Labroligamentous Complex Research Articles

Arthroscopic Fixation of Bony Bankart Lesion Using Inverted All-Suture Anchor Through Bone Tunnel

A bony Bankart lesion is a condition where the labroligamentous complex is detached from the anterior glenoid rim, often accompanied by a fracture. It is a common occurrence found in up to 70% of traumatic shoulder dislocations. Arthroscopic surgery has become the mainstream approach for treating this condition. However, the commonly used techniques, such as labrum alone, transosseous, and double-row, can encounter difficulties passing sutures and may cause damage to the surrounding tissues, especially when dealing with large bony fragments. In this technical note, we describe our preferred technique for fixing bony Bankart lesions, which involves fixing the bony Bankart fragment through the bone tunnel using an all-suture anchor. The surgery is performed with the patient in the lateral decubitus position. Our technique offers a reliable and effective approach to treat bony Bankart lesions while minimizing the risks of complications associated with conventional techniques.

COMPARATIVE ANALYSIS OF HIGH RESOLUTION ULTRASONOGRAPHY AND MAGNETIC RESONANCE IMAGING IN SHOULDER PATHOLOGIES

Introduction: A wide plethora of Shoulder Pathologies are frequently encountered in patients presenting with shoulder pain. They are routinely evaluated using High Resolution Ultrasonography, Magnetic Resonance Imaging and Arthrography. Despite good diagnostic accuracy in using each of these modalities, certain limitations persist. To recognize com Aims and Objectives: mon pathologies of the Shoulder on Ultrasonography and Magnetic Resonance Imaging. Correlate Ultrasonography and Magnetic Resonance Imaging ndings and establish the superiority and determine diagnostic modality of choice for various pathologies Results: Overall detection rates (sensitivity) of any kind of rotator cuff tears using ultrasound were 78.38 %. This sensitivity difference was statistically very signicant. US has a very high specicity rate of 90.91 %. Ultrasound suffers severe handicaps when it comes to study the labroligamentous complex injuries in patients with instability, Whereas MRI proved to be far superior in labroligamentous complex injuries. High Resolution Ultrasonography and Magneti Conclusion c Resonance Imaging are excellent modalities with high efciency in the detection of various shoulder pathologies, provided user is adequately experienced / trained and familiar with complex shoulder anatomy. MRI is a versatile investigation tool for studying all shoulder pathologies affording great soft tissue contrast and multiplanar imaging and ultrasound has signicant clinical applications outside rotator cuff evaluation

Arthroscopic Techniques to Stabilize Glenoid Bony Bankart Fragments

A bony Bankart lesion is an avulsion of the labroligamentous complex associated with an anterior glenoid rim fracture. Bony Bankart lesions can be seen in up to 70% of traumatic shoulder dislocations. With such a high prevalence, the development of an optimal repair technique is important. Selection of the most appropriate repair method depends heavily on the individual hard- and soft-tissue characteristics of the presenting lesion, as well as surgeon experience with the various repair options. We describe 3 arthroscopic Bankart fixation techniques (labrum alone, transosseous, and double row) to address a range of presenting Bankart pathologies.

Role of ABER Positioning in Evaluation of Anteroinferior Labroligamentous Lesions in Shoulder MR Arthrograms

Background: MR arthrography in the abduction and external rotation (ABER) position has been demonstrated to enhance the diagnostic ratio of anterior labro-ligamentous complex tears. Meanwhile, the diagnostic and discriminatory rates of MR arthrography in this position in various types of the antero-inferior labro-ligamentous lesions have not been completely discovered. Aim: This study aimed to perform comparison between ABER MR and the conventional MR arthrography considering the diagnostic rate and discriminatory precision of various anteroinferior labro-ligamentous lesions. Methods: We studied 38 patients who suffered from shoulder conditions and evaluated the results of both conventional MR and ABER MR arthrography. An antero-inferior labro-ligamentous lesion was diagnosed with the detection of absence, fray, detachment, displacement of the antero-inferior labrum or detection of the contrast material inside the labrum, or avulsion, rupture of the inferior glenohumeral ligament at the humeral or labral attachment. All study subjects have undergone shoulder arthroscopy after MR technique. Results: ABER MR arthrography was associated with significant increased accuracy and diagnostic sensitivity than that of conventional MR regarding the diagnostic rate of various types of the antero-inferior labro-ligamentous lesions (p < 0.05). Conclusion: Based on our results, ABER MR arthrography would add more value to the diagnosis if the conventional MR were doubtful in suspected antero-inferior labro-ligamentous complex injuries.

