Wang C, Liu Y, Ding M, Wan S, Lin K, Tian Z, Li L. Knotless versus knotted arthroscopic Bankart repairs for anterior shoulder instability: a systematic review and meta-analysis.
BMC Musculoskelet Disord 2025;
26:571. [PMID:
40483425 PMCID:
PMC12144794 DOI:
10.1186/s12891-025-08832-4]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2024] [Accepted: 05/30/2025] [Indexed: 06/11/2025] Open
Abstract
BACKGROUND
Arthroscopic Bankart repair can be performed via a more contemporary knotless procedure or a more traditional knotted procedure. Nonetheless, comparisons between these two techniques remain controversial.
METHODS
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search of PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science was conducted. Randomized controlled trials (RCTs) and cohort studies directly comparing the knotless and knotted arthroscopic Bankart procedures were included. The primary outcomes were rates of recurrent instability and revision surgeries. Secondary outcomes encompassed number of anchors, operative time, improvements in functional scores including Rowe score and Constant-Murley score (CMS), pain level assessed by the visual analogue scale (VAS) score, range of motion (ROM), adverse events, and radiological results. Quality assessment was performed using RoB2 and MINORS tools. Meta-analysis pooled RCT data using Review Manager 5.4.1, and non-pooled outcomes from cohort studies or limited RCT data were reported separately.
RESULTS
This meta-analysis included nine studies with a total of 729 patients. Pooled data from three RCTs demonstrated no significant differences between the two techniques in terms of re-dislocation (P = 0.78), recurrent anterior subluxation and positive apprehension test (P = 0.78), revision surgery (P = 0.94), number of anchors used (P = 0.26), or improvements in Rowe score (P = 0.15). For outcomes not suitable for pooling, qualitative analysis of trends indicated comparable outcomes between the groups, except a slightly reduced operative time in the knotless repair group. Adverse events were infrequently reported and occurred at similar rates in both groups. Limited radiological data from one RCT showed no significant differences in MRI parameters at the 24-month follow-up.
CONCLUSION
Both techniques demonstrate comparable clinical outcomes. The only potential advantage of the knotless technique is a possible reduction in operative time, though its clinical significance remains uncertain. Given the limitations of the evidence, these findings should be interpreted cautiously.
CLINICAL TRIAL NUMBER
Not applicable.
PROSPERO REGISTRATION ID
CRD42024586135.
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