The Bankart repair: past, present, and future.

Arthur Sidney Blundell Bankart was a London-based orthopedic surgeon who discovered the essential lesion in recurrent anterior shoulder instability in 1923. He pioneered a technique, the Bankart repair, to re-establish stability to the glenohumeral joint, without sacrificing native joint motion. In this article, the original Bankart repair is compared to the modern arthroscopic Bankart repair, accompanied by a surgical video of Blundell Bankart performing the Bankart repair in 1951, shortly before his death. Bankart's original description included an open repair with a coracoid osteotomy and subscapularis tenotomy and repair. The history of the technique, its utility in present day, and the future of the Bankart repair are discussed.

[Structural damage after shoulder dislocation and development of surgical treatment from a historical perspective]. / Struktureller Schaden nach Schulterluxation und operative Therapieentwicklung aus historischer Sicht.

In the nineteenth century there was a high incidence of habitual shoulder instability caused by epileptic seizures and accompanied by therapeutic dilettantism, which led to socioeconomic problems in the working population. In the preradiography era the pathomechanism of shoulder dislocation was only known on the basis of cadaver studies and autopsy findings. The underlying structural disorders of habitual shoulder instability in the Bismarck era were published by Malgaigne, Broca and Hartmann. In1898 the first surgical reconstructive stabilization procedure for habitual shoulder dislocation was performed by Wilhelm Müller in Rostock. At the beginning of the twentieth century Perthes introduced the anatomical reconstruction of the capsulolabral complex, which was copied in the English speaking area by Bankart. Surgical wrong tracks through extra-anatomical procedures, capsulorrhaphy and tendon transfer, were followed by bone block procedures according to Eden-Hybinette and a modification of this procedure by Lange. In the French speaking area Latarjet introduced the transfer of the coracoid process in the middle of the 1950s, which brought the advantage of simultaneous dynamic stabilization to bony augmentation of the glenoidacetabulum .

Emergencies and acute diseases in the collected works of Hippocrates: observation, examination, prognosis, therapy.

The collected works οf Hippocrates include a wealth of references to emergencies and acute conditions; if the physician could treat these, he would be considered superior to his colleagues. Works most relevant to current Emergency Medicine are presented. They indicate Hippocrates' remarkable insight and attention to the value of close observation, meticulous clinical examination, and prognosis. Hippocrates and his followers disdained mystery and were not satisfied until they had discovered a rational cause to diseases. They assigned great significance to distressing signs and symptoms - the famous Hippocratic face, the breathing pattern, pain, seizures, opisthotonus - pointing to a fatal outcome, which they reported to their patient. The principles of treatment of emergencies, such as angina, haemorrhage, empyema, ileus, shoulder dislocations and head injuries, are astonishingly similar to the ones used nowadays.

History of surgical intervention of anterior shoulder instability.

BACKGROUND: Anterior glenohumeral instability most commonly affects younger patients and has shown high recurrence rates with nonoperative management. The treatment of anterior glenohumeral instability has undergone significant evolution over the 20th and 21 centuries. METHODS: This article presents a retrospective comprehensive review of the history of different operative techniques for shoulder stabilization. RESULTS: Bankart first described an anatomic suture repair of the inferior glenohumeral ligament and anteroinferior labrum in 1923. Multiple surgeons have since described anatomic and nonanatomic repairs, and many of the early principles of shoulder stabilization have remained even as the techniques have changed. Some methods, such as the Magnusson-Stack procedure, Putti-Platt procedure, arthroscopic stapling, and transosseous suture fixation, have been almost completely abandoned. Other strategies, such as the Bankart repair, capsular shift, and remplissage, have persisted for decades and have been adapted for arthroscopic use. DISCUSSION: The future of anterior shoulder stabilization will continue to evolve with even newer practices, such as the arthroscopic Latarjet transfer. Further research and clinical experience will dictate which future innovations are ultimately embraced.

