APEX Shoulder Mastering Surgical Techniques for Clinical Success-Tips for Knots and Knotless Fixation

Tips for Knots and Knotless Fixation – Is the Technique Different_

Video Transcription

Video Summary

Paul Caldwell from Tucko Orthopedics discusses the evolution of arthroscopic labral repair, focusing on the transition from knotted to knotless techniques. Starting from the 1988 Caspari transglenoid suture technique, advancements included suture anchors, knot tying, and eventually the first knotless suture anchor invented in 1998. He highlights the benefits of modern knotless repairs using smaller, bioabsorbable anchors and softer tape, which improve fixation, reduce knot-related complications, and allow retensioning during surgery. Using a case of a young football player with recurrent shoulder dislocations, Caldwell demonstrates the current percutaneous knotless repair method, emphasizing secure fixation and labral mobilization. He presents evidence that knotless techniques provide comparable biomechanical strength and clinical outcomes to knotted repairs, with fewer complications like knot migration and articular surface abrasion. Knotless repair offers advantages such as improved loop security, easier tissue shifting, decreased operative time, and better postoperative imaging. Caldwell concludes by encouraging adoption of knotless methods for shoulder instability treatment.

Asset Caption

Paul Caldwell, MD

Keywords

arthroscopic labral repair

knotless suture anchor

shoulder instability

knotless repair advantages

transglenoid suture technique