Open Bankart repair with suture anchors for traumatic recurrent anterior shoulder instability: comparison of results between small and large Bankart lesions

This retrospective study was to demonstrate the clinical outcome of open Bankart repair with suture anchors for recurrent anterior shoulder instability, and to compare surgical results of small (<3 clock units) and large (>3 clock units) Bankart lesions. With an average follow-up of 55.6 months (2–8 years), there were 82 patients (60 right, 22 left shoulders) with the mean age of 27 years accepting open Bankart repair with suture anchors and capsular shift procedure by the same team. According to surgical findings, these patients were grouped into small (<3 clock units) and large (>3 clock units) Bankart lesions. Subjective outcomes were recorded according to the Bankart scoring system of Rowe. Rowe scores averaged 85.9±12.9 (range 25–100). The patients, 92–7 %, had objectively excellent or good results. Twenty nine patients (35.4%) had small Bankart lesions and 53 patients had large Bankart lesions. The Rowe scores in small Bankart lesions were better than that in large Bankart lesions (93.5±6.8 vs.81.8±13.6, Wilcoxon rank sum test, P<0.001). Mean scores of stability (Wilcoxon rank sum test, P=0.043), motion (Wilcoxon rank sum test, P=0.037), and function (Wilcoxon rank sum test, P<0.001) in small lesions also had superior outcomes than in large lesions. Four patients (4.9%) got fair results and two (2.4%) patients got poor results at the end of follow-up. The average loss of external rotation is 10°. Open Bankart repair with the aid of suture anchors still got satisfactory results in the treatment of traumatic recurrent anterior instability of the shoulder. The size of the Bankart lesion was a factor affecting surgical outcome. Small Bankart lesions usually got better results than large Bankart lesions.     

MSCT、MRI联合运用在复发性肩关节前脱位Bankart病损中的应用价值

目的:探讨MSCT、MRI联合运用在复发性肩关节前脱位Bankart病损中的应用价值。方法:回顾性分析经临床、影像证实的复发性肩关节前脱位Bankart病损10例患者的MSCT、MRI表现,主要观察肩关节盂唇前方的CT、MRI改变。结果:10例中,CT发现肩关节盂前下份撕脱性骨折4例,MRI发现肩关节前下盂唇撕脱性骨折1例;MRI发现肩关节盂唇损伤10例,CT不能显示;CT发现合并Hill-Sachs损伤6例,MRI发现Hill-Sachs损伤8例;CT未能发现肱骨头骨挫伤3例;MRI发现肩袖损伤6例,Slap损伤1例。结论:MSCT、MRI能够相互补充,清晰显示Bankart病损及其他合并病变,为临床诊断及治疗提供更加充分的资料。     

Return to sport after a Bankart operation of the shoulder using the Mitek® anchor system

Sixteen athletes suffering anteior instability of the shoulder after primary or recurrent traumatic anterior dislocation were followed for a mean of 23.9 months after an open Bankart operation using Mitek® anchors. Nine patients resumed sports an average of 4.4 months postoperatively, while the remaining seven patients did not return to sports at all. By comparing the group of athletes who had resumed sports and the group who had not, we found in the former group a lower mean age, a higher number of athletes who had inflicted their first anterior dislocation during sports and a larger number of people injured on the dominant arm. However, none of the above-mentioned differences were statistically significant, and there were no differences in range of motion, degree of disability or stability of the operated shoulders in the two groups: returned vs. not-returned to sports. All the athletes performing sports at elite-level returned to sports, whereas all the recreational athletes did not. Among the reasons for not resuming sport, 71% gave sociopsychological reasons such as anxiety or lack of time. Two athletes (12.5%) had suffered redislocations after 12 and 19 months, respectively. No complications or other problems related to the use of Mitek anchors were observed.     

Isolated HAGL lesion after arthroscopic Bankart repair in a professional soccer player

Post-traumatic anterior shoulder instability commonly occurs following an avulsion of capsulolabral complex from glenoid (Bankart lesion) or rarely after humeral avulsion of the glenohumeral ligaments (HAGL lesion). Arthroscopic Bankart repair offers high success rates of healing. However, trauma following the treatment may cause implant failure or re-avulsion of the treated tissue. We aim to present the diagnosis and treatment of an isolated HAGL lesion in a professional soccer player who had previously undergone arthroscopic Bankart repair.     

