Thank you, Dr. Ganley, Dr. Wilson, the Society for allowing us to present, and my co-authors for their help in this project. Our disclosures are available on the AOSSM app. It's well known, especially when dealing with characters like this, that adolescent shoulder instability can be a complex problem with recurrence rates as high as 100% with non-surgical treatment. We're doing better with surgery, however, at two years the recurrence rate can still be upwards of 20% in these young athletes. For arthroscopic shoulder stabilization, it's dependent upon several factors, one of which is the implant choice and the utilization and execution of the use of that implant. Successful outcomes with suture anchors is highly dependent on knot security, and arthroscopic knot tying can be technically difficult, even amongst expert arthroscopists. Knot migration and high-profile knots may cause discomfort and chondral abrasion. In 2001, knotless suture anchors were first introduced. There was concern with first-generation implants regarding the pull-out strength, late disengagement of those implants, and gap formation at the interface between the tissue and the implant. In 2006, an adult in vivo study showed a potential for increased rates of failure with recurrent instability with knotless fixation. Therefore, the purpose of our study was to compare the effect of knotted versus knotless suture anchors on post-operative outcomes of arthroscopic shoulder instability surgery in adolescent athletes. Our primary aim was to determine if patient-reported outcomes, including re-dislocation, subsequent surgery, and return to sport were different between the two cohorts. And our secondary aim was to determine if any perioperative factors, such as number of prior dislocations, surgical duration, could account for any differences observed. This was a multi-center retrospective comparative cohort study that included youth athletes ageless and 20 that underwent primary arthroscopic stabilization between the years 2015 and 2017 with a minimum of three-and-a-half-year follow-up. Athletes were excluded if they had an isolated slap repair, combined usage of knotted versus knotless suture anchors in the same shoulder at the same surgical intervention, and greater than 20% of gonoid bone loss. Data collected was patient demographics, the extent of the labral injury, the surgical time, patient-reported outcome measures, including the pass and the SANE score, and any recurrence of instability or revision surgery post-operatively and the return to their primary sport. We had 40 shoulders in each group. Average age was about 16 years. There was a little bit of a difference between the groups between the male-female breakdown, 30 males in the knotted group versus 23 in the knotless group. Instability type was also different between groups, 21 anterior instability in the knotted group versus 7 in knotless, and a higher preponderance of posterior at 16 in the knotless group versus 4 in the knotted group. However, the combined instability types of anterior and posterior was quite similar between the two groups at 15 and 17. Prior dislocations were slightly higher in the knotted groups prior to surgery at 3.4 versus 1.9 in the knotless group, and most patients were overhead or contact athletes in both groups. Mean follow-up was close to four-and-a-half years in both groups. Return to primary sport was significantly higher in the knotless group. The patient-reported outcome score, PASS and SANE was more favorable in the knotless group and that was significant. The recurrence of instability was higher in the knotted cohort with 50% of patients experiencing recurrence of instability versus 18% and repeat surgery was about the same at 10% and 8%. Surgical time was significantly shorter in the knotless group versus the knotted group. And the number of suture anchors was greater in the knotted group at 5 versus 3.7 in the knotless group. We observed a decreased surgical time using knotless suture anchors, which may reduce the anesthetic and infection complications associated with longer surgical times, may improve operating room efficiency, and may decrease overall cost. There was a variation in the number of anchors used between the two groups. This may be due to increased control provided with the knotless mechanism to adjust tension as shown in this video where you can grab the tissue and place it where you want it to lay as you engage the knotless mechanism. This may also be related to a variance in the anterior to posterior labral repairs between the cohorts. Limitations of the study was the instability types were not perfectly matched. Prior dislocation events were also not perfectly matched and we only had a 69% response rate for the patient-reported outcomes. However, in conclusion, the use of knotless over knotted suture anchors for the treatment of shoulder instability in adolescent athletes is at least equivalent. We observed better patient-reported outcomes, reduced surgical times, higher return to sport rates and lower failure rates at intermediate follow-up with the knotless suture anchors. And knotless suture anchors appear at least to be safe and effective for anterior and posterior instability surgery in adolescents. And we were unable to identify any risk factors noted for variance in outcomes. Thank you from our centers and I appreciate your attention.

study

knotted suture anchors

knotless suture anchors

arthroscopic shoulder stabilization surgery

adolescent athletes