Arthroscopic Bankart Reconstruction Research Articles

Arthroscopic Bankart Reconstruction with Minimal Bone Loss

Arthroscopic shoulder stabilization is the most commonly used technique to treat shoulder instability; however, recurrence rates have been shown to be high in our literature. Optimizing treating of glenohumeral instability is crucial to improve patient outcomes. This chapter will provide a basic review of the key steps in the evaluation and management of patients with shoulder instability with minimal bone loss.

Clinical Validation of the Glenoid Track Concept in Anterior Glenohumeral Instability.

Glenoid and humeral bone loss are well-described risk factors for failure of arthroscopic shoulder stabilization. Recently, consideration of the interactions of these types of bone loss (bipolar bone loss) has been used to determine if a lesion is "on-track" or "off-track." The purpose of this study was to study the relationship of the glenoid track to the outcomes of arthroscopic Bankart reconstructions. Over a 2-year period, 57 shoulders that were treated with an isolated, primary arthroscopic Bankart reconstruction performed at a single facility were included in this study. The mean patient age was 25.5 years (range, 20 to 42 years) at the time of the surgical procedure, and the mean follow-up was 48.3 months (range, 23 to 58 months). Preoperative magnetic resonance imaging was used to determine glenoid bone loss and Hill-Sachs lesion size and location and to measure the glenoid track to classify the shoulders as on-track or off-track. Outcomes were assessed according to shoulder stability on examination and subjective outcome. There were 10 recurrences (18%). Of the 49 on-track patients, 4 (8%) had treatment that failed compared with 6 (75%) of 8 off-track patients (p = 0.0001). Six (60%) of 10 patients with recurrence of instability were off-track compared with 2 (4%) of 47 patients in the stable group (p = 0.0001). The positive predictive value of an off-track measurement was 75% compared with 44% for the predictive value of glenoid bone loss of >20%. The application of the glenoid track concept to our cohort was superior to using glenoid bone loss alone with regard to predicting postoperative stability. This method of assessment is encouraged as a routine part of the preoperative evaluation of all patients under consideration for arthroscopic anterior stabilization. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Bone mineral decreases in the calcanei in men after arthroscopic shoulder surgery: a prospective study over 5years.

It is well known that injuries and surgical procedures in the lower extremities affect bone mineral both in the injured limb and in the contralateral limb. The possible effect on bone mineral after upper extremity surgery is not well studied, and the aim of this study was to study the effect on bone mineral in the calcanei after arthroscopic shoulder surgery. Twenty-two men scheduled for arthroscopic shoulder surgery underwent bone mineral area (BMA) mass measurements in both calcanei using the Calscan DXL device prior to surgery and after 6, 18, 36 and 60months. On every occasion, the Tegner activity score and EuroQoL 5-dimensions (EQ-5D) were assessed. During 5years, there was a significant decrease in the BMA in both calcanei (p=0.003). The Tegner activity score decreased from preinjury to the operation and did not increase significantly after the operation. The EQ-5D increased significantly after the operation. The bone mineral in the calcanei in men during the 5-year study period decreased more than the expected age-dependent decline after arthroscopic shoulder surgery. There was an increase in health-related quality of life as measured with the EQ-5D after arthroscopic Bankart reconstruction. Case-control study, Level III.

Predictive Value and Clinical Validation of the “On-Track” vs. “Off-Track” Concept in Bipolar Bone Loss in Anterior Glenohumeral Instability

