Sliding or Nonsliding Arthroscopic Knots for Shoulder Surgery: A Systematic Review.

BACKGROUND

Knot tying is a crucial component of successful arthroscopic shoulder surgery. It is currently unknown whether sliding or nonsliding techniques result in superior clinical outcomes.

PURPOSE

To assess the clinical outcomes of arthroscopic sliding knot (SK)- versus nonsliding knot (NSK)-tying techniques during arthroscopic shoulder surgery, including rotator cuff repair, Bankart repair, and superior labral anterior-posterior (SLAP) repair.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

A systematic search of the PubMed, Embase, and Cochrane Library databases was performed using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. All English-language literature published between 2000 and 2018 reporting clinical outcomes utilizing SK- or NSK-tying techniques during rotator cuff repair, Bankart repair, and SLAP repair with a minimum 24-month follow-up was reviewed by 2 independent reviewers. Information on type of surgery, knot used, failure rate, patient satisfaction, and patient-reported outcomes was collected. Patient-reported outcome measures included the Constant-Murley score, Rowe score, and visual analog scale for pain. Study quality was evaluated using the modified Coleman Methodology Score.

RESULTS

Overall, 9 studies (6 level 3 and 3 level 4) with a total of 671 patients (mean age, 52.8 years [range, 16-86 years]; 65.7% male; 206 SK and 465 NSK) were included. There were 4 studies that reported on Bankart repair in 148 patients (63 SK and 85 NSK), 3 on SLAP repair in 59 patients (59 SK), and 2 on rotator cuff repair in 464 patients (84 SK and 380 NSK). Also, 6 studies compared knot-tying with knotless techniques (3 Bankart repair studies and 3 SLAP repair studies), while the studies reporting the outcomes of SLAP repair evaluated SK-tying techniques only. The failure rate for Bankart repair was 3.2% (2/63) for SKs and 4.7% (4/85) for NSKs. The failure rate for rotator cuff repair was 2.4% (2/84) for SKs and 6.3% (24/380) for NSKs. The failure rate for SLAP repair was 11.9% (7/59). Because of inconsistencies in outcomes and procedures, no quantitative analysis was possible. The mean modified Coleman Methodology Score for all studies was 65.1 ± 8.77, indicating adequate methodology.

CONCLUSION

The literature on clinical outcomes using SKs or NSKs for shoulder procedures is limited to level 4 evidence. Future studies should be prospective and focus on comparing the use of SKs and NSKs for shoulder procedures to elucidate which arthroscopic knot results in superior clinical outcomes.

Informations de copyright

© The Author(s) 2020.

Déclaration de conflit d'intérêts

One or more of the authors has declared the following potential conflict of interest or source of funding: E.C.M. has received research support from Arthrex, Biomet, Breg, Mitek, Ossur, Smith & Nephew, and Stryker; consulting fees from DePuy and Zimmer Biomet; speaking fees from Arthrex; and royalties from Elsevier and Zimmer Biomet. A.J.S. has received educational support from Gemini Mountain Medical and Arthrex, honoraria from Encore Medical, and consulting fees from Medacta. M.L.W. has received educational support from Gemini Mountain Medical. A.F.V. has received educational support from Arthrex, consulting fees from Stryker and Smith & Nephew, and speaking fees from Arthrex and Smith & Nephew. R.M.F. has received grant support from Arthrex; educational support from Arthrex, Medwest, and Smith & Nephew; speaking fees from Arthrex; and royalties from Elsevier. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.