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Suture Anchors and How Repairs Are Held to Bone

102 citationsUpdated Oct 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview¶

Suture anchors and tacks serve as the primary interface for securing soft-tissue repairs to bone, with their successful use governed by biological and biomechanical factors [2]. The field has undergone a major shift from metallic to bioabsorbable anchors, driven by higher complication rates associated with metallic devices and lower rates with bioabsorbable alternatives [35]. All-suture anchors possess similar or better mechanical properties than regular anchors, and their low-profile design preserves bone tissue [5]. While various bone changes are observed after implantation of an all-suture anchor, these changes are not clinically relevant [1]. The 2.6-mm all-suture anchor mitigates risks and difficulties associated with other fixation devices while providing ease and efficiency for the surgeon [4].

Complications related to suture anchors and tacks can be categorized as technique-related or device-related issues [9]. Prevention of these complications depends on the surgeon's familiarity with the devices and knowledge of their indications and limitations [9]. Careful attention to proper anchor insertion techniques can limit the potential for complications [6], while newer materials may address concerns regarding biocompatibility and material strength in bioabsorbable anchors [6]. Routine radiographic follow-up is recommended after the use of metallic anchors to ensure identification of early failure by anchor pullout [11].

Outcomes vary by specific application and technique. Suture anchors simplify the open Bankart procedure, with no specific complications seen as a result of the modified open Bankart technique using suture anchors [12]. Good long-term results were observed after arthroscopic Bankart repair in patients older than 20 years with 3 or more suture anchors used [21]. Arthroscopic transosseous superior capsular reconstruction outcomes are not inferior to those of anchor-based techniques, involving less suture tangling, more precise suture pass points, and lower costs [8]. Similarly, arthroscopic transosseous rotator cuff repair using a bone tunneling device facilitates robust and reproducible repairs and substantially reduces procedural costs compared to suture anchor techniques [37]. Transosseous suture fixation is not necessarily a "weak link" of repairs [25].

Anatomy & Pathophysiology¶

Bony Anatomy¶

The proximal humerus comprises four main parts: the humeral head, greater tuberosity (GT), lesser tuberosity (LT), and humeral shaft [63]. The articular head of the humerus is spherical with a diameter of 37 to 57 mm [63] and a radius of curvature of approximately 25 mm [75]. The articular surface is essentially spherical, with an arc of approximately 160 degrees covered by articular cartilage [75]. The most superior portion of the articular surface averages 8 mm above the greater tuberosity [63], while the superior margin of the humeral head articular surface is normally superior to the top of the greater tuberosity by 8 to 10 mm [75]. Humeral version averages 29.8 degrees, with a range of 10 to 55 degrees [63], and the humeral head is retroverted an average of 30 degrees [64] relative to the transepicondylar axis of the humerus [77]. Other sources report an average retroversion of 19° [66]. The humeral head is inclined approximately 130 degrees with respect to the humeral shaft [63], and the neck-shaft angle of the proximal humerus measures an average of 135 degrees [64]. Another measurement reports the average neck-shaft angle as 45 degrees (±5 degrees), with a range of 30 to 50 degrees [75]. The greater tuberosity serves as the attachment site for the supraspinatus, infraspinatus, and teres minor tendons of the rotator cuff [63], while the lesser tuberosity serves as the attachment site for the subscapularis tendon [63]. The distance from the lateral base of the coracoid process to the lateral margin of the greater tuberosity is called the lateral humeral offset [75].

The glenoid is a convex structure of shallow depth shaped like an inverted pear [63] and is a shallow socket, approximately one third the size of the humeral head [64]. The glenoid articular surface radius of curvature is 2 to 3 mm larger than that of the humeral head [75]. The subchondral bone of the glenoid is relatively flat, with articular concavity augmented by cartilage and a circumferential labrum [66]. The glenoid is retroverted approximately 5 degrees relative to the scapular body [66, 77]. The scapula is attached to the axial skeleton by the acromioclavicular (AC) and sternoclavicular (SC) joints [65]. The glenoid is connected with the flat body of the scapula by the scapular neck [65]. The coracoid process curves forwards from the superior surface of the scapular neck [65], and the acromion is a flattened bony process that curves forwards from the scapular spine [65]. The highest concentration of bony mass in the scapula is located in the glenoid, the scapular neck, and the lateral border of the scapular body [65]. Two bony pillars transmit compressive forces from the glenoid fossa: the lateral pillar and the spinal pillar [65]. The weakest bone in the scapula is located primarily in the central part of the infraspinous fossa [65], and the weakest area of the circumference of the biomechanical body of the scapula is the spinomedial angle [65].

Soft Tissue Anatomy¶

The rotator cuff is a sheet of conjoined tendons closely applied over the shoulder capsule, inserting mainly into the greater tuberosity of the humerus [71]. The subscapularis tendon inserts into the lesser tuberosity [71]. The coracoacromial arch is formed by the acromion process posterosuperiorly, the coracoid process anteriorly, and the coracoacromial ligament joining them [71]. The subacromial bursa separates the rotator cuff tendons from the coracoacromial arch, allowing them to glide [71]. The subscapular bursa lies between the subscapularis tendon and the neck of the scapula [67] and communicates with the joint cavity between the superior and middle glenohumeral ligaments [67]. The rotator interval is defined medially by the base of the coracoid, superiorly by the supraspinatus tendon, and inferiorly by the subscapularis tendon [66]. The rotator interval contains the coracohumeral (CH) ligament, the superior glenohumeral ligament (SGHL), and the intra-articular portion of the long head of the biceps tendon [66].

