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No Clear Difference in Clinical Outcomes Between Knotted and Knotless Arthroscopic Bankart Repair: A Systematic
Gunjar Jain1, Rameshwar Datt2, Anant Krishna3
1Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, India.
Purpose:
To analyze whether the arthroscopic Bankart repair using a knotless suture anchor has a better functional outcome than the conventional knot-tying Bankart repair.
Methods:
A comprehensive literature search was done in the PubMed, Scopus, Embase, and Cochrane databases in May 2023. Studies comparing the clinical outcome of Bankart repair using knotless and knot-tying techniques were included in the study. In vitro, animal, and Level IV and V studies were excluded. The risk of bias in randomized controlled trials was calculated according to the RoB 2 tool, and for nonrandomized studies, Methodological Index for Non-Randomized Studies criteria were used. Statistical analysis was done using RevMan software.
Results:
A total of 9 studies, including 2 randomized controlled trials and 7 nonrandomized comparative studies involving 720 patients, were included in the systematic review. The ROWE score ranged from 81.7 to 94.3 in the knot-tying group and 86 to 96.3 in the knotless group. Visual Analog Scale scores at the final follow-up ranged from 0.1 to 1.7 in the knot-tying group and 0.7 to 2.5 in the knotless group. The rate of redislocation, subluxation, and revision surgery in the knot-tying group ranged from 0% to 14.7%, 16.7% to 29.7%, and 1.6% to 17.6%, respectively, whereas that in the knotless group ranged from 2.4% to 23.8%, 7.4% to 22.2%, and 2.4% to 19%, respectively. The mean external rotation was 54° to 65° in the knot-tying group and 61° to 99° in the knotless group. The mean forward-flexion was 164 to 172 in the knot-tying group and 165 to 174 in the knotless group. Our subjective synthesis does not reveal any difference in the outcome between the 2 groups.
Conclusions:
The available literature does not demonstrate a clear difference in functional outcomes, residual pain, and rate of complications as redislocation, subluxation, and revision surgery between Bankart repairs performed with knotted and knotless anchors.
Level Of Evidence:
Level III, systematic review of Level I to III studies.
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