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Excellent Functional Outcomes and Low Complication Rates Following Knotless Arthroscopic Bankart Repair: A Systematic Review of Clinical and Biomechanical Studies.

ABSTRACT:

Purpose

To provide a comprehensive review of the current clinical and biomechanical evidence for the use of knotless suture anchors during arthroscopic Bankart repair.

Methods

A comprehensive search of 5 electronic databases from inception to July 2020 was performed for clinical and biomechanical studies in English evaluating outcomes following arthroscopic Bankart repair using knotless suture anchors. Two independent reviewers assessed articles for inclusion. Risk of bias was assessed using the Methodological Index for Non-Randomized Studies (MINORs) criteria. Clinical outcomes of interest and key findings from biomechanical studies were summarized.

Results

Ten clinical studies (430 knotless repairs), including 4 cohort studies directly comparing knotless (N = 117) to knot-tying repairs (N = 192), were deemed eligible. Four biomechanical studies were also identified. Heterogeneity and the lack of randomized studies precluded data pooling and quantitative meta-analysis. Rates of redislocation ranged from 2.2% to 14.7% and 1.5% to 23.8% for knot-tying and knotless repair, respectively. Both knot-tying and knotless repair demonstrated excellent postoperative functional outcome, as assessed by visual analog scale, Constant-Murley, Rowe, and QuickDASH scores, with 80% to 94% of patients returning to sports participation. Biomechanical studies showed similar stiffness and load to failure between knot-tying and knotless repairs, with the most common mode of failure being retear at the suture-soft tissue interface.

Conclusions

Current level II to IV clinical and biomechanical evidence supports knotless arthroscopic Bankart repair as an effective procedure with excellent functional outcomes and low rates of complication and reoperation.

Level of evidence

Level IV, systematic review of level II to IV studies.

SUBMITTER: Mei XY

PROVIDER: S-EPMC8220618 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:PurposeTo compare the outcomes of athletes who have been treated for either primary or recurrent anterior shoulder instability with arthroscopic Bankart repair (ABR).MethodsA retrospective review of patients who underwent ABR for anterior shoulder instability, with a minimum of 24 months' follow-up, was performed. Those who underwent ABR for primary instability were matched in a 1:1 ratio for age, sex, sport, and level of preoperative play to those who underwent ABR for recurrent instability. The rate, level, and timing of return to play (RTP), as well as the Shoulder Instability-Return to Sport After Injury score, were evaluated. Additionally, the recurrence rate, visual analog scale score, Subjective Shoulder Value, Rowe score, satisfaction, and whether patients would undergo the same operation again were compared.ResultsAfter analysis of 467 patients, 100 athletes who underwent ABR for primary instability were identified and subsequently pair matched to 100 patients who underwent ABR for recurrent instability, with a mean age of 27.2 years, 87% male patients, 68% collision athletes, and a mean follow-up period of 61.9 months. There was no significant difference between the groups in the rate of RTP (80% vs 79%, P = .86) or RTP at the preinjury level (65% vs 65%, P >. 999); however, there was a significant difference in time to RTP (6.9 ± 2.9 months vs 5.9 ± 2.5 months, P = .02). There were no significant differences in visual analog scale score, Shoulder Instability-Return to Sport After Injury score, Subjective Shoulder Value, Rowe score, patient satisfaction, and whether patients would undergo the operation again (P > .05 for all). There was no difference in the rate of recurrent instability after ABR (10% vs 16%, P = .29).ConclusionsABR results in excellent clinical outcomes, high rates of RTP, and low recurrence rates for both athletes with primary instability and those with recurrent instability.Level of evidenceLevel III, retrospective comparative cohort study.