The tendons of the infraspinatus and supraspinatus muscles join approximately 15 mm proximal to their insertion [76]. The supraspinatus and subscapularis tendons join as a sheath that surrounds the biceps tendon at the entrance of the bicipital groove [76]. The coracohumeral ligament is a thick band of fibrous tissue extending from the coracoid process along the surface of the capsule to the tuberosities between the supraspinatus and subscapularis tendons [76]. The glenohumeral ligaments provide static restraint based on arm position. The superior glenohumeral ligament is the primary restraint to inferior humeral subluxation in 0 degrees of abduction [76] and the primary static restraint against anterior translation with the arm at the side [66]. It also restrains external rotation and inferior translation of the adducted or slightly abducted arm [77]. The middle glenohumeral ligament limits external rotation when the arm is in the lower and middle ranges of abduction [76] and is a primary static restraint against anterior translation with the arm in external rotation and 45° of abduction [66]. It restrains anterior translation with the arm abducted to 45 degrees [77]. The inferior glenohumeral ligament is composed of an anterior band, a posterior band, and a thinner intervening axillary pouch, creating a hammock-type sling [76]. The anteroinferior glenohumeral ligament complex is the main stabilizer to anterior and posterior stresses when the shoulder is abducted 45 degrees or more [76]. The anterior band of the inferior glenohumeral ligament is a primary static restraint against anterior-inferior dislocation of the glenohumeral joint in 90° of abduction and external rotation [66] and restrains anterior and inferior translation with the arm externally rotated and abducted to 90 degrees [77]. The posterior band of the inferior glenohumeral ligament is a primary static restraint against posterior-inferior translation in internal rotation and adduction [66] and restrains posterior and inferior translation with the arm internally rotated and abducted to 90 degrees [77]. The coracohumeral ligament restricts external rotation in adduction and is a static restraint to inferior and posterior translation in adduction and external rotation [66].

Vascular Supply¶

The proximal humerus receives its blood supply from the anterior and posterior humeral circumflex branches from the third division of the axillary artery [63]. The anterior humeral circumflex artery provides vascular inflow to the humeral head by way of its terminal anterolateral branch known as the artery of Laing (arcuate artery) [63]. The ascending branch of the anterior humeral circumflex artery enters the humeral head at the interface of the bicipital groove and greater tuberosity [63]. The major blood supply to the humeral head is through the ascending branch of the anterior humeral circumflex artery, which penetrates the head at the bicipital groove and becomes the arcuate artery [64]. The anterolateral ascending branch of the anterior humeral circumflex artery provides the primary blood supply to the humeral head [66]. The terminal intraosseous portion of the anterior humeral circumflex artery enters at the proximal aspect of the intertubercular groove as the arcuate artery [66]. Quantitative assessment has shown that 64% of the humeral head blood supply arises from the posterior humeral circumflex artery [70].

Pathophysiology of Failure¶

The bony anatomy of the glenohumeral joint contributes little to stability, having been compared with a golf ball on a tee [76]. Most stability of the shoulder is provided by surrounding muscles and ligaments due to the lack of bony constraint [76]. The glenohumeral joint depends on static and dynamic stabilizers for movement and stability, especially the rotator cuff [75]. The rotator cuff stabilizes the glenohumeral joint while allowing greater freedom of motion and fixes the fulcrum of the upper extremity against which the deltoid can contract [75]. The rotator cuff muscles serve as depressors of the humeral head to allow the deltoid to efficiently abduct the humerus [64]. The infraspinatus and teres minor are external rotators, while the subscapularis is an internal rotator of the humerus [64]. The most important force couple for shoulder stability involves the subscapularis and posterior rotator cuff, providing a compressive force that centers the humeral head in the glenoid cavity [76].

The glenoid labrum increases the depth of the socket by 50% around the humeral head [76] and provides a bumper to translation [77]. The glenoid articular surface and labrum combine to create a socket approximately 9 mm deep in the superoinferior direction and 5 mm deep in the anteroposterior direction [76]. Adding the glenoid labrum increases the glenoid surface to 75% of the humeral head vertically and 57% horizontally [76].

First- and second-generation repair techniques fail at a rate in excess of 30% primarily because of sutures pulling through tendons or tendons failing to heal at the tendon-bone junction [106]. The healing zone at the tendon-bone junction is no more substantive than fibrovascular scar [106]. The goals of rotator cuff repair are to keep the tendon "long enough" and "good enough" to achieve pain reduction and improvements in strength and function [106]. In revision rotator cuff repairs, modes of failure include tendon pulling through suture, tear in a new location, suture anchors pulling out of bone, and suture breakage or suture knot [23]. In a study of 22 revision rotator cuff repairs, only 1 case was associated with a loose suture anchor [23]. Osteoporosis in the proximal humerus can result in poor fixation of the anchor to bone [23]. Suture anchors are contraindicated in elderly patients with osteoporotic bone according to several authors based on ex vivo investigations [23].

Biomechanical comparisons of repair configurations show that the biomechanical properties of a double-row rotator cuff repair are superior to a single-row repair [104]. However, there is no evidence that double-row fixation results in better functional outcomes compared to single-row fixation [113]. Rotator cuff tendons repaired via the knotted TOE technique display superior time-zero biomechanical properties, including greater ultimate load to failure, compared with rotator cuffs repaired via the knotless TOE technique [121]. There was conflicting evidence supporting knotless or knotted anchors in biomechanical studies for labral repair [130]. Operative times may be reduced with the use of knotless anchors for labral repair [130]. Bone fixation seems to be improved with knotless anchor systems [3]. The development of knotless suture anchors has allowed for the expansion of their use with elimination of the side effects caused by suture knots without impact on biomechanical strength [52]. By eliminating suture knots, postoperative trochanteric pain is reduced in abductor tendon repair [52]. The knotless, low-profile design eliminates a prominent knot stack superiorly and decreases the risk of stress riser in the acromion and distal clavicle compared to larger, solid body anchors [126].

Complications related to hardware include cartilage damage caused by migration of suture anchors or mini screws, which might progress and cause symptoms in the future even after the loosened anchor or screw is removed [31]. Shoulder function improved in all patients after the loosened anchor or screw was removed [31]. All-suture anchors with various deployment configurations produced different tunnel enlargements, with the diameter more pronounced at the inferior region of the anterior glenoid [131]. Ensuring proper anchor angle is necessary to avoid damage to the cartilage during knotless anchor placement [112]. The TOAK technique eliminates the potential risk for loose hardware in the subacromial space [17].

Clinical outcomes for various techniques include the following. The double-row, transosseous-equivalent suture-bridge repair facilitates the achievement of pain reduction and restoration of shoulder functionality [44]. The knotless double-row technique for reinforcing anterosuperior medium-to-large rotator cuff repairs aims to maximize footprint coverage, increase tendon thickness and effective length, and restore superior stability of the glenohumeral joint [128]. Significant improvements were observed across pain, range of motion, strength, and functional outcomes in a prospective cohort of 1000 consecutive cases of undersurface rotator cuff repair using the Opus knotless system [125]. The retear rate for undersurface rotator cuff repair using the Opus knotless system was 1.4% [125]. At 24 weeks, forward flexion and shoulder strength in abduction, adduction, external rotation, internal rotation, and lift-off improved compared with preoperative levels following arthroscopic stabilization using PEEK knotless anchors [120]. Current level II to IV clinical and biomechanical evidence supports knotless arthroscopic Bankart repair as an effective procedure with excellent functional outcomes and low rates of complication and reoperation [117]. The augmentation of large to massive, posterosuperior rotator cuff tears with human dermal allograft patch resulted in improved shoulder function and greater range of motion compared with the nonaugmented group [116].

