A Biomechanical, Cadaveric Evaluation of Single- Versus Double-Row Repair Techniques on Stability of Bony Bankart Lesions

Background: Previous studies comparing stability between single- and double-row arthroscopic bony Bankart repair techniques focused only on the measurements of tensile forces on the bony fragment without re-creating a more physiologic testing environment. Purpose: To compare dynamic stability and displacement between single- and double-row arthroscopic repair techniques for acute bony Bankart lesions in a concavity-compression cadaveric model simulating physiologic conditions. Study Design: Controlled laboratory study. Methods: Testing was performed on 13 matched pairs of cadaveric glenoids with simulated bony Bankart fractures with a defect width of 25% of the inferior glenoid diameter. Half of the fractures were repaired with a double-row technique, and the contralateral glenoids were repaired with a single-row technique. To determine dynamic biomechanical stability and ultimate step-off of the repairs, a 150-N load and 2000 cycles of internal-external rotation at 1 Hz were applied to specimens to simulate early rehabilitation. Toggle was quantified throughout cycling with a coordinate measuring machine. Three-dimensional spatial measurements were calculated. After cyclic loading, the fracture displacement was measured. Results: The bony Bankart fragment–glenoid initial step-off was found to be significantly greater ( P < .001) for the single-row technique (mean, 896 µm; SD, 282 µm) compared with the double-row technique (mean, 436 µm; SD, 313 µm). The motion toggle was found to be significantly greater ( P = .017) for the single-row technique (mean, 994 µm; SD, 711 µm) compared with the double-row technique (mean, 408 µm; SD, 384 µm). The ultimate interface displacement was found to be significantly greater ( P = .029) for the single-row technique (mean, 1265 µm; SD, 606 µm) compared with the double-row technique (mean, 795 µm; SD, 398 µm). Conclusion: Using a concavity-compression glenohumeral cadaveric model, we found that the double-row arthroscopic fixation technique for bony Bankart repair resulted in superior stability and decreased displacement during simulated rehabilitation when compared with the single-row repair technique. Clinical Relevance: The findings from this study may help guide surgical decision-making by demonstrating superior biomechanical properties (improved initial step-off, motion toggle, and interface displacement) of the double-row bony Bankart repair technique when compared with single-row fixation. The double-row repair construct demonstrated increased stability of the bony Bankart fragment, which may improve bony Bankart healing.

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Double-Row Repair Technique Provides Improved Dynamic Stabilization over Single-Row Repairs for Acute Bony Bankart Lesions

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00437 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0043

Author(s):

Alexander Greenstein ◽

Alexander M. Brown ◽

Aaron Roberts ◽

Raymond Edward Chen ◽

Emma Knapp ◽

...

Keyword(s):

External Rotation ◽

Bankart Repair ◽

Fixation Technique ◽

Double Row ◽

Single Row ◽

Bony Bankart Lesion ◽

Bony Bankart ◽

Double Row Repair ◽

Cadaveric Model ◽

Bankart Lesions

Objectives: Previous studies of bony Bankart repair comparing single- and double-row reconstruction techniques have examined static forces required to displace the bony Bankart lesion. No studies, to date, have examined stability of bony Bankart repair with more physiologic concavity-compression model. We hypothesize the double-row fixation technique would provide superior stability and decreased displacement of a simulated bony Bankart lesion in a concavity-compression cadaveric model compared with single-row technique.Our aim was to examine the dynamic stability and ultimate displacement of single- vs double-row repair techniques for acute bony Bankart lesions Methods: Testing was performed on 13 matched pairs of glenoids with simulated bony Bankart fractures with a defect width of 25% of the glenoid diameter. Half of the fractures were repaired with a double-row technique, while the contralateral glenoids were repaired with a single-row technique. To determine dynamic biomechanical stability and ultimate step-off of the repairs a 150 N load and 2000 cycles of internal-external rotation at 1 Hz was applied to specimens to simulate standard rehabilitation protocols. Toggle was quantified throughout cycling with a coordinate measuring machine. After cyclic loading, the fracture displacement was measured. 3D spatial measurements were calculated using MATLAB. Results: The double-row technique resulted in significantly (p=0.005) less displacement (mean=342.48 µm SD=300.64 µm) than single-row technique (mean=981.84 µm, SD=640.38 µm). Ultimate fracture displacement of double-row repair was significantly less (mean=792.23 µm, SD=333.85 µm, p=0.046) after simulated rehabilitation by internal-external rotation cycling compared to single-row repair (mean=1,267.38 µm, SD=640.38 µm). Conclusion: The double-row fixation technique for arthroscopic bony Bankart repair results in superior stability throughout simulated rehabilitation and decreases ultimate displacement in a concavity-compression cadaveric model.

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Chondral Damage After Arthroscopic Repair Techniques for Acute Bony Bankart Lesions: A Biomechanical Study

The American Journal of Sports Medicine ◽

10.1177/03635465211023758 ◽

2021 ◽

pp. 036354652110237

Author(s):

Alexander S. Greenstein ◽

Raymond E. Chen ◽

Alexander M. Brown ◽

Emma Knapp ◽

Aaron Roberts ◽

...

