Failure Rate After Shoulder Stabilization Procedures in the Military With Use of Knotless Suture Tape: A Case-Control Study.

Background: Biomechanical studies have demonstrated improved loading properties and tissue tear-through of suture tapes as compared with suture, suggesting that a tape construct in labral repair may reduce failure rates. However, comparative clinical studies are lacking. Purpose/Hypothesis: The purpose was to determine the rate of recurrent instability after arthroscopic stabilization and compare survivability and risk factors for failure in a persistently high-demand military population. The null hypothesis was that there would be no difference between the failure rates of arthroscopic stabilization procedures when utilizing a suture tape construct as compared with suture for all instability patterns. Study Design: Case-control study; Level of evidence, 3. Methods: The authors retrospectively reviewed all shoulder stabilization procedures performed by 3 fellowship-trained sports surgeons at a single high-volume military facility from 2010 to 2020. Given the purported benefits of tape constructs, the surgeons at this facility transitioned from knotted suture to knotless suture tape constructs in 2015. Patients were included who underwent arthroscopic labral repair with minimum 2-year follow-up. Descriptive data, prior instability events, surgical details, and revision procedures were recorded. Intraoperative details included size and location of the tear, concurrent lesions, number and type of anchors, and suture type used. Glenoid bone loss was measured using the circle method, and the Hills-Sachs index was used to evaluate for the presence of off-track lesions. The primary outcome was repair failure. Survival analysis and univariate and multivariate logistic regression analyses were performed by instability pattern groups to identify factors most associated with failure. Results: A total of 448 procedures were identified, of which 163 anterior, 51 posterior, and 111 combined labral repairs were analyzed. Median follow-up was >6.5 years across groups. On univariate analysis for posterior instability, the use of a knotless suture tape construct was associated with a lower chance of failure when compared with knotted suture constructs (0% vs 20.6%; Conclusion: In a young, at-risk military population undergoing primary arthroscopic labral repair, the use of knotless suture tape was associated with decreased failure regardless of instability pattern.