Revisability of polyetheretherketone suture anchors utilised in primary and revision Bankart repair

BackgroundPolyetheretherketone (PEEK) suture anchors are frequently used in Bankart shoulder stabilisation. This study analyzed the primary stability and revisability of PEEK anchors in-vitro in case of primary Bankart repair and revision Bankart repair after failed primary repair.MethodsTo simulate primary Bankart repair, 12 anchors (Arthrex PEEK PushLock® 3.5 mm) were implanted in 1, 3, 5, 7, 9 and 11 o'clock positions in cadaveric human glenoids and then cyclically tested. To simulate revision Bankart repair, 12 anchors were implanted in the same manner, over-drilled and 12 new anchors of the same diameter were implanted into the same bone socket as the primary anchors and then cyclically tested. The maximum failure loads (F_max), system displacements, force at clinical failure and modes of failure were recorded.ResultsOne primary anchor failed prematurely due to a technical problem. Three out of 12 revision anchors (25%) dislocated while setting the 25 N preload. The F_max, the displacement and clinical failure of the remaining 9 revision anchors were non-significant when compared to the 11 primary repair anchors. The main mode of failure in the primary and revision Bankart surgery group was suture slippage. Anchor dislocations were observed four times in the primary and once in the revision repair groups.ConclusionsRevision Bankart repair using PEEK anchors of the same diameter in a pre-existing bone socket is possible but bears high risk of premature anchor failure and can jeopardize the reconstruction. PEEK suture anchor in revision Bankart surgery should be implanted in a new bone socket if possible.     

Can arthroscopic Bankart repairs using suture anchors restore equivalent stability to open repairs in the management of traumatic anterior shoulder dislocation? A meta-analysis

Background

Recently, arthroscopic Bankart repairs have become much more popular than open repairs for the treatment of recurrent anterior shoulder instability. However, it is unclear whether the modern arthroscopic Bankart repairs using suture anchors could restore equivalent stability to open repairs. We conducted a meta-analysis to compare arthroscopic Bankart repairs using suture anchors and open repairs in regard to clinical outcomes.

关节镜下生物骨锚钉修复肩关节Bankart损伤

目的：探讨关节镜下采用生物骨锚钉固定缝合治疗肩关节Bankart损伤的方法及疗效。方法：自2010年1月至2017年6月收治23例肩关节复发性脱位患者,诊断为单纯肩关节Bankart损伤,男20例,女3例;年龄19~34（23.4±3.9）岁;右肩14例,左肩9例;军事训练伤17例,运动损伤5例,摔伤1例。受伤至手术时间3~36（10.9±5.8）个月。使用双线生物骨锚钉行关节盂前方肩关节囊-韧带-盂唇复合体提拉紧缩缝合术。采用肩关节Rowe评分评价临床疗效。结果：23例均获随访,时间18~39（24.5±3.7）个月,末次随访时,患侧肩关节无再发脱位,均恢复正常运动及工作。肩关节Rowes评分术前（53.91±11.67）分,术后（91.74±12.30）分,评价分级术前优0例、良0例、可9例、差14例,术后优16例、良4例、可3例、差0例（P<0.01）。结论：关节镜下生物骨锚钉缝合修复肩关节Bankart损伤是一种可靠有效、性价比高的治疗方法,适用于Bankart损伤翻修手术。     

Arthroscopic Repair of Combined Bankart and SLAP Lesions: Operative Techniques and Clinical Results

Background

To evaluate the clinical results and operation technique of arthroscopic repair of combined Bankart and superior labrum anterior to posterior (SLAP) lesions, all of which had an anterior-inferior Bankart lesion that continued superiorly to include separation of the biceps anchor in the patients presenting recurrent shoulder dislocations.

Methods

From May 2003 to January 2006, we reviewed 15 cases with combined Bankart and SLAP lesions among 62 patients with recurrent shoulder dislocations who underwent arthroscopic repair. The average age at surgery was 24.2 years (range, 16 to 38 years), with an average follow-up period of 15 months (range, 13 to 28 months). During the operation, we repaired the unstable SLAP lesion first with absorbable suture anchors and then also repaired Bankart lesion from the inferior to superior fashion. We analyzed the preoperative and postoperative results by visual analogue scale (VAS) for pain, the range of motion, American Shoulder and Elbow Surgeon (ASES) and Rowe shoulder scoring systems. We compared the results with the isolated Bankart lesion.