Keyword(s):

Humeral Head ◽

Cartilage Damage ◽

Bankart Repair ◽

Double Row ◽

Single Row ◽

Chondral Damage ◽

Bony Bankart ◽

Cadaveric Model ◽

Bankart Lesions ◽

Repair Techniques

Background: Bony Bankart lesions can be encountered during treatment of shoulder instability. Current arthroscopic bony Bankart repair techniques involve intra-articular suture placement, but the effect of these repair techniques on the integrity of the humeral head articular surface warrants further investigation. Purpose: To quantify the degree of humeral head articular cartilage damage secondary to current arthroscopic bony Bankart repair techniques in a cadaveric model. Study Design: Controlled laboratory study. Methods: Testing was performed in 13 matched pairs of cadaveric glenoids with simulated bony Bankart fractures, with a defect width of 25% of the glenoid diameter. Half of the fractures were repaired with a double-row technique, while the contralateral glenoids were repaired with a single-row technique. Samples were subjected to 20,000 cycles of internal-external rotation across a 90° arc at 2 Hz after a compressive load of 750 N, or 90% body weight (whichever was less) was applied to simulate wear. Cartilage defects on the humeral head were quantified through a custom MATLAB script. Mean cartilage cutout differences were analyzed by the Wilcoxon rank-sum test. Results: Both single- and double-row repairs showed macroscopic damage. The histomorphometric analysis demonstrated that the double-row technique resulted in a significantly ( P = .036) more chondral damage (mean, 57,489.1 µm2; SD, 61,262.2 µm2) than the single-row repair (mean, 28,763.5 µm2; SD, 24,4990.2 µm2). Conclusion: Both single-row and double-row arthroscopic bony Bankart fixation techniques resulted in damage to the humeral head articular cartilage in the concavity-compression model utilized in this study. The double-row fixation technique resulted in a significantly increased cutout to the humeral head cartilage after simulated wear in this cadaveric model. Clinical Relevance: This study provides data demonstrating that placement of intra-articular suture during arthroscopic bony Bankart repair techniques may harm the humeral head cartilage. While the double-row repair of bony Bankart lesions is more stable, it results in increased cartilage damage. These findings suggest that alternative, cartilage-sparing arthroscopic techniques for bony Bankart repair should be investigated.

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Biomechanical Comparison of Arthroscopic Single- and Double-Row Repair Techniques for Acute Bony Bankart Lesions

The American Journal of Sports Medicine ◽

10.1177/0363546514532782 ◽

2014 ◽

Vol 42 (8) ◽

pp. 1939-1946 ◽

Cited By ~ 11

Author(s):

Ulrich J. Spiegl ◽

Sean D. Smith ◽

Jocelyn N. Todd ◽

Garrett A. Coatney ◽

Coen A. Wijdicks ◽

...

Keyword(s):

Double Row ◽

Bony Bankart ◽

Biomechanical Comparison ◽

Double Row Repair ◽

Bankart Lesions ◽

Repair Techniques

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Biomechanical Comparison of Single- and Double-Row Repair Techniques for Acute Bony Bankart Lesions

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2019.11.058 ◽

2019 ◽

Vol 35 (12) ◽

pp. e22-e23

Author(s):

Ilya Voloshin ◽

Alexander Brown ◽

Aaron Roberts ◽

Raymond Chen ◽

Alexander Greenstein

Keyword(s):

Double Row ◽

Bony Bankart ◽

Biomechanical Comparison ◽

Double Row Repair ◽

Bankart Lesions ◽

Repair Techniques

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Arthroscopic three-point double-row repair for acute bony Bankart lesions

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-008-0659-y ◽

2008 ◽

Vol 17 (1) ◽

pp. 102-106 ◽

Cited By ~ 25

Author(s):

Kyung Cheon Kim ◽

Kwang Jin Rhee ◽

Hyun Dae Shin

Keyword(s):

Double Row ◽

Bony Bankart ◽

Double Row Repair ◽

Bankart Lesions

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Arthroscopic Single-Row versus Double-Row Suture Anchor Rotator Cuff Repair

The American Journal of Sports Medicine ◽

10.1177/0363546505279575 ◽

2005 ◽

Vol 33 (12) ◽

pp. 1861-1868 ◽

Cited By ~ 292

Author(s):

Augustus D. Mazzocca ◽

Peter J. Millett ◽

Carlos A. Guanche ◽

Stephen A. Santangelo ◽

Robert A. Arciero

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Double Row ◽

Single Row ◽

Load To Failure ◽

Arthroscopic Rotator Cuff ◽

Double Row Repair ◽

Cuff Repair ◽

Repair Techniques

Background Recurrent defects after open and arthroscopic rotator cuff repair are common. Double-row repair techniques may improve initial fixation and quality of rotator cuff repair. Purpose To evaluate the load to failure, cyclic displacement, and anatomical footprint of 4 arthroscopic rotator cuff repair techniques. Hypothesis Double-row suture anchor repair would have superior structural properties and would create a larger footprint compared to single-row repair. Study Design Controlled laboratory study. Methods Twenty fresh-frozen cadaveric shoulders were randomly assigned to 4 arthroscopic repair techniques. The repair was performed as either a single-row technique or 1 of 3 double-row techniques: diamond, mattress double anchor, or modified mattress double anchor. Angle of loading, anchor type, bone mineral density, anchor distribution, angle of anchor insertion, arthroscopic technique, and suture type and size were all controlled. Footprint length and width were quantified before and after repair. Displacement with cyclic loading and load to failure were determined. Results There were no differences in load to failure and displacement with cyclic loading between the single-row repair and each double-row repair. All repair groups demonstrated load to failure greater than 250 N. A significantly greater supraspinatus footprint width was seen with double-row techniques compared to single-row repair. Conclusions The single-row repair technique was similar to the double-row techniques in load to failure, cyclic displacement, and gap formation. The double-row anchor repairs consistently restored a larger footprint than did the single-row method. Clinical Relevance The arthroscopic techniques studied have strong structural properties that approached the reported performance of open repair techniques. Double-row techniques provide a larger footprint width; although not addressed by this study, such a factor may improve the biological quality of repair.

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