No difference between knotless sutures and suture anchors in arthroscopic repair of Bankart lesions in collision athletes

The purpose of this study was to compare the clinical results of knotless and knot-tying suture anchors in arthroscopic Bankart repair of collision athletes. Thirty-eight athletes underwent arthroscopic Bankart repairs. The mean age of the patients at the time of surgery was 23 years. Bio-Knot-tying anchors were used in 18 patients, and Bio-Knotless suture anchors were used in 20 patients. Preoperative and postoperative evaluations were performed by Rowe scores. At the end of 40 months follow-up, both the knot-tying and the knotless suture anchor groups had similar postoperative results. There were no differences between Knot-Tying and Knotless repair about late disengagement and re-dislocation in this patient group. Knotless repair provided secure and low-profile repair without introducing complexities to the procedure of arthroscopic knot tying one.     

部队官兵复发性肩关节脱位诊治及疗效评估

目的探讨基层部队官兵复发性肩关节脱位的原因、治疗方法及预后。方法回顾分析我院骨科2000年8月—2012年8月期间收治的确诊为复发性肩关节脱位的27例官兵的临床资料,并采用Rowe评分量表和牛津大学肩关节不稳评分量表(OSIS)对随访患者进行评估。结果 25例患者接受手术,术后21例完成随访,随访时间为6～72(46.7±3.76)个月。15例肩关节功能恢复正常,3例外旋、上举轻度受限,2例脱位复发,1例存在活动疼痛。手术前后Rowe评分为(38.1±14.8)分和(85.8±14.6)分(P<0.01)。术后优良率较术前提高76.1%;手术前后OSIS评分为(42.7±6.4)分和(19.7±5.8)分(P<0.01)。结论初次脱位后全面的诊断、充足的固定时间、合适的手术方式选择以及术后系统的康复锻炼是预防和治疗部队官兵复发性肩关节脱位的关键环节。     

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

After mobilizing anteroinferior osseous Bankart lesion from the glenoid neck, a suture anchor loaded with differently colored non-absorbable braided sutures is placed on the medial edge in the glenoid neck along the rim fracture through the anterior-inferior trans-subscapularis tendon portal. Two same-colored suture limbs on the anchor are then pulled through the labrum using PDS suture shuttling simultaneously. These steps are repeated for the others suture limbs. The two same-color suture limbs located inferiorly are retrieved using the trans-subscapularis tendon portal. Both suture strands are threaded through the eyelet of a PushLock anchor on the distal end of the driver. The anchor is advanced into the pilot hole completely. These steps are repeated for a second anchor at the upper edge of the fracture in the glenoid rim using the anterior portal. This technique confers effective, firm fixation of the bony Bankart lesion by three-point fixation without the suture material crossing the glenoid cavity.     

The Bankart lesion of the shoulder: A biomechanical analysis following repair

The Bankart lesion of the shoulder has long been associated with anterior instability. Our laboratory has developed a biomechanical model of the human shoulder which was used to determine the effects of creating a Bankart lesion on cadaveric specimens and then to compare the effects of two repair techniques. The model simulates the abducted, externally rotated position of the glenohumeral joint and uses pneumatic cylinders to simulate the rotator cuff forces. Specimens were tested intact following a partial Bankart lesion, following a complete Bankart lesion, and after performing a Bankart repair using three Mitek suture anchors. Finally, both the traditional and Mitek repairs were tested until failure. Strain in the inferior glenohumeral ligament (IGHL) and torque resistance was measured as an indication of instability of the joint. Strain was noted to decrease with increasing depth of lesion of the IGHL. Torsional rigidity of the shoulder decreased with increasing depth of lesion as well. Repairing the shoulder restores the strain and rigidity to control conditions. The mean load until failure was greater with the traditional repair than with the suture anchor technique. This study quantitates the effects of a Bankart lesion of the shoulder, and demonstrates that repairing the lesion with a suture anchor technique restores the biomechanics of the shoulder.Investigation performed at the Albert B. Ferguson, Jr., MD Laboratory for Orthopaedic Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USAThis work was supported by a grant from the Whitaker Foundation     

Simultaneous bilateral posterior dislocation of the shoulder: diagnostic problems and management

We present the case of a patient who sustained simultaneous bilateral posterior dislocation of the shoulder after a possible epileptic fit. The confirmation of the diagnosis was reached only by a computed tomography (CT) scan, after the clinical suspicion. Under general anesthesia, close reduction of both shoulder dislocations was done. Posterior dislocation of the shoulder—especially the bilateral one—is very rare. When the history describes an electric shock or convulsive seizure, any shoulder injury demands a careful clinical and radiological evaluation. It is usually associated with reverse Hill-Sachs lesion (an impression defect of the anteromedial aspect of the humeral head), in which the size determines the treatment options.     