Objectives:Bone loss is a well-described risk factor for failure with arthroscopic stabilization. The isolated importance of bone loss on both the glenoid and humeral side has been increasingly studied. A more recent evolution considers how both the glenoid and humeral bone loss interact to determine whether their combination results in an “on-track” or “off-track” lesion, which may be more predictive of recurrent instability than looking at either side individually. While the biomechanics of this concept have been elucidated, no study has tested this theory in a clinical population. The purpose of this study is to compare a series of arthroscopic Bankart reconstructions stratified by whether they are “on-track” or “off-track” with regard to bipolar bone loss and to compare their rates of recurrence and functional outcome scores.Methods:Over a two year period, all isolated, primary Bankart reconstructions performed at a single facility by one of three fellowship trained Orthopaedic Sports Surgeons were included in this study. All patients had preoperative advanced imaging and had postoperative outcome measures including SANE and WOSI scores, as well as data return to work status. Glenoid bone loss, Hill-Sachs lesion size and location, as well as a radiographic measurement of the glenoid track were measured. Patients were stratified according to whether they sustained a subsequent recurrence of their instability, and these groups were analyzed according to their bone loss status, specifically whether they were “on-track” or “off-track”.Results:57 shoulders met inclusion criteria. The average age was 25.5 years (range 20-42) at the time of surgery. Average follow up was 28.4 mos. There were 10 recurrences (18%). Patients in the recurrent group had WOSI and SANE scores that were roughly half as good as the group that did not recur (p=0.003 and p=0.002 respectively). Of the 49 on-track patients, 4 (8.2%) failed. Conversely, of the 8 off-track patients, 6 (75%) failed (p=0.0001). Six of the 10 (60%) of the patients who sustained a recurrence of their instability after arthroscopic stabilization were off-track at the time of their surgery. In contrast, in the 47 patients who remained stable at latest follow-up, only 2 (4.3%) were off-track (p=0.0001). Eight of 47 patients (17%) in the non-recurrent group had glenoid bone loss greater than 20%; two of 47 stable patients (4%) were off-track. The positive predictive value (PPV) of the off-track measurement was 75% which was significantly higher than the predictive value of glenoid bone loss >20% (PPV=43%, p=0.02).Conclusion:This is the first study to apply the on-track vs. off-track assessment of bipolar bone loss to a clinical population. In this study, being off-track was a significant predictor of recurrent instability after isolated Bankart reconstruction, correctly predicting failure in 75% of cases. This was superior to the predictive value of glenoid bone loss >20% alone, which correctly predicted failure 43% of the time. Recurrence correlated with worse functional outcomes scores. Bipolar bone loss as measured by the track method is quite accurate in predicting success and failure after arthroscopic Bankart reconstruction in a clinical population. This method of assessment is encouraged as a routine part of the preoperative evaluation of all patients under consideration for arthroscopic anterior stabilization.

