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

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.