The value of ultrasonography in the preoperative diagnostic evaluation of patients with recurrent anterior shoulder dislocation: a prospective study of 44 patients

The purpose of this study was to investigate the value of ultrasonography in the pre-operative assessment of patients with recurrent post-traumatic, anterior shoulder instability. Forty-four consecutive patients, 44 men and 12 women, with unilateral, post-traumatic, recurrent instability of the shoulder were included in the study. One experienced radiologist examined all patients, using a 5.0 or 7.5 MHz linear-array transducer, with the arm in different positions, one of which was used to provoke apprehension of the shoulder. Special attention was paid to the evaluation of the joint capsule, the anterior labrum, especially in terms of the presence of a Bankart lesion. All patients were subsequently treated surgically. After a diagnostic arthroscopy either an open or arthroscopic stabilisation of the shoulder was performed. Ultrasonography disclosed an unstable anterior labrum (equivalent to a Bankart lesion) in 36 shoulders; the lesion was verified in all 36 shoulders during arthroscopy. In three shoulders, arthroscopy disclosed an injured labrum, which had healed in an anterio-medial position on the scapular neck. In these three shoulders, ultrasonography failed to show any lesion. In five shoulders no Bankart lesion was found at arthroscopy. All these patients had increased shoulder laxity, and ultrasonography did not show any Bankart lesion. Furthermore a judgement of the joint capsule was not possible either. A bony Bankart lesion was found in four shoulders, using both arthroscopy and ultrasonography. The sensitivity of the ultrasonographic evaluation was 92%, and the specificity 100%. The positive predictive value was 100%, and the negative predictive value 63%. Ultrasonography showed a high correlation with the arthroscopic findings, with a high sensitivity and specificity. Therefore, we conclude that US can give important pre-operative information in patients with recurrent, unilateral, post-traumatic, anterior shoulder instability.     

Anterior-inferior labral lesions of recurrent shoulder dislocation evaluated by MR arthrography in an adduction internal rotation (ADIR) position

PURPOSE: To introduce and evaluate the usefulness of the adduction internal rotation (ADIR) position in MR arthrography for discriminating the following subtypes of Bankart lesions: classic Bankart lesions, anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions, and Perthes lesions. MATERIALS AND METHODS: The study group consisted of 25 patients who had been referred for MR arthrography of the shoulder and then underwent arthroscopy due to recurrent episodes of shoulder dislocation. MR arthrography was performed in three different positions: neutral, abduction external rotation (ABER), and ADIR. The authors evaluated the statistical significance of the method's discriminative diagnostic ability for the subtypes of Bankart lesions according to the position changes. RESULTS: Twenty-three patients had the following single or complex labral lesions: classic Bankart (N = 8), ALPSA (N = 3), complex classic Bankart/ALPSA (N = 8), and complex ALPSA/Perthes (N = 4). Two patients had no visible anteroinferior labral lesions. The performance of ADIR positioning for differentiating ALPSA lesions was superior to the neutral or ABER positioning. The difference of the discriminative lesion detection ability was statistically significant (P <.01) only for detecting ALPSA lesions in the ADIR position. CONCLUSION: MR arthrography in the ADIR position provides high accuracy for the diagnosis of ALPSA lesions, and complements routine MR arthrography when used to diagnose labroligamentous lesions in patients with recurrent shoulder dislocations.     

Early arthroscopic treatment of primary traumatic anterior shoulder dislocation. A follow-up study

This study evaluates the results of early arthroscopic Bankart repair in patients with primary traumatic anterior dislocation of the shoulder. The patients'age range was 17–34 years. Arthroscopic Bankart repair was performed within 12 days after the dislocation. First follow-up was at 18 months. According to Rowe's score, 11 patients (73%) were excellent, 3 (20%) were good and 1 (7%) was poor. The median external rotation deficit was 4 in the adducted position. At a second follow-up at 34 months, two patients had redislocated. Both of these patients had severe generalized joint laxity. Another patient reported frequent subluxations. We conclude that in young patients with primary anterior traumatic shoulder dislocation, early arthroscopic Bankart repair implies a low recurrence rate and restores shoulder function to normal. Generalized joint laxity could indicate an increased risk for recurrent dislocation.     

