Biomechanical Comparison of Knotless All-Suture Anchors and Knotted All-Suture Anchors in Type II SLAP Lesions: A Cadaveric Study

Arthroscopy. 2020 Aug;36(8):2094-2102. doi: 10.1016/j.arthro.2020.04.026. Epub 2020 Jun 23.


Purpose: To compare the biomechanical performance of knotless versus knotted all-suture anchors for the repair of type II SLAP lesions with a simulated peel-back mechanism.

Methods: Twenty paired cadaveric shoulders were used. A standardized type II SLAP repair was performed using knotless (group A) or knotted (group B) all-suture anchors. The long head of the biceps (LHB) tendon was loaded in a posterior direction to simulate the peel-back mechanism. Cyclic loading was performed followed by load-to-failure testing. Stiffness, load at 1 and 2 mm of displacement, load to repair failure, load to ultimate failure, and failure modes were assessed.

Results: The mean load to repair failure was similar in groups A (179.99 ± 58.42 N) and B (167.83 ± 44.27 N, P = .530). The mean load to ultimate failure was 230 ± 95.93 N in group A and 229.48 ± 78.45 N in group B and did not differ significantly (P = .958). Stiffness (P = .980), as well as load at 1 mm (P = .721) and 2 mm (P = .849) of displacement, did not differ significantly between groups. In 16 of the 20 specimens (7 in group A and 9 in group B), ultimate failure occurred at the proximal LHB tendon. Failed occurred through slippage of the labrum in 1 specimen in each group and through anchor pullout in 2 specimens in group A.

Conclusions: Knotless and knotted all-suture anchors displayed high initial fixation strength with no significant differences between groups in type II SLAP lesions. Ultimate failure occurred predominantly as tears of the proximal LHB tendon.

Clinical relevance: All-suture anchors have a smaller diameter than solid anchors, can be inserted through curved guides, preserve bone stock, and facilitate postoperative imaging. There is a paucity of literature investigating the biomechanical capacities of knotless versus knotted all-suture anchors in type II SLAP repair.

Publication types

  • Comparative Study

MeSH terms

  • Biomechanical Phenomena
  • Cadaver
  • Humans
  • Male
  • Middle Aged
  • Orthopedic Procedures / instrumentation
  • Orthopedic Procedures / methods
  • Osteotomy
  • Scapula / surgery
  • Shoulder / physiopathology
  • Shoulder / surgery
  • Shoulder Injuries* / physiopathology
  • Shoulder Injuries* / surgery*
  • Shoulder Joint / physiopathology
  • Shoulder Joint / surgery*
  • Suture Anchors*
  • Suture Techniques*
  • Tendons / physiopathology
  • Tendons / surgery*