Specific technical applications include the following. The Knotless FiberTak is equipped with a shuttling suture mechanism that allows the repair suture to be passed through its locking mechanism [53]. The knotless tensionable anchor technique allows for the desired tension to be given to the construct by pulling the SutureTape shuttle through the splice locking mechanism [53]. The zip-tie technique allows for greater control over tensioning while preserving joint access throughout the repair of multidirectional instability [112]. Premature capsular tightening in conventional approaches can create unnecessary tension, complicating subsequent anchor placement and reducing surgical flexibility [112]. The inability to fine-tune tension at the end of a procedure may lead to suboptimal capsular volume reduction [112]. The risk of shoulder loosening at 5-8 years postoperatively is a potential pitfall of the zip-tie technique for multidirectional instability [112]. The "Suture Staple" knotless anchor technique is suitable for tibial tubercle avulsion fractures where the fragment is too small for screw fixation [52]. The metal-free autograft bone block suture tape cerclage technique resulted in a 4º decrease in external rotation at the side and a 3º decrease in external rotation in 90º of abduction [59]. The arthroscopic transosseous equivalent technique for bony Bankart repair is simple and readily applied in any arthroscopic shoulder surgery practice [60]. The intra-articular subscapularis repair using the transtendon lasso-loop technique with an all-suture anchor expands the surgical armamentarium for managing complex subscapularis pathology [111]. The tensionable knotless tendon-sparing biceps rerouting technique is reproducible, minimally invasive, and suitable for degenerative or inflamed tendons [114]. The fixation of the proximal hamstring tendon using an all-suture tensionable knotless technique combines the biomechanical strength of using multiple smaller anchors with knotless fixation [127]. The single medial-row anchor with biceps tenodesis in a transosseous double-row construct is a promising technique for the repair of massive rotator cuff tendon tears due to technical efficiency and strong biomechanical construct [136]. The double-barrel knot is a new arthroscopic sliding knot for soft tissue reconstruction and repair procedures in arthroscopic and open shoulder surgery [138].

Classification¶

Complication Categories: Suture anchor complications are categorized as either technique-related or device-related issues [9]. Careful attention to proper anchor insertion techniques can limit the potential for complications with bioabsorbable anchors [6]. Newer materials for bioabsorbable anchors may address concerns of biocompatibility and material strength [6]. The new resorbable suture anchor offers the possibility of greater biocompatibility than currently available absorbable suture anchors [55].

Postage Stamp Fractures: Postage stamp fractures are frequently reported in patients who are male, age 25 years or younger, and participants in sporting activities [10]. These fractures are also frequently reported in cases initially stabilized with 3 or more anchors or conventional knot-tying anchors [10]. Additionally, postage stamp fractures are frequently reported in cases that experienced osteolysis around anchor sites [10].

Modes of Failure: Suture anchors pulling out of bone is one of the identified modes of failure for rotator cuff repair at revision surgery [23]. Tendon pulling through suture is one of the identified modes of failure for rotator cuff repair at revision surgery [23]. A tear in a new location is one of the identified modes of failure for rotator cuff repair at revision surgery [23]. Suture breakage or suture knot is one of the identified modes of failure for rotator cuff repair at revision surgery [23]. In a study of 22 revision rotator cuff repairs, only 1 was associated with a loose suture anchor [23]. The loose suture anchor in the revision study may have been the result of poor placement rather than the anchor pulling out [23].

Perianchor Bone Reaction: The perianchor bone reaction grade 0 was observed in 70.1% of patients with all-suture-type anchors [122]. The perianchor bone reaction grade 1 was observed in 21.2% of patients with all-suture-type anchors [122]. The proportion of patients with perianchor bone cysts (grade 2 or above) was 8.8% for all-suture-type anchors [122]. The perianchor bone reaction grade 0 was observed in 64.9% of patients with bioabsorbable-type anchors [122]. The perianchor bone reaction grade 1 was observed in 19.4% of patients with bioabsorbable-type anchors [122]. The proportion of patients with perianchor bone cysts (grade 2 or above) was 16.7% for bioabsorbable-type anchors [122]. The perianchor bone reaction grade 0 was observed in 72.5% of patients with PEEK-type anchors [122]. The perianchor bone reaction grade 1 was observed in 15.0% of patients with PEEK-type anchors [122]. The proportion of patients with perianchor bone cysts (grade 2 or above) was 12.5% for PEEK-type anchors [122]. No significant difference in perianchor bone reactions was observed among the different anchor types [122]. Various bone changes are seen after implantation of an all-suture anchor, but these are not clinically relevant [1].