Results

VAS for pain was decreased from preoperative 4.9 to postoperative 1.9. Mean ASES and Rowe shoulder scores were improved from preoperative 56.4 and 33.7 to postoperative 91.8 and 94.1, respectively. There were no specific complication and no significant limitation of motion more than 10 degree at final follow-up. We found the range of motions after the arthroscopic repair in combined lesions were gained more slowly than in patients with isolated Bankart lesions.

Conclusions

In recurrent dislocation of the shoulder with combined Bankart and SLAP lesion, arthroscopic repair using absorbable suture anchors produced favorable clinical results. Although it has technical difficulty, the concomitant unstable SLAP lesion should be repaired in a manner that stabilizes the glenohumeral joint, as the Bankart lesion can be repaired if the unstable SLAP lesion is repaired first.     

Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair

BACKGROUND: The higher failure rates reported with arthroscopic stabilization of traumatic, recurrent anterior shoulder instability compared with open stabilization remain a concern. The purpose of this study was to evaluate the outcomes of arthroscopic Bankart repairs with the use of suture anchors and to identify risk factors related to postoperative recurrence of shoulder instability. METHODS: Ninety-one consecutive patients underwent arthroscopic stabilization for recurrent anterior traumatic shoulder instability. The mean age (and standard deviation) at the time of surgery was 26.4 +/- 5.4 years. Seventy-one patients were male. Seventy-nine patients were involved in sports (forty, in high-risk sports). Capsulolabral reattachment and capsule retensioning was performed with use of absorbable suture anchors (mean, 4.3 anchors; range, two to seven anchors). All patients were prospectively followed, and, at the time of the last review, the patients were examined and assessed functionally by independent observers. RESULTS: At a mean follow-up of thirty-six months, fourteen patients (15.3%) experienced recurrent instability: six sustained a frank dislocation and eight reported a subluxation. The mean delay to recurrence was 17.6 months. The risk of postoperative recurrence was significantly related to the presence of a bone defect, either on the glenoid side (a glenoid compression-fracture; p = 0.01) or on the humeral side (a large Hill-Sachs lesion; p = 0.05). By contrast, a glenoid separation-fracture was not associated with postoperative recurrent dislocation or subluxation. Recurrence of instability was significantly higher in patients with inferior shoulder hyperlaxity (p = 0.03) and/or anterior shoulder hyperlaxity (p = 0.01). On multivariate analysis, the presence of glenoid bone loss and inferior hyperlaxity led to a 75% recurrence rate (p < 0.001). Lastly, the number of suture-anchors was critical: patients who had three anchors or fewer were at higher risk for recurrent instability (p = 0.03). CONCLUSIONS: In the treatment of traumatic recurrent anterior shoulder instability, patients with bone loss or with shoulder hyperlaxity are at risk for recurrent instability after arthroscopic Bankart repair. At least four anchor points should be used to obtain secure shoulder stabilization.     

Arthroscopic revision Bankart repair: a preliminary evaluation

Arthroscopic stabilization of primary, recurrent anterior shoulder instability has become the procedure of choice with infrequent exceptions. Failures of stabilization can and do occur. This is a Level IV retrospective analysis of arthroscopic revision Bankart surgery performed on 15 non-consecutive patients over a 4-year period with an average 22-month follow-up. The average patient age was 27.5 with 12 men and 3 women. Four of the 15 failures were from the senior author's (R.K.N.R.) practice with the remaining 11 referred for treatment. Four of the 15 failures resulted from open surgery while the remaining 11 failed an arthroscopic stabilization procedure. Four contact/collision athletes were included, and significant bone loss was recorded in 5 patients. Operative findings included 10 recurrent Bankart lesions while 9 patients were felt to demonstrate capsular attenuation. Fourteen of the 15 had a Hill-Sachs lesion while chondromalacic change involving the anterior glenoid was noted in 13 of the 15 patients. A suture anchor technique was used with an average of 2.5 double-loaded suture anchors. In this series, 4 failures occurred after revision arthroscopic stabilization (27%) with an average SANE score of 86 (range, 65-100). One of the 5 patients with significant bone loss sustained a recurrence while 1 of 4 contact athletes failed the revision arthroscopic stabilization. Two of the 4 failures in this study subsequently underwent an open bone block procedure. Arthroscopic revision Bankart repair can be an effective alternative, but should only be considered in the properly selected patient.     