Role of MRI Arthrography Compared to Conventional MRI in Assessment of Shoulder Joint Disorders

Abstract Glenohumeral joint instability is extremely common. With regard to primary anterior shoulder dislocations, the incidence is between 8.2 and 23.9 per 100 000 person-years, with an estimated prevalence of 1.7%. Many imaging methods, including arthrography, CT arthrography, MR arthrography, have been used to image the glenoid labrum and the associated structures of the capsular mechanism. The aim of the study is to prove MR arthrography is the preferred imaging technique for the investigation of patients with shoulder instability. MR arthrography reliably shows subtle lesions of the labroligamentous complex, providing information essential to the surgeon concerning the surgery or arthroscopic repair .Thirty Patients with clinically evident or suspected shoulder impingemint or glenohumeral instability.of both sexes were included , conventional MRI was performed for all patients followed by CT guided intraarticular contrast injection then MRI Arthrography images taken within thirty minutes. Data were collected, revised, coded and entered to the Statistical Package for Social Science (IBM SPSS) version 20.

The spectrum of MRI findings in painful shoulder: A prospective study of 81 cases

Background: Shoulder MRI is now considered the standard among the imaging methods to diagnose the etiology of shoulder pain as MRI allows the direct visualization of the rotator cuff tendons, their tears and abnormalities, their relationship to the undersurface of the acromion and the acromioclavicular (AC) joint and also identifiestears of labro-ligamentous complex. Objective: The purpose of this study was to highlight the MRI spectrum of various non-infective, non-neoplastic pathologies of shoulder joint in patients presenting with pain and to analyse the results statistically.Materials & Methods: This prospective cross-sectional study was conducted on 81 patients in the age group of 16 to 72 years with the complaints of shoulder pain with or without associated instability and restricted mobility using conventional 1.5 T MRI. Informed consent was taken from all the participants.Results: In our study, Rotator cuff tear was the most common lesion noted in 85% cases, out of which the predominant lesion was full-thickness supraspinatus tear, in 29.6% cases. Rotator cuff tendinosis & Impingement syndrome were the second & third most common lesions encountered on MRI in painful shoulder, observed in 77.7% & 39% of the patients respectively. 49% cases showed lesions of both rotator cuff & rotator interval, However only 3% had isolated involvement of rotator interval. 42% had MRI diagnosis of labro-ligamentous tears with bankart lesion & its variants accounted maximum (25%) and its co-occurrence with hill-sachs defect noted in 81% cases.Conclusion: This study concludes that MRI is well accepted, non-invasive imaging modality and can evaluate the patients with shoulder pain efficiently due to its excellent soft tissue contrast and multiplanar acquisition. It also suggests that besides rotator cuff tears, the infrequent but important shoulder pathologies like tears of rotator interval and labro-ligamentous complex can also be detected on conventional MRI with thorough observation.

Reliability of high-resolution ultrasound and magnetic resonance arthrography of the shoulder in patients with sports-related shoulder injuries

IntroductionThe shoulder, a very complex joint, offers a wide range of pathologies. Intraarticular abnormalities and rotator cuff injuries are mainly assessed and diagnosed by magnetic resonance arthrography (MRA). In contrast to this well-established gold standard, high-resolution ultrasound (US) offers an additional easy and excellent modality to assess the shoulder joint. Therefore, the purpose of this study was to evaluate in which anatomic structures and pathologies comparable results of US and MRA could be achieved.Materials and methodsIn this IRB-approved prospective study 67 patients with clinically suspected labral lesions, rotator cuff rupture, or injury of the long head of the biceps (LHB) tendon were enrolled. Each participant was examined with high resolution US, and directly followed by MRA at 3 Tesla with a standard sequence protocol. To evaluate the agreement of the diagnostic performance between US and MRA a weighted kappa statistic was used.ResultsBoth of the investigated modalities yielded a moderate to almost perfect agreement in assessing a wide range of shoulder joint pathologies. For the rotator cuff, consistency was found in 71.64% for the supraspinatus tendon, in 95.52% for the infraspinatus tendon, in 83.58% for the subscapularis tendon, and in 98.51% for the teres minor tendon.The diagnostic accuracy between both modalities was 80.60% for the LHB tendon, 77.61% for the posterior labroligamentous complex, 83.58% for the acromioclavicular joint, and 91.04% for the assessment of osseous irregularities and impaction fractures.ConclusionsHigh resolution US is a reliable imaging modality for the rotator cuff, the LHB tendon, and the acromioclavicular joint, so for these structures we recommend a preference for US over MRA based on its diagnostic accuracy, comfortability, cost effectiveness, and availability. If the diagnosis remains elusive, for all other intraarticular structures we recommend MRA for further diagnostic assessment.

