Both Knotless and Traditional Knot-Tying Suture Anchors Result in Favorable Clinical Outcomes in the Treatment of Acetabular Labral Tears: A Systematic Review.

Purpose: To compare clinical outcomes and complication profile of knotless versus knot-tying suture anchors in arthroscopic hip labral repair. Methods: A systematic review was performed following Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Data on suture anchor type, patient-reported outcomes (including modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport Specific Subscale, Visual Analog Scale, International Hip Outcome Tool-12), complications, and concomitant procedures were extracted. Bias was assessed via Risk of Bias in Non-randomized Studies and Revised Cochrane Risk-of-Bias Tool for Randomized Trials. Results: A total of 10 studies met all the inclusion criteria, including 2 studies that directly compared knotless with knot-tying suture anchors. All studies had a minimum of 12-month follow-up. Both knotless and knot-tying suture anchors showed significant improvement across all measured patient-reported outcomes (mean modified Harris Hip Score preop-postop: knotless vs knot-tying =61.0-84.8 vs 68.6-85.9; mean Hip Outcome Score-Activities of Daily Living preop-postop: knotless vs knot-tying = 52.3-79.1 vs 51.4-77.7; mean Hip Outcome Score-Sport Specific Subscale preop-postop: knotless vs knot-tying = 44.9-76.1 vs 49.3-77.9; mean Visual Analog Scale preop-postop: knotless vs knot-tying = 5.6-1.9 vs 5.6-1.9; mean International Hip Outcome Tool-12 preop-postop: knotless vs knot-tying = 35.4-77.2 vs 37.4-76.7). Across studies reporting patient-level thresholds, high proportions of patients achieved clinically meaningful improvement, with minimal clinically important difference achievement ranging from approximately 74% to 100% and patient acceptable symptom state achievement ranging from 46% to 100% across outcome measures, with no consistent differences between knotless and knot-tying anchor constructs. Complication, revision, and total hip arthroplasty conversion rates were low in both groups (revision rate range: knotless = 1.9%-6.8%, knot-tying = 0%-12.8%; total hip arthroplasty conversion rate range: knotless = 2.6%-5.7%, knot-tying =0.0%-4.7%). One study reported that postoperative synovitis was found in more patients in the knot-tying group than in the knotless group (17 vs 5). In the included studies, there was risk of bias, including confounding bias (6/8 studies) and selection bias (7/8 studies). Conclusions: Knotless and knot-tying suture anchors are both safe and effective options for hip labral repairs with anticipated improvement in patient-reported outcomes regardless of the anchor type used. Across studies reporting patient-level thresholds, a high proportion of patients achieved minimal clinically important difference and patient acceptable symptom state, supporting the clinical relevance of postoperative improvement in both constructs. There were no significant differences in revision rates or conversion to total hip arthroplasty and complications are low in both groups. Level of Evidence: Level IV, systematic review of Level II to IV studies.