The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals

STUDY DESIGN: Two-group comparison. OBJECTIVE: To compare scapular kinematics during arm elevation between groups distinguished by pectoralis minor resting length. BACKGROUND: Studies have demonstrated that individuals with subacromial impingement have altered scapular kinematics, such as loss of posterior tipping and increased internal rotation. One proposed mechanism for these alterations is an adaptively short pectoralis minor. This anterior scapulothoracic muscle may impact normal scapular kinematics if adaptively short. METHODS AND MEASURES: Fifty volunteers without shoulder pain were divided into long or short groups according to normalized pectoralis minor resting length. An electromagnetic motion capture system determined the angular orientation of the scapula, humerus, and trunk during arm elevation in 3 separate planes. Groups were compared for 3-dimensional scapular orientation relative to the trunk at arm elevation angles of 30 degrees, 60 degrees, 90 degrees, and 120 degrees, using a mixed-model analysis of variance (ANOVA). RESULTS: There were statistically significant interaction effects between group and arm elevation angle for scapular tipping in all planes of arm elevation, with the scapula for the short group staying anteriorly tipped at higher angles. There was also a significant interaction for scapular internal rotation at lower arm elevation angles in the coronal plane only, with individuals with a shorter pectoralis minor demonstrating a more internally rotated scapula. CONCLUSIONS: The group distinguished by a short pectoralis minor demonstrated scapular kinematics similar to the kinematics exhibited in earlier studies by subjects with shoulder impingement. These results support the theory that an adaptively short pectoralis minor may influence scapular kinematics and is therefore a potential mechanism for subacromial impingement.     

Effects of trapezius kinesio taping on scapular kinematics and associated muscular activation in subjects with scapular dyskinesis

Study DesignCrossover repeated-measure design.IntroductionScapular dyskinesis rehabilitation programs that focus on inhibiting upper trapezius (UT) and activating the lower trapezius (LT) may assist in restoring scapular movements. We hypothesized that taping may be able to normalize scapular movements and associated muscular recruitment.Purpose of the StudyThe purpose of this study was to investigate the immediate effects of kinesio taping over trapezius on scapular kinematics and muscular activation in different dyskinesis patterns. We expected that taping can improve scapular kinematics and muscular activation in subjects with dyskinesis.MethodsFifty-four participants with inferior angle prominence (pattern I), medial border prominence (pattern II), and mixed pattern (pattern I + II) were recruited. Kinesio taping was applied over 3 parts of trapezius muscles, including UT, middle trapezius (MT), and LT. The scapular kinematics and electromyographic data of trapezius and serratus anterior were collected during scapular plane elevation without taping and after each taping application.ResultsUT taping decreased UT activity (5%-7%; P = .001-.003) in 72% of participants with pattern II and pattern I + II dyskinesis, with increased posterior tipping (2.2°-2.5°; P = .003) in pattern II dyskinesis. MT taping increased UT activity (3%; P = .003) in 48% of participants with pattern II dyskinesis.DiscussionThe taping over the trapezius muscle may help to restore coordinated scapular muscle balance and increased upward rotation of the scapula, especially in pattern II dyskinesis. Although no electromyography or kinematic difference was found with LT taping in each dyskinesis pattern, methods of applying LT taping need to be further investigated.ConclusionReduced UT muscle activity and scapular posterior tipping are appropriate when applying taping over UT muscle in patterns II and I + II dyskinesis. Caution should be taken when applying taping over MT and LT muscles in terms of increased UT activity, especially in pattern II dyskinesis.     

Alterations in scapular kinematics in subjects with idiopathic loss of shoulder range of motion

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To determine the effect of idiopathic loss of shoulder range of motion on scapular kinematics. BACKGROUND: Subjects with idiopathic loss of shoulder range of motion have difficulty performing activities of daily living. Previous investigations have focused on the glenohumeral component of shoulder complex motion. MATERIALS AND METHODS: Seventeen unilaterally impaired and 17 nonimpaired subjects. The 3-dimensional motion of the humerus, scapula, and trunk were measured withthe Fastrak electromagnetic motion-tracking system during humerus-to-trunk scapular plane elevation. An analysis of variance compared the impaired subjects noninvolved to the nonimpaired subjects' scapulae at 4 scapularplane elevation positions. A repeated-measures analysis of variance compared the impaired subjects' involved and noninvolved scapulae at 3 scapular plane elevation positions, and matched-pairs t test compared peak elevation values. RESULTS: The between-group ANOVAs demonstrated no difference in anterior tipping, internal rotation, or upward rotation. The repeated-measures ANOVAs demonstrated no difference in anterior tipping or internal rotation and a position-by-side interaction in upward rotation. The involved-side scapulae were more upwardly rotated (7.7 degrees) at peak humerus-to-trunk scapular plane elevation. DISCUSSION AND CONCLUSION: The impaired subjects' noninvolved scapular kinematics were not significantly different than the nonimpaired subjects, but were significantly different than their involved scapulae. The upward rotation differences may be a substitution pattern used to accomplish functional elevation.     