Other Considerations: The bearing area of a suture anchor can be used to predict the pullout strength independent of design in a soft-bone model [15]. All-suture anchors have similar or better mechanical properties than regular anchors [5]. All-suture anchors have a low-profile design that preserves bone tissue [5]. The Micro bone suture anchor provides a stronger tendon to bone repair than the pullout button or the Mini anchor in human cadaveric hands [20]. Suture anchor fixation is stronger than screw fixation immediately after surgery for humeral greater tuberosity fractures [33]. The TOAK technique is a biomechanically strong and secure cuff fixation that eliminates the potential risk for loose hardware in the subacromial space [17]. No single technique is overwhelmingly superior for managing intraoperative anchor pullout during arthroscopic rotator cuff repair [22]. In a study of 342 patients, 21 (6%) subsequently underwent a revision rotator cuff repair by the same surgeon [23]. In a study of 342 patients, 1 patient had a second revision surgery [23]. A greater number of suture anchors results in greater strength of the repair [28]. The mean number of suture anchors varied among studies and within repair groups in the same study [28]. The repair technique (knotted suture-bridging or knotless tape-bridging) did not have a significant effect on the final outcome at a mean of 2.9 years [16]. Bone fixation seems to be improved with the knotless anchor systems in latissimus dorsi transfer fixation [3]. The small, 2.6-mm all-suture anchor mitigates risks and difficulties associated with other fixation devices while providing ease and efficiency for the surgeon [4]. The knotless double-loaded suture anchor technique for bony Bankart lesion fixation requires only 2 suture anchors, fewer than for double-row repair [7]. The knotless double-loaded suture anchor technique allows slow, controlled compression of the fracture during reduction [7]. The outcomes of arthroscopic transosseous superior capsular reconstruction are not inferior to those of anchor-based techniques [8]. Arthroscopic transosseous superior capsular reconstruction involves more precise suture pass points than anchor-based techniques [8]. The suture anchors were found to simplify the procedure in open Bankart operations [12]. No specific complications as a result of the modified technique using suture anchors were seen in open Bankart operations [12]. The arthroscopic retro all-suture anchor technique for subscapularis repair avoids a difficult trajectory and large-diameter bone punches during anchor insertion [14]. The arthroscopic retro all-suture anchor technique for subscapularis repair provides a reproducible and secure fixation [14]. A possible large defect is a disadvantage if the 4.0-mm-size knotless all-suture anchor were to pull out [26]. There is no clear differentiator between the looped and non-looped end of the passing suture in the joint when using a knotless all-suture anchor with suture tape [26]. The suture dyeing method is particularly useful in large tears with multiple anchors or when suture limbs are entangled [36]. The transosseous rotator cuff repair system using a bone tunneling device facilitates robust and reproducible repairs [37]. The transosseous rotator cuff repair system using a bone tunneling device substantially reduces procedural costs compared to suture anchor techniques [37]. The all-suture tape cerclage technique for AC joint separation fixation was designed to minimize the risk of complications inherent to currently popular procedures [102]. The stump classification was significantly correlated with retear in the suture-bridge and double-row repair techniques [105]. The dermal tuberoplasty technique using self-punching, knotless fixation simplifies graft delivery and suture management [108]. The suture staple knotless anchor technique for tibial tubercle avulsion fractures is based on the technique described by Ratner et al. for capsulotenodesis [52]. Knotless suture anchors allow for the expansion of their use with elimination of the side effects caused by suture knots without impact on biomechanical strength [52]. Lacheta et al. found similar biomechanical strength for first failure load, ultimate load, and stiffness between knotless all-suture anchors and knotted all-suture anchors [52]. Hartigan et al. described that eliminating suture knots in abductor tendon repair reduces postoperative trochanteric pain [52]. The goals of the review on suture anchors and tacks are to review the biological and biomechanical factors that influence the successful evaluation and use of suture anchors and tacks [2]. The repair technique using a combination of suture anchor and miniscrew can be applied in any similar case, regardless of suture anchor type [19]. Future studies are required to validate the biomechanical principles, clinical outcomes, and economics of the double-row repair technique reinforced with modified Mason–Allen and simple sutures [51].

Clinical Presentation¶

Postage stamp fractures are frequently reported in patients who are male, age 25 years or younger, and participants in sporting activities [10]. These fractures are also frequently reported in injuries initially stabilized with 3 or more anchors or conventional knot-tying anchors [10], as well as in fractures that experienced osteolysis around anchor sites [10]. Routine radiographic follow-up is recommended after the use of metallic anchors to ensure the identification of early failure by anchor pullout [11]. Overtightening sutures may cause anchor pull-out [13].

Long-term Outcomes and Revision Patterns¶

At a mean follow-up of 18.3 years, arthroscopic single-row suture anchor fixation of bony Bankart lesions demonstrated low rates of recurrent dislocation and subjective instability [18]. Good longterm results were observed after arthroscopic Bankart repair in patients older than 20 years with 3 or more suture anchors used [21]. In 22 revision rotator cuff repair cases, modes of failure included tendon pulling through suture, tear in a new location, suture anchors pulling out of bone, and suture breakage or suture knot [23]. Specifically, in 2 revision cases, the rotator cuff tendon tear was identified in a new location adjacent to the area that was previously repaired [23], and in 1 of 22 revision rotator cuff repairs, a loose suture anchor was associated with the failure [23].

Complications and Device-Specific Issues¶

Disadvantages of a 4.0-mm-size knotless all-suture anchor include a possible large defect if the anchor were to pull out [26], and no clear differentiator between the looped and non-looped end of the passing suture in the joint [26]. Osteolyses, sometimes major, have been highlighted following surgeries using resorbable anchors [24]. In a study of 52 patients who underwent shoulder stabilization with PLLA tacks, a 19% complication rate was noted [47]. All 10 patients with complications presented within 8 months of the index surgical procedure with complaints of pain and stiffness [47]. On repeat arthroscopy, all 10 patients with complications had synovitis [47], 9 patients had implant debris [47], and 6 patients had evidence of full-thickness chondral injury [47]. In a series of 6 patients with failed bioabsorbable tacks made of PLLA used for superior labral repair, all patients had MRI identification of the broken or dislodged tacks [47]. All patients in this series required repeat arthroscopic reevaluation for fragment removal, evaluation of the biceps anchor, and restabilization of the superior labrum [47]. No inflammatory reactions were documented in the studied biodegradable lactide-containing suture anchors [50].

Investigations¶

Plain radiography: Routine radiographic follow-up is recommended after the use of metallic suture anchors to identify early failure by anchor pullout [11]. The standard shoulder series should include a true AP view in the scapular plane, an AP view, an axillary view, and a scapular Y view [90]. The axillary view is necessary for the evaluation of glenohumeral joint instability and enables determination of the humeral head position in the glenoid fossa [90]. Secondary degenerative joint disease with a central humeral defect from contact with suture anchors can be observed on anteroposterior and axillary radiographs [40]. Various bone changes are seen on radiographs after implantation of an all-suture anchor, but these changes are not clinically relevant [1]. Radiolucent rings around bioabsorbable anchors after rotator cuff repair are not associated with clinical outcomes [129]. Most radiolucent rings around bioabsorbable anchors appeared at anteromedial anchors, indicating that mechanical factors may play a role for the radiolucencies [129]. Osteolysis, sometimes major, has been reported following surgeries using resorbable anchors [24].

CT: CT imaging is frequently used to evaluate fractures of the shoulder, assess for bony lesions in recurrent instability cases, or for preoperative templating for shoulder arthritis [89]. CT with three-dimensional reconstructions is the advanced imaging study of choice for determining the extent of glenoid bone loss in the setting of shoulder instability [90].

