Lesión de Bony Bankart: conceptos fundamentales para su comprensión y tratamiento / Bony Bankart lesions: fundamental concepts to understand and treat them

Las lesiones óseas en el borde anterior del anillo glenoideo secundarias a un episodio de inestabilidad anterior del hombro cada vez son más reportadas. Conocidas como lesión de Bony Bankart, su presencia genera una pérdida de la estabilidad estática glenohumeral que provoca un aumento del riesgo de un nuevo evento de luxación. Por ende, resulta fundamental que los cirujanos ortopédicos comprendan y diagnostiquen estas lesiones de forma correcta y oportuna para evaluar la necesidad de restaurar la superficie articular glenoidea. El objetivo de esta revisión narrativa es otorgar los conceptos más importantes de la lesión ósea de Bankart para comprender y enfrentar de forma adecuada esta lesión.

Bony lesions of the anterior glenoid rim secondary to an episode of anterior instability of the shoulder are increasingly being reported. Known as a bony Bankart lesion, its presence generates a loss of static glenohumeral stability that causes an increased risk of a new dislocation event. Therefore, it is essential that orthopedic surgeons correctly and accurately diagnose these injuries to assess the need to restore the glenoid articular surface. The purpose of the present narrative review is to provide the essential concepts of the bony Bankart lesion to properly understand and deal with this type of injury.

Arthroscopic repair of Bankart lesion with bioabsorbable suture anchors / 中国骨伤

OBJECTIVE@#To evaluate early clinical effects of bioabsorbable suture anchors for the treatment of Bankart lesion.@*METHODS@#Total 23 patients with the Bankart lesion were treated with arthroscopic repair using bioabsorbable suture anchors from January 2010 to June 2017. There were 20 males and 3 females, with an average age of (23.4±3.9) years old (ranged, 19 to 34 years old). Fourteen patients had injuries on the right shoulder joint and 9 patients had the injuries on the left side. The mechanism of primary dislocation included 17 cases of training, 5 cases of sports injury and 1 case of falling down. The mean interval time from injury to surgery was(10.9±5.8) months (ranged, 3 to 36 months). The Bankart lesion was repaired by bio-cortical suture anchors. The Rowes rating system for Bankart repair was used to evaluate therapeutic effects.@*RESULTS@#All 23 patients were followed up, with a mean duration of(24.5±3.7) months(ranged, 18 to 39 months). At the latest follow up, there was no recurrent dislocation occurred, and all patients had returned to sports and work. The Rowes rating system for Bankart repair was 53.91±11.67 pre-operationally and 91.74±12.30 post operationally, respectively (@*CONCLUSION@#Applying bio-cortical bone suture anchors for the Bankart lesion is a reliable, efficient and cost effective treatment, which is also suitable for the revision of the Bankart lesion.

Biomecánica de las lesiones en hombro: Revisión bibliográfica crítica desde la perspectiva médico legal laboral / Biomechanics of shoulder injuries: Critical bibliographic review from the medical-legal-occupational perspective

Resumen La base fundamental de la valoración médico legal de un individuo es establecer la relación de causalidad entre la historia narrada por el mismo y los hallazgos documentados. La biomecánica del trauma es una herramienta que permite dilucidar dicha concordancia, ya que su estudio involucra los mecanismos de trauma implicados en la génesis de las distintas lesiones. Este artículo consiste en una revisión bibliográfica y crítica de la literatura actual en materia de etiopatogenia de las lesiones en hombro por su alta incidencia laboral y capacidad de generar secuelas.

Abstract The basis of the forensic evaluation of an individual is to establish the relationship of causality between the story that has been told by the patient and the documented findings. The study of injury biomechanics is a tool that helps to clarify said concordance, since it involves the trauma mechanisms that are implied in the genesis of the different lesions. This article consists of a bibliographical revision and critique of the current literature about the etiopathogenesis of the shoulder lesions, since they are frequent in the work place and can generate sequels.

