Effect of rotator interval closure on glenohumeral stability and motion: a cadaveric study

The effect of rotator interval closure, which is performed as an adjunct to arthroscopic stabilization of the shoulder, has not been clarified. Fourteen fresh-frozen cadaveric shoulders were used. The position of the humeral head was measured using an electromagnetic tracking device with the capsule intact, sectioned, and imbricated between the superior glenohumeral ligament and the subscapularis tendon (SGHL/SSC closure) or between the superior and middle glenohumeral ligaments (SGHL/MGHL closure). The direction of translational loads (10, 20, and 30 N) and arm positions were (1) anterior, posterior, and inferior loads in adduction; (2) anterior load in abduction/external rotation in the scapular plane; and (3) anterior load in abduction/external rotation in the coronal plane. The range of motion was measured using a goniometer under a constant force. Both methods reduced anterior translation in adduction. Only SGHL/MGHL closure reduced anterior translation in abduction/external rotation in the scapular plane and posterior translation in adduction. Both methods reduced the range of external rotation and horizontal abduction. Rotator interval closure is expected to reduce remnant anterior/posterior instability and thereby improve the clinical outcomes of arthroscopic stabilization procedures.     

Rationales of arthroscopic shoulder stabilization

Arthroscopic reconstruction of glenohumeral instability has become more common during the past decade. Compared with open reconstruction, which is still the gold standard in the treatment of shoulder instability, arthroscopic techniques allow for improved diagnosis of numerous intraarticular findings. This review presents an appropriate system for the arthroscopic classification of most pathological findings in patients with anterior shoulder instability. Based on the presented classification, a rationale for arthroscopic reconstruction under special conditions is given. Several operative techniques and implants are discussed and their use in certain circumstances analyzed. Special emphasis is targeted on techniques of realizing sufficient capsular shift or plication. Arthroscopic procedures remain technically demanding and require skills to address the great variety of possible situations. On the other hand, arthroscopic techniques in shoulder reconstruction benefit patients by avoiding the morbidity of open surgery. However, the surgeon must be prepared to address numerous conditions beyond a mere Bankart lesion, especially those involving capsular laxity, rotator interval lesions, and SLAP (superior labrum lesions from anterior to posterior) lesions. Nowadays, considering all the new technical possibilities of arthroscopic shoulder reconstruction including capsular shift procedures, most cases of anterior shoulder instability are suitable for arthroscopic reconstruction. Further studies are necessary to validate the continued efficacy of arthroscopic stabilization.     

The Hill-Sachs lesion: diagnosis, classification, and management

The Hill-Sachs lesion is an osseous defect of the humeral head that is typically associated with anterior shoulder instability. The incidence of these lesions in the setting of glenohumeral instability is relatively high and approaches 100% in persons with recurrent anterior shoulder instability. Reverse Hill-Sachs lesion has been described in patients with posterior shoulder instability. Glenoid bone loss is typically associated with the Hill-Sachs lesion in patients with recurrent anterior shoulder instability. The lesion is a bipolar injury, and identification of concomitant glenoid bone loss is essential to optimize clinical outcome. Other pathology (eg, Bankart tear, labral or capsular injuries) must be identified, as well. Treatment is dictated by subjective and objective findings of shoulder instability and radiographic findings. Nonsurgical management, including focused rehabilitation, is acceptable in cases of small bony defects and nonengaging lesions in which the glenohumeral joint remains stable during desired activities. Surgical options include arthroscopic and open techniques.     

Arthroscopic treatment of traumatic anterior glenohumeral instability

The main pathology in traumatic anterior instability of the shoulder is a Bankart lesion and capsuloligamentous laxity. Success in the treatment of glenohumeral instability mainly relies on an anatomical attachment of the fibrocartilaginous labrum and restoration of tension of the capsuloligamentous structures. Suture anchors are preferred for the fixation of soft tissues. Excessive capsular laxity can be treated by capsular plication or thermal capsulorrhaphy. Arthroscopy enables examination and repair of the glenohumeral structures, with several advantages over open techniques, including less morbidity and pain, shorter hospitalization, better cosmetic appearance, and a lower complication rate. These advantages have contributed to the growing acceptance of arthroscopic treatment in dealing with traumatic anterior glenohumeral instability. Moreover, its success rate has increased thanks to advances in technology and surgical techniques. Yet, appropriate selection of patients, the quality of capsulolabral structures, coexisting pathologies, and experience on the part of the surgeon are important factors in the success of arthroscopic treatment of anterior shoulder instability. This paper discusses the rationale for a treatment algorithm for arthroscopic applications together with recommendations about anterior instability of the shoulder.     

