Similar results seen with knotless vs knotted anchors for arthroscopic shoulder stabilization
BOSTON — Patients who underwent arthroscopic shoulder stabilization with knotless anchors had outcomes similar to patients who had traditional knotted anchors, according to a presentation at the American Orthopaedic Society for Sports Medicine Annual Meeting. In addition, investigators found all-suture-based anchors may be correlated with lower redislocation rates.
“Patients undergoing arthroscopic Bankart stabilization either anterior or posterior with a knotless vs. knotted anchor had [experienced] similar clinical outcomes,” Jonathan T. Bravman, MD, said during his presentation. “Although in the bivariate analysis [there was] an association between knotless anchors and redislocation, as well as a concerning trend in the multivariate analysis, this affect appears to be attenuated by age, suggesting this may be the primary cofounder here.”
Bravman and colleagues prospectively identified 447 patients in the Multicenter Orthopaedic Outcomes Network Shoulder Group instability database who underwent primary arthroscopic shoulder stabilization. Of these patients, 112 patients underwent surgery with knotless anchors and 335 patients had knotted anchors. There were 70 patients who underwent surgery with all-suture anchors and 377 patients had non-suture anchors. Investigators obtained data on the incidence of subsequent shoulder surgeries, redislocations or subluxation and return to sport.
Results showed significantly more patients with knotless anchors who underwent surgery in the beach chair position compared with patients who had knotted anchors. There were significantly more patients with non-suture anchors who underwent surgery in the beach chair position vs. those with all-suture anchors.
Investigators noted the primary instability direction was anterior, with 78.6% in the knotless group, 71.3% in the knotted group, 82.9% in the all-suture group and 71.4% in the non-suture group. Groups were similar with regard to the number of contact athletes. There were 75% contact athletes in the knotless group, 66% in the knotted group, 70% in the all-suture group and 67.9% in the non-suture group.
Patients with knotless anchors compared to those with knotted anchors used significantly more anchors (4.2 vs. 3.9). Furthermore, patients with all-suture anchors compared to those with non-suture anchors used significantly more anchors (5.3 vs. 3.7).
Significantly more patients with knotless anchors and non-suture anchors had redislocations compared with those with knotted anchors and all-suture anchors. No significant differences were seen between anchor type and anchor material with regard to improvements in patient-reported outcomes, the incidence of return to sport, subsequent shoulder surgeries or subluxations. – by Monica Jaramillo
Houck DA, et al. Abstract 27. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 11-14, 2019; Boston.
Disclosure: Bravman reports he has no relevant financial disclosures.