Arthroscopic treatment of irreducible hip posterior dislocation caused by acetabular labrum bony Bankart lesions / 中国修复重建外科杂志

Objective: To investigate the effectiveness of arthroscopic treatment for irreducible hip posterior dislocation caused by acetabular labrum bony Bankart lesions. Methods: Between February 2008 and August 2016, 11 patients with irreducible hip posterior dislocation caused by acetabular labrum bony Bankart lesions, were treated with arthroscopic reduction and fixation of bony Bankart lesions. There were 7 males and 4 females, with an average age of 23.7 years (mean, 15-36 years). The injury was caused by traffic accident in 8 cases and falling from height in 3 cases. The interval between hip dislocation and the first manual reduction was 2-8 hours (mean, 5.3 hours) and between the first manual reduction and arthroscopic surgery was 6-31 days (mean, 12.8 days). The preoperative visual analogue scale (VAS) was 5.2±0.9, the modified Harris score was 32±8, and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) was 30±5. Results: The operative time was 90-150 minutes (mean, 120.9 minutes), with no hip arthroscopic surgery related complications. All incisions healed by first intention. All patients were followed up 26-68 months (mean, 42.7 months). Postoperative X-ray films showed that all hip joints were reduction; CT showed that the reduction of posterior acetabular wall fracture was satisfactory. And all fractures healed at last follow-up with no avascular necrosis of the femoral head or osteoarthritis. At last follow-up, the VAS score was 0.5±0.5, the modified Harris score was 94±5, and the WOMAC score was 95±4. There were significant differences in those indexes between pre- and post-operation ( P<0.05). Conclusion: The irreducible hip posterior dislocation caused by acetabular labrum bony Bankart lesions is rare. Arthroscopic therapy has the advantages of less trauma, quick recovery, and less complications.

Arthroscopic Treatment of a Type II Superior Labrum Anterior to Posterior (SLAP) Lesion Combined with a Bankart Lesion: Comparative Study between Debridement and Repair of Type II SLAP Lesion by the Status of Lesion

BACKGROUND: The purpose of this study is to evaluate results of superior labrum anterior to posterior (SLAP) repairs and debridement of type II SLAP lesions combined with Bankart lesions. METHODS: Between 2010 and 2014, total 58 patients with anterior shoulder instability due to a Bankart lesion combined with a type II SLAP lesion were enrolled. Patients were divided into two groups: group C consisted of 30 patients, each with a communicated Bankart and type II SLAP lesion and group NC consisted of 28 patients, each with a non-communicated Bankart and type II SLAP lesion. Bankart repairs were performed for all patients. SLAP lesions were repaired in group C and debrided in group NC. Clinical results were analysed to compare groups C and NC by using the visual analogue scale pain score, American Shoulder and Elbow Surgeons score, Constant scores, Rowe score for instability and range of motion assessments. RESULTS: The clinical scores were improved in both groups at final follow-up. Also, there were no differences between two groups. No significant difference was found in terms of the range of motion measured at the last follow-up. The number of suture anchors used was significantly higher in group C than in group NC (5.6 vs. 3.8; p=0.021). CONCLUSIONS: In this study, it is considered that Bankart repair and SLAP debridement could be a treatment option in patients with a non-communicated type II SLAP lesion combined with a Bankart lesion (study design: IV, therapeutic study, case series).

Arthroscopic surgery for treatment of first-time shoulder dislocation combined with Bankart lesions / 局解手术学杂志

Objective To evaluate the curative effect of arthroscopic surgery for the treatment of first-time shoulder dislocation combined with Bankart lesions.Methods Retrospectively analyzed the clinical data of 35 cases who were admitted into our hospital from June 2015 to October 2016 and underwent arthroscopic surgery for the treatment of first-time shoulder dislocation.All the 35 cases were combined with Bankart lesions,and the lacerated glenoid labrum were repaired with suture anchorsy.The postoperative ASES scroe and Rowe score were adopted for the final evaluation.Results All the 35 cases were followed up for 1 to 6 months,3 months averagely.All the patients had satisfactory shoulder function,with no shoulder dislocation occured again.The ASES score and Rowe score after surgery was better than that before surgery with statistically significant difference(P<0.05).Conclusion Arthroscopic surgery for the treatment of first-time shoulder dislocation combined with Bankart lesions has many advantages such as mini-invasion,rapid recovery and satisfactory outcome in function and motion.