Arthroscopic Shoulder Stabilization: Is There Ever a Need to Open?

Recent studies show comparable results of arthroscopic shoulder stabilization techniques compared with the gold standard open Bankart reconstruction. Great technical advances and ever-increasing surgeon experience have rendered pathology once deemed an indication for open surgery as treatable by arthroscopic means. With this movement toward a more universal application of all-arthroscopic techniques, we might consider the following question: Is there ever a need to open? To answer this question, we must first consider normal anatomy and then appreciate the contribution of deranged pathoanatomy to recurrent instability in each individual case. The surgeon must then determine whether this is best addressed via an arthroscopic or open technique. Arthroscopy, as compared with open stabilization procedures, holds the potential benefits of decreased morbidity rates, early functional rehabilitation, and improved range of motion. Despite potential advantages, arthroscopic stabilization is clearly contraindicated when a significant pathologic lesion contributing to recurrent instability cannot be adequately addressed as a result of the limitations of current techniques or instrumentation. On the basis of this principle, we believe that sizable glenohumeral bone defects remain the only absolute contraindication to an all-arthroscopic approach. Many complicating issues, such as attenuated capsule, humeral avulsion of the glenohumeral ligament lesions, cases of revision surgery, and collision or contact athletes, exist and warrant close attention. We prefer to think of these situations as “challenges” for which both arthroscopic and open surgery should be considered, rather than as true contraindications to arthroscopic shoulder stabilization. We are, by no means, advocating arthroscopic treatment in all cases of shoulder instability, because this would represent a gross oversimplification of the issues at hand. However, we do acknowledge that the steadfast contraindications to arthroscopic shoulder stabilization are decreasing every day.     

Results and factors affecting outcome of revision surgery for shoulder instability

We conducted a clinical study identifying the causes of failure and the variables affecting outcome in 28 patients with failed open or arthroscopic anterior shoulder reconstruction for anterior glenohumeral instability. All patients underwent an open revision stabilization procedure. Surgical outcomes at a minimum 24 months' follow-up were available in 25 patients. The most common findings at revision surgery were capsular redundancy and Bankart lesions. Satisfactory results were found in 21 patients (84%) after repeat instability surgery. Factors contributing to negative outcome were glenohumeral arthritis, age greater than 30 years, 2 or more previous instability procedures, a bony Bankart lesion, the diagnosis of multidirectional instability, and surgery involving the nondominant arm (P < .05). Revision shoulder stabilization can be successful when the correct diagnosis is made and appropriate surgery performed. However, the outcome is less predictable in patients with multiple previous surgeries.     

Magnetic resonance imaging evaluation of the inferior glenohumeral ligament: non-arthrographic imaging in abduction and external rotation

The anterior band of the inferior glenohumeral ligament is the most important restraint for preventing traumatic anterior glenohumeral instability. The condition of this ligament markedly affects the results of arthroscopic Bankart repair. We compared non-arthrographic magnetic resonance imaging (MRI) in abduction and external rotation and arthroscopic findings of the ligament in 51 shoulders with traumatic anterior glenohumeral instability. The condition of the ligament was evaluated based on the presence of a thick low-signal band between the anterior labrum and the head of the humerus in all magnetic resonance images obtained from the 3- to 5-o'clock position of the glenoid rim (right shoulder). The sensitivity and specificity of the MRI evaluation were 94% and 82%, respectively. MRI in abduction and external rotation is fairly useful for predicting the condition of the ligament in advance of invasive measures (ie, arthroscopy).     

