To Knot or Not Knot That Is the Question

Except when it comes to arthroscopic Bankart repair. According to a new study, it doesn’t really matter. Both knotted and knotless suture anchors yield similar clinical results. Surprised?

In the study, “No clinical or radiographic difference seen in arthroscopic Bankart repair with knotted versus knotless suture anchors. A randomized controlled trial at short term follow up,” researchers compared clinical and radiographic differences between arthroscopic Bankart repair with knotted suture anchors to Bankart repair with knotless suture anchors. Their conclusion? No discernable clinical or radiographic differences.

The study was published on December 21, 2021, in the journal Arthroscopy.

For the study, 64 patients were randomly assigned by the research team to receive either the knotted or knotless suture anchor. The research team collected outcome data using the Rowe Score, Western Ontario Shoulder Instability Index, Single Assessment Numeric Evaluation, Visual Analog Scale for pain, range of motion and rate of postoperative recurrence. They then assessed each patients’ outcomes at 6, 12 and 24 months postoperatively.

The researchers also conducted postoperative magnetic resonance imaging and measured anterior and inferior labrum glenoid height indices and anterior and inferior labral slopes. The primary endpoint was the Rowe Score at 24 months postoperatively.

Fifty-one patients in total completed the 24 months of follow-up.

At 24 months, the Rowe Scores were 81.7 ±19.9 points and 85.9 ±14 points, for knotted and knotless suture anchors respectively (p = 0.623); the Western Ontario Shoulder Instability Index scores were 509.2 ±480.1 points and 555.9 ±393.6 points, respectively (p = 0.533); the Single Assessment Number Evaluation scores were 90.7 ±18.7 points and 89.2 ±14.8 points, respectively (p = 0.427); and the Visual Analog Scores for pain were 1.7 ±2.5 points and 2.5 ±2.7 points, respectively (p = 0.275).

In addition, there was no significant difference in range of motion, postoperative recurrence, or MRI parameters between the groups. All participants in both groups exceeded the minimal clinically important difference of 9.7 for the Rowe score (p > 0.999).

“Repair of Bankart’s lesion through the use of knotted and knotless suture anchors yielded similar clinical and radiographic results upon analysis at 24 months post operation,” the researchers wrote.

The study authors include Frederico Lafraia Lobo, M.D., Mauro Emilio Conforto Gracitelli, M.D., Eduardo Angeli Malavolta, M.D., Renata Vidal Leao, M.D., Fernando Brando de Andrade e Silva, M.D., Jorge, Henrique Assuncao, M.D. and Arnaldo Amado Ferreira Neto, M.D. of Hospital das Clinicas, Universidade de Sao Paulo, Brazil.