Revisiting the open Bankart experience: a four- to nine-year follow-up

BACKGROUND: The open Bankart technique for posttraumatic recurrent anterior instability has become the procedure of choice for patients who do not respond to nonoperative treatment. HYPOTHESIS: The open Bankart procedure renders stable and well-functioning shoulders in the long term in a large proportion of patients. STUDY DESIGN: Retrospective follow-up study with independent reexaminers. METHODS: Fifty-four patients (54 shoulders) with symptomatic, posttraumatic, recurrent anterior shoulder instability underwent an open Bankart reconstruction procedure with suture anchors. All of the patients had a Bankart lesion. Forty-seven patients (87%) were reexamined by independent observers at a mean follow-up period of 69 months (range, 48 to 114). RESULTS: The recurrence rate, including both dislocations and subluxations, was 17% (8 of 47). The median Rowe score was 90 points (range, 24 to 100) at the follow-up, and the median Constant score was 88.5 points (range, 41 to 100). External rotation in abduction was a median of 90 degrees (range, 25 degrees to 125 degrees ) in the involved shoulders, as compared with 97.5 degrees (80 degrees to 125 degrees ) in the noninjured shoulders (P < 0.0001). CONCLUSIONS: We conclude that, in the long term, the open Bankart procedure resulted in an unexpectedly high number of patients with failure in terms of stability. These results emphasize the importance of performing long-term follow-up studies after surgical reconstruction for unidirectional, posttraumatic, anterior shoulder instability using any type of technique.     

Nonabsorbable versus absorbable suture anchors for open Bankart repair. A prospective, randomized comparison

Suture anchors facilitate the surgical repair of capsuloligamentous structures to bone. Bioabsorbable suture anchors, which obviate potential pitfalls in the periarticular use of permanent implants, have recently become available. We randomly assigned 40 patients to undergo modified Bankart shoulder repairs with either nonabsorbable or absorbable suture anchors. The patients had a history of recurrent traumatic anterior instability that had not improved with nonoperative management. The average patient age was 22 years (range, 17 to 46), and the average preoperative Rowe score was 47 points in the nonabsorbable anchor group and 47 points in the absorbable anchor group. Average postoperative Rowe scores were 96 and 93 points, respectively. There was one failed result in the nonabsorbable anchor group and two in the absorbable anchor group. No statistically significant subjective or objective differences were found at an average of 25 months postoperatively. Our results reveal that, in this application, bioabsorbable suture anchors are a viable option for the repair of soft tissue to bone.     

Comment to the paper "Ultrasound and computer tomography in staging of bladder tumours"

The interference of Transurethral Resection (TUR) with CT staging of bladder cancer is discussed in reaction to a recent publication.     

A decade of experience of examining candidates for entry to the army.

A total of 3886 civilian candidates were medically examined for entry to the Army during the period 1980 to 1990. Eight per cent of the candidates failed their examination. The commonest causes for rejection were back and knee disorders, the majority associated with trauma. The next most common disorder was hearing loss, closely followed by myopia. Analysis of the incidence of individual conditions showed that only hearing loss and myopia were more prevalent than spondylolisthesis. It is felt, therefore, that consideration should be given to the routine radiographic screening of all candidates for spondylolisthesis and indeed for spondylolysis. The incidence of medical conditions was low. In the assessment of the individual's fitness for entry, the effects of military training and service in the field on his or her functional capacity must be considered. Problems that may arise when a candidate is rejected are discussed.     

From open to arthroscopic anatomical ACL-reconstructions: the long way round. A statement paper

The single-incision anterior cruciate ligament (ACL) reconstruction evidently has its shortcomings. In an attempt to improve the biomechanical but also the biological state of the knees after an ACL-reconstruction, double, even triple-bundle reconstructions have been popularised recently. As a positive side effect, details concerning ACL-insertion anatomy were brought back into the focus. In our opinion it would be more straight forward and logical to replace the non-anatomical single-incision technique with a more anatomic single-bundle ACL-reconstruction technique.     

A rational approach to "in vitro" thyroid function testing.

A system of "in vitro" thyroid function testing is proposed whereby laboratory staff select the most appropriate screening test depending on the information supplied by the clinician. Total serum triiodothyronine (T3) or thyroxine (T4) are used for screening as appropriate. In borderline cases, secondary tests are performed automatically according to a flow chart. This system improves efficiency and is cost effective, saving approximately 1,800 pounds annually in a laboratory handling about 5,000 requests for thyroid function tests each year.     

A primer on molecular biology for imagers IX. How to become a "molecular imager"

This is the conclusion of our series of articles entitled “A Primer on Molecular Biology for Imagers,” and hopefully this will serve as the beginning of many readers’ journey in becoming a molecular imager. There is no real barrier to achieving stage one of development, which requires only acquisition of the knowledge base and the use of this knowledge in our practice of imaging sciences and also in our everyday life. We have made much progress in building the foundation for further development of molecular imaging and we are optimistic that many of our readers will participate in the revolution of biomedicine in the genomic era.