The glenohumeral micromotion and influence of the glenohumeral ligaments during axial rotation in varying abduction angle

BackgroundThe patients with shoulder instability or disorders in overhead athletes have been considered to have an abnormal micromotion at the glenohumeral joint. However, the normal range of the micromotion has not been available during axial rotation with various abduction angles, especially above 90° abduction. This study aimed to investigate the glenohumeral translation and influence of the glenohumeral ligaments during axial rotation with up to maximum abduction.MethodsFourteen healthy volunteers performed active axial rotations at 0°, 90°, 135°, and maximal abduction angles. The positions of the humeral head center relative to the glenoid at maximally external, neutral, and maximally internal rotations (ER, NR, IR, respectively) for each abduction angle were evaluated using two- (2D) and three-dimensional (3D) shape matching registration techniques. The shortest pathway and its length between the origin and insertion of the superior, middle, and inferior glenohumeral ligaments (SGHL, MGHL, and IGHL, respectively) were calculated for each position.ResultsThe glenohumeral joint showed 3.1 mm of superoinferior translation during axial rotation at 0° abduction (P < 0.0001), and 2.6 mm and 4.5 mm anteroposterior translation at 135° and maximal abduction (P < 0.0001), respectively. The SGHL and MGHL reached a maximum length at ER with 0° abduction, and the anterior and posterior bands of the IGHL reached a maximum at ER with 90° abduction and IR with 0° abduction.ConclusionsThese findings indicated that the SGHL played a role as an inferior suppressor at 0° abduction, while the anterior band of IGHL played a role as an anterior stabilizer at 90° abduction. Every glenohumeral ligament did not get taut and the anteroposterior translation became greater with increasing abduction angle, above 90°. These results could be used as a reference when comparing with the pathological shoulders in the future study.     

Editorial Commentary: Recurrence After Arthroscopic Bankart Repair: What the Instability Severity Index Score Will and Will Not Predict

The recurrence of shoulder instability is a challenging complication after anterior open or arthroscopic stabilization in patients with glenohumeral instability. Use of the arthroscopic Bankart procedure has increased over the last decade, because of its less invasiveness and low complication rates compared with the Latarjet procedure. However, arthroscopic repair has the possibility of a greater recurrent instability rate. The Instability Shoulder Index Score (ISIS) has been developed to predict the success of isolated arthroscopic Bankart repair for the management of recurrent anterior shoulder instability. The risk factors associated with the recurrence of instability are age, level and type of sports participation, shoulder hyperlaxity, and humeral and glenoid bony lesions. The ISIS is a validated tool to predict the recurrence of dislocation after arthroscopic surgery in patients with shoulder instability. The arthroscopic Bankart procedure can be performed in patients with ISIS ≤3 with a low risk of recurrence of glenohumeral instability. The Latarjet procedure should be recommended in patients with ISIS >6. The management of patients with ISIS between 4 and 6 is still controversial and ranges from arthroscopic Bankart procedure with the addition of remplissage to the Latarjet procedure. Because advanced imaging techniques, such as computed tomography scans, allow us to assess appropriately the glenoid and humeral bone defect, their use is recommended in addition to ISIS.     

Biomechanical tests for type II SLAP lesions of the shoulder joint before and after arthroscopic repair

Superior labral anterior-to-posterior (SLAP) lesions can cause shoulder pain partly by causing glenohumeral instability. The purpose of this study was to examine the effect of a simulated type II SLAP lesion and subsequent repair on glenohumeral translation of the vented shoulder. In eight cadaver joints, a robotic/UFS testing system was used to measure joint translation by applying an anterior, posterior, or inferior load of 50 N to each shoulder. The "apprehension tests" for anterior and posterior instability were simulated by applying an anterior load of 50 N with an external rotation torque of 3 Nm or a posterior load of 50 N with an internal rotation torque of 3 Nm. Each loading condition was applied at 30 degrees and 60 degrees of glenohumeral abduction with a constant joint compressive load (44 N) to the intact, simulated SLAP lesion, and repaired shoulder. Repair of the type II SLAP was then performed by placing a Suretac through the labrum both anterior and posterior to the biceps anchor and testing was repeated. ANOVA was used to compare translation of the intact joint, the joint after the type II SLAP lesion had been simulated, and after repair. At 30 degrees of abduction, anterior translation of the intact vented shoulder joint from anterior loading was 18.7+/-8.5 mm and increased to 26.2+/-6.5 mm after simulation of the type II SLAP lesion ( p< or =0.05). The arthroscopic repair did not restore anterior translation (23.9+/-8.6 mm) to the same degree as the intact joint ( p> or =0.05). At 60 degrees of abduction, anterior translation of 16.6+/-9.6mm in the intact joint was not significantly increased at 19.4+/-10.1 after simulation of the type II SLAP lesion ( p=0.0527). AP loading also resulted in inferior translation. At 30 degrees of abduction it was 3.8+/-4.0 mm in the intact joint and increased to 8.5+/-5.4 mm after the type II SLAP lesion ( p< or =0.05. After repair the inferior translation decreased significantly to 6.7+/-5.3 mm ( p< or =0.05). Although inferior translations were less at 60 degrees of abduction, results were similar to those at 30 degrees after repair. There were no significant increases in translation after SI/AP combined external rotation torque or posterior-anterior combined internal rotation torque loading.In this study the repair of a type II SLAP lesion only partially restored translations to the same degree as an intact vented shoulder joint. Therefore, improved repair techniques or an anteroinferior capsulolabral procedure in addition to the type II SLAP lesion repair might be needed to restore normal joint function.     