MRI: MRI is the modality of choice for evaluating the rotator cuff, biceps, and subacromial bursa [89]. All-suture anchors do not distort MRI, allowing the surgeon to better assess the quality of repair [42]. All-suture anchor fixation facilitates postoperative imaging on magnetic resonance imaging [48]. T1-weighted MRI can reveal Hill-Sachs lesions and is often used with magnetic resonance arthrograms to provide a more detailed picture of the joint surfaces [89]. T2-weighted MRI provides better visualization of full thickness rotator cuff tears [89]. MR arthrography is considered the benchmark for evaluation for labral tears and rarely is indicated for evaluation of rotator cuff pathology [89]. Magnetic resonance accuracy in identifying labral and rotator cuff tears in the literature ranges from 70% to 100% [87]. In a meta-analysis of 6 studies including 4,667 shoulders, MRA had greater diagnostic test accuracy for the detection of glenoid labral lesions than MRI, with MRA sensitivity of 88% and specificity of 93% versus MRI sensitivity of 76% and specificity of 87% [87]. MRI data suggest improved healing rates in single-row repairs in the entire patient population [145]. Double-row repair showed improved radiographic healing when similar-sized tears were compared [145]. Radiographic healing is significantly improved in double-row repairs [148].

Ultrasonography: Ultrasonography is a low-cost alternative to MRI and arthrography for evaluating both skeletal and soft-tissue structures of the shoulder [89]. Ultrasonography can provide immediate, real-time visualization of the rotator cuff, biceps tendon, and calcific deposits [89]. Ultrasonography is a simple and accurate test for identifying rotator cuff tears and calcific tendinitis [80]. The sensitivity of ultrasonography for the detection of full-thickness rotator cuff tears is 98% [90]. The specificity of ultrasonography for the detection of full-thickness rotator cuff tears is 80% [90]. The positive predictive value of ultrasonography for the detection of full-thickness rotator cuff tears is 90% [90]. The negative predictive value of ultrasonography for the detection of full-thickness rotator cuff tears is 95% [90]. The accuracy of ultrasonography for the detection of full-thickness rotator cuff tears is 94% [90]. Ultrasonography is highly operator dependent and is not as useful for evaluating labral tears or rotator cuff tears that are very small or larger than 3 cm [89].

Treatment¶

Operative¶

Indications: Arthroscopic suture anchor-based repair is indicated for posterior labral pathology, demonstrating lower recurrence rates and increased patient-reported outcomes compared to suture fixation alone or open surgical interventions [43]. For open Bankart repair, suture anchors are a standard fixation method, though recurrence rates vary across studies, ranging from 5.9% to 10% [45]. In contrast, the conventional transosseous suture technique for open Bankart repair carries a lower recurrence rate of 2.2% [45].

Surgical Approach / Technique: The choice between knotless and knotted systems does not significantly alter clinical outcomes or return-to-sport rates following arthroscopic anterior labral repair [29]. Knotless and knotted all-suture anchors yield comparable results in this setting [29]. In open Bankart operations, suture anchors simplify the procedure without introducing specific complications associated with modified techniques [12]. For intraoperative anchor pullout, bar anchoring with a threaded Steinmann pin is a viable solution that utilizes primary anchor sites with acceptable results [22]. The modified arthroscopic en masse suture bridge technique is effective for repairing delaminated rotator cuff tears, yielding favourable clinical outcomes comparable to those of nondelaminated tears [107].

Implant Selection: All-suture anchors possess similar or better mechanical properties than regular anchors, with a low-profile design that preserves bone tissue [5]. Biomechanical studies indicate similar properties between knotless and knotted anchors, as well as between all-suture and hard-bodied anchors in Bankart repair models [29]. Prior work demonstrates similar load-to-failure outcomes for “all-suture” suture anchor fixation compared to traditional suture anchors [43]. All-suture anchors have a smaller diameter than traditional hard-bodied anchors, allowing for more points of fixation over a given surface area and improved preservation of glenoid bone stock [29]. Advantages of knotless suture anchors include decreased surgical time, ease of use, improved ability to tension the repair, and low-profile fixation that alleviates concerns for articular cartilage abrasion from intraarticular knots [29]. The Knotless FiberTak is equipped with a shuttling suture mechanism, which allows the repair suture to be passed through its locking mechanism [53]. Bone fixation seems to be improved with the knotless anchor systems in arthroscopically assisted latissimus dorsi transfer fixation [3].

Adjuncts: Double-row suture anchor fixation does not improve clinical outcome according to published literature, although some studies report it may improve tendon healing [49]. Tape-like double-row suture bridge repair was clinically non-superior to conventional double-row suture bridge repair despite theoretical biomechanical advantages [61]. However, double-row suture bridge rotator cuff repair with all-suture anchors for medial row fixation demonstrated excellent short-term clinical outcomes and substantial improvements [38]. Arthroscopic tendon-to-bone transfer (ATSCR) outcomes are not inferior to anchor-based techniques and involve less suture tangling, more precise suture pass points, and lower costs [8]. This system facilitates robust and reproducible repairs while substantially reducing procedural costs compared to suture anchor techniques [37].

Complications and Risks: Complications related to suture anchors and tacks are categorized as technique-related or device-related issues, with prevention dependent on the surgeon's familiarity with the devices and knowledge of their indications and limitations [9]. Postage stamp fractures were reported frequently in patients who were male, age 25 years or younger, and participants in sporting activities, and in fractures initially stabilized with 3 or more anchors or conventional knot-tying anchors or that experienced osteolysis around anchor sites [10]. Bioabsorbable PLDLA anchor material led to significantly more SLAP repair failures and reoperations compared with nonabsorbable suture anchors [143]. Disadvantages of the 4.0-mm-size knotless all-suture anchor include a possible large defect if the anchor were to pull out and no clear differentiator between the looped and non-looped end of the passing suture in the joint [26]. In a series of 72 patients treated with open repair using Mitek anchors and capsular shift, there were 2 reluxations after 9 and 12 months and one instance of anchor loosening seen on X-ray without recurrent instability [81].

Other Considerations: Careful attention to proper anchor insertion techniques can limit the potential for complications, and newer materials may address concerns of biocompatibility and material strength [6]. A new resorbable anchor offers the possibility of greater biocompatibility than currently available absorbable suture anchors [55]. This method can be applied in any similar case, regardless of suture anchor type [19]. It requires only 2 suture anchors, fewer than for double-row repair, and allows slow, controlled compression of the fracture during reduction [7]. Radiological review of patients who underwent “allsuture” suture anchor fixation demonstrated similar healing rates to traditional suture anchor counterparts without bony reactions or cystic changes [43]. Routine radiographic follow-up is recommended after use of metallic anchors to ensure identification of early failure by anchor pullout [11].

Complications¶

General Classification and Prevention¶

Complications associated with suture anchors and tacks are categorized as either technique-related or device-related issues [9]. Suture anchor designs and materials have evolved specifically to minimize these complications [140].

