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Objectives and questions: To compare stiffness and elongation between Bankart repair with vs. without an additional posteroinferior (PI) anchor as well as with vs. without suture retensioning.

Material and methods: Ten fresh-frozen cadaveric shoulders (age: 61.3 ± 5.1 years, sex: 90.0% male) were tested in the present study. After preconditioning, Bankart lesions were created and each shoulder underwent four different repair states using knotless soft body anchors: 1) 3-anchor Bankart repair (5:30, 4:30 and 3:30 o’clock), 2) 4-anchor Bankart repair with a PI anchor (6:30 o’clock), 3) 3-anchor Bankart repair with suture retensioning and 4) 4-anchor Bankart repair with a PI anchor and suture retensioning. Repair sutures were passed through 1 cm of capsulolabral tissue and tensioned to 50 N. Retensioning of each suture was performed to 50 N twice. Stiffness and elongation were evaluated before and after 100 cycles of cyclic loading to 25 N.

Results: Stiffness after cyclic loading was highest in the 4-anchor Bankart repair with suture retensioning and was significantly stiffer than the 3-anchor and the 4-anchor Bankart repair (P = .013 and P = .040, respectively). It was not significantly stiffer than the 3-anchor Bankart repair with suture retensioning (P > .127). Elongation after cyclic loading was lowest in the 4-anchor Bankart repair with suture retensioning and was significantly lower than the 3-anchor and 4-anchor Bankart repair (P = .042 and P = .020, respectively). It was not significantly different than the 3-anchor Bankart repair with suture retensioning (P > .232).

Discussion and conclusions: Adding both suture retensioning and a PI anchor to the Bankart repair significantly increases stiffness and decreases elongation. Beyond a potentially decreased risk for instability recurrence, adding both suture retensioning and a PI anchor to the Bankart repair may also encourage an accelerated postoperative rehabilitation process.