Die arthroskopische Bankart-Operation mit Hilfe von resorbierbaren Nahtankern

OBJECTIVE: Arthroscopic refixation of the labrum-ligament complex at the glenoid. INDICATIONS: Posttraumatic anterior or anterior-inferior shoulder instability with Bankart or ALPSA lesion (anterior labral periosteal sleeve avulsion). CONTRAINDICATIONS: Atraumatic shoulder instability. Instabilities due to blunted or frayed degeneration of the labrum-ligament complex. HAGL lesion (humeral avulsion of the glenohumeral ligaments) with humeral detachment of the glenohumeral ligaments. Larger bony glenoid defects. SURGICAL TECHNIQUE: Mobilization of the labrum-ligament complex from the neck of the glenoid, superior tightening and refixation at the glenoid rim with the aid of absorbable suture anchors. POSTOPERATIVE MANAGEMENT: Immobilization of the affected arm for 4 weeks in an immobilization bandage with abduction pillows. Daily pendulum exercises. Active flexion up to 70 degrees and abduction up to 40 degrees, all in neutral or internal rotation. Avoidance of external rotation for a total of 6 weeks. RESULTS: From January 1999 to December 2001, 58 patients with a Bankart or ALPSA lesion were treated with arthroscopic shoulder stabilization using absorbable suture anchors and slowly absorbable braided sutures. 56 patients underwent a follow-up clinical examination after, on average, 31 months (24-48 months). None of these patients had suffered more than five shoulder dislocations before the operation (average 2.8). Of the intraoperative lesions, a plain Bankart lesion was present in twelve patients (21.4%), 44 patients had an ALPSA lesion (78.6%), of which one in two were combined with an SLAP 2 or SLAP 3 lesion (superior labrum from anterior to posterior). In the evaluation using the Rowe Score, there was an excellent result for 40 patients (71.4%), and a good result for twelve (21.4%). Four patients suffered a repeat dislocation and were therefore classified as poor results (7.2%).     

Subcoracoid impingement syndrome: a painful shoulder condition related to different pathologic factors

Subcoracoid impingement syndrome represents a rare cause of shoulder pain. To date, there are a few papers in literature that have addressed specifically the subcoracoid impingement. We reviewed 13 consecutive patients suffering from this syndrome who underwent an arthroscopic treatment. There were 4 men and 9 women with a mean age of 45 years (range, 23-58 years). The diagnosis of subcoracoid impingement was carried out on the basis of clinical examination and magnetic resonance imaging finding. Arthroscopic surgery consisted of a coracoplasty alone in 2 patients, coracoplasty and acromioplasty in 2 patients, coracoplasty and subscapularis tendon repair in 4 patients, and in the last 5 patients no coracoplasty was done and surgery consisted in treating a minor shoulder instability. Patients were reviewed at a mean follow-up of 2.4 ± 0.7 years. We evaluated the difference between preoperative and final postoperative range of motion, VAS, UCLA, SST and Constant score using a Student's t test. At follow-up, we observed a significant improvement in range of motion and shoulder scores; moreover, clinical findings of subcoracoid impingement were negative in all patients. Different pathological shoulder conditions can be responsible for a subcoracoid impingement that can be primary or secondary to factors different from mechanic attrition against the coracoid because of its morphology. In case of primary impingement, coracoplasty is a good treatment to relieve clinical symptoms. In patients suffering from an associated minor shoulder instability with MGHL capsulolabral lesion, surgical treatment of this lesion without coracoplasty led to the improvement in symptoms.     