关节镜下非打结型缝合锚钉修补Bankart损伤治疗复发陛肩关节前脱位

目的 探讨关节镜下非打结型缝合锚钉修补Bankan损伤治疗复发性肩关节前脱位的疗效.方法 复发性肩关节前脱位患者14例,均为男性;年龄18～34岁,平均25.2岁;左侧4例,右侧10例,涉及主力侧12例;均为单向不稳.术前脱位次数为3～36次,平均13.5次.关节镜下采用可吸收非打结型缝合锚钉治疗Bankart损伤.术前及术后随访采用ASES评分及Constant-Murley功能评估.结果 所有患者均获得随访,随访时间11～22个月,平均17个月.术中发现9例合并Hill-Sachs损伤,3例合并骨性Bankart损伤,2例合并后下盂唇损伤,2例合并SLAPⅡ型损伤,1例合并关节内游离体.14例患者术前及末次随访时肩关节平均前屈上举为163.4°±8.6°和169.7°±4.2°;外展90°时,平均外旋角度分别为58.5°+13.6°和90.3 °±5.5.;术后外展90°时,患侧外旋角度较健侧受限8.4°±6.2°术前及末次随访时ASES评分为(77.4±3.7)分和(94.3±2.6)分,两者比较差异有统计学意义(P＜0.05);其中VAS不稳定评分平均为(7.2±1.4)分和(1.2 ±0.6)分(P＜0.01);Constant-Mudey评分平均为(78.1±4.6)分和(93.9±3.7)分.术后无一例患者发生再脱位,且均重返伤前工作岗位.结论 肩关节镜下Bankart 重建手术是治疗复发性肩关节脱位的有效方法 .非打结型缝合锚钉简化了手术操作步骤,减少手术时间和创伤.     

Knotless suture anchor: arthroscopic bankart repair without tying knots

Arthroscopic Bankart repair done using suture anchors most closely mimics open repair techniques. The challenge with the arthroscopic technique is tying consistent, good quality arthroscopic knots. A unique knotless suture anchor and method of use for arthroscopic Bankart repair is described. The Knotless Suture Anchor has a short loop of suture secured to the tail end of the anchor. A channel is located at the tip of the anchor that functions to capture the loop of suture after it has been passed through the ligament. The ligament is tensioned as the anchor is inserted into bone to the appropriate depth. Mechanical testing showed increased suture strength in the Knotless Suture Anchor compared with standard suture anchors. This is attributable to the doubled suture configuration that is created with the Knotless Suture Anchor loop. To the author's knowledge, the current study describes the first knotless suture anchor. A secure, low-profile repair can be created without arthroscopic knot tying.     

Arthroscopic anterior stabilization of the shoulder: two to six-year follow-up

BACKGROUND: The purpose of this study was to evaluate prospectively the surgical outcomes of arthroscopic repair of anterior capsulolabral lesions with use of suture anchors in a large series of patients who were followed for two to six years. METHODS: We evaluated the results of arthroscopic Bankart repair with use of suture anchors and nonabsorbable sutures in 167 patients with traumatic recurrent anterior instability of the shoulder. The mean age at the time of the operation was twenty-five years. Preoperatively and at the time of follow-up (at a mean of forty-four months), the patients were assessed with three objective outcome measurement tools (the Rowe score, the University of California at Los Angeles [UCLA] shoulder rating scale, and the American Shoulder and Elbow Surgeons [ASES] score) and two subjective measurement tools (pain and function visual analog scales). The recurrence rate, range of motion, and risk factors for postoperative recurrence were evaluated. RESULTS: All shoulder scores improved after surgery (p < 0.001). According to the Rowe scale, 130 patients (78%) had an excellent score; twenty-nine (17%), a good score; six (4%), a fair score; and two (1%), a poor score. Overall, the rate of postoperative recurrence of instability was 4% (one dislocation, two subluxations, and four positive results on the anterior apprehension test). Postoperative recurrence was related to an osseous defect of >30% of the entire glenoid circumference. In the patients with recurrent postoperative instability, the episodes were less frequent than they had been preoperatively and shoulder function was related to activity level. A revision arthroscopic Bankart repair stabilized three of the four shoulders in which it was performed. One hundred and fifty-two patients (91%) returned to >/=90% of their preinjury activity level. The mean loss of external rotation (and standard deviation) was 2.0 degrees +/- 4.0 degrees. CONCLUSIONS: We found that, in contrast to previous reports on the results of arthroscopic repair, arthroscopic capsulolabral repair with use of suture anchors can provide satisfactory outcomes in terms of recurrence rate, activity, and range of motion.     

