The Bankart Shoulder Reconstruction

Abstract

The pull-out wire technique for suturing tendons and ligamentous structures was originally described by Bunnell. Its application to the present problem has been carried out by the authors since 1947. A comparable method, used for two years, was described in 1949 by Luckey who had operated on fifteen patients. After simiiar exposure, Luckey preserved and divided the capsule and sutured its lateral end to the freshened glenoid rim with a No. 24 or No. 26 gauge steel wire. He employed only one pull-out stitch through two drill holes and did not attempt to repair time labrum in any instance nor did he shorten the subscapularis. He reported no recurrence after follow-ups of one to two years. The method reported here, therefore, is by no means original. We prefer the use of braided wire because of its great tensile strength and the ease with which it can be handled. We use large coat buttons in tying the sutures. The steps described, we believe, are not sufficiently different from Bankart technique to incur his disapproval. We have, like him, never attempted to show the defect in the humeral head and have trusted our repair to overcome the increased tendency to recurrence that it causes when present. The essential points of our technique are then: (1) adequate assistance and positioning; (2) use of the Bankart retractor; (3) attachment of the glenoid labrum, the capsule or lateral subscapularis or both to the freshened neck by means of two Bunnell braided wire pull-out sutures; (4) shortening of subscapularis; (5) postoperative fixation and resistance exercises.