In arthroscopic rotator cuff repair, the suture bridge technique can be performed with or without knots in the medial row. This article summarises a 2023 meta-analysis comparing the two approaches.
Why the question matters
The effect of medial-row knots on tendon fixation and retear pattern is debated. A knotless approach removes the knot-tying step, but removing a step does not in itself mean the clinical outcome differs. Comparative data are therefore needed.
Scope of the meta-analysis
The PRISMA-compliant, PROSPERO-registered study by Xiao et al. includes 10 publications: 1 randomised controlled trial, 4 prospective and 5 retrospective cohort studies, with 1,146 patients in total.[1]
Findings
| Outcome | Knotted / knotless comparison | Statistical significance |
|---|---|---|
| Retear | RR 1.05 (95% CI 0.79–1.40) | Not significant (P = 0.74) |
| Type 1 retear | RR 0.78 (95% CI 0.56–1.08) | Not significant (P = 0.14) |
| UCLA, ASES, Constant | CIs of pooled differences include zero | Not significant |
| Range of motion and VAS | CIs of pooled differences include zero | Not significant |
The authors interpret the clinical outcomes of the two approaches as equivalent, and note that their conclusions rest on short-term follow-up.[1]
Limitations
- There is only one randomised controlled trial; the rest are observational.
- Tear size, retraction and fatty infiltration were not analysed.
- Some studies included additional procedures (e.g. acromioplasty).
- The authors call for larger, higher-quality studies, particularly in patients with osteoporosis.[1]
References
- Xiao Q, Quan X, Hu S, Xiao Y, Wu J, Nie M. A comparison between knotted and knotless medial row of suture bridge technique in arthroscopic rotator cuff repair surgery: a meta-analysis. J Orthop Surg Res. 2023;18:338. doi:10.1186/s13018-023-03812-7