Editorial Commentary: Anchor Position Affects Glenoid Resorption Rates After Arthroscopic Bankart Repair: Shoulder Stabilization Surgery Is a Game of Millimeters

The technical nuances of arthroscopic Bankart repair cannot be overstated. Previous literature has identified a number of risk factors for failure of arthroscopic stabilization procedures, and the implications of glenoid bone loss is widely recognized as a critical driver of postoperative outcomes. However, other technical considerations (inadequate number of suture anchors, improper position of suture anchors) have been acknowledged as risk factors for the failure of arthroscopic stabilization procedures. More recently, concerns have been raised regarding the observed rates of glenoid bone resorption following arthroscopic Bankart repair, which theoretically may predispose higher rates of clinical failure. Furthermore, certain techniques for placing anchors on the glenoid during arthroscopic Bankart repair may accelerate these resorptive changes. Precise measures of poststabilization surgery glenoid resorption coupled with comprehensive assessments of clinical outcomes are required to determine the optimal technique for anchor insertion during arthroscopic Bankart repair.     

关节镜下非打结型与打结型缝合锚钉Bankart重建治疗复发性肩关节前向不稳

目的探讨关节镜下非打结型与打结型缝合锚钉对复发性肩关节前向不稳Bankart损伤的临床效果。方法回顾性分析2006年3月至2009年1月广州军区广州总医院收治的44例复发性肩关节脱位Bankart损伤患者的临床资料,根据关节镜下修复方式的不同分为非打结组（可吸收非打结型缝合锚钉修复,20例）和打结组（打结型缝合锚钉修复,24例）。采用美国肩肘外科医师（ASES）评分及Constant-Murley功能评分对患者术前、末次随访时肩关节功能进行评估,记录肩关节活动范围,观察并发症发生情况。结果所有患者获得随访,随访时间20～46个月,平均随访时间30个月。非打结组术前和终末随访时肩关节前屈上举角度、外展90°时外旋角度分别为（163±9）°和（170±4）°、（58±14）°和（90±6）°,术后外展90°时患侧外旋角度较健侧受限（8±6）°;术前和终末随访时ASES评分、Constant-Murley评分分别为（77.4±3.7）分和（94.3±2.6）分、（78.1±4.6）分和（93.9±3.7）分,两者比较,差异有统计学意义（P〈0.05）。打结组术前和终末随访时肩关节前屈上举角度、外展90°时外旋角度分别为（162±8）°和（170±6）°、（61±13）°和（91±6）°,术后外展90°时患侧外旋角度较健侧受限（5±3）°;术前和终末随访时ASES评分、Constant-Murley评分分别为（75.8±2.9）分和（95.1±3.7）分、（76.2±5.9）分和（92.8±5.2）分,两者比较,差异有统计学意义（P〈0.05）。两组间术前、术后各项指标比较,差异无统计学意义（P〉0.05）。患者均未出现术后再脱位,均重返伤前工作岗位。结论肩关节镜下Bankart重建手术是治疗复发性肩关节前向不稳的有效方法,非打结型和打结型缝合锚钉修复Bankart损伤疗效相似。     

Increasing preoperative dislocations and total time of dislocation affect surgical management of anterior shoulder instability

Purpose:Our purpose was to determine the relationship between number of preoperative shoulder dislocations and total dislocation time and the need to perform bone deficiency procedures at the time of primary anterior instability surgery. Our hypothesis was that need for bone deficiency procedures would increase with the total number and hours of dislocation.Results:Ten arthroscopic Bankart repairs, 13 arthroscopic Bankart plus remplissage procedures, and 9 Latarjet reconstructions were available for review. Total dislocations (P = 0.012) and total hours of dislocation (P = 0.019) increased from the Bankart, to the remplissage, to the Latarjet groups. Patients with a total dislocation time of 5 h or more were more likely to require a Latarjet reconstruction (P = 0.039). Patients with only 1 preoperative dislocation were treated with an isolated Bankart repair in 64% (7 of 11) of cases, whereas those with 2 or more dislocations required a bone loss procedure in 86% (18 of 21) of cases (P = 0.013).Conclusion:Increasing number of dislocations and total dislocation time are associated with the development of glenoid and humeral head bony lesions that alter surgical management of anterior shoulder instability. The necessity for the addition of a remplissage to an arthroscopic Bankart repair or the use of a Latarjet reconstruction increases with only 1 recurrent dislocation.