Advantages of Scorpion Suture Passer and 70 Degrees Arthroscope in Arthroscopic Bankart Repair: Usefulness for Inferior Labral Repair

BACKGROUND: The blunted tip of a reusable with multiple uses can cause problems with the passing procedure in arthroscopic Bankart repair. This study assessed the advantage of Scorpion with a 70° arthroscope in arthroscopic Bankart repair compared to hook typed suture passer. METHODS: Scorpion in 19 patients, the hook type suture passer (conventional group) in 18 patients were used. All patients underwent the same procedure except for the type of suture passer used. Another different point of the procedure were telescopes and the number of portals used; three arthroscopic portals (posterior, anterorsuperiorlateral, and mid-anterior) and a 30° arthroscope in the conventional group, but two portals and a 70° arthroscope as well as the 30° one in the Scorpion group. The surgery time and the surgical complications including an iatrogenic axillary nerve injury were recorded. RESULTS: The Scorpion group showed a significant decrease in surgery time compared to the conventional group. In contrast to the conventional group, Scorpion provided an easy estimation of the exit of suture passing, no iatrogenic labral injury during the passing procedure with straight movement and the sharp tip of the knife installed. Iatrogenic supraspinatus injuries could be avoided when making an accessory anteosuperiorlateral portal due to the 70° arthroscope. CONCLUSIONS: In arthroscopic Bankart repair, the use of the Scorpion suture passer and a 70° arthroscope can reduce the surgery time, avoid unnecessary supraspinatus injury, and avoid iatrogenic axillary nerve damage through the relatively easy and precise suture passing and saving of the anterosuperior portal.

Clinical Results of the Arthroscopic “Multiple Pulled Suture” Technique for Large or Comminuted Bony Bankart Lesion

BACKGROUND: Arthroscopic fixations for large and comminuted bony Bankart lesions are technically difficult. We developed an arthroscopic multiple pulled suture (MPS) technique to restore large and comminuted bony Bankart lesions. METHODS: Ten patients (mean age, 49.8 years; range, 31–79 years) underwent bony Bankart repair using the illustrated MPS technique and were then followed for a mean of 27.3 months. A plain radiograph series and three-dimensional computed tomography scans were taken at the initial clinical evaluation and 3 months postoperatively. Outcome measurements included the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, University of California at Los Angeles (UCLA) score, and subjective patient satisfaction, along with surgical complications. RESULTS: Union of an osseous fragment with the glenoid rim was confirmed in all patients on a computed tomography scan 3 months after operation. The osseous fragment was restored to proper articular congruence and reduction. The affected shoulder was stable in nine of the 10 patients. One patient presented with a redislocation after a sports injury 3 years postoperatively. The ASES, Rowe, and UCLA scores improved at the final evaluation, and median patient satisfaction at the final follow-up was 9 of 10 points (range, 6–10 points). CONCLUSIONS: The arthroscopic MPS technique for bony Bankart lesions with large or comminuted osseous fragments was a relatively easy and safe method for stable fixation of the osseous fragment. Therefore, the arthroscopic MPS technique resulted in good restoration of stability with high patient satisfaction and low complication rates.

Advantages of Scorpion Suture Passer and 70 Degrees Arthroscope in Arthroscopic Bankart Repair: Usefulness for Inferior Labral Repair

BACKGROUND: The blunted tip of a reusable with multiple uses can cause problems with the passing procedure in arthroscopic Bankart repair. This study assessed the advantage of Scorpion with a 70° arthroscope in arthroscopic Bankart repair compared to hook typed suture passer. METHODS: Scorpion in 19 patients, the hook type suture passer (conventional group) in 18 patients were used. All patients underwent the same procedure except for the type of suture passer used. Another different point of the procedure were telescopes and the number of portals used; three arthroscopic portals (posterior, anterorsuperiorlateral, and mid-anterior) and a 30° arthroscope in the conventional group, but two portals and a 70° arthroscope as well as the 30° one in the Scorpion group. The surgery time and the surgical complications including an iatrogenic axillary nerve injury were recorded. RESULTS: The Scorpion group showed a significant decrease in surgery time compared to the conventional group. In contrast to the conventional group, Scorpion provided an easy estimation of the exit of suture passing, no iatrogenic labral injury during the passing procedure with straight movement and the sharp tip of the knife installed. Iatrogenic supraspinatus injuries could be avoided when making an accessory anteosuperiorlateral portal due to the 70° arthroscope. CONCLUSIONS: In arthroscopic Bankart repair, the use of the Scorpion suture passer and a 70° arthroscope can reduce the surgery time, avoid unnecessary supraspinatus injury, and avoid iatrogenic axillary nerve damage through the relatively easy and precise suture passing and saving of the anterosuperior portal.