Complications from metal staples, including dislocation of these staples, occur in up to 12% of cases [133].

Osteolyses, sometimes major, have been reported following surgeries using resorbable anchors [24]. In a series of 52 patients undergoing shoulder stabilization with PLLA tacks, a 19% complication rate (10/52) was noted [47]. All 10 patients presenting with complications did so within 8 months of the index surgical procedure [47]. On repeat arthroscopy, all 10 patients had synovitis [47], 9 of the 10 had implant debris [47], and 6 of the 10 had evidence of full-thickness chondral injury [47]. Three patients with chondral damage did not experience significant pain relief after debridement and lavage [47]. Additionally, six patients with failed bioabsorbable tacks made of PLLA used for superior labral repair required repeat arthroscopic reevaluation for fragment removal [47]. No inflammatory reactions were documented in studied biodegradable lactide-containing suture anchors [50]. Radiological review of patients who underwent “all-suture” suture anchor fixation demonstrated similar healing rates to traditional suture anchor counterparts without bony reactions or cystic changes [43].

“Postage stamp” fractures were reported frequently in fractures initially stabilized with 3 or more anchors [10] and in fractures initially stabilized with conventional knot-tying anchors [10]. Complications such as needle breakage and fractures of the glenoid rim while drilling the holes have also been reported [133].

Suture anchor complications, such as prolapse, are a concern in medical practice [118].

Tying arthroscopic knots for fixation is a common site of fixation failure [29]. Intraarticular knots raise concerns for articular cartilage abrasion [29]. ATSCR involves less suture tangling compared to anchor-based techniques [8].

Recurrence and Instability¶

The recurrence rate for open Bankart repair using the Statak device was 8.7% (2 resubluxations out of 23 operations) [45]. The recurrence rate for open Bankart repair using the Mitek Gl anchor was 5.9% (1 recurrence out of 17 cases) with 12 to 24 months of follow-up [45], 7.1% (2 of 28 cases) with a follow-up of 33 to 61 months [45], and 10% (2 redislocations in 20 patients) [45]. The failure rate for open Bankart repair using Statak suture anchors was 20% [133]. The failure rate for open Bankart repair using Mitek GI anchors was 7% (2 of 28 patients) with a follow-up of 42 months [133].

Revision Surgery Outcomes¶

Of the original 342 patients in a rotator cuff repair study, 21 (6%) subsequently underwent a revision rotator cuff repair by the same surgeon [23]. In a study of 22 revision rotator cuff repair cases, modes of failure included tendon pulling through suture, tear in a new location, suture anchors pulling out of bone, and suture breakage or suture knot [23]. In two cases of revision rotator cuff repair, the rotator cuff tendon tear was identified in a new location adjacent to the area that was previously repaired [23].

Recovery¶

Other Considerations: The recovery profile for suture anchor repairs is characterized by specific material-related changes and long-term surveillance requirements rather than a standardized, evidence-based timeline for activity restriction. Resorbable anchors are associated with osteolyses, which can be major in extent [24]. Newer materials are being developed to address concerns regarding biocompatibility and material strength for these bioabsorbable devices [6].

Anchor integrity is a critical component of the recovery phase. The security of a 1.8-mm all-suture anchor at the time of implantation is exceptionally reliable, with no demonstrable learning curve in the hands of an experienced surgeon [151]. Intraoperatively, secure fixation of soft tissue to bone was accomplished in every case, and follow-up x-ray films showed that 65 of the implants remained securely anchored in bone [27].

Long-term clinical outcomes indicate that following arthroscopic double-row suture-bridge rotator cuff repair, longer follow-up time was associated with better patient-reported outcomes in both anchor type groups [56]. However, long-term follow-up will be necessary to determine if the durability of these repairs and the structural integrity of these constructs maintain their performance over time [109]. Similarly, long term followup is necessary to determine the effectiveness of capsulorrhaphy using non absorbable suture anchors [150].

Complications and functional changes are monitored during recovery. Despite the increased incidence of a postoperative complication after knotted anchor fixation compared with knotless anchor fixation, multiple regression analysis showed that anchor design and anchor position were not significantly predictive of the incidence of complications [57]. In cases of metal-free autograft bone block suture tape cerclage for recurrent anterior shoulder instability, external rotation at the side and in 90º of abduction decreased 4º and 3º respectively [59].