关节镜下Bankart修复治疗训练伤所致慢性肩关节前方不稳

目的观察关节镜下Bankart修复治疗训练伤所致慢性肩关节前方不稳的临床疗效。方法选择21例肩关节前方不稳的患者,关节镜下锚钉修复盂唇损伤,同时修复合并出现的上盂唇前后(SLAP)损伤,较大的Hill-sachs损伤。采用UCLA功能评分标准和SST评分进行疗效的评估,记录术前和终末随访的得分。结果术后患者随访12~45个月,平均随访27个月。SST得分术前为(6.72±2.38)分,术后终末随访评分为(11.24±1.46)分,同术前比较差异有统计学意义(P<0.01)。术前UCLA平均得分为(19.55±5.02)分,术后终末随访评分为(33.19±4.61)分,与术前比较差异有统计学意义(P<0.01)。结论关节镜下Bankart修复治疗训练伤所致肩关节前方不稳疗效满意,可以很好恢复肩关节功能。     

MRI examination of the glenohumeral joint after traumatic primary anterior dislocation

Primary traumatic anterior dislocation of the shoulder in young patients has a high recurrency rate. There are varying opinions on the pathology behind the recurrences. The aim of this study was to describe the MRI characteristics of the acute lesion, and at 6-month follow-up. Thirty patients aged 18–30 years with primary traumatic anterior dislocation of the shoulder were randomized into two groups. One group was treated with acute arthroscopic lavage within 10 days. The control group was treated with traditional non-operative therapy. All patients underwent acute MRI within 10 days and before the arthroscopic lavage, and again at the 6-month follow-up, for evaluation of the lesions. The acute MRI verified Hill-Sachs lesions in all patients. At the 6-month follow-up MRI, there was no change in the size of the Hill-Sachs lesion. This was also the case with the six patients in the control group with recurrent dislocations during the first 6 months. Twenty-nine patients (97%) had joint effusion at the acute MRI, which was very useful for evaluation of the soft tissue pathology. The glenohumeral ligaments were detached in 20/30 patients (66%), and the labrum in 22/30 patients (70%). A capsulolabral detachment classified as a Baker 3 lesion was seen in 16/30 (53%) of the patients, including all six patients with recurrent dislocation. At the 6-month control, only 3/30 (10%) of the patients had joint effusion for adequate evaluation of the labrum and ligamentous pathology. A Hill-Sachs lesion was found in 100% of the patients after primary dislocation, and recurrent dislocations did not change the size of the lesion. The study supports the opinion that this lesion is overlooked in the clinical situation. The joint effusion at the acute MRI was of utmost importance for evaluation of the soft tissue pathology. The 6-month MRI control was therefore considered inconclusive when evaluating capsulolabral lesions, due to lack of effusion. MRI arthrography with contrast administration would have been very helpful at the 6-month examination.     

肩关节后脱位3例报告

目的 通过分析肩关节后脱位的诊治情况,探讨其诊断及治疗方法,从而提高对这一损伤的认识,减少误漏诊.方法 回顾分析3例肩关节后脱位患者的临床资料,分析其临床表现,影像学特点及治疗方法.结果 随访6~24个月,2例肩关节活动良好,美国加州大学肩关节评分系统(UCLA)评分为30分、33分;1例肩关节活动受限,UCLA评分2...     

Developments in Bankart repair for treatment of anterior instability of the shoulder

In the past 10 years, Bankart repair for operative treatment of recurrent luxation of the shoulder has become well established. Recently, the arthroscopic Bankart procedure has been developed. Since 1991, cannulated, bioabsorbable plugs are being used (Suretac; Acufex Microsurgical, Mansfield, Ma., USA). This investigation examines what the advantages of this micro-invasive technique are compared with the open Bankart procedure. From 1986 to 1995, 120 patients underwent Bankart repair of the shoulder in our hospital. Since 1993 we have preferred using arthroscopy, and since 1994 with Suretac. We were able to follow-up 93 patients. The results were assessed using the criteria of stability, range of motion, pain and functional results. The patients were evaluated using the Rowe score. The mean follow-up time was much shorter in the arthroscopic group. Nevertheless, we registered a higher reluxation rate (2 patients, 8%) in comparison with the group that underwent open surgery (3 patients, 4%). As postoperative pain and deterioration of range of motion are less, however, the mean Rowe score shows no significant difference. In conclusion, proper selection of patients has to be performed: arthroscopic Bankart repair is recommended for refixation of a detached anterior labrum. It is disadvantageous when the labrum is degenerated or the capsular tissue is attenuated. That is why, in our opinion, the open Bankart procedure with its capsulorrhaphy cannot be renounced completely.