Level of evidence:

Level III, retrospective comparative study.     

A Knotless Suture Anchor: Technique for use in arthroscopic Bankart repair

Arthroscopic Bankart repair performed using suture anchors most closely mimics open repair techniques. One of the challenges with the arthroscopic technique is tying consistent, good-quality arthroscopic knots. The unique Knotless Suture Anchor (Mitek Products, Westwood, MA) and method of use for arthroscopic Bankart repair is described. The Knotless Suture Anchor has a short loop of suture secured to the tail end of the anchor. A channel is located at the tip of the anchor that functions to capture the loop of suture after it has been passed through the ligament. The ligament is tensioned as the anchor is inserted into bone to the appropriate depth. The doubled suture configuration that is created with the loop increases the suture strength in the Knotless Suture Anchor compared with standard suture anchors with the same size suture. To my knowledge, this article describes the first knotless suture anchor. A secure, low-profile repair can be created without arthroscopic knot tying.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 2 (February), 2001: pp 213–218     

肩关节脱位合并肩袖与Bankart损伤的诊治

目的 探讨关节镜下修复肩关节前脱位合并肩袖与Bankart损伤的疗效.方法 1999年9月至2007年7月收治16例肩关节脱位合并肩袖与Bankart损伤患者,男14例,女2例;左肩6例,右肩10例.交通伤8例,运动伤4例,牵拉伤4例.受伤至手术时间平均4.5个月(1.5～11.0个月).肩关节x线片显示肩盂撕脱骨折3例.16例患者肩关节核磁共振造影显示肩袖与Bankart损伤.关节镜探查发现肩袖于肱骨大结节处撕脱伴肩袖挛缩12例.采用关节镜下松解、缝合锚钉和骨锚钉同定缝合9例;因肩袖挛缩明显,进行关节镜与小切口辅助下肩袖缝合固定术3例;肩衲组织因牵拉松弛抬肩无力,采用等离子刀皱缩和肩袖缝合紧缩术4例.Bankart损伤采用关节镜下可吸收Bankart钉固定3例,钛合金缝合锚钉固定3例,关节镜下直接缝合修补盂唇3例,骨锚钉加会属锚钉固定7例.结果 16例患者术后获平均16.5个月(7～34个月)随访.肩关节稳定,肩外展和上举功能恢复正常12例,术后肩关节外展、抬举活动轻度受限2例,前伸活动疼痛2例.金属锚钉拔出再手术2例.采用美国加州洛杉矶大学UCLA肩关节功能评分:术前平均(21.5±5.5)分;术后平均(32.4±5.6)分,优12例,良4例.结论 肩关节脱位合并肩袖与Bankart损伤核磁共振造影有助于诊断;肩袖挛缩者应进行充分松解,无张力缝合固定有利于肩袖愈合;异体骨锚钉修复肩袖与Bankart损伤,生物固定、费用低廉,具有重要的价值.     

Failure of anterior shoulder instability repair caused by eyelet cutout of absorbable suture anchors

Repair of soft tissue to bone is increasingly frequently performed using absorbable suture anchors. If a repair fails clinically, it is often impossible to identify the cause of failure at repeat surgery. We report on 2 cases of recurrence of instability after arthroscopic Bankart repair. In reoperation in these cases, all sutures were correctly knotted around the labrum but were intact and torn out of the anchor eyelets. No sign of anchor displacement (3 anchors in each patient) was seen. This is the first clinical report of unambiguous structural suture anchor failure. These observations emphasize the sensitivity of Bankart repair to weak links in the repair chain, which must be avoided.     