Clinical Results of the Arthroscopic “Multiple Pulled Suture” Technique for Large or Comminuted Bony Bankart Lesion

BACKGROUND: Arthroscopic fixations for large and comminuted bony Bankart lesions are technically difficult. We developed an arthroscopic multiple pulled suture (MPS) technique to restore large and comminuted bony Bankart lesions. METHODS: Ten patients (mean age, 49.8 years; range, 31–79 years) underwent bony Bankart repair using the illustrated MPS technique and were then followed for a mean of 27.3 months. A plain radiograph series and three-dimensional computed tomography scans were taken at the initial clinical evaluation and 3 months postoperatively. Outcome measurements included the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, University of California at Los Angeles (UCLA) score, and subjective patient satisfaction, along with surgical complications. RESULTS: Union of an osseous fragment with the glenoid rim was confirmed in all patients on a computed tomography scan 3 months after operation. The osseous fragment was restored to proper articular congruence and reduction. The affected shoulder was stable in nine of the 10 patients. One patient presented with a redislocation after a sports injury 3 years postoperatively. The ASES, Rowe, and UCLA scores improved at the final evaluation, and median patient satisfaction at the final follow-up was 9 of 10 points (range, 6–10 points). CONCLUSIONS: The arthroscopic MPS technique for bony Bankart lesions with large or comminuted osseous fragments was a relatively easy and safe method for stable fixation of the osseous fragment. Therefore, the arthroscopic MPS technique resulted in good restoration of stability with high patient satisfaction and low complication rates.

Advances on treatment of Bankart lesions / 医学研究生学报

The shoulder joint is the largest joint of range of motion in the human body,but the stability is relatively low.Ath-letes and soldiers who engage in the high strength training are prone to shoulder joint instability, while Bankart lesion is the common factor which leads to shoulder joint instability.With the invention of the new medical devices and updating therapeutic method, the treatment of Bankart lesions is improved continuously.In this paper, we will review the key points of diagnosis and therapeutic method.

Hill-Sachs Lesion on MR Arthrography of the Shoulder: Relationship with Bankart Lesion on Arthroscopy and Frequency of Shoulder Dislocations

PURPOSE: This study was performed to evaluate the presence and severity of Hill-Sachs (HS) lesions on MR arthrography (MRA) of shoulder in patients with Bankart lesions following anterior dislocation and to investigate their relationship with Bankart lesions and frequency of dislocations. MATERIALS AND METHODS: 86 MRA of shoulder were evaluated in patients with arthroscopic Bankart repairs following anterior dislocations. The largest surface length of HS lesion on MRA and extent of Bankart lesions on arthroscopy were measured. Relationships between length of HS lesions and extent of Bankart lesions and frequency of dislocations were assessed. RESULTS: HS lesions were identified on MRA in 78 patients. The largest surface length of HS lesion ranged from 9.3 mm to 29.6 mm (mean, 18.8 mm). The extent of Bankart lesion ranged from one to six o'clock extent (mean, 4.25 o'clock extent). Three patients had single dislocation and the other 75 patients had recurrent dislocations (mean 24.5 times). The largest surface length of HS lesions was positively correlated with extent of Bankart lesions (p = 0.001, r = 0.37), but not with frequency of dislocation. CONCLUSION: HS lesion was very common in patients with Bankart lesion. The severity of HS lesions was correlated with extent of Bankart lesions.

