EVIDENCE-BASED REVIEWS & RECOMMENDATIONS FROM THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY: LABRAL REPAIR FOR ANTERIOR SHOULDER INSTABILITY — MORE THAN TWO ANCHORS VERSUS UP TO TWO ANCHORS

Abstract

ABSTRACT Introduction: Anterior shoulder instability is a common condition that mainly affects young adults. It is most often traumatic and is frequently associated with a Bankart lesion, characterized by detachment of the anteroinferior glenoid labrum. When conservative treatment fails, surgical repair is usually indicated. Biomechanical studies suggest that a greater number of anchors may increase the contact area and provide greater stability between the labrum and the glenoid, promoting a more stable reconstruction of the capsulolabral complex. Methods: A systematic review was conducted in PubMed, Embase, Cochrane Library, and the Virtual Health Library (VHL) up to March 2026 to evaluate whether the use of more than two anchors is more effective than the use of up to two anchors for the arthroscopic treatment of anterior shoulder instability in adults. The certainty of the evidence was assessed with the GRADE approach. Results: One randomized controlled trial and two cohort studies were included. For function and complications, there was no evidence showing that the use of three or more anchors was more effective than the use of two anchors. For recurrence, there was evidence, although the certainty of the evidence was very low, that the use of three or more anchors was more effective than the use of up to two anchors. Conclusion: The surgeon should individually assess patient- and disease-related characteristics to make the best treatment decision. Regarding recurrence, the SBCOC Consensus Project suggests a preference for three or more anchors, given a trend toward a lower recurrence rate. Level of evidence II; Systematic review.