锚钉固定位置与角度对肩关节前关节囊修复效果影响

目的探讨不同锚钉位置及角度对关节镜治疗复发性肩关节前向不稳临床疗效的影响。 方法回顾性分析85例于2018年1月至12月因复发性肩关节前向不稳在南部战区总医院接受肩关节镜手术治疗的患者排除严重骨缺损、翻修等其他损伤。使用术后肩关节CT测量锚钉位置及插入角度，采用视觉模拟评分系统(VAS评分)及Rowe评分系统对患者术后关节疼痛程度、稳定性、活动度及功能进行综合评价。不同锚钉位置及角度与VAS评分及Rowe评分的关系使用独立样本t检验分析。 结果在85例患者中，有57例患者的所有锚钉均在肩胛盂关节面上，28例患者的锚钉部分在肩胛盂关节面上，部分在肩胛盂边缘。两组的比较中，VAS评分差异无统计学意义(t ＝－0.829，P>0.05)；所有锚钉均在肩胛盂关节面上的患者Rowe评分较高(t＝－4.072，P<0.05)。通过术后Rowe评定分级对锚钉打入角度的反向比较中，2点、3点、4点和5点钟4个位点对应锚钉角度之间的比较均无统计学差异(t＝0.312、0.885、0.775、0.934，均为P>0.05)。 结论肩关节镜下缝合锚钉在合理插入角度范围内固定于肩胛盂边缘稍内侧的关节面上可以使复发性肩关节前向不稳的患者获得更好的近期疗效，而远期疗效需要进一步深入研究。     

Arthroscopic versus open treatment of Bankart lesion of the shoulder: A prospective randomized study

Purpose: The purpose of this study was to compare the results of arthroscopic and open repair of isolated Bankart lesions of the shoulder using metallic suture anchors. Type of Study: Prospective randomized clinical study. Methods: Sixty patients with traumatic anterior shoulder instability underwent a surgical repair of an isolated Bankart lesion. The patients were divided into 2 groups of 30 patients each. In group 1, an arthroscopic repair was performed, and in group 2, an open procedure was performed. The groups were homogeneous for gender, age, dominance, number of dislocations, time elapsed between first dislocation and surgery, and pathologic findings. In all cases of both groups, the lesion was repaired using metallic suture anchors carrying nonabsorbable braided sutures. Postoperative rehabilitation was the same for the 2 groups. Two years’ follow-up evaluation included Constant and Rowe shoulder scores. Statistical analysis of data was performed using an unpaired t test (significance for P < .05). Results: No recurrence of dislocation of the involved shoulder has been reported in either group. Follow-up Constant and Rowe scores of the 2 groups were not significantly different. The only significant difference seen between the 2 groups was for range of motion evaluation with the Constant score. The mean value for group 1 (39.6 ± 0.8) was significantly greater (P = .017) than that for group 2 (37.8 ± 2.0). Conclusions: Arthroscopic repair with suture anchors is an effective surgical technique for the treatment of an isolated Bankart lesion. Open repair does not offer a significantly better 2-year result in terms of stability, and furthermore, can negatively affect the recovery of full range of motion of the shoulder. Level of Evidence: Level I.     

关节镜下Bankart修复术治疗肩关节复发性前脱位:手术效果及复发危险因素分析

目的 探讨关节镜下Bankart修复术(缝合锚钉技术)治疗肩关节复发性前脱位的临床效果,并对术后复发不稳的可能危险因素进行分析.方法 2002年3月至2010年3月连续收治肩关节复发性前脱位患者259例,均采用关节镜下缝合锚钉技术进行Bankart修复手术,其中188例患者获得随访.患者手术时平均年龄25.3岁(13～58岁);其中男性143例、女性45例;运动员50名、非运动员138名.随访时采用美国肩肘关节外科协会评分系统(ASES)肩关节评分、Rowe评分以及患者满意度评价手术效果.术前肩关节ASES评分平均72.6分,Rowe评分平均33.4分.对于肩关节术后不稳的复发率、关节活动范围以及术后复发不稳的危险因素进行评估.结果 188例患者术后平均随访38.6个月(12～110个月).术后肩关节ASES评分平均91.9分,与术前比较差异具有统计学意义(P＜0.001);术后Rowe评分平均81.9分,与术前比较差异具有统计学意义(P＜0.001).患者手术满意度调查显示,满意152例、基本满意16例、不满意20例,满意率为89.4%.术后有24例患者复发脱位,总体复发率为12.8%;运动员患者复发率为28.0%,非运动员复发率为7.2%.术后患者平均肩关节外展外旋为75.2°,与术前比较无明显丧失(P＞0.05).关节镜Bankart修复术后复发不稳与患者年龄及是否为运动员明显相关(P＜0.05);而与术前病程长短、锚钉类型、锚钉数目、骨性Bankart损伤、合并肩关节上盂唇撕裂损伤、合并后或下方盂唇损伤、合并肩袖撕裂、关节松弛以及肩袖间隙闭合等因素无明显相关(P＞0.05).结论 关节镜下采用缝合锚钉进行Bankart修复术是治疗肩关节复发性前脱位的有效方法,临床效果比较满意.年轻患者(≤20岁)和运动员患者是术后肩关节复发不稳的高危因素,必要时选择切开手术.

