Description
Acetabular labral tears are often repaired with knotted or knotless suture anchors. Use of knotless technology is increasing due to technical efficiency and potential avoidance of knot loosening, migration, and abrasion of surrounding tissue. However, the literature lacks support of one method over the other. Therefore, a systematic review and meta-analysis was performed, comparing clinical outcomes of knotted and knotless suture anchors for primary arthroscopic labral repair in the setting of femoroacetabular impingement (FAI) with a minimum two year follow-up. 7 studies were included, with 4 knotted (n=749) and 3 knotless (n=505) cohorts. Studies with hip dysplasia, Tonnis >2, prior hip surgery, and/or concomitant abductor repair were excluded. Our analysis found no significant difference in mean improvement of Modified Harris Hip Score (mHHS) (Knotted, 23.44; Knotless 25.11, p=0.23) with a moderator analysis identifying no significant interaction between mHHS and age (p=0.72), follow-up (p=0.85), or gender distribution (p=0.34). There was also no notable difference in secondary outcomes, including revision rates (knotted 7.6%, knotless 7.95%, p=0.96) and conversion to total hip arthroplasty (knotted 2.12%, knotless 4.9%, p=0.23). Both knottless and knotted suture anchor techniques demonstrated improved clinical outcomes for hip arthroscopic labral repair. However, neither offer superior results in patient reported outcomes, revision rates, or conversion to total hip arthroplasty.