History of shoulder instability surgery.

PURPOSE: The surgical management of shoulder instability is an expanding and increasingly complex area of study within orthopaedics. This article describes the history and evolution of shoulder instability surgery, examining the development of its key principles, the currently accepted concepts and available surgical interventions. METHODS: A comprehensive review of the available literature was performed using PubMed. The reference lists of reviewed articles were also scrutinised to ensure relevant information was included. RESULTS: The various types of shoulder instability including anterior, posterior and multidirectional instability are discussed, focussing on the history of surgical management of these topics, the current concepts and the results of available surgical interventions. CONCLUSIONS: The last century has seen important advancements in the understanding and treatment of shoulder instability. The transition from open to arthroscopic surgery has allowed the discovery of previously unrecognised pathologic entities and facilitated techniques to treat these. Nevertheless, open surgery still produces comparable results in the treatment of many instability-related conditions and is often required in complex or revision cases, particularly in the presence of bone loss. More high-quality research is required to better understand and characterise this spectrum of conditions so that successful evidence-based management algorithms can be developed. LEVEL OF EVIDENCE: IV.

Addressing the Hill-Sachs Lesion Humeral Head Bone Loss and Glenohumeral Instability.

Osseous injuries affecting the posterosuperolateral aspect of the humeral head, also known as the Hill-Sachs lesion, are common and can pose a difficult problem for the operating surgeon. Hill-Sachs lesions can lead to recurrent shoulder instability if not identified and addressed. This review will focus on osseous defects of the humeral head and address the pathoanatomy, diagnosis, indications, and surgical techniques for the treatment of these lesions.

Orthopedic surgery in ancient Egypt.

BACKGROUND: Ancient Egypt might be considered the cradle of medicine. The modern literature is, however, sometimes rather too enthusiastic regarding the procedures that are attributed an Egyptian origin. I briefly present and analyze the claims regarding orthopedic surgery in Egypt, what was actually done by the Egyptians, and what may have been incorrectly ascribed to them. METHODS: I reviewed the original sources and also the modern literature regarding surgery in ancient Egypt, concentrating especially on orthopedic surgery. RESULTS: As is well known, both literary sources and the archaeological/osteological material bear witness to treatment of various fractures. The Egyptian painting, often claimed to depict the reduction of a dislocated shoulder according to Kocher's method, is, however, open to interpretation. Therapeutic amputations are never depicted or mentioned in the literary sources, while the specimens suggested to demonstrate such amputations are not convincing. INTERPRETATION: The ancient Egyptians certainly treated fractures of various kinds, and with varying degrees of success. Concerning the reductions of dislocated joints and therapeutic amputations, there is no clear evidence for the existence of such procedures. It would, however, be surprising if dislocations were not treated, even though they have not left traces in the surviving sources. Concerning amputations, the general level of Egyptian surgery makes it unlikely that limb amputations were done, even if they may possibly have been performed under extraordinary circumstances.

Anterior shoulder instability - a history of arthroscopic treatment.

The glenohumeral joint is the most commonly dislocated joint in the body. The prevalence of this condition and the instability that may result from it has been a focus of diagnosis and treatment since the original description of the Bankart lesion in 1923. Now, with the introduction of MRI, lesions causing anterior shoulder instability can be diagnosed more accurately. This has led to improved understanding of the pathoanatomy that must be addressed and corrected during surgical repair. Initial attempts at arthroscopic treatment, including staple repair, transosseus suture repair, rivets, and thermal capsulorraphy were fraught with complications and unacceptably high recurrence rates. The development of arthroscopic suture anchors have revolutionized the treatment of anterior shoulder instability, such that arthroscopic management is now the standard of care. In the hands of experienced surgeons, outcomes for arthroscopic treatment of shoulder instability now approaches the success of open treatment.

An approach to the natural: the Kenneth Russell memorial lecture.