Key Evidence¶

[L3] Various bone changes are seen after implantation of an all-suture anchor, but these are not clinically relevant. [1] (10.1177/17585732221127433)
[L5] The goals of this article are to review the biological and biomechanical factors that influence the successful evaluation and use of suture anchors and tacks. [2] (10.1177/0363546505282621)
[Paper] Bone fixation seems to be improved with the knotless anchor systems. [3] (10.1002/jor.24963)
[L5] The small, 2.6-mm all-suture anchor mitigates risks and difficulties associated with other fixation devices while providing ease and efficiency for the surgeon. [4] (10.1016/j.eats.2023.02.030)
[L4] All-suture anchors have similar or better mechanical properties than regular anchors, with low-profile design preserving bone tissue. [5] (10.1016/j.asmr.2020.02.007)
[L4] Careful attention to proper anchor insertion techniques can limit the potential for complications, and newer materials may address concerns of biocompatibility and material strength. [6] (10.1016/j.arthro.2008.08.018)
[L5] It requires only 2 suture anchors, fewer than for double-row repair, and allows slow, controlled compression of the fracture during reduction. [7] (10.1016/j.eats.2024.103297)
[L5] The outcomes of ATSCR are not inferior to those of anchor-based techniques and involve less suture tangling, more precise suture pass points, and lower costs. [8] (10.1016/j.eats.2023.03.022)
[L4] Complications related to suture anchors and tacks can be categorized as technique-related or device-related issues, and prevention depends on the surgeon's familiarity with the devices and knowledge of their indications and limitations. [9] (10.1177/0363546505284240)
[L4] Postage stamp fractures were reported frequently in patients who were male, age 25 years or younger, and participants in sporting activities and in fractures initially stabilized with 3 or more anchors or conventional knot-tying anchors or that experienced osteolysis around anchor sites. [10] (10.1016/j.arthro.2019.02.047)
[L3] We recommend routine radiographic follow-up after use of metallic anchors to ensure identification of early failure by anchor pullout. [11] (10.1016/j.arthro.2009.08.015)
[L3] The suture anchors were found to simplify the procedure, and no specific complications as a result of the modified technique were seen. [12] (10.1016/s1058-2746(96)80444-7)
[L5] The authors summarize the pearls and pitfalls of the new technique, noting that overtightening sutures may cause anchor pull-out. [13] (10.1016/j.eats.2023.11.019)
[L5] This technique avoids a difficult trajectory and large-diameter bone punches during anchor insertion seen with other techniques, providing a reproducible and secure fixation. [14] (10.1016/j.eats.2024.103354)
[L5] The bearing area of a suture anchor can be used to predict the pullout strength independent of design in a soft-bone model. [15] (10.1002/jor.20856)
[L3] The repair technique (knotted suture-bridging or knotless tape-bridging) did not have a significant effect on the final outcome at a mean of 2.9 years. [16] (10.1007/s00402-017-2750-7)
[L5] The TOAK technique is a biomechanically strong and secure cuff fixation that eliminates the potential risk for loose hardware in the subacromial space. [17] (10.1097/00132589-200412000-00004)
[L4] At a mean follow-up of 18.3 years, arthroscopic single-row suture anchor fixation of bony Bankart lesions demonstrated low rates of recurrent dislocation and subjective instability. [18] (10.1002/arj.70565)
[L5] This method can be applied in any similar case, regardless of suture anchor type. [19] (10.1142/s242483551872030x)
[L2] The Micro bone suture anchor provides a stronger tendon to bone repair than the pullout button or the Mini anchor. [20] (10.1053/jhsu.2001.24135)
[L4] Good longterm results were observed after arthroscopic Bankart repair in patients older than 20 years with 3 or more suture anchors used. [21] (10.1016/j.jse.2018.09.027)
[L3] While no single technique is overwhelmingly superior, bar anchoring with a threaded Steinmann pin is a viable solution that utilizes primary anchor sites with acceptable results. [22] (10.1007/s00167-020-05935-4)
[L3] [23] (10.1067/mse.2003.21)
[L4] The study highlights osteolyses, sometimes major, following surgeries using resorbable anchors. [24] (10.1016/j.main.2013.10.109)
[L5] Transosseous suture fixation is not necessarily a "weak link" of repairs. [25] (10.1016/s1058-2746(96)80169-8)
[L5] However, disadvantages include a possible large defect if the 4.0-mm-size anchor were to pull out and no clear differentiator between the looped and non-looped end of the passing suture in the joint. [26] (10.1016/j.eats.2025.103598)
[L4] Intraoperatively, secure fixation of soft tissue to bone was accomplished in every case, and follow-up x-ray films showed that 65 of the implants remained securely anchored in bone. [27] (10.1016/0363-5023(94)90201-1)
[L1] [28] (10.1016/j.arthro.2013.03.076)
[L3] [29] (10.1177/17585732261472078)
[L4] The shoulder function improved in all patients after the loosened anchor or screw was removed, but the cartilage damage might progress and cause symptoms in the future. [31] (10.1016/s1058-2746(98)90208-7)
[L5] Deep placement of suture anchors for increased purchase caused greater displacement and is not recommended. [32] (10.1016/j.jse.2005.03.011)
[L3] The results suggest that suture anchor fixation would be stronger than screw fixation immediately after surgery for humeral GT fracture. [33] (10.1002/jor.21530)
[L5] There has been a major shift from metallic to bioabsorbable anchors due to higher complication rates with metallic anchors and lower rates with bioabsorbable ones. [35] (10.1016/j.arthro.2007.05.011)
[L5] This method is particularly useful in large tears with multiple anchors or when suture limbs are entangled. [36] (10.1016/j.eats.2022.12.007)
[L5] This system facilitates robust and reproducible repairs while substantially reducing procedural costs compared to suture anchor techniques. [37] (10.1016/j.eats.2025.103566)
[L4] Our study demonstrated excellent short-term clinical outcomes and substantial improvements for patients undergoing double-row suture bridge RCR with all-suture anchors for medial row fixation. [38] (10.1177/23259671231192134)
[L3] [42] (10.1177/2325967126s00050)
[L5] [43] (10.1016/j.eats.2023.03.011)
[Paper] This technique is an advance in rotator cuff surgery and will help to facilitate the achievement of the main goals of rotator cuff surgery: pain reduction and restoration of shoulder functionality. [44] (10.1097/bte.0000000000000064)
[L3] [45] (10.1016/s1058-2746(99)90052-6)
[L5] [47] (10.1177/0363546511417573)
[L5] All-suture anchor fixation preserves glenoid bone stock, facilitates postoperative imaging on magnetic resonance imaging, and offers a biomechanically stable fixation. [48] (10.1016/j.eats.2025.103636)
[L2] At present, the data in the published literature do not support the use of DR suture anchor fixation to improve clinical outcome, but there are some studies that report that DR suture anchor fixation may improve tendon healing. [49] (10.1016/j.arthro.2009.02.005)
[L4] No inflammatory reactions were documented in the studied anchors. [50] (10.1016/j.arthro.2014.02.011)
[L5] Future studies are required to validate the biomechanical principles, clinical outcomes, and economics of this technique. [51] (10.1016/j.eats.2022.08.039)
[L4] [52] (10.1002/atn2.70169)
[L5] [53] (10.1016/j.eats.2024.102909)
[L5] This new anchor offers the possibility of greater biocompatibility than currently available absorbable suture anchors. [55] (10.1067/mse.2001.113085)
[L2] Following arthroscopic double-row suture-bridge RCR, longer follow-up time was associated with better patient-reported outcomes (PROs) in both anchor type groups. [56] (10.1016/j.xrrt.2025.100639)
