Juggerknot

After the Institutional Review Board review and approval, a single-institution chart review was conducted on 310 consecutive patients who had previously undergone an arthroscopic Bankart lesion repair between January 2008 and February 2014. There were 35 patients who had repairs that utilized anchorless fixation (JuggerKnot®, Zimmer Biomet, Warsaw, IN). These 35 patients were then age-, gender-, and surgeon-matched to 35 patients who received Bankart lesion repair using traditional suture anchors. Patients were contacted via postal mail to participate in the study. Participation included the completion of an ASES questionnaire as well as questions regarding re-dislocations and further shoulder surgery. Twenty-six total completed questionnaires were returned and scored for this study (11 in the anchorless group and 15 in the matched cohort). Demographic data were obtained as well as the number of anchors or anchorless implants included in the surgical repair. Statistical analysis of the compiled data included Student t-tests comparing re-dislocation, additional surgery, and ASES scores between the two groups (Microsoft® Excel; Microsoft Corp., Redmond, WA). The significance level was set at p < 0.05. There was no external funding used for this study.

A standard arthroscopic Bankart repair with refixation of the anteroinferior labrum and capsule was performed in both groups. Patients were placed in the lateral decubitus position with the affected arm in a traction device. A diagnostic arthroscopy was performed via a posterior portal. Then an anteroinferior and anterosuperior portal were created and the arthroscope was switched to the anterosuperior portal. Two twist-in cannulas (Arthrex, Naples, FL, USA) were inserted in the anteroinferior and posterior portal for easier shuttling of the sutures. At first the capsule-labrum complex was mobilized and the glenoid rim cleared of soft tissue. For refixation of the labrum, two different kinds of anchors were used. In the SA group, the anchor-first technique was used using all-suture anchors (Juggerknot by Zimmer Biomet, Warsaw, IN, USA). In the KA group, the suture-first technique was applied using knotless suture anchors (Pushlock by Arthrex, Naples, FL, USA). An additional Remplissage was performed in cases of off-track Hill Sachs lesions in both groups.