Redefining “Critical” Bone Loss in Shoulder Instability

Background: Glenoid bone loss is a common finding in association with anterior shoulder instability. This loss has been identified as a predictor of failure after operative stabilization procedures. Historically, 20% to 25% has been accepted as the “critical” cutoff where glenoid bone loss should be addressed in a primary procedure. Few data are available, however, on lesser, “subcritical” amounts of bone loss (below the 20%-25% range) on functional outcomes and failure rates after primary arthroscopic stabilization for shoulder instability. Purpose: To evaluate the effect of glenoid bone loss, especially in subcritical bone loss (below the 20%-25% range), on outcomes assessments and redislocation rates after an isolated arthroscopic Bankart repair for anterior shoulder instability. Study Design: Cohort study; Level of evidence, 3. Methods: Subjects were 72 consecutive anterior instability patients (73 shoulders) who underwent isolated anterior arthroscopic labral repair at a single military institution by 1 of 3 sports medicine fellowship-trained orthopaedic surgeons. Data were collected on demographics, the Western Ontario Shoulder Instability (WOSI) score, Single Assessment Numeric Evaluation (SANE) score, and failure rates. Failure was defined as recurrent dislocation. Glenoid bone loss was calculated via a standardized technique on preoperative imaging. The average bone loss across the group was calculated, and patients were divided into quartiles based on the percentage of glenoid bone loss. Outcomes were analyzed for the entire cohort, between the quartiles, and within each quartile. Outcomes were then further stratified between those sustaining a recurrence versus those who remained stable. Results: The mean age at surgery was 26.3 years (range, 20-42 years), and the mean follow-up was 48.3 months (range, 23-58 months). The cohort was divided into quartiles based on bone loss. Quartile 1 (n = 18) had a mean bone loss of 2.8% (range, 0%-7.1%), quartile 2 (n = 19) had 10.4% (range, 7.3%-13.5%), quartile 3 (n = 18) had 16.1% (range, 13.5%-19.8%), and quartile 4 (n = 18) had 24.5% (range, 20.0%-35.5%). The overall mean WOSI score was 756.8 (range, 0-2097). The mean WOSI score correlated with SANE scores and worsened as bone loss increased in each quartile. There were significant differences (P < .05) between quartile 1 (mean WOSI/SANE, 383.3/62.1) and quartile 2 (mean, 594.0/65.2), between quartile 2 and quartile 3 (mean, 839.5/52.0), and between quartile 3 and quartile 4 (mean, 1187.6/46.1). Additionally, between quartiles 2 and 3 (bone loss, 13.5%), the WOSI score increased to rates consistent with a poor clinical outcome. There was an overall failure rate of 12.3%. The percentage of glenoid bone loss was significantly higher among those repairs that failed versus those that remained stable (24.7% vs 12.8%, P < .01). There was no significant difference in failure rate between quartiles 1, 2, and 3, but there was a significant increase in failure (P < .05) between quartiles 1, 2, and 3 (7.3%) when compared with quartile 4 (27.8%). Notably, even when only those patients who did not sustain a recurrent dislocation were compared, bone loss was predictive of outcome as assessed by the WOSI score, with each quartile’s increasing bone loss predictive of a worse functional outcome. Conclusion: While critical bone loss has yet to be defined for arthroscopic Bankart reconstruction, our data indicate that “critical” bone loss should be lower than the 20% to 25% threshold often cited. In our population with a high level of mandatory activity, bone loss above 13.5% led to a clinically significant decrease in WOSI scores consistent with an unacceptable outcome, even in patients who did not sustain a recurrence of their instability.

Critical Bone Loss in Shoulder Instability Reconsidered: Subcritical Bone Loss Correlates to Worse Outcome in Arthroscopic Bankart Repair

Critical Bone Loss in Shoulder Instability Reconsidered: Subcritical Bone Loss Correlates to Worse Outcome in Arthroscopic Bankart Repair

Do Reduction and Healing of the Bony Fragment Really Matter in Arthroscopic Bony Bankart Reconstruction?

Background: Bony Bankart lesions can be treated with arthroscopic repair. However, few studies have evaluated the importance of bony fragment reduction and healing to stability of the glenohumeral joint after arthroscopic bony Bankart repair. Purpose: To evaluate functional results after surgery and determine the correlation between reduction and healing of the fracture and postoperative stability of the glenohumeral joint. Study Design: Case series; Level of evidence, 4. Methods: A total of 50 patients (47 men, 3 women; average age, 27.6 years; range, 16.5-50.1 years) with bony Bankart lesions and recurrent anterior shoulder dislocations were treated with arthroscopic reduction and internal fixation with suture anchors. The average follow-up period was 32.5 months (range, 24.3-61.2 months). Preoperative and postoperative range of motion and American Shoulder and Elbow Surgeons (ASES), Constant-Murley, and Rowe scores were compared to evaluate the results of the surgeries. Sequential 3-dimensional computed tomography (CT) scans were available for 37 patients and were analyzed to investigate the effect of the bony defect of the glenoid and the correlation between the success of the surgery and reduction and healing of the bony fragment. Results: After surgery, active forward elevation was significantly improved (P < .05). No significant differences were found regarding external and internal rotations after surgery. The ASES, Constant-Murley, and Rowe scores improved significantly after surgery. Redislocations occurred in 3 patients, and a positive anterior apprehension sign was detected in 1 patient during follow-up. The overall failure rate was 8.0% (4/50). The CT scans during the follow-up period showed a nonunion of the bony fragment in 13.5% of cases (5/37). The reconstructed size of the glenoid was <80% in 3 of the 4 failure cases but >80% in all of the successful cases. Conclusion: Arthroscopic reduction and fixation of a bony Bankart lesion can achieve good results in selected cases. The size of the reconstructed glenoid is crucial to the success of the surgery.