Abstract：

Objective To evaluate retrospectively the results of arthroscopic Bankart repair using suture anchors for recurrent anterior shoulder dislocation with a minimum 1-year follow-up and to assess risk factors for recurrence.Methods From March 2002 to March 2010,259 patients with recurrent anterior shoulder dislocation underwent arthroscopic Bankart repair with suture anchors.And 188 patients(50 athletes,138 nonathletes)were available for follow-up.The mean age at the time of surgery was 25.3 years (range,13-58 years).The mean follow-up was 38.6 months(range,12-110 months).All of the 188 patients were evaluated preoperatively and postoperatively with the American Shoulder and Elbow Society (ASES)shoulder score and Rowe score system.The rate of recurrent instability,range of motion,and risk factors for postoperative recurrence were evaluated.The ASES score was 72.6 preoperatively,and Rowe score was 33.4.Results The ASES scores improved significantly to 91.9 postoperatively(P＜0.001).The Rowe scores improved to 81.9 postoperatively(P＜0.001).And 152 patients were greatly satisfied with the results,16 satisfied and 20 unsatisfied.The satisfactory rate was 89.4%.24 patients(12.8%)suffered a recurrence after surgery,14 athletes and 10 nonathletes.The recurrence rates were 28.0% in the athlete group and 7.2% in the nonathlete group.On average there was no significant loss of external rotation postoperatively(average,75.2° preoperatively and 67.2° postoperatively).Patients under age 20,and athlete patients were associated with recurrence(P＜ 0.05).Other factors including length of time until surgery,type of anchors,number of anchors,presence of bony Bankart lesion,presence of a superior labrum,anterior and posterior tear,presence of posterior or inferior labrum lesion,presence of rotator cuff tear,ligamentous laxity and rotator interval closure did not influence the recurrence rate(P＞0.05).Conclusions Arthroscopic Bankart repair is a good option for the treatment of recurrent anterior shoulder dislocation.Identification of risk factors for recurrence allows for consideration of open stabilization.In the series,patients under age 20 and athlete patients are the most important risk factors for recurrence.     

Arthroscopic labral reconstruction for anterior shoulder instability. Failure analysis in 187 patients]

Comparing open with arthroscopic labral reconstruction for anterior shoulder instability we found a higher recurrence rate after arthroscopic capsulolabral repair. The aim of this study was, to analyse the reasons for recurrent instability after arthroscopic labral repair. MATERIALS AND METHODS: Between 1989 and 1995 we performed a arthroscopic labral reconstruction on 187 patients with anterior shoulder instability. 118 patients (63%) were treated with a transglenoid suture technique and 69 patient (37%) with a suture anchor technique. The average age at the time of the operation was 26.4 +/- 6.3 years (14-52 years). There were 41 women (21.9%) and 146 men (78.1%). RESULTS: The minimum follow-up was 18 months. The average follow-up was 3.7 +/- 1.1 years. The average Rowe Score increased from 34.7 points (0-75) preoperatively to 75.3 points (15-100) postoperatively. There were 47 (25.1%) excellent. 76 (40.6%) good, 21 (11.3%) fair, and 43 (23.0%) poor results. 105 patients (56.1%) regained their preoperative level of activity. 50 patients (26.7%) had recurrent subluxations or dislocations postoperatively. All failures occurred within two years (0.5-21 months) after the operation. Failure rates were associated with the patients age (p < 0.001), the level of activity (p < 0.05), the number of the preoperative dislocations (p < 0.01), the degree of the labral lesion (p < 0.001), and the operation method (p < 0.05). No correlation was found for the parameters sex, handiness, time between luxation and operation, size of Hill-Sachs-lesion and numbers of used sutures or anchors. CONCLUSION: We prefer the arthroscopic suture anchor technique if there are less than 5 preoperative dislocation and a type 1 or 2 labral lesion. If there are more than 5 preoperative dislocations and a degenerative labrum defect we favor the open Bankart repair technique.