Anchor Placement on the Glenoid Faceplate Does Not Improve Stability With Bankart Repair (SS-02)

Abstract

Introduction Some surgeons recommend that suture anchors used during Bankart repair should be placed a few millimeters on the glenoid faceplate to enhance stability. However, there is risk with placing the anchors in this location due to the potential problem of anchor back-out and early arthritis. Also, it has been suggested that a Bankart lesion should be repaired with a bumper of the capsulolabral tissue created to obtain a more stable shoulder. However, it has not been biomechanically determined that these techniques really improve stability. The purpose of this study was to determine 1) whether the shoulder would become stable by creating a bumper, and 2) whether placing the suture anchors on the glenoid faceplate would make the shoulder more stable. Methods Nine fresh-frozen cadaveric shoulders (mean age, 75 years) were investigated. A custom testing machine with a six-degree-of-freedom load-cell was utilized. With a 50-N axial force applied to the humerus, the humeral head was translated in the anterior direction and the peak translational force was measured at both the end-range (60° of abduction relative to the scapula and maximum external rotation) and mid-range (60° of abduction and neutral rotation) positions with the intact capsule, with a Bankart lesion, and after Bankart repair with and without a bumper. Bankart repair was performed at five different positions (glenoid rim, glenoid surface-2 mm (2 mm inside from the glenoid rim), glenoid surface-5 mm, scapular neck-2 mm (2 mm medial on the scapular neck from the glenoid rim), and scapular neck-5 mm). Bumper was created gathering up the capsule to form a thickened mass of tissue. Results The peak translational force which significantly decreased after creating a Bankart lesion returned to almost the intact condition level after Bankart repair at both arm positions. However, there were no significant differences between the forces after Bankart repair with and without the bumper. The force significantly decreased after scapular neck fixation-2 mm and −5 mm compared to the one after glenoid rim fixation. However, there were no significant differences between the forces after glenoid rim fixation and glenoid surface fixation-2 mm at both arm positions. On the other hand, the force significantly increased at the end-range position and decreased at the mid-range position after glenoid surface fixation-5 mm. Conclusion Although some surgeons recommend that the suture anchors should be placed on the glenoid faceplate surface, our data showed that glenoid faceplate fixation did not make the shoulder more stable. The shoulder did not become more stable even after creating the bumper.