What is the current practice in Europe when difficult shoulder injuries are treated?

In this issue of the journal, a group of Italian researchers discusses the European orthopedic surgeon’s management of choice for several difficult clinical scenarios of shoulder pathologies [1]. They divided their survey into four scenarios; i.e., anterior shoulder dislocation, shoulder arthritis combined with rotator cuff tear, large rotator cuff tendon tears combined with major fatty infiltration of the infraspinatus muscle and instability of the long head of the biceps and finally adhesive capsulitis. It might be claimed that at least three out of four are difficult cases. Therefore, the answers are of great interest. The authors used an online Web-based questionnaire and it is obvious that a questionnaire of this kind has the potential to improve our knowledge about the current trends in modern technology and ultimately might be helpful in creating clinical guidelines on a large scale. The first scenario was related to anterior dislocation of the shoulder. Interestingly, more than 70 % of the orthopedic surgeons recommended arthroscopic Bankart reconstruction, approximately half as an acute procedure and the rest as a planned procedure. This is the case description: ‘‘21-year-old male, recreational soccer player, first-time shoulder dislocation, with a minimal Hill-Sachs lesion, and a Bankart lesion’’… Less than 30 % of the surgeons recommended non-surgical treatment, which is of interest. The question is whether we really know that an acute/ semi-acute surgical procedure is the correct way to approach this particular—and in fact very common— problem. There might be arguments for instance for a more conservative approach. Also interesting is the recommendation for a brace in internal or external rotation in almost 75 %. The second scenario is a 55-year-old female with painful shoulder arthritis, total supraspinatus tear and infraspinatus fatty infiltration. In this case, the majority of surgeons (more than 60 %) recommended surgical treatment, while less than 40 % would favor a conservative regimen. Supraspinatus tendon repair/reconstruction was recommended by 85 % of all surgeons, with or without biceps tenodesis/tenotomy. The question is whether we really know if biceps tenodesis/tenotomy is needed in a case like this? Again, the dominance of surgical approach is of great interest. Only few surgeons recommended either debridement or shoulder replacement (15 %) in this patient. The third scenario is a 65-year-old male manual worker,

Arthroscopic Posterior Stabilization and Anterior Capsular Plication for Recurrent Posterior Glenohumeral Instability

The purpose of this study was to evaluate the outcomes and identify predictors of success for arthroscopic posterior Bankart reconstruction with modern suture anchor repair and anterior capsulolabral plication in a well-defined patient population-recurrent, traumatic, involuntary, unidirectional posterior shoulder instability. Patients with recurrent, traumatic, involuntary, unidirectional posterior shoulder instability who underwent arthroscopic repair with a minimum of 2 years' follow-up were identified and evaluated retrospectively with outcome measures in the form of objective and subjective scores. Statistical analysis was performed to identify predictors of success with significance set at .05. Twenty-nine consecutive patients with a mean age of 26.3 years underwent posterior reconstruction and anterior balancing capsulolabral plication as needed with a mean follow-up of 5.5 years. Outcome scores averaged as follows: American Shoulder and Elbow Surgeons, 90.7; University of California, Los Angeles, 32.6; Simple Shoulder Test, 11.7; and Western Ontario Shoulder Instability, 82.9% of normal. Recurrent instability occurred in 3.4% of patients, 84.6% returned to sports, and 96.6% of patients believed surgery was successful and worthwhile. Patients who were younger (<30 years) or patients with more extensive pathology who required additional surgical procedures or received supplemental anterior plication sutures had less reliable or worse outcomes (P < or = .041). In a traumatic patient population with involuntary, unidirectional posterior shoulder instability, modern suture anchor repair of posterior labral lesions is effective and provides reliable outcomes. Younger patients and patients with worse pathology who required additional procedures had less reliable outcomes. Patients with supplemental anterior plication had more postoperative pain, and this adjunctive procedure may not be necessary for traumatic posterior labral tear surgery. Level IV, therapeutic case series.