Correção da lesão de Bankart por cirurgia artroscópica comparada com a cirurgia aberta: uma revisão sistemática / The Bankart lesion repaired by arthroscopic surgery versus open surgery: a systematic review

Introdução: A instabilidade anterior traumática do ombro é uma doença ortopédica comum que acomete pacientes jovens e/ou atletas. Na maioria das vezes, a lesão de Bankart encontra-se associada. Nesta situação o tratamento cirúrgico é comumente indicado. O objetivo deste estudo é comparar, através de revisão sistemática da literatura, a taxa de insucesso da técnica de Bankart, via artroscópica, com a técnica de Bankart aberta, através da taxa de insucesso de ambas as técnicas nos artigos revisados. Métodos: Através do MEDLINE/Pubmed, pesquisaram-se as palavraschave: a) anterior shoulder instability; b) Bankart lesion; c) traumatic recurrent anterior shoulder instability; d) open Bankart repair; e) arthroscopic Bankart repair; f ) arthroscopic versus open Bankart repair em artigos publicados entre 1998 a 2008, que comparavam a técnica aberta com a técnica artroscópica, exclusivamente operados pela técnica de Bankart. Sete artigos preencheram os critérios de seleção. Entre as variáveis estudadas estavam o número de pacientes e ombros operados por cada técnica, o sexo, o tipo de escore de avaliação e o desfecho. Resultados: Foram abarcados 478 pacientes, 481 ombros, dos quais 54,9% foram operados pela técnica de Bankart contra 45,1% pela técnica aberta. 84,7% (405) eram homens, 15,3% (73) eram mulheres. O escore de Rowe foi mencionado em todos os artigos avaliados. A taxa de insucesso na técnica artroscópica foi de 10,6% contra 7,8% na técnica aberta. Conclusão: As técnicas artroscópica e aberta produziram bons resultados para o tratamento da instabilidade anterior traumática de ombro. Ambas as técnicas apresentaram resultados similares na taxa de insucesso

Introduction: The traumatic anterior instability of the shoulder is a common orthopedic disease that affects young patients and/or athletes. Most often the Bankart lesion is associated. In this situation surgery is usually indicated. The aim of this study is to compare, through a systematic review of the literature, the Bankart technique via arthroscopy with the open Bankart technique through the failure rates of both techniques in the reviewed articles. Methods: Using the MEDLINE/PubMed databases, the following keywords were searched: a) anterior shoulder instability; b) Bankart lesion; c) traumatic recurrent anterior shoulder instability; d) open Bankart repair; e) arthroscopic Bankart repair, and f ) arthroscopic versus open Bankart repair, in articles published from 1998 to 2008 comparing the open technique with the arthroscopic technique performed exclusively with the Bankart technique. Seven articles met the selection criteria. Among the variables studied were the number of patients and shoulders operated by each technique, sex, type of evaluation score, and outcome. Results: The study covered 478 patients, 481 shoulders, of which 54.9% were operated by the Bankart technique against 45.1% by the open technique. 84.7% (405) were men and 15.3% (73) were women. The Rowe score was mentioned in all of the reviewed articles. The failure rate in the arthroscopic technique was 10.6% versus 7.8% in the open technique. Conclusion: The open and arthroscopic techniques have produced good results for the treatment of traumatic anterior shoulder instability. Both techniques showed similar results in the failure rate

One Anchor Double Fixation (OADF) Technique for Arthroscopic Bony Bankart Repair

PURPOSE: The aim of this study was to evaluate the usefulness of arthroscopic Bony Bankart repair using a One Anchor Double Fixation Technique. MATERIALS AND METHODS: Seventeen patients with a Bony Bankart lesion were treated using the One Anchor Double Fixation Technique (OADF Technique). There were 13 males and 4 females. The average age was 24 years (range 17-42). The average follow-up period was 22.3 months. One 3.0 mm suture anchor with doubly loaded sutures was inserted into the glenoid rim. One suture strand was passed the around the small bony fragment and tied first. Another suture strand was passed through the capsule and tied over the bony fragment. The result was measured using Rowe's evaluation index & KSS score. The glenoid defect & bony fragment were measured by 3D-CT scan. RESULTS: Rowe's evaluation index on the final follow-up showed an overall improvement from an average of 54 (range, 23-71) to 83.4 (range 71-90). Of the 17 cases, 13 were excellent, 3 were good, and 1 was fair. KSS scores showed improvement from an average of 71 (range 49-82) to 92.5 (range 82-94). There were no cases where pain continued to the final follow-up, and no cases being re-dislocated during the follow-up period. For six cases, we confirmed the bony healing of the bony Bankart lesion by CT. CONCLUSION: Bony Bankart lesion repair using this new method achieves excellent clinical results with low recurrence rates and is considered another choice for bony Bankart lesions.