Assessment of scapulohumeral rhythm for scapular plane shoulder elevation using a modified digital inclinometer

AIM: To develop a better understanding of scapulohumeral rhythm during scapular plane shoulder elevation.METHODS: Thirteen healthy, college-aged subjects participated in this study. Subjects were free from any upper extremity, neck or back pathology. A modified digital inclinometer was utilized to measure scapular upward rotation of the subject’s dominant shoulder. Upward rotation was measured statically as subjects performed clinically relevant amounts of shoulder elevation in the scapular plane. Testing order was randomized by arm position. Scapular upward rotation was assessed over the entire arc of motion and over a series of increments. The percent contributions to shoulder elevation for the scapula and glenohumeral joint were calculated. Scapulohumeral rhythm was assessed and represented the ratio of glenohumeral motion to scapulothoracic motion (glenohumeral elevation: scapular upward rotation). A one-way ANOVA was used to compare scapular upward rotation between elevation increments.RESULTS: Scapulohumeral rhythm for the entire arc of shoulder elevation was equal to a ratio of 2.34 :1 and ranged from 40.01:1 to 0.90:1 when assessed across the different increments of humeral elevation. Total scapular motion increased over the arc of shoulder elevation. The scapula contributed 2.53% of total motion for the first 30 degrees of shoulder elevation, between 20.87% and 37.53% for 30^o-90^o of shoulder elevation, and 52.73% for 90^o-120^o of shoulder elevation. Statistically significant differences in scapular upward rotation were identified across the shoulder elevation increments [F_(3,48) = 12.63, P = 0.0001].CONCLUSION: Clinically, we must recognize the usefulness of the inclinometer in documenting the variable nature of scapulohumeral rhythm in healthy and injured shoulders.     

Effect of shoulder tightness on glenohumeral translation, scapular kinematics, and scapulohumeral rhythm in subjects with stiff shoulders.

Shoulder tightness may cause altered kinematics and lead to development of subacromial impingement, tendinitis, and degenerative changes. In this investigation, the humeral head translations, scapular kinematics, and scapulohumeral rhythm were determined with a three-dimensional electromagnetic tracking device during arm elevations in six subjects with anterior shoulder tightness and in six subjects with posterior shoulder tightness to study the effects of anterior/posterior tightness on shoulder kinematics. Subjects with anterior tightness showed lower slopes in curves of glenohumeral elevation plotted against scapular upward rotation (scapulohumeral rhythm, 0.11 to 0.32; p = 0.021) and less posterior scapular tilt (2.9 to 7.5 degrees; p = 0.002) during arm elevations when compared to the group with posterior tightness. The humeral head was positioned less posteriorly (2.2 to 3.4 mm; p = 0.004) and more superiorly (3.8 to 7.0 mm; p < 0.0005) during arm elevation in subjects with posterior tightness. The alternations in shoulder kinematics between subjects with anterior and posterior shoulder tightness may be relevant to the development of subacromial impingement, tendinitis, and degenerative changes as seen in subjects with stiff shoulders.     

Arthroscopic repair of Bankart lesion in traumatic anterior-inferior shoulder instability using the two-portal method: A preliminary report

