Assessments of activities of daily living after arthroscopic SLAP repair with knot-tying versus knotless suture anchors

Reinig Y, Welsch F, Hoffmann R, et al. Assessments of activities of daily living after arthroscopic SLAP repair with knot-tying versus knotless suture anchors. ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY. 2019;139(7):981-990.PurposeThe clinical influence of knot-tying or knotless anchor systems for the arthroscopic repair of SLAP lesions (superior labrum lesion from anterior to posterior) remain unclear.Materials and methodsIn a retrospective cohort analysis, 61 of 78 (78.2%) patients with isolated symptomatic SLAP II lesions were examined with a minimum of 24months after arthroscopic SLAP repair compared to a control group: 28 patients with knot-tying anchors (group I, G1; 28.959.48 years, 23 male/5 female), 33 with knotless anchors (group II, G2; 3110.09 years, 26 male/7 female) and 140 healthy volunteers (group III, G3; 30.9 +/- 8.9 years, 109 male/31 female). The clinical assessment included an examination and estimated parameters of ADL (activities of daily living), the CS (Constant score), ASES (American Shoulder and Elbow score), DASH (disability of arm-shoulder hand) and the RS (Rowe score).Results The ROM analysis recorded no significant differences for the external rotation in 0 degrees abduction (G1 63.75 degrees +/- 15.55 degrees versus=vs G2 65.30 degrees +/- 18.15 degrees; p(ERG1 vs G2)=0.72). The clinical outcomes revealed significantly decreased pain status in G1 for the O'brien test and in G2 for the Palm-up test, whereas Yergason test showed similar pain levels (p(O'brien)=0.03; p(palm up)=0.02; p(yergason)>0.5). The pulley associated rotator cuff tests revealed a significantly inferior force status in G2 compared to G1 (p(lift-off)=0.005, p(Jobe)=0.02) whereas the further rotator cuff assessments were equal. In general, the intervention group showed increased pain level and functional deficits compared to the G3. The score analysis detected no significant differences with P-CSG1 vs G2, P-ASESG1 vs G2, P-DASHG1 vs G2 and P-RSG1 vs G2 all >0.05 and significant impairments compared to G3 in all scores p(G1/G2 vs G3) < 0.05 (CSG1 = 88.28 +/- 14.42, CSG2=92.73 +/- 9.24, CSG3 = 96.2 +/- 4.96; ASES(G1) = 81.10 +/- 21.69, ASES(G2) = 85.35 +/- 17.12, ASES(G3) = 94.95 +/- 10.39,; DASH(G1)= 35.75 +/- 13.44, DASH(G2) = 36.03 +/- 17.55, DASH(G3) = 27.13 +/- 6.52; RSG1 = 90.71 +/- 9.88, RSG2 = 88.33 +/- 11.22, RSG3= 92.96 +/- 11.27).ConclusionsThe clinical assessment revealed for both anchor systems similar outcomes but showed general underestimated impairments after the SLAP repair surgery compared to the healthy control. The clinical status only marginally differed between both techniques, wherefore the present assessment of ADL allowed no recommendation of one of these two specific surgery technique for SLAP repair