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.     

Combined Bankart and HAGL lesion associated with anterior shoulder instability

Traumatic anterior shoulder instability has been shown to be associated with a spectrum of capsulolabral pathology, including separation of the labrum (Bankart lesion), capsular rupture, and humeral avulsion of the glenohumeral ligaments (HAGL lesion). We describe a case of combined Bankart and HAGL lesions, a condition that has not been described before. Careful anatomic repair of both components of this bipolar capsular injury resulted in an excellent outcome.     

First-time anterior shoulder dislocations: should they be arthroscopically stabilised?

The glenohumeral joint is inherently unstable because the large humeral head articulates with the small shadow glenoid fossa. Traumatic anterior dislocation of the shoulder is a relatively common athletic injury, and the high frequency of recurrent instability in young athletes after shoulder dislocation is discouraging to both the patient and the treating physician. Management of primary traumatic shoulder dislocation remains controversial. Traditionally, treatment involves initial immobilisation for 4–6 weeks, followed by functional rehabilitation. However, in view of the high recurrence rates associated with this traditional approach, there has been an escalating interest in determining whether immediate surgical intervention can lower the rate of recurrent shoulder dislocation, improving the patient’s quality of life. This review article aims to provide an overview of the nature and pathogenesis of first-time primary anterior shoulder dislocations, the widely accepted management modalities, and the efficacy of primary surgical intervention in first-time primary anterior shoulder dislocations.     

RETRACTED: Early outcome of arthroscopic Bankart's repair for Recurrent traumatic anterior shoulder instability

Background/objectives

Despite the improvements in the methods of arthroscopic stabilization of anterior shoulder instability, a recurrence rate of as high as 30% is reported in the literature. In this context, we report the outcome of arthroscopic Bankart repair in anterior shoulder instability, with the use of bio-absorbable suture anchors for patients that were followed up for at least two years from the date of surgery.The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. We would like to report the 2-year clinical outcomes of bio-absorbable suture anchors used in traumatic anterior dislocations of the shoulder.

Methods

Data from 79 shoulders in 74 patients were collected over 4 years (2005–2009). Each patient was followed up over a period of 2 years. The patients underwent arthroscopic Bankart repair using bio-absorbable suture anchors for their anterior shoulder instability. These surgeries were performed at a single institution by a single surgeon over the time period. The patients were assessed with two different outcome measurement tools. The University of California at Los Angeles (UCLA) shoulder rating scale and the Simple Shoulder Test (SST) score. The scores were calculated before surgery and at the 2-year follow-up. The recurrence rates, range of motion as well post-operative function and return to sporting activities were evaluated.

Results

SST results from the 12 domains showed a significant improvement from a mean of 6.1 ± 3.1 to 11.1 ± 1.8 taken at the 2-year follow-up (p < 0.0001). Data from the UCLA scale showed a pre and post-operative mean of 20.2 ± 5.0 and 32.4 ± 4.6 respectively (p < 0.0001). 34 had excellent post-operative scores, 35 had good scores, 1 had fair score and 3 had poor scores. 75% of the patients returned to sports while 7.6% developed a recurrence of shoulder dislocation or subluxation.

Conclusion

Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent post-operative shoulder motion and low recurrence rates.     

Magnuson法与Bankart法治疗习惯性肩关节前脱位的疗效比较

目的：比较Magnuson法与Bankart法手术治疗习惯性肩关节前脱位的临床效果。方法回顾性分析2011年1月至2012年10月广州军区广州总医院采用Magnuson法和Bankart法手术治疗的43例习惯性肩关节前脱位患者的临床资料,其中Magnuson组21例、Bankart组22例。观察两组切口长度、术中出血量和手术时间的差异,采用肩关节功能Neer评分评价术前,术后6、12个月的肩关节功能。结果两组切口长度、术中出血量和手术时间比较,差异无统计学意义（P＞0.05）。43例患者均获随访,随访时间11～18个月（平均15.3个月）。末次随访时两组患者均未再次出现肩关节脱位。与术前比较,两组术后6、12个月肩关节功能Neer评分均较术前有明显改善（P＜0.05）。Bankart组术后6个月肩关节功能Neer评分优于Magnuson组（P＜0.05）,但术后12个月两组Neer评分比较,差异无统计学意义（P ＞0.05）。结论对于习惯性肩关节前脱位患者,Bankart法较Magnuson法术后肩关节功能恢复快,但两种术式对肩关节功能的远期改善程度似无明显差别。     

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.