BackgroundIn this report, we describe our preliminary clinical results of arthroscopic Bankart repair in traumatic anterior-inferior shoulder instability using the two-portal method.MethodFrom August 2009 to December 2011, arthroscopic repair of Bankart lesion using this method was performed in 16 consecutive patients who were prospectively enrolled. Fifteen shoulders were treated with two-anchor sutures and one was treated with three-anchor sutures. Twelve patients received metallic anchor screws and four patients received bioanchor screws. The assessments were performed using the Rowe score, the University of California at Los Angeles shoulder rating scale, the American Shoulder and Elbow Surgeons score, and the shoulder range of motion (ROM) deficit.ResultsWith an average follow-up period of 22.9 months, all shoulder scores improved after surgery (p < 0.001). The average ROM deficit of the operated shoulders was not significant as compared with the healthy side in forward elevation (p > 0.05), but was significant in external rotation (p < 0.05). All of the 16 shoulders remained stable (100%) after the arthroscopic repair surgery. All patients returned to their preinjury levels of daily activity without recurrent problems.ConclusionIn patients with traumatic anterior glenohumeral instability, arthroscopic Bankart repair with the two portal method can provide good results. It can be an alternative method of treating patients with Bankart lesion without associated major glenoid defect or rotator cuff lesion in traumatic anterior-inferior instability.     

Scapular and clavicular kinematics during humeral elevation: a study with cadavers.

A combination of kinematic testing and graphic reconstruction of cadaveric shoulders was used to characterize shoulder kinematics during a simulated passive clinical range-of-motion examination. Cadaveric shoulders were elevated in the coronal, scapular, and sagittal planes while the scapula, clavicle, and humerus were kinematically tracked. Graphic models of each shoulder were created from computed tomography data. The models were animated to display the experimental motions. Shoulder kinematics varied between elevation planes. The scapular and clavicular rotations were relatively small until the humerus reached approximately 90 degrees of elevation. Clavicular and scapular rotations that occurred at low humeral elevation angles for elevation in the coronal plane were significantly larger than for the other two planes. The glenohumeral to scapulothoracic ratio was approximately equal to 2 for the entire range of elevation for each elevation plane, but it was dramatically larger during early elevation than during late elevation.     

The prevalence of scapular malalignment in elementally school aged baseball player and its association to shoulder disorder

Background

Various shoulder disorders have been reported to be associated with scapulothoracic joint dysfunction in adult overhead athletes. However, little is known about the prevalence of scapular malalignment and its relationship to shoulder injuries in skeletally immature baseball players.The purpose of the current study was to investigate the prevalence of scapular malalignment in elementary school-aged baseball players, as well as its association with shoulder disorder.

Arthroscopic Bankart repair]

Traumatic anterior shoulder instability is the most common type of shoulder instability. Treatment is surgical and there is no single best procedure. Arthroscopic Bankart repair restores stability by reattaching the labrum or capsule directly to the anterior glenoid rim. The aim of the study was to assess the clinical value of the arthroscopic Bankart repair. Between 2001 and 2005 twenty eight patients with traumatic anterior shoulder instability were treated. During the operation the capsulolabral tissue was mobilized from the anterior glenoid rim and neck of scapula, then 3 Mitek suture anchors were inserted and the labrum was sutured to the anterior glenoid rim. The patients were clinically evaluated according to MISS questionnaire. Up till now the recurrence of the anterior shoulder instability were not seen in the 25 patients operated with the aforementioned method. MISS questionnaire values were significantly higher following the surgery. Arthroscopic Bankart repair restores joint stability, helps to avoid complications associated With opening of the shoulder and gives a better cosmetic effect.     

Three-dimensional rotation of the scapula during functional movements: an in vivo study in healthy volunteers

The goal of this study was to measure 3-dimensional shoulder motion by use of a direct invasive technique during 4 different arm movements in healthy volunteers. Eight subjects with healthy shoulders were recruited. Optoelectronic marker carriers (ie, infrared light-emitting diodes) were mounted on bone pins, which were inserted into the lateral scapular spine. Subjects performed 4 different arm movements while the motion was being recorded by a precision optoelectronic camera. Joint angles were calculated in 3 dimensions. Intraclass correlation coefficients and root-mean-square differences were calculated as measures of reliability. During abduction, the scapula tipped posteriorly (44 degrees +/- 11 degrees), rotated upward (49 degrees +/- 7 degrees), and rotated externally (27 degrees +/- 11 degrees). For reaching, the scapula consistently rotated upward (17 degrees +/- 3 degrees) and rotated internally (18 degrees +/- 6 degrees) whereas tipping was generally less than 10 degrees (5 degrees +/- 2 degrees). Overall, the range of scapular movement for the hand behind the back was small and variable, with most rotations not exceeding 15 degrees. For horizontal adduction, the scapula tipped anteriorly (8 degrees +/- 3 degrees), rotated upward (5 degrees +/- 2 degrees), and rotated internally (27 degrees +/- 6 degrees). These scapular rotations provide normative data that will be useful for diagnosing scapular dysfunction.     

Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo.

The purpose of this study was to describe 3-dimensional scapular motion patterns during dynamic shoulder movements with the use of a direct technique. Direct measurement of active scapular motion was accomplished by insertion of 2 1.6-mm bone pins into the spine of the scapula in 8 healthy volunteers (5 men, 3 women). A small, 3-dimensional motion sensor was rigidly fixed to the scapular pins. Sensors were also attached to the thoracic spine (T3) with tape and to the humerus with a specially designed cuff. During active scapular plane elevation, the scapula upwardly rotated (mean [SD] = 50 degrees [4.8 degrees ]), tilted posteriorly around a medial-lateral axis (30 degrees [13.0 degrees ]), and externally rotated around a vertical axis (24 degrees [12.8 degrees ]). Lowering of the arm resulted in a reversal of these motions in a slightly different pattern. The mean ratio of glenohumeral to scapulothoracic motion was 1.7:1. Normal scapular motion consists of substantial rotations around 3 axes, not simply upward rotation. Understanding normal scapular motion may assist in the identification of abnormal motion associated with various shoulder disorders.     

The effects of scapular taping on electromyographic muscle activity and proprioception feedback in healthy shoulders

We investigated the effects of scapular tape on the electromyographic (EMG) activity of the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), anterior deltoid (AD), and shoulder proprioception in 12 healthy shoulders. Participants were blindfolded and required to complete a target end/mid range position with the hand. They performed six trials under two experimental conditions; no tape and therapeutic tape. EMG activity was measured by surface electrodes, and proprioception was measured by the FASTRAK electromagnetic motion tracking system. Two‐way repeated measures ANOVA showed that UT and AD activities decreased 2.65% (p = 0.001), and SA muscular activities increased 1.9% (p = 0.015) in the taping condition. The proprioceptive feedback magnitude was significantly lower in the taping condition than in the no taping condition (11.9°, p < 0.005). Additionally, correlation coefficients were higher than 0.5 between muscle activity and proprioceptive feedback with the taping condition; UT and magnitude in the mid range task (R = 0.516); LT and magnitude in the end range task (R = ?0.524); and SA and magnitude in the mid range task (R = ?0.576). The results suggest that scapular tape affects the muscle activity of UT, AD, and SA, and that the effects are related to proprioception feedback. These results implicate that the mechanisms by which scapular taping induces effects can be explained by neuromuscular control and proprioceptive feedback factors. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 29:53–57, 2011     

Three-dimensional kinematics of glenohumeral elevation

To help resolve longstanding uncertainties about kinematics of the shoulder, we studied three-dimensional glenohumeral joint motion during arm elevation. A magnetic tracking system was used to monitor the three-dimensional orientation of the humerus with respect to the scapula. Appropriate coordinate transformations were then performed for the calculation of glenohumeral joint rotation based on the defined Eulerian angle. The effects of the plane of elevation and the humeral rotation on the magnitude of arm elevation were documented. The maximum humeral elevation at the glenohumeral joint took place in a plane anterior to the scapular plane. Maximum elevation in all planes anterior to the scapular plane required external axial rotation of the humerus. Conversely, internal axial rotation was necessary for maximum elevation posterior to the scapular plane. Quantifying the obligatory axial rotation explains the relationship of internal and external rotation with maximum elevation.     

Comparison of In Vivo Three-Dimensional Glenohumeral Positions and Scapular Kinematics between Young and Older Male Groups

BackgroundMany researchers have questioned whether shoulder kinematics such as the glenohumeral position and scapular kinematics would be different in different age groups. However, studies comparing shoulder kinematics between different age groups have been rare. The aim of this study was to analyze and compare the three-dimensional (3D) glenohumeral position, scapular kinematics, and scapulohumeral rhythm (SHR) during scapular plane arm abduction between a normal young male group and a normal older male group.MethodsTwenty normal men (10 young and 10 older) were enrolled in this controlled laboratory study. Fluoroscopic images were obtained using a single plane X-ray system. Bilateral computed tomography scans were taken to create a 3D model. A 3D-2D registration technique was used to determine the 3D position and orientation of the bones of the shoulder.ResultsDuring scapular plane arm abduction, there were significant differences in scapular kinematics between the groups. The older male group showed more upward rotation, posterior tilt, and external rotation than the young male group. On the other hand, the glenohumeral position such as superior inferior translation, anterior posterior translation, and external rotation of the humeral head did not show significant difference between the groups. The mean value of SHR for the overall arm elevation range from start to maximum elevation angle for the older group and young group was 2.298 ± 0.964 and 2.622 ± 0.931, respectively, showing a significant difference between the two groups (p = 0.035).ConclusionsScapular kinematics and SHR were significantly different between the older male group and the young male group. Our study could provide reference values of shoulder kinematics for older men aged 55–65 years.     