A 7-Year Prospective, Randomized, Clinical, and Radiographic Study After Arthroscopic Bankart Reconstruction Using 2 Different Types of Absorbable Tack

Background Recent studies have shown that techniques for arthroscopic Bankart reconstruction using suture anchors or tacks can equal the results after an open procedure in the treatment of posttraumatic, recurrent, unidirectional shoulder instability. Which kind of technique and which implants to be used still need further study. Purpose The aim of this study was to compare the clinical and radiographic results after arthroscopic Bankart reconstruction using 2 different types of absorbable implants. Study Design Randomized controlled trial; Level of evidence, 1. Methods A randomized series of 40 patients who had recurrent shoulder instability underwent reconstruction involving either polygluconate-B polymer or self-reinforced poly-L-lactic acid polymer tack implants. The patients underwent radiographic and clinical assessments preoperatively and at 7 years. Blood levels of C-reactive protein were analyzed preoperatively and postoperatively. Results The radiographic visibility of the drill holes was significantly (P = .0001) greater in the poly-L-lactic acid polymer group than in the polygluconate-B polymer group. The failure rate in terms of stability was 5 of 36 (14%) after 7 years and, as previously reported by Magnusson et al, 2 of 40 (5%) after 2 years. Analyses preoperatively and postoperatively of C-reactive protein revealed no significant difference between the groups. No significant differences were found between the groups in terms of strength in abduction, range of motion, and Rowe or Constant scores. Conclusion Seven years after Bankart repair using either implant, the overall clinical results were satisfactory. The visibility of the drill holes was significantly greater after using poly-L-lactic acid polymer implants.

Arthroscopic Posterior Stabilization and Anterior Capsular Plication for Recurrent Posterior Glenohumeral Instability (SS-18)

Posterior shoulder instability is less common than anterior shoulder instability and consists of a broad spectrum of clinical presentations and pathology. Recurrent, traumatic, involuntary, unidirectional posterior instability is the most common form. Arthroscopic techniques are currently employed as treatment for these patients. The purpose of this study is to evaluate the outcomes of arthroscopic posterior Bankart reconstruction with modern suture anchor repair in a well-defined patient population and to evaluate preoperative and operative factors as determinants of success. Thirty patients with an average age of 26.9 years (range 15.7-43.4) all had traumatic detachment of the posterior labrum and underwent suture anchor repair with posterior capsulolabral plication. Supplemental anterior capsulolabral plication and additional surgeries were performed as required. Patients were evaluated an at an average follow-up of 5.5 years (range 2.0-12.4 years) with shoulder outcomes scores including the American Shoulder and Elbow Surgeons (ASES) Rating Scale, the Western Ontario Shoulder Instability (WOSI) Index, the University of California at Los Angeles (UCLA) score and the Simple Shoulder Test (SST). Subjective patient evaluations for success, strength, range of motion, instability, pain and return to sport were also recorded. All patients had posterior Bankart lesions that required suture anchor repair. The average postoperative ASES score was 90.0 (range 53.3-100), UCLA score of 32.6 (range 24-35), SST of 11.7 (10-12), WOSI of 366 (0-1033) or 82.6% of normal (50.8-100%). Ninety-seven percent of patients (29/30) reported they were satisfied and better, 97% (29/30) reported a successful treatment and 97% (29/30) felt the surgery was worthwhile and would repeat it if necessary. Recurrent postoperative posterior instability occurred in 3.3% (1/30) of patients. Eighty-five percent of patients (23/27) returned back to sports with 69.2% (18/26) being able to return to the their previous level of athletics. Patients who required additional procedures at the time of surgery had worse postoperative ASES, WOSI, UCLA outcomes scores (p<0.0107) and higher subjective pain and instability scores (p<0.0428). Younger patients (<30 years old) reported lower subjective postoperative strength and higher instability scores (p<0.0347). Patients who received supplemental anterior plication capsulolabral sutures reported higher subjective pain scores (p<0.0315). This is the longest known follow-up reported for arthroscopic posterior shoulder instability surgery. Suture anchor stabilization of posterior Bankart lesions is an effective treatment for recurrent, traumatic, involuntary, unidirectional posterior shoulder instability. Younger patients and patients with more extensive pathology who require supplemental procedures may have slightly less reliable outcomes.