Intracapsular origin of the long head of the biceps tendon with glenoid avulsion of the glenohumeral ligaments

An 18-year-old woman presented with a history of recurrent glenohumeral dislocations involving her right dominant shoulder. Physical examination suggested physiologic hyperlaxity and anterior instability. Magnetic resonance arthrography demonstrated an anomalous intracapsular origin of the long head of the biceps tendon (LHBT), with normal-appearing LHBT in the intertubercular groove. Diagnostic arthroscopy confirmed the absence of the LHBT attachment on the superior labrum. Instead, the LHBT originated from the capsule of the shoulder joint. Diagnostic arthroscopy also revealed glenoid avulsion of the glenohumeral ligaments (GAGL) lesion as a tear in the anterior-inferior capsule near its insertion on the glenoid and labrum. An arthroscopic anterior capsulolabral repair was performed with rotator interval closure by imbrication of superior and middle glenohumeral ligaments. A retrospective review of the magnetic resonance arthrogram identified irregularity and interposition of contrast between the capsule and the anterior-inferior labrum that was reproduced in the abduction-external rotation view corresponding with the GAGL lesion seen at arthroscopy. At 12 months postoperatively, the patient demonstrated full range of motion and no signs of instability. This case report helps to raise awareness about 2 rare shoulder lesions: the anomalous origin of LHBT and the GAGL lesion. Diagnosing such lesions on preoperative magnetic resonance imaging may aid in operative planning and avoid unexpected intraoperative findings.     

Editorial Commentary: For Shoulder Hill-Sachs Lesion Remplissage,Medial Anchor Position Must Be Optimized to Achieve Stability Yet Minimize External Rotation Loss

An off-track Hill-Sachs lesion (HSL) is a significant risk factor for recurrent shoulder instability after arthroscopic Bankart repair. Bankart repair combined with remplissage can better restore shoulder stability versus isolated Bankart repair when treating a combined Bankart lesion and off-track HSL. However, remplissage may be nonanatomic and associated with limitation of shoulder external rotation (ER), especially when the arm is in a 90° shoulder abduction position. Excessive medial placement of remplissage anchors is associated with postoperative ER loss and increased glenohumeral cartilage degeneration. The use of 2 medial anchors results in lower articular forces. Thus, in patients with shoulder instability, we recommend using 2 remplissage anchors in those with a Bankart lesion plus an off-track HSL. The anchors should be placed medially to achieve stability—but not so medial as to result in postoperative stiffness and significant ER loss.     

Open surgical treatment of recurrent anterior instability of the shoulder

Recurrent anterior gleonohumeral instability is the most frequent joint instability of the body. Because of the complex stability mechanisms and diverse instability patterns of the glenohumeral joint, most cases present with more than one anatomic cause. Thus, the treatment of recurrent anterior instability of the shoulder should be designed to treat these pathologies. Although arthroscopic repair has outweighed the use of open surgical methods especially for the first dislocations, recurrent dislocations still require open repair techniques to overcome capsular laxity accompanying a Bankart lesion.     

Recurrent anterior shoulder dislocation caused by a midsubstance complete capsular tear