Does scapular corrective taping alter periscapular muscle activity and 3-dimensional scapular kinematics? A systematic review

Study DesignThis is a systematic review.IntroductionScapular taping is widely used in the management of scapular dysfunction. However, its effects on the scapular kinematics and the electromyography (EMG) activity of the periscapular muscles are not clear.Purpose of the StudyThe purpose of the study was to systematically review the current literature to examine whether scapular corrective taping alters the EMG activity of the periscapular muscles and the 3-dimensional scapular kinematics.MethodMEDLINE and Web of Science databases were searched using specific mesh terms up to April 2018. A hand search was also conducted on the reference list of the included articles. A total of 157 studies were identified, and they were further analyzed for the eligibility to the systematic review. Studies that investigated the effects of scapular corrective taping on the EMG activity of the periscapular muscles and on the 3-dimensional scapular kinematics on patients with shoulder problems or asymptomatic subjects were eligible for the systematic review. The Cochrane Effective Practice and Organization of Care criteria were modified and used for the risk-of-bias assessment.ResultsEleven articles met the inclusion criteria and were included in the systematic review. Five studies investigated the effects of corrective taping on the scapular kinematics and 8 studies reported the effects of corrective taping on the EMG activity of the periscapular muscles. There was an agreement among the studies that scapular upward rotation is increased with the corrective taping, while there are inconsistent results concerning the scapular external rotation and posterior tilt. In addition, studies mostly reported that corrective taping decreases the activity of the upper trapezius, while it has conflicting effects on the activity patterns of other periscapular muscles.DiscussionScapular corrective taping was found to increase the scapular upward rotation; however, its effects on scapular external rotation and posterior tilt are controversial. It was also found that corrective taping might decrease the EMG activity of the upper trapezius, while it had no effects on the activity of lower trapezius, and its effects on other periscapular muscles were controversial.ConclusionThe results of the studies indicated that scapular corrective taping might alter the 3-dimensional scapular kinematics, while there are controversies about the effects of corrective taping on the EMG activity of the periscapular muscles. Further studies are needed to clarify the conflicts.     

The reliability of three-dimensional scapular attitudes in healthy people and people with shoulder impingement syndrome

Background  

Abnormal scapular displacements during arm elevation have been observed in people with shoulder impingement syndrome. These abnormal scapular displacements were evaluated using different methods and instruments allowing a 3-dimensional representation of the scapular kinematics. The validity and the intrasession reliability have been shown for the majority of these methods for healthy people. However, the intersession reliability on healthy people and people with impaired shoulders is not well documented. This measurement property needs to be assessed before using such methods in longitudinal comparative studies. The objective of this study is to evaluate the intra and intersession reliability of 3-dimensional scapular attitudes measured at different arm positions in healthy people and to explore the same measurement properties in people with shoulder impingement syndrome using the Optotrak Probing System.     

Radiographic assessment of scapular rotational tilt in chronic shoulder impingement syndrome

This study presents an objective evaluation of both scapular upward and axial rotational tilts in shoulder impingement syndrome, using a scapular spine line defined on antero-posterior (AP) radiographs of the shoulder as the referential line. Twenty-seven patients with unilateral shoulder motion pain, who were diagnosed as having chronic shoulder impingement syndrome, were enrolled in the study. Scapular upward and axial rotational tilts were compared between the affected and contralateral shoulders. AP radiographs were obtained at shoulder abduction angles of 0°, 45°, and 90°, and the X-ray films were digitized by computer. The upward and axial rotational tilts of the scapula were then evaluated on the digital images. In shoulder impingement syndrome, both upward and axial external rotations of the scapula were impaired at the painful arc angle of abduction. This tended to be more apparent for the axial rotation of the scapula than for the upward rotation. These reductions in scapular rotations reduce available clearance for the rotator cuff and humeral greater tuberosity as the shoulder is abducted. Received: January 13, 2000 / Accepted: October 2, 2000     