A Prospective, Randomized, Clinical and Radiographic Study After Arthroscopic Bankart Reconstruction Using 2 Different Types of Absorbable Tacks

A Prospective, Randomized, Clinical and Radiographic Study After Arthroscopic Bankart Reconstruction Using 2 Different Types of Absorbable Tacks

A Prospective, Randomized, Clinical and Radiographic Study After Arthroscopic Bankart Reconstruction Using 2 Different Types of Absorbable Tacks

The aim of the study was to compare the clinical and radiographic results after arthroscopic Bankart reconstruction using 2 different types of absorbable implant. Randomized controlled trial. A randomized series of 40 patients who had recurrent, unidirectional, post-traumatic shoulder instability were included in the study. All patients underwent an arthroscopic Bankart reconstruction involving either polygluconate co-polymer (PGACP group, n = 20) or self-reinforced poly-L-lactic acid polymer (PLLA group, n = 20) tack implants. The patients underwent clinical and radiographic assessments preoperatively and at 2 years. Additional radiographic assessments were performed at 6 months. Preoperatively, the study groups were comparable in terms of demographics as well as clinical parameters. One patient in each group had a redislocation (5%) during the follow-up period of 2 years. No subluxations were registered. No statistically significant differences were found between the study groups in terms of strength in abduction, range of motion, and Rowe or Constant scores. There was a significant increase in degenerative changes during the follow-up period in both study groups (P = .004). However, no significant differences in degenerative changes were registered between the study groups either preoperatively or at the 2-year follow-up. There were no significant differences in the radiographic visibility of the drill holes used for the absorbable implants between the study groups at the 6-month assessment. However, at the 2-year assessment, the radiographic visibility of the drill holes was significantly greater (P = .004) in the patients in the PLLA group than those in the PGACP group. At the 2-year assessment, no correlation was found between the appearance of the drill holes and the degenerative findings (PGACP group, rho = 0.44; PLLA group, rho = 0.42). Two years after arthroscopic Bankart reconstruction using either PGA polymer or PLA polymer implants, the overall clinical results were comparable. Radiographic assessments revealed that the degenerative changes increased in both study groups during the follow-up period. Furthermore, the visibility of the drill holes on the 2-year radiographs was greater after using PLLA implants than after using PGACP implants. Level I.

좌 체위 견관절 수술 후 발생한 설하신경 단독 편마비 - 증례 보고 -

Arthroscopic surgery of the shoulder is regarded as a convenient and safe approach, but there is a possibility of complication during procedure. We report an isolated unilateral hypoglossal neurapraxia following combined arthroscopic and open Bankart reconstruction performed in beach-chair position under general anesthesia with orotracheal intubation.