BACKGROUND: A midsubstance complete capsular tear is one of the well-known causes of anterior glenohumeral instability. However, its prevalence and clinical picture have not been well elucidated. The purpose of this study was to examine the prevalence of isolated complete capsular tears and to assess the clinical features as well as the results of surgical treatment of recurrent anterior glenohumeral instability caused by such tears. METHODS: Three hundred and three shoulders underwent surgery to treat recurrent anterior glenohumeral instability at our institution during a five-year period. Twelve (4.0%) of these shoulders had an isolated complete capsular tear as the main pathological condition. Those twelve patients (nine male and three female) were the subjects of the present study. The average age at the time of the operation was twenty-five years. Patient age; the cause of the initial dislocation; the position of the arm at the initial dislocation; and the findings of the preoperative physical examination, of computed tomographic arthrography, and at surgery were assessed. Eleven patients underwent arthroscopic capsular repair, and one was treated with an open capsular repair. RESULTS: The twelve patients either did not have a Hill-Sachs lesion or had a chondral indentation-type of Hill-Sachs lesion. When assessed with arthrography, the Hill-Sachs lesions were small compared with those in shoulders with an isolated Bankart lesion and, interestingly, they were quite similar in size to those seen with humeral avulsion of the inferior glenohumeral ligament. The average Rowe score for the twelve patients improved from 30.4 points preoperatively to 90.4 points at an average of thirty-one months postoperatively. CONCLUSIONS: The prevalence of isolated complete capsular tears causing recurrent glenohumeral instability was 4.0% (twelve of 303). These tears were associated with either a small or no Hill-Sachs lesion. We believe that a complete capsular tear should be recognized as one of the essential lesions causing recurrent anterior shoulder dislocation. Arthroscopic examination and repair can provide effective treatment.     

Humeral avulsion of glenohumeral ligaments as a cause of anterior shoulder instability

The avulsion of the glenohumeral ligament labral complex at the glenoid (Bankart lesion), as well as ligamentous laxity are well known causes of anterior shoulder instability. A lesser known entity, the humeral avulsion of glenohumeral ligaments (HAGL), was studied to determine its incidence and its role in anterior glenohumeral instability. Sixty-four shoulders with the diagnosis of anterior instability were prospectively evaluated by arthroscopy for intraarticular pathology, including Bankart, capsular laxity, and HAGL lesions. Six shoulders were found to have HAGL lesions (9.3%), 11 shoulders with generalized capsular laxity (17.2%), and 47 shoulders with Bankart lesions (73.5%). In patients with documented anterior instability without a demonstratable “primary” Bankart lesion, a HAGL lesion should be ruled out. This lesion is readily recognized arthroscopically, and an appropriate repair of this lesion can restore anterior stability to the patient. The pathological anatomy of the HAGL lesion and our treatment of this lesion is discussed.     

Arthroskopische Schulterstabilisierung mittels Fadenankern unter besonderer Berücksichtigung des tiefen anterior-inferioren Zugangs (5:30 Uhr)

OBJECTIVE: Arthroscopic (re)stabilization of the unstable shoulder by anatomic refixation of the detached capsulolabral complex with suture anchors or reduction of excessive capsule volume by capsule plication. INDICATIONS: Any type of shoulder instability (anterior, posterior, inferior, or multidirectional instability). Revision stabilization (even after primary open stabilization). Bone defects affecting < 25% of the glenoid surface. Lesions of the superior biceps tendon anchor complex (SLAP lesion). CONTRAINDICATIONS: Preexisting bone defects of the glenoid affecting > 25% of the glenoid surface. "Engaging" Hill-Sachs defects: osseous defects of the humeral head that engage with the anterior glenoid rim in extreme external rotation/abduction and consequently lead to shoulder dislocation. Bone-related etiology, e. g., clearly increased glenoid retroversion/anteversion or glenoid dysplasias (e. g., inverse pear shape). Voluntary shoulder dislocation in young patients until the end of the growth period. SURGICAL TECHNIQUE: Diagnostic arthroscopy and additional procedures based on clinical and intraoperative findings. For anterior-inferior instability, an anterior-superior approach is made with mobilization of the labrum and decortication of the glenoid. Creation of deep anterior-inferior portal and insertion of the anchors in 5.30, 4.30 and 3.00 o'clock position. The sutures are pulled through the capsulolabral complex and tied arthroscopically. Reconstruction of the inferior glenohumeral ligament is especially important. Lesions of the superior biceps tendon anchor and/or posterior labrum detachment can be treated by the same technique. Capsule plication with PDS sutures can be performed to decrease a large rotator interval or excessive capsule volume. The range of motion at the shoulder is limited for 6 weeks postoperatively (depending on the initial direction of the instability). RESULTS: At the authors' hospital over 600 arthroscopic shoulder stabilizations using the deep anterior-inferior portal have been completed so far. The redislocation rate for the first 147 patients (average follow-up of 3 years) treated with the technique described here is 6.1% and is slightly higher for arthroscopic revision stabilizations (n=43; of these, redislocation n=3 and reinstability n=3). There were no instances of axillary nerve lesion.     

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.