Abstract
BACKGROUND: Traumatic anterior shoulder dislocations in young adults often result in Bankart lesions, which contribute to recurrent instability. Arthroscopic Bankart repair is a commonly utilized and well-established treatment option that employs either knot-tying or knotless suture anchors. While knot-tying suture anchors allow for customizable tensioning and have demonstrated strong fixation, they require technical expertise and may be associated with complications related to knots. Knotless anchors offer a simplified technique and eliminate knot-related issues, although they may provide less intraoperative adjustability. PURPOSE: To compare the clinical outcomes of knot-tying and knotless suture anchors in arthroscopic Bankart repair for anterior shoulder instability. STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 3. METHODS: PubMed, Scopus, and Ovid Medline databases were searched up to January 2025. The inclusion criteria encompassed comparative studies (levels 1-3) reporting redislocation rates, revision rates, patient-reported outcomes, or range of motion. Data were independently extracted and quality assessed using the Methodological Index for Non-Randomized Studies and the Modified Coleman Methodology Score criteria. Statistical analyses utilized fixed- or random-effects models based on heterogeneity. RESULTS: Ten studies comprising 793 patients-415 in the knot-tying group and 378 in the knotless group (mean age, 21.1-32.6 years)-met the inclusion criteria. Redislocation rates were 9.5% and 10.6% for knot-tying and knotless anchors, respectively, with no significant difference (odds ratio [OR], 0.95; P = .83). Revision rates (7.8% vs 6.7%) and Rowe scores (mean difference [MD], 2.09 [95% CI, -0.72 to 4.90]; P = .14) showed no statistical disparity. Knot-tying anchors demonstrated lower visual analog scale pain scores (MD, -0.31; P = .001). Range of motion, including external rotation and forward flexion, was comparable between groups. CONCLUSION: Knot-tying and knotless suture anchors yield similar outcomes for arthroscopic Bankart repair regarding redislocation, revision rates, and functional recovery. Knot-tying anchors may slightly reduce pain; however, the magnitude of this difference appears to be below the threshold for clinical importance. Both techniques are viable, allowing surgeons to base their choice on preference and case specifics.