Glenohumeral arthropathy after arthroscopic anterior shoulder stabilization

Purpose: We present 5 cases of iatrogenic arthropathy after arthroscopic Bankart reconstruction using a metallic suture anchor. Type of Study: Retrospective case series. Methods: Five patients with pain and crepitus on motion were referred to our institution for further evaluation of the previous procedure on anterior shoulder instability. Screw-type metallic suture anchors were used in all cases. All patients were men, with an average age of 23 years (range, 21 to 26). Surgical records on previous procedure were reviewed, and the clinical symptoms were evaluated using a visual analogue scale (VAS), the Simple Shoulder Test (SST), and the Rowe scoring system. The secondary surgery for each patient was performed at an average of 12 months (range, 7 to 20) after the initial arthroscopic stabilization, except in one patient who wanted to postpone the revision surgery. Results: Protrusion of the anchor tip was seen in all and chondral defects in the humeral head with some degree of synovitis were also seen. Slight differences between preoperative and postoperative pain were seen, but almost no improvement in function, including range of motion, stability, and average Rowe score were seen after the second procedure. Patients who underwent revision surgery were dissatisfied with the final outcomes. Conclusions: Careful attention should be paid when using a metallic suture anchor. A secure, buried placement of the anchor is required in arthroscopic Bankart reconstruction. Poorly placed suture anchors may damage the glenohumeral joint, and if these are not corrected either at arthroscopic surgery or shortly after, the results can be suboptimal. If a patient complains of unusual mechanical symptoms after using anchors, radiographs should be performed. This kind of serious complication can be discovered earlier to prevent the severe destruction of the glenohumeral joint. Level of Evidence: Level IV.

Arthroscopic bankart reconstruction with a bioabsorbable anchor

This study evaluated the clinical effectiveness of a poly- l–lactic acid biodegradable suture anchor for arthroscopic Bankart reconstruction with a prospective multicenter study. Inclusion criteria were one or more episodes of traumatic dislocation or multiple posttraumatic subluxations as a manifestation of unidirectional anterior instability. Exclusion criteria were significant glenoid bone deficiency, large Hill-Sachs lesions, rotator cuff tears, multidirectional instability, posterior labrum tears, or biceps ruptures. Fifty-seven patients were followed up for a mean of 24 months. Postoperative apprehension tests were negative in all but two. Motion improved from 155° preoperatively to a mean of 175° postoperatively. Four patients had postoperative instability symptoms (two dislocators and two with subluxations). Postoperative radiographs demonstrated no lytic or resorptive bone changes from the suture anchors. The mean postoperative Rowe score was 93. The biodegradable suture anchor achieved good clinical results when used for arthroscopic Bankart reconstruction with no material-related adverse events.

Current trends in the treatment of glenohumeral instability

The treatment of glenohumeral instability has changed significantly in the past several years. The introduction of arthroscopic techniques has changed the way in which many physicians approach glenohumeral instability and has allowed a better understanding of the pathology underlying this condition. Although arthroscopy has been a great advance in the treatment of many pathologic processes in the shoulder, arthroscopic treatment for glenohumeral instability continues to present significant challenges. Advances such as arthroscopically placed suture anchors in arthroscopic Bankart reconstruction and thermal capsulorrahaphy show great promise, but continued clinical and basic science research is needed to prove the efficacy and safety of these new techniques. Curr Opin Orthop 1999, 10:310–315 © 1999 Lippincott Williams & Wilkins, Inc.

Two- to five-year followup of arthroscopic Bankart reconstruction using a suture anchor technique.

This is a retrospective review of 27 patients (27 shoulders) with recurrent anterior instability who underwent arthroscopic Bankart reconstruction with a suture anchor technique between 1990 and 1993. Average length of followup was 40 months (range, 26 to 64). The average Bankart rating score was 88 (range, 45 to 100) with 70% good-to-excellent results and 30% fair-to-poor results. The average University of California (Los Angeles) shoulder function score was 32 (range, 27 to 35). The average loss of external rotation in abduction was 1 degree. Eight patients (30%) failed the procedure and had recurrent anterior shoulder instability; seven of these had repeat traumatic events. A Pearson chi-square analysis of multiple variables was performed to determine which variables correlated with a successful result. A higher success rate was obtained if the patient had five or fewer dislocations before surgical reconstruction. This technique should be limited to patients not returning to contact sports, or in whom the improved cosmetic results or increased postoperative external rotation of the arthroscopic procedure are valued.