Arthroscopic Transosseous Suture Repair for Bankart Lesion with a Flexible Drill Device: An Experimental and Preliminary Clinical Report

PURPOSE: Too develop a flexible drill device that can be inserted into the shoulder joint so that arthroscopic transosseous suture repair for Bankart lesion is possible. MATERIALS AND METHODS: We created a device composed of a flexible drill unit and a guide pipe unit. The flexible drill unit was made of flexible multifilament wires (1.2 mm in diameter) that was twisted into one cord so that it can flex in any direction and a drill bit (1.2 mm in diameter) that is attached onto one end of the flexible wire. The guide pipe unit was a 150 mm long metal pipe (2.0 mm in inner diameter and 3.0 mm in outer diameter), with one end bent to 30 degrees. The flexible drill set was inserted into the shoulder joint through the posterior portal of the joint. The guide pipe component was placed onto the medial wall of the glenoid so that the pipe was placed 5 mm posterior to the margin of the anterior glenoid rim. The flexible drill was driven through the glenoid by the power drill so that holes were made in the glenoid. A non-absorbable suture was passed through the hole. Tying of a sliding knot tying was accomplished over the capsule and labrum after making a stitch through the capsule and labrum with a suture hook loaded with suture passer. The same procedures were done at the 2 and 4 O'Clock positions of the glenoid. RESULTS: Five cases with Bankart lesion received arthroscopic transosseous repair with our flexible drill device. There were no intraoperative problems. Neither redislocation nor subluxation was reported at final follow-up. CONCLUSION: Arthroscopic transosseous suture repair without suture anchors and easy tying of a sliding knot are possible with a flexible drill set.

Arthroscopic Bankart Repair and Rotator Interval Plication by Transglenoid Technique: Preliminary Report / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical results of arthroscopic Bankart repair and rotator interval plication by the transglenoid technique on Traumatic Unidirectional Bankart Surgery (TUBS) with concomitant rotator interval widening. MATERIALS AND METHODS: From May 2002 to May 2003, 13 cases who underwent arthroscopic Bankart repair and rotator interval plication by the transglenoid technique were studied, out of the 14 cases that were diagnosed as TUBS with concomitant rotator interval widening. Follow up period was at least 1 year. Results were evaluated by Rowe score before and after surgery. RESULTS: All the cases were male. Nine cases were on the right shoulder and 4 on the left. The mean age was 22 years old (range, 14-26 years old). The mean duration from injury to operation was 4.3 (range, 1.3-10) years. The Rowe score was improved from 58.3 to 86.4 (p=0.00). Overall outcomes were excellent in 10 cases, good in 2 and fair in 1 at final follow up. There was no sulcus sign in any of the cases at the last follow up, and redislocation did not appear in any of the cases during the follow up period. CONCLUSION: In the treatment of TUBS with concomitant rotator interval widening, arthroscopic Bankart repair and rotator interval plication by the transglenoid technique have made good results.

Open repair of Bankart lesion in the treatment of anterior instability of shoulder / 中华创伤骨科杂志

Objective To evaluate the outcome of open repair of Bankart lesion in the treatment of anterior instability of shoulder.Methods From March 2001 to June 2005,34 cases (36 shoulders) of anterior instability of shoulder underwent open repair of Bankart lesion.Twenty-seven shoulders with Bankart injury were diagnosed by CT scan.Nine shoulders were diagnosed as ALPSA(anterior labrum periosteal sleeve avulsion).Twenty-five shoulders presented with anterior instability only,and 11 combined anterior and inferior instability.Twenty-seven cases had a definite history of injury.Twelve cases presented with Hill-Sachs sign.We used open incision to repair lesions to the capsule glenoid labrum complex with suture anchors.Results The average duration of follow-up was 2.2 years (six months to four years).By Walch-Duplay score system,the good to excellent rate was 86.1%,the moderate rate 8.3%,and the poor rate 5.6%.Redislocation occurred in one case after operation due to injury.The rate of recurrence was 3%.Conclusion Open repair of Bankart lesion in the treatment of anterior shoulder in- stability can lead to good recovery of shoulder function,few complications and a low rate of recurrence.