The influence of three-dimensional scapular kinematics on arm elevation angle in healthy subjects

BackgroundWe often clinically observe individual differences in arm elevation angles, but the motion producing these differences remains unclear, partly because of the difficulty of accurately measuring scapular motion. The aim of this study was to determine whether the scapular or glenohumeral (GH) motion has more influence on differences in the arm elevation angles by capturing not only the humerus and scapula but also the trunk using two- (2D) and three-dimensional (3D) shape-matching registration techniques.MethodsFifteen healthy subjects (13 male and 2 female; mean age: 27.7 years) were instructed to elevate their arms in the sagittal, scapular, and coronal planes. They were divided into high and low groups based on the average of arm elevation angle measured by a goniometer. The 3D scapular, thoracohumeral, and glenohumeral motions were evaluated using 2D/3D single-plane registration. To compare 3D motions between groups, we performed a two-way repeated measures analysis of variance.ResultsEight subjects were assigned to the high group, while seven subjects were assigned to the low groups based on an average elevation angle of 172°. The low group demonstrated a significant larger scapular protraction during elevation in all planes (P = 0.0002 for flexion; P = 0.0047 for scaption; P = 0.0314 for abduction), and smaller posterior tilting only during flexion (P = 0.0157). No significant differences occurred in scapular upward rotations or the glenohumeral positions and rotations.ConclusionsThis study revealed that insufficient scapular retraction and posterior tilting results in lower arm elevation angles, suggesting that improving the flexibility and activation of muscles surrounding the scapula may be important to achieve complete arm elevation.     

Predictors of scapular notching in patients managed with the Delta III reverse total shoulder replacement

BACKGROUND: The reverse Delta III shoulder prosthesis can relieve pain and restore function in patients with cuff tear arthropathy. The most frequently reported radiographic complication is inferior scapular notching. The purpose of the present study was to evaluate the clinical relevance of notching and to determine the anatomic and radiographic parameters that predispose to its occurrence. METHODS: Seventy-seven consecutive shoulders in seventy-six patients with an irreparable rotator cuff deficiency were managed with a reverse Delta III shoulder arthroplasty and were followed clinically and radiographically for a minimum of twenty-four months. The effects of cranial-caudal glenoid component positioning and the prosthesis-scapular neck angle on the development of inferior scapular notching and clinical outcome were assessed. RESULTS: All shoulders that had development of notching did so in the first fourteen months. Of the seventy-seven shoulders that were studied, thirty-four (44%) had inferior scapular notching, twenty-three (30%) had posterior notching, and six (8%) had anterior notching. Osteophytes along the inferior part of the scapula occurred in twenty-one (27%) of the seventy-seven shoulders. The angle between the glenosphere and the scapular neck (r = 0.667) as well as the craniocaudal position of the glenosphere (r = 0.654) were highly correlated with inferior notching (p < 0.001). A notching index was calculated with use of the height of implantation of the glenosphere and the postoperative prosthesis-scapular neck angle. This allowed prediction of the occurrence of notching with a sensitivity of 91% and specificity of 88%. The height of implantation of the glenosphere had approximately an eight times greater influence on inferior notching than the prosthesis-scapular neck angle did. Inferior scapular notching was associated with a significantly poorer clinical outcome. CONCLUSIONS: Inferior scapular notching after reverse total shoulder arthroplasty adversely affects the intermediate-term clinical outcome. It can be prevented by optimal positioning of the glenoid component.     

Modified double-row technique for arthroscopic Bankart repair: surgical technique and preliminary results

Fixation by a double-row technique is a new concept in arthroscopic capsulolabral reconstruction for anterior shoulder instability. We report here a modified double-row arthroscopic Bankart repair technique. The capsulolabral complex is stabilised by sutures placed in a V-shaped manner. The sutures are fixed to the glenoid by suture anchors, thereby eliminating the necessity to tie or relay sutures under the scope. Compared with the conventional single-row repair method, our method has an advantage in that the complex is attached to the glenoid over a larger area. This procedure was performed on 28 shoulders in 25 patients. The operation time was shortened by almost 30% from that with the conventional procedure, and no complications were encountered in these patients. No recurrence of dislocation or subluxation was noted in 19 joints followed for 24 months or longer.