73 Arthroscopic bankart repair for recurrent anterior dislocation and subluxation of the shoulder: Intraarticular pathology versus clinical results

Background: Literature on arthroscopic stabilization in adolescent patients participating in collision and contact sports is limited, as most studies include adolescents within a larger sample group comprised primarily of adults. Purpose: To review the outcomes of arthroscopic Bankart repair for anterior shoulder instability in an adolescent population participating in collision and contact sports. Study Design: Case series; Level of evidence, 4. Methods: This retrospective review included 39 shoulders in 37 adolescent (≤19 years) athletes who underwent primary arthroscopic Bankart repair using suture anchors with at least 2-year follow-up. All patients had a history of trauma to their shoulder resulting in an anterior dislocation. Outcome measures included patient satisfaction, the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score. Recurrence of dislocation and return to sporting activity were also assessed. Results: The mean age at the time of surgery was 16.9 years (range, 15-19 years), and the mean follow-up was 6.3 years (range, 4.3-10.0 years); 58.6% of patients participated in collision sports. Time to surgery after the initial dislocation episode was 9.2 months (range, 0.5-36.2 months). Four shoulders (10.3%) had dislocation events postoperatively. The majority (78.1%) of patients returned to sports at the same level of competition. Mean VAS was 0.49 ± 1.0, and the mean ASES and Rowe scores were 92.8 ± 12.6 and 85.0 ± 24.2, respectively. Univariate analyses demonstrated that subjective functional outcomes were negatively correlated with recurrence (ASES, P = .005; Rowe, P = .001) and failure to return to sport (ASES, P = .016; Rowe, P = .004). Independent variables shown to have no significant relationship to functional outcomes included age, follow-up, number of preoperative dislocations, time to surgery, sport classification, competition level, tear extent, number of anchors, concurrent Hill-Sachs lesion, and repair of a superior labral anterior-posterior (SLAP) lesion. Conclusion: Arthroscopic Bankart repair is an effective surgical option for traumatic shoulder instability in adolescents participating in collision and contact sports. At a minimum 4-year follow-up, arthroscopic Bankart repair effectively restored stability in 90% of cases; 80% returned to their preinjury level of sport.

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Differences in Failure Mode Between Simple and Mattress Suture Configuration in Arthroscopic Bankart Repairs: A Cadaveric Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120942133 ◽

2020 ◽

Vol 8 (8) ◽

pp. 232596712094213

Author(s):

Shana N. Miskovsky ◽

Lee M. Sasala ◽

Christopher N. Talbot ◽

Derrick M. Knapik

Keyword(s):

Failure Mode ◽

Testing Machine ◽

Bankart Repair ◽

Anterior Dislocation ◽

Suture Repair ◽

Mattress Suture ◽

Arthroscopic Bankart Repair ◽

The Right ◽

Cadaveric Model ◽

Horizontal Mattress Suture

Background: Traumatic anterior shoulder dislocations disrupt the anteroinferior labrum (Bankart lesion), leading to high rates of instability and functional disability, necessitating stabilization. Purpose: To investigate modes and locations of repair failure between simple and horizontal mattress suture configurations after arthroscopic Bankart repair using suture anchors in a cadaveric model. Study Design: Controlled laboratory study. Methods: A total of 48 fresh-frozen human cadaveric shoulders from 48 specimens underwent creation of Bankart lesions from either the 3:00 to 6:00 o’clock position on the right glenoid or the 6:00 to 9:00 o’clock position on the left glenoid. Shoulder laterality between specimens was alternated and randomized to either simple or mattress suture repair configurations. In each shoulder, anchors were placed on the glenoid at the 3:00, 4:30, and 6:00 o’clock positions on the right or 6:00, 7:30, and 9:00 o’clock positions on the left and were secured via standard arthroscopic knot-tying techniques. Specimens were tested in the supine anterior apprehension position using a servohydraulic testing machine that was loaded to failure, simulating a traumatic anterior dislocation. After dislocation, open inspection of specimens was performed, and failure mode and location were documented. Differences in failure mode and location were compared using nominal multivariate generalized estimating equations. Results: Simple suture repairs most frequently failed at the labrum, while mattress suture repair failed at the capsule. Regardless of configuration, repairs failed most commonly at the 3:00 o’clock position on the right shoulder and 9:00 o’clock position on the left shoulder. Compared with mattress suture repairs, simple suture repairs failed at a significantly higher rate at the 6:00 o’clock position. Conclusion: Traumatic anterior shoulder dislocation after arthroscopic Bankart repair in a cadaveric model resulted in simple suture configuration repairs failing most commonly via labral tearing compared with capsular tearing in mattress repairs. Both repair configurations failed predominately at the anterior anchor position, with simple suture repairs failing more commonly at the inferior anchor position. Clinical Relevance: Horizontal mattress suture configurations create a larger area of repair, decreasing the risk of repair failure at the labrum. The extra time required for mattress suture placement at the inferior anchor position is used effectively, resulting in lower biomechanical failure rates.

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Arthroscopic Revision Bankart for Recurrent Anterior Shoulder Dislocation : Contributing Factor Analysis and a Case Report

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00484 ◽

2019 ◽

Vol 7 (11_suppl6) ◽

pp. 2325967119S0048

Author(s):

Andri Lubis ◽

Prima Rizky Oktari

Keyword(s):

New York ◽

Shoulder Dislocation ◽

Suture Anchor ◽

Preoperative Assessment ◽

Late Complications ◽

Bankart Repair ◽

Anterior Dislocation ◽

Range Of Movement ◽

Arthroscopic Bankart Repair ◽

Recurrent Shoulder Dislocation

Objectives: Recurrent shoulder dislocation after arthroscopic Bankart repair (ABR) is still a matter of discussion. The recurrence rate varies between four to fourteen percent in the general population. Re-injury timing, large anatomical defect, and anchor techniques are the factors contributing to re-dislocation after ABR, yet there was still no consensual algorithm for Bankart revision. Case presentation: We presented a case of 27 years old woman with recurrent anterior dislocation after seven years of arthroscopic Bankart repair. Seven years ago, we did Bankart repair using a 2.8 mm fiber-wire anchor (FASTak® (Arthrex, Karsfield Germany)). Now we decided to do arthroscopic revision using all suture anchor technique (Y-Knot® Flex All-Suture Anchor, 1.3mm – One strand of #2 Hi-Fi® (Conmed, New York)). Results: From preoperative and intraoperative assessment, we found that the mechanism of injury, Hill’s-Sachs lesion, Bankart lesion and the number of anchors contributed to re-dislocation. Four months postoperative follow up showed that the patient could gain a normal range of movement. No early or late complications were observed. Conclusion: The success of arthroscopic Bankart repair greatly depended on the preoperative assessment. The arthroscopic revision will do many benefits to the patient since it is less invasive and not compromising the post-operative range of motion of the shoulder.

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