Arthroscopic SLAP IIb Repair Using Knot-Tying Versus Knotless Suture Anchors: Is There a Difference?

Author and Disclosure Information


  • SLAP IIb tears are common injuries in overhead athletes, yet surgical outcomes are variable, with throwers commonly having difficulty with return to play at the same level.
  • In this study, 92% of athletes returned to play post-operatively, yet only around 55% returned at the same level.
  • In overhead athletes, overall return to play was 85.7%, yet only 39.3% returned at the same level.
  • Knotless fixation required less revision surgery and had higher outcome scores and return to play when compared to knotted fixation; however, this did not reach statistical significance.
  • Knotless fixation should be considered in SLAP IIb repairs given their lower profile leading to less rotator cuff irritation, the ability to better provide more consistent tensioning, and decreased surgical time.




The use of knotless suture anchors has increased in popularity; however, there is a paucity of literature examining the difference in clinical outcomes with traditional knotted fixation. It was hypothesized that knotless fixation would provide superior clinical outcomes, improved return to play (RTP), and lower revision rates as compared with traditional knotted fixation in the repair of SLAP IIb tears. Seventy-four athletes who underwent arthroscopic SLAP IIb repair with traditional (n = 42) and knotless anchors (n = 32) by a single surgeon were evaluated after a minimum 2-year follow. Demographic and surgical data, RTP, Kerlan-Jobe Orthopaedic Clinic (KJOC) score, American Shoulder and Elbow Surgeons (ASES) score, stability, strength, and pain scores were compared. Knotless anchors had slightly higher RTP (93.5% vs 90.2%, P = .94) and RTP at the same level (58.1% vs 53.7% P = .81) compared with knotted fixation, but the difference did not reach statistical significance. Knotless anchors were less likely to require revision surgery than traditional anchors (9% vs 17%, P = .50), but the difference was not statistically significant. When comparing knotless and traditional knotted suture anchor repair of type llb SLAP tears, knotless fixation required less revision surgery and had higher RTP, ASES, and KJOC scores; however, statistical significance was not achieved in this relatively small cohort.

Continue to: Injury of the anterosuperior...


Recommended Reading

Ultrasound excels for assessing shoulder dislocation
MDedge Surgery
Reverse Total Shoulder Arthroplasty: Indications and Techniques Across the World
MDedge Surgery
Medical Complications and Outcomes After Total Shoulder Arthroplasty: A Nationwide Analysis
MDedge Surgery
Upper Extremity Injuries in Soccer
MDedge Surgery
The PASTA Bridge – A Repair Technique for Partial Articular-Sided Rotator Cuff Tears: A Biomechanical Evaluation of Construct Strength
MDedge Surgery