Arthroscopic Labral Repair of Adolescent Athlete Shoulder Instability With Knotted Versus Knotless Suture Anchors

BACKGROUND: Shoulder instability is a common and complex problem seen in adolescent athletes. The use of bioabsorbable suture anchors with arthroscopically hand tied knots is widely accepted and has shown to provide reliable biomechanical and clinical results. Knotless suture anchor technology has become increasingly popular with proposed advantages of minimizing technical difficulty as well as mitigating knot migration and subsequent intraarticular cartilage irritation and damage. While there have been studies comparing knotted versus knotless suture anchors, studies comparing clinical outcomes solely focused on the adolescent athlete are limited. PURPOSE: To evaluate and compare outcomes of adolescent athletes treated with arthroscopic labral repair using knotted versus knotless bioabsorbable suture anchors. METHODS: Adolescent athletes with shoulder instability treated arthroscopically with labral repair and a minimum of 2 year follow up were retrospectively reviewed. All patients had < 20% glenoid bone loss and a non-engaging Hill Sachs lesion at surgery. Patients were divided into three cohorts based on suture anchor knot management – knotted, knotless and combined. Data points examined included post-operative return to primary sport, recurrent instability, re-operation, and patient reported outcome measures (PROMs) utilizing the Pediatric/Adolescent Shoulder Survey (PASS). PASS was only collected on patients with no reported subsequent instability events. RESULTS: 51 adolescent athletes (average age 16.3 ± 2.6 years) were identified. There were 20 athletes in the knotted fixation group, 17 in the knotless, and 14 in the combination group. Average follow up was 4.25 ± 1.2 years (Range 2.09-6.34 years). 46/51 athletes (90.2%) returned to sports post-operatively with only 34/51 athletes (66.7%) returning to their primary sport. Of the 17 athletes who did not return to their primary sport 14/17 athletes (82.4%) switched sports by choice, while the other 3/17 (17.6%) athletes stopped due to their shoulder. There were no significant differences between cohorts based on return to sport, re-operation, or post-operative PASS (average 90.2 ± 11.7). Recurrent instability episodes were reported in 12/51 athletes (23.5%), with significantly higher recurrence in the knotted group (7/20 athletes, 35%) and combination group (5/14 athletes, 35.7%), when compared to the knotless group (0/17 athletes, 0%). (p < 0.05). CONCLUSION: Arthroscopic labral repair for adolescent shoulder instability demonstrated high return to sport rates and equivalent PROMs with a significantly higher incidence of recurrent instability noted with knotted fixation when compared to knotless fixation. Favorable outcomes can be achieved in adolescent athletes undergoing shoulder stabilization with knotless suture anchors.