Curved-guide system is useful in achieving optimized trajectory for the most inferior suture anchor during arthroscopic Bankart repair.

BACKGROUND: A curved-drill guide system was recently introduced to achieve a better trajectory for a low anteroinferior anchor during arthroscopic Bankart repair. However, the clinical performance of such a device remains unclear. The purpose of this study was to evaluate the trajectory and position of the low anteroinferior suture anchor with use of the curved-guide system in clinical cases. METHODS: We enrolled 41 cases of arthroscopic Bankart repair in this study. Of these cases, 9 were repaired using the curved drill guide whereas 32 were repaired using a conventional straight guide. Postoperative computed tomography scans were obtained, and 3-dimensional models of the scapula were reconstructed. Notable perforations of the opposite cortex by the most inferior anchors were recorded. The clock-face angle, insertion angle, and insertion distance were measured. RESULTS: The anchor perforation rate in the curved-guide group (11%) was significantly lower than that in the straight-guide group (56%) (P = .02). The insertion distance in the curved-guide group was significantly shorter than that in the straight-guide group (4.0 ± 1.6 mm vs. 7.0 ± 2.4 mm, P < .01). The clock-face angle and insertion angle were significantly greater in the perforated straight-guide group than in the nonperforated groups. The percentage of anchors in the absolute safe zone (clock-face angle > 135° and < 165° and insertion angle < 100°), where no anchors perforated, was greater in the curved-guide group than the straight-guide group. CONCLUSION: Compared with the conventional straight guide, the curved-guide system provides better placement of the most inferior suture anchor during arthroscopic Bankart repair.

Medial Meniscal Root Repair Using Curved Guide and Soft Suture Anchor.

Medial meniscal root tears have been repaired using various methods. Arthroscopic all-inside repair using a suture anchor is one of the popular methods. However, insertion of the suture anchor into the proper position at the posterior root of the medial meniscus is technically difficult. Some methods have been reported to facilitate suture anchor insertion through a high posteromedial portal, a posterior trans-septal portal, or a medial quadriceptal portal. Nevertheless, many surgeons still have difficulty during anchor insertion. We introduce a technical tip for easy suture anchor insertion using a 25° curved guide and a soft suture anchor through a routine posteromedial portal.

Medial Meniscal Root Repair Using Curved Guide and Soft Suture Anchor

Medial meniscal root tears have been repaired using various methods. Arthroscopic all-inside repair using a suture anchor is one of the popular methods. However, insertion of the suture anchor into the proper position at the posterior root of the medial meniscus is technically difficult. Some methods have been reported to facilitate suture anchor insertion through a high posteromedial portal, a posterior trans-septal portal, or a medial quadriceptal portal. Nevertheless, many surgeons still have difficulty during anchor insertion. We introduce a technical tip for easy suture anchor insertion using a 25° curved guide and a soft suture anchor through a routine posteromedial portal.

Inferior suture anchor placement during arthroscopic Bankart repair: influence of portal placement and curved drill guide.

BACKGROUND: During arthroscopic Bankart repair, inferior anchor placement is critical to a successful outcome. Low anterior anchors may be placed with a standard straight guide via midglenoid portal, with a straight guide with trans-subscapularis placement, or with curved guide systems. Purpose/ HYPOTHESIS: To evaluate glenoid suture anchor trajectory, position, and biomechanical performance as a function of portal location and insertion technique. It is hypothesized that a trans-subscapularis portal or curved guide will improve anchor position, decrease risk of opposite cortex breach, and confer improved biomechanical properties. STUDY DESIGN: Controlled laboratory study. METHODS: Thirty cadaveric shoulders were randomized to 1 of 3 groups: straight guide, midglenoid portal (MG); straight guide, trans-subscapularis portal (TS); and curved guide, midglenoid portal (CG). Three BioRaptor PK 2.3-mm anchors were inserted arthroscopically, with an anchor placed at 3, 5, and 7 o'clock. Specimens were dissected with any anchor perforation of the opposite cortex noted. An "en face" image was used to evaluate actual anchor position on a clockface scale. Each suture anchor underwent cyclic loading (10-60 N, 250 cycles), followed by a load-to-failure test (12.5 mm/s). Fisher exact test and mixed effects regression modeling were used to compare outcomes among groups. RESULTS: Anchor placement deviated from the desired position by 9.9° ± 11.4° in MG specimens, 11.1° ± 13.8° in TS, and 13.1° ± 14.5° in CG. After dissection, opposite cortex perforation at 5 o'clock occurred in 50% of MG anchors, 0% of TS, and 40% of CG. Of the 90 anchors tested, 17 (19%) failed during cyclic loading, with a similar failure rate across groups (P = .816). The maximum load was significantly higher for the 3-o'clock anchors when compared with the 5-o'clock anchors, regardless of portal or guide (P = .021). For the 5-o'clock position, there were significantly fewer "out" anchors in the TS group versus the CG or MG group (P = .038). There was no statistically significant difference in maximum load among groups at 5 o'clock. CONCLUSION: Accuracy in suture anchor placement during arthroscopic Bankart repair can vary depending on both portal used and desired position of anchor. The results of the current study indicate that there was no difference in ultimate load to failure among anchors inserted via a midglenoid straight guide, midglenoid curved guide, or percutaneous trans-subscapularis approach. However, midglenoid portal anchors drilled with a straight or curved guide and placed at the 5-o'clock position had significant increased risk of opposite cortex perforation compared with trans-subscapularis percutaneous insertion, with no apparent biomechanical detriment. CLINICAL RELEVANCE: The findings from this study will facilitate improved understanding of risks and benefits of several techniques for arthroscopic shoulder instability treatment with regard to suture anchor fixation.