This paper reports on the disability resulting from the dislocation, later recurrent, of the right shoulder suffered by Winston Churchill in 1896. It considers the management principles enunciated by Hippocrates and their relevance to his situation and to contemporary practice.

Luxação recidivante do ombro: do papiro de Edwin Smith à capsuloplastia térmica / Shoulder recurrent dislocation: from Edwin Smith's papyrus to thermal capsuloplasty

O primeiro registro de luxação glenoumeral remonta ao papiro de Edwin Smith (3000-2500 a.C.), sendo conhecida e estudada por Hipócrates (470-377 a.C.). Desde então, houve grande evolução no diagnóstico, entendimento e, especialmente, no tratamento dessa patologia e das lesões a ela associadas. Os avanços dos métodos diagnósticos e o conhecimento anatômico permitiram que novas lesões associadas fossem reveladas (SLAP, GLAD, ALPSA, HAGL), modificando o método de tratamento. O entendimento da avulsão do lábrum, conhecida como lesão de Bankart, e denominada "lesão essencial", foi fundamental para o aprimoramento da técnica cirúrgica. As técnicas cirúrgicas antigas, que visavam a estabilização através de encurtamento capsular ou bloqueio da rotação externa, sem corrigir a lesão labral, foram substituídas pela reinserção do lábrum, restaurando a anatomia. O emprego das âncoras de sutura diminuiu o tempo cirúrgico e facilitou tecnicamente o procedimento. O entendimento dos conceitos de instabilidade e de frouxidão capsuloligamentar foram igualnente importantes na escolha da técnica apropriada. As técnicas cirúrgicas atuais visam a reconstrução das lesões associadas, sem causar restrição da mobilidade ou de atividade do paciente. A análise de diversas publicações demonstra que a técnica aberta para o tratamento da luxação recidivante é um procedimento com resultados conhecidos e com baixo índice de recidiva e outras complicações, sendo considerado ainda como o golden standard. A técnica artroscópica, minimamente invasiva, sem dúvida trouxe grande avanço, com melhor conhecimento das lesões associadas, melhor cosmese e com preservação do músculo subescapular. Apresenta resultados comparáveis aos da técnica aberta, quando a adequada seleção do paciente é realizada. A cirurgia de Bristow permanece sendo um procedimento de "salvação", nos casos de grande fratura do rebordo da glenóide e falha da técnica convencional. A capsuloplastia térmica produz resultados incertos e seu uso vem sendo abandonado

On the articulations. The genuine works of Hippocrates.

From The Genuine Works of Hippocrates, Baltimore, Wilkins & Wilkins 205-214, 1939. Francis Adams, translator.

Arthroscopic stabilization of anterior shoulder instability: a historical perspective.

The role of arthroscopic procedures in the management of glenohumeral instability continues to evolve and represents an effective alternative for addressing the pathology associated with this condition. Patient selection criteria, operative techniques, and implants all continue to evolve and have resulted in improved rates of success. Arthroscopic procedures benefit patients by avoiding the common morbidities associated with the disruption of the anterior soft tissues, including a loss of external rotation associated with open procedures. Arthroscopic procedures remain technically demanding and require skills to address all of the existing pathology. The surgeon must be prepared to address many conditions beyond the Bankart lesions including glenoid bone lesions. capsular laxity, rotator interval lesions, and SLAP lesions. In addition to the documentation of recurrence, the success of this procedure must be evaluated within the context of retained ranges of motion, recovery time, proprioceptive control, and the return to prior levels of activity. Further studies are necessary to continue to validate the efficacy of arthroscopic stabilization.

From Hippocrates to the Eskimo--a history of techniques used to reduce anterior dislocation of the shoulder.

It has been recognised for thousands of years that the shoulder joint is particularly prone to dislocation following trauma. From the time of Hippocrates, physicians have described a variety of different techniques aimed at reducing shoulder dislocations. In this article we review the historical development of these techniques and suggest that, despite being described as new, many of these are simply variations on an already established method.