Results According to Arthroscopic Repair Methods of Bankart Lesion (Operative Methods According to Labral Tear) / 대한정형외과학회잡지

PURPOSE: To recommend optimal surgical techniques in cases of remaining anterior instability after Bankart repair, according to the amount of remaning labrum. MATERIALS AND METHODS: Between December 1996 and April 1999, we experienced 27 pateints that have undergone arthroscopy for recurrent shoulder dislocation. They were followed over 1 year (1 year to 3 year 2 months) and classified into three groups: Group I (Arthroscopic Bankart repair by transglenoid technique); 9 cases, Group II (Arthroscopic Bankart repair by suture anchor); 11 cases, Group III (Arthroscopic Bankart repair by transglenoid technique with suture anchor); 7 cases. RESULTS: A significant difference was found between Group I and Group III patients with poor or no remaining labrum, especially in teims of shoulder stability and range of motion recovery. CONCLUSION: Arthroscopic Bankart repair by suture anchor in a shoulder that has good labrum produced a good result. However, in a shoulder with poor labrum, the combination method of transglenoid technique with suture anchor should be considered to reduce recurrency.

Arthroscopic Repair of Bankart Lesion for the Treatment of the Traumatic Anterior Shoulder Instability / 대한정형외과학회잡지

The purpose of this retrospective study was to evaluate the efficacy of arthroscopic repair of Bankart lesion using the biodegradable polyglyconate implant(Suretac) for the treatment of traumatic anterior shoulder instability. Although the arthroscopic procedure using the Suretac device has some technical advantages over others, there have been reports of the higher failure rate than open procedure. Eight shoulders in 8 patients who had traumatic anterior instability of the shoulder with Bankart lesion were managed with this procedure. They were followed up for average 2 years (range 1 year 4 months to 2 years 5 months). During the follow-up period, all the patients showed full range of motion of the shoulder without recurrence of instability. It was our impression that success rate of the procedure could be improved by careful selection of the patient, the accurate arthroscopic technique, and the good rehabilitation program.

Arthroscopic Transglenoid Suture Technique ( Rhee's method ): Cadaveric Studies on Relationship between Pinning site and Neurovascular Structures / 대한정형외과학회잡지

Arthroscopic treatment of shoulder instability involves two techniques mainly, transglenoid suture technique and anterior anchoring system. However, anterior anchoring system has some disadvantages such as limited indication, high cost, technical difficulty and incapability to suture or reconstruct for all types of Bankart lesion. Disadvantages of transglenoid suture techniques are indirect suture tie, bump effect and possibility of the suprascapular nerve injury. The authors use modified transglenoid suture technique (Rhees method) for shoulder instability involving Bankart lesion, type II SLAP lesion and capsular laxity. The purpose of this study is to accurately describe the relationship between the major neurovascular structures and the pinning sites used in transglenoid suture technique (Rhees method). Placement of two or three arthroscopic Beath pinning sites was simulated in four fresh cadaveric shoulder specimens by placing Steinman pins into the glenoid rim under open field. The specimens were then dissected and the relationship of the pinning sites to the suprascapular nerve and suprascapular artery were recorded. In Bankart lesion repair, safe zone of pinning sites were 2 and 5 oclock in two portals in right shoulder, safe zone of pinning sites were 7 and 10 oclock in two portals in left shoulder. Safe direction of pinning was as possible as inferomedial side in scapula. In type II SLAP repair, safe zone of pinning sites were 2 oclock and just above 2 oclock of glenoid in right shoulder and 10 oclock and just above 10 oclock of glenoid in left shoulder. Safe direction of pinning was pararell to glenoid cavity and slightly superior in horizontal plane. From this study, these sites and directions appeared to be safe. Proper pinning depends on careful attention to the topographical anatomy about the shoulder.