Abstract
Objectives:
In biomechanical studies, suture tapes have demonstrated improved load to failure and tissue tear-through for labral repair compared to suture, suggesting that a tape construct in labral repair may reduce failure rates. However, clinical studies, especially comparative, are lacking. The purpose of this study was to 1) determine the rate of recurrent instability at a minimum 2-year follow-up for shoulders with isolated anterior, isolated posterior, or combined anterior and posterior instability and 2) compare survivability and risk factors for failure in a persistently high-demand military population.
Methods:
We performed a retrospective cohort study of active duty servicemembers who underwent arthroscopic shoulder stabilization performed by 3 fellowship-trained sports surgeons at a single high-volume military facility between 2010 and 2020. Based on the purported benefits of tape constructs, the surgeons at this facility transitioned to use of suture tape in 2015. We included all patients who underwent isolated anterior or posterior or combined labral repair. We excluded all patients who underwent superior labral repair or with follow-up less than 2 years. We collected patient demographics, prior instability events, details of surgery, and revision procedures. We measured glenoid bone loss using the circle method and used the Hills-Sachs index to evaluate for presence of off-track lesions. Intraoperative details included size and location of the tear, concurrent lesions, number of anchors, and suture type used. The primary outcome was repair failure, defined as recurrent shoulder instability events including subjective subluxation and dislocation, recurrence of pain consistent with instability, functionally limiting apprehension, or undergoing a revision stabilization procedure. We performed survival analysis and univariate and multivariate logistic regression analyses to identify factors most associated with failure.
Results:
We identified 448 arthroscopic stabilization procedures in total (211 anterior, 79 posterior, and 158 combined anterior/posterior labral repairs). We excluded all patients undergoing superior labral repair (27 anterior, 23 posterior, and 27 combined) and then further excluded patients with less than 2 years follow-up (21 anterior, five posterior, and 21 combined), leaving 163 anterior, 51 posterior, and 110 combined procedures for analysis (Table 1).
On univariate analysis, patients who experienced failure after anterior labral repair were more likely to be older (21.4 versus 20.5 years, p = 0.041) and to have bone loss >10% (p = 0.012). The only factor significantly associated with failure after posterior repair was use of sutures alone (p = 0.044), and notably, no patient who underwent suture tape fixation experienced failure (0/18). For combined labral tears, failure was associated with more anchors (5.5 vs 5.0, p = 0.016). Survival curves for repairs demonstrate the overall long-term failure rates after repair (Figure 1).
We performed multivariate logistic regression to determine factors associated with higher likelihood of failure after anterior (Table 2) and combined (Table 3) repairs. Labral tape was associated with a lower chance of failure for anterior repairs (p = 0.041). There was a similar trend that did not reach significance after combined repairs (p = 0.085). Because the failure event rate was zero after posterior repair performed with labral tapes, coefficients and confidence intervals were unable to be calculated and this multivariate analysis was not performed.
Conclusions:
In addition to previously established risk factors for failure following arthroscopic stabilization procedures, use of suture tape was protective against failure in a young, high-demand military population. Overall failure rates were consistent with previously published literature in similar populations and this clinical study validates prior biomechanical studies supporting the use of suture tape. Further clinical study on the use of suture tape in labral repair is warranted.
