Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 9, pp 1273–1285 | Cite as

Outcome of arthroscopic SLAP repair using knot-tying-suture anchors compared with knotless-suture anchors in athletes

  • Y. Reinig
  • F. Welsch
  • R. Hoffmann
  • D. Müller
  • K. F. Schüttler
  • E. Zimmermann
  • Thomas Stein
Arthroscopy and Sports Medicine



Arthroscopic repair is one option for the surgical treatment of type II superior labrum tears from anterior to posterior (SLAP) lesions in athletes’ shoulders.

Materials and methods

Sixty-one of 78 (78.2%) athletes were retrospectively examined after isolated arthroscopic SLAP repair (group 1/G1: 28x knot-tying anchors; group 2/G2: 33 knotless anchors; follow-up 24 months) and compared to two specific, separate matched volunteer athlete control groups (group 3/G3: 28 athletes matched to G1; group 4/G4: 33 athletes matched to G2). The assessment of G1–4 included numerical analogue scales (NASs: 1–15 scales) and the Athletic Shoulder Outcome Scoring System (ASOSS) score, and the Shoulder Sport Activity Score (SSAS). The preinjury status (FU-1), the status before surgery (FU0), and at follow-up (FU1) were assessed.


High external rotation at abduction (hER) was significantly worse in G1 than G2 (FU1: G1, 86.6° ± 7.7° versus = vs G2, 91.1° ± 10.7°; p = 0.03). The ASOSS and SSAS revealed significant impairment in G1–2 compared to G3–4 (ASOSS FU1: 83.9 ± 19.9 G1 vs 94.6 ± 7.7 G3; p = 0.002 and 80.3 ± 17.7 G2 vs 91.8 ± 9.1 G4; p = 0.002; SSAS 5.9 ± 2.7 G1 vs 6.9 ± 1.8 G3; p = 0.02 and 6.3 ± 2.5 G2 vs 7.4 ± 1.4 G4; p = 0.06), with 17–20% loss on ASOSS and 23–25% deficits on SSAS. The NAS analysis detected for pain (4 ± 3.5 vs 3.2 ± 2.6), satisfaction (2 ± 0.8 vs 1.8 ± 0.9), reduction of function (4.6 ± 3.9 vs 3.9 ± 3.8) and proficiency (9.6 ± 4.7 vs 10.9 ± 3.9) similar impairments in G1–2 (p > 0.05) and better results in G3 and G4 (all p < 0.001).


After SLAP repair, athletes showed underestimated impairment of shoulder sport resumption and proficiency with high rates of shoulder sports cessation. The present data favor the knotless fixation technique, because this fixation technique allowed bilaterally equivalent ranges of motions. The uninjured shoulder athletes also showed functional deficits with significant shoulder sport impairments, which must be considered in outcome analysis and for the rehabilitation program.

Level of evidence

III, retrospective cohort study.


SLAP lesion Athlete shoulder Suture anchor horizontal knot Knotless 



The authors appreciate the assistance of Dr. rer. med. Hanns Ackermann for collection and analyzing the data.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Sports Orthopedics, Knee- and Shoulder-SurgeryBerufsgenossenschaftliche Unfallklinik Frankfurt am MainFrankfurt am MainGermany
  2. 2.Department of Trauma and Orthopedic SurgeryBerufsgenossenschaftliche Unfallklinik Frankfurt am MainFrankfurt am MainGermany
  3. 3.Department of Sports MedicineUniversity of BielefeldBielefeldGermany
  4. 4.Department of Orthopaedics and RheumatologyUniversity Hospital MarburgMarburgGermany
  5. 5.Department of Trauma, Hand and Reconstructive SurgeryUniversity HospitalFrankfurt am MainGermany

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