[L4] Despite the increased incidence of a postoperative complication after knotted anchor fixation compared with knotless anchor fixation, multiple regression analysis showed that anchor design and anchor position were not significantly predictive of the incidence of complications. [57] (10.1177/2325967120911361)
[L3] External rotation at the side and in 90º of abduction decreased 4º and 3º respectively. [59] (10.1016/j.jseint.2024.08.159)
[L5] This arthroscopic variation of a well-known technique is simple and readily applied in any arthroscopic shoulder surgery practice. [60] (10.1016/j.eats.2023.02.024)
[L3] Tape-like double-row suture bridge repair was clinically non-superior to conventional double-row suture bridge repair despite theoretical biomechanical advantages. [61] (10.1007/s00167-023-07454-4)
[L3] [81] (10.1016/s1058-2746(96)80394-6)
[L5] This all-suture tape cerclage technique for the fixation of high-grade AC joint separations was designed to capitalize on the physical properties of this recently developed suture material while minimizing the risk of complications inherent to currently popular procedures. [102] (10.1016/j.eats.2024.103184)
[L2] The current literature reveals that the biomechanical properties of a double-row rotator cuff repair are superior to a single-row repair. [104] (10.1016/j.jse.2009.07.002)
[L3] The stump classification was significantly correlated with retear in the suture-bridge and double-row repair techniques. [105] (10.1007/s00167-020-06415-5)
[L5] [106] (10.1016/j.arthro.2010.02.007)
[L4] The modified arthroscopic en masse suture bridge technique was effective for repairing delaminated RCTs, yielding favourable clinical outcomes comparable to those of nondelaminated tears. [107] (10.1002/ksa.12412)
[L5] The technique described simplifies graft delivery and suture management by using a graft inserter and a self-punching, knotless technique of graft fixation. [108] (10.1016/j.eats.2022.08.060)
[L4] Long-term follow-up will be necessary to determine if the durability of these repairs and the structural integrity of these constructs maintain their performance over time. [109] (10.1177/0363546510397725)
[L4] By addressing the dual imperatives of tissue preservation and biomechanical stability, this technique expands the surgical armamentarium for managing complex subscapularis pathology while mitigating risks associated with conventional repair strategies. [111] (10.1016/j.eats.2025.103736)
[L5] [112] (10.1016/j.eats.2025.103762)
[L4] Although double-row fixation restores the rotator cuff footprint and shows biomechanical superiority, there is no evidence that it results in better functional outcomes compared to single-row fixation. [113] (10.1016/j.arthro.2007.01.031)
[L5] The approach is reproducible, minimally invasive, and suitable for degenerative or inflamed tendons, providing biomechanical stability and improved functional outcomes. [114] (10.1002/atn2.70092)
[L3] The augmentation also resulted in improved shoulder function and greater range of motion compared with the nonaugmented group. [116] (10.1016/j.jse.2023.08.002)
[L4] Current level II to IV clinical and biomechanical evidence supports knotless arthroscopic Bankart repair as an effective procedure with excellent functional outcomes and low rates of complication and reoperation. [117] (10.1016/j.asmr.2021.01.014)
[Case_report] Suture anchor complications, such as prolapse, are a concern in medical practice. [118] (10.1186/s12891-024-07476-0)
[L3] At 24 weeks, forward flexion and shoulder strength in abduction, adduction, external rotation, internal rotation, and lift-off improved compared with preoperative levels. [120] (10.1097/bte.0000000000000186)
[L1] On the basis of the included cadaveric studies, rotator cuff tendons repaired via the knotted TOE technique display superior time-zero biomechanical properties, including greater ultimate load to failure, compared with rotator cuffs repaired via the knotless TOE technique. [121] (10.1016/j.arthro.2021.09.017)
[L3] [122] (10.1016/j.arthro.2019.03.032)
[L4] Significant improvements were observed across pain, range of motion, strength, and functional outcomes. [125] (10.1016/j.jseint.2026.101778)
[L5] The knotless, low-profile design, using a readily available biomechanically tested anchor, eliminates a prominent knot stack superiorly and decreases the risk of stress riser in the acromion and distal clavicle compared to larger, solid body anchors. [126] (10.1016/j.eats.2024.103226)
[L5] This technique combines the biomechanical strength of using multiple smaller anchors with knotless fixation. [127] (10.1016/j.eats.2023.03.016)
[L5] The construct aims to maximize footprint coverage, increase tendon thickness and effective length, and restore superior stability of the glenohumeral joint while relying on widely available implants and reproducible steps. [128] (10.1002/atn2.70153)
[Paper] Most radiolucent rings appeared at anteromedial anchors, indicating that mechanical factors may play a role for the radiolucencies. [129] (10.1007/s00402-017-2772-1)
[L1] However, there was conflicting evidence supporting knotless or knotted anchors in the biomechanical studies, though operative times may be reduced with the use of knotless anchors. [130] (10.1016/j.arthro.2020.11.056)
[L3] All-suture anchors with various deployment configurations produced different tunnel enlargements, with the diameter more pronounced at the inferior region of the anterior glenoid. [131] (10.1177/23259671251319533)
[L2] [133] (10.1016/s1058-2746(03)00032-6)
[L5] Due to technical efficiency of the proposed procedure, and ability to still maintain a strong biomechanical construct, we believe that a single anchor medial-row construct to be a promising technique in the repair of even massive rotator cuff tendon tears. [136] (10.1016/j.eats.2022.03.035)
[L5] The double-barrel knot is a new arthroscopic sliding knot for soft tissue reconstruction and repair procedures in arthroscopic and open shoulder surgery. [138] (10.1097/bth.0b013e318285b4e4)
[L4] Suture anchors have revolutionized upper limb surgery by enabling arthroscopic soft tissue-to-bone repair, with designs and materials evolving to minimize complications. [140] (10.1016/j.hcl.2012.08.002)
[L3] Bioabsorbable PLDLA anchor material led to significantly more SLAP repair failures and reoperations compared with nonabsorbable suture anchors. [143] (10.1016/j.arthro.2011.06.021)
[L3] Although MRI data suggest improved healing rates in SR repairs in the entire patient population, DR repair showed improved radiographic healing when similar-sized tears were compared. [145] (10.1016/j.arthro.2010.03.013)
[L3] However, radiographic healing is significantly improved in the double row repairs. [148] (10.1016/j.arthro.2009.04.005)
[L4] Although the early results of this study are promising, long term followup is necessary to determine the effectiveness of this procedure. [150] (10.1016/s1058-2746(96)80119-4)
[L4] The data support that the security of this particular 1.8-mm all-suture anchor at the time of implantation is exceptionally reliable, and there is no demonstrable learning curve in employing the product in the hands of an experienced surgeon. [151] (10.1016/j.arthro.2017.09.049)

References¶

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[40] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > Radiographic Evaluation.

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[50] Adverse Events Associated With Biodegradable Lactide‐Containing Suture Anchors. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.02.011

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[52] A “Suture Staple” Knotless Anchor Technique for Fixation of Tibial Tubercle Avulsion Fractures in Pediatric Patients. Arthroscopy Techniques. 2026. DOI: 10.1002/atn2.70169

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[55] A novel, resorbable suture anchor: Pullout strength from the human cadaver greater tuberosity. Journal of Shoulder and Elbow Surgery. 2001. DOI: 10.1067/mse.2001.113085

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