations

Conflict of interest

I.T.W., V.S.D, D.R.M., and C.L.C. have no disclosures. J.D.B. is a paid consultant for Stryker. J.S. is a paid consultant for Wright Medical Technology and Exactech; editorial board member for Journal of Orthopaedics and Traumatology, Journal of Shoulder and Elbow Arthroplasty, and Journal of Shoulder and Elbow Surgery; board or committee member of American Shoulder and Elbow Surgeons and Acumed; receives publishing royalties, financial or material support from Journal of Shoulder and Elbow Surgery, Elsevier, and Oxford University Press; IP royalties from Stryker; and is a paid presenter for Acumed, Styker, and Wright Medical Technology. D.L.D. is a board or committee member of American Orthopaedic Society for Sports Medicine and NBA/GE Strategic Advisory Board; receives research support from Arthrex, Inc; and spouse owns stock or stock options and receives royalties from Tenex Health, Inc and Sonex Health, LLC. A.J.K. is a paid consultant for Arthrex, JRF Ortho, and Vericel; board or committee member of International Cartilage Repair Society, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, Minnesota Orthopedic Society, and Musculoskeletal Transplantation Foundation; editorial or governing board member of American Journal of Sports Medicine; and receives research support from Aesculap/B.Braun, Arthrex, Arthritis Foundation, Ceterix, and Histogenics.

Funding

No external or internal funding was used for this investigation.

Ethical approval

The study was approved by the Institutional Review Board.

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Wu, I.T., Desai, V.S., Mangold, D.R. et al. Comparable clinical outcomes using knotless and knot-tying anchors for arthroscopic capsulolabral repair in recurrent anterior glenohumeral instability at mean 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 29, 2077–2084 (2021). https://doi.org/10.1007/s00167-020-06057-7

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