Arthroscopic repair of glenoid rim fractures: a ligamentotaxis surgical technique.

Glenoid fractures occur as a result of direct impact of the humeral head against the glenoid rim following high-energy trauma. They frequently involve one-third of the glenoid surface with an oblique fracture rim from 2 to 6-7 o'clock, and they must not be confused with bony Bankart lesions. In medium-age patients, they are frequently associated with acute cuff tear while in older patients with chronic cuff tear: These conditions increase the instability of the shoulder if not treated. With this study, we reported the results of the arthroscopic ligamentotaxis technique treatment of acute antero-inferior glenoid fractures type IA of Ideberg with a cuff repair associated. Eleven patients with IA Ideberg glenoid fracture were treated with ligamentotaxis technique. Mean age: 56years (45-70); 80% dominant side; male/female: 1.2. Mean extension area of glenoid fracture: 25%. The fragment was fixated reinserting the labro-ligamentous complex with a single 2o'clock anchor. In six patients (55%), a rotator cuff tear was present, repaired during the surgical intervention. Radiological assessment: X-rays and CT with PICO method to measure the glenoid area involved. Clinical assessment: VAS, constant score, Dash score and Rowe score. After 30months of follow-up (12-50), no differences in flexion, abduction, rotations and pain were reported compared to the contralateral side (p > 0.05). The mean normalized constant was 101 (60-123), and the mean Rowe was 93 (65-100). X-rays showed good healing without articular surface depressions or step in all cases. Two patients had a progression of gleno-humeral arthritis. Acute antero-inferior glenoid rim fractures are uncommon but they are increasing in over 55years population (frequently associated with cuff tear). Correct classification and treatment are necessary to achieve good results. The X-ray assessment includes the Neer's trauma series and the CT study with PICO measurement of glenoid fragment size. Wrong treatment can lead to chronic instability, degenerative joint disease and poor results. The arthroscopic repair with ligamentotaxis is a good solution and permits the treatment of the associated rotator cuff tear. Arthroscopic technique imposes a long learning curve. CT can be used to confirm the anatomic reduction and the healing of the fracture but since it uses X-rays it must be reserved to comminuted fractures.

Arthroscopic Osseous Bankart Repair in the Treatment of Recurrent Anterior Glenohumeral Instability.

Anterior glenohumeral instability associated with an anterior-inferior fracture of the glenoid (osseous Bankart lesion) can be treated successfully with arthroscopic, rather than open, surgical repair, or fixation of the osseous fragment. Place the patient in the beach-chair position and examine both shoulders for laxity after induction of general anesthesia with an interscalene block. Create a standard posterior viewing portal and anterior and anterosuperior working portals. Separate the displaced osseous fragment associated with the labroligamentous complex from the glenoid neck and mobilize the labroligamentous complex together with the fragment up to the 7 o'clock or 7:30 position (in a right shoulder). Perform an inferior labrum repair by inserting 2 suture anchors at the anteroinferior part of the glenoid face. Fix the osseous fragment by passing the sutures either through or around the fragment with use of a bone penetrator, or Bone Stitcher, while stabilizing the labrum and fragment with a large grasper. Rotator interval closure, done with the arm in >60° of external rotation, is the most frequently performed augmentation procedure. A consecutive series of 46 patients with an osseous Bankart lesion who demonstrated >15% glenoid bone loss underwent osseous Bankart repair, which was performed regardless of the fragment size, between January 2005 and December 20061.

Role of conventional MRI and MR arthrography in evaluating shoulder joint capsulolabral-ligamentous injuries in athletic versus non-athletic population

ObjectiveThe aim of this study was to assess diagnostic value of direct MR arthrography compared to conventional MR imaging in the diagnosis of different pathologic entities affecting the capsule-labral complex in athletic and non-athletic population. Subjects and methodsThis study included 60 patients complaining of shoulder pain. Conventional MRI and MR arthrography (MRA) were done for all cases. The musculoskeletal radiologist reviewed the images for evidence of pathologies of the labroligamentous complex. Inter-observer agreement was determined with kappa statistics, and the diagnostic accuracy of each technique was calculated. ResultsComparing the sensitivity of conventional MRI versus MRA was done by correlating the final diagnosis of each modality with the results of arthroscopy. MRI revealed sensitivity (SEN) of 72%, specificity (SPE) of 78%, while MRA revealed a SEN of 78%, SPE of 100%, PPV of 100%, and NPV of 21%. ConclusionMR techniques cannot replace arthroscopy; however, they could be a potent additional tool for diagnosis of the main pathological affection of the shoulder joint guided by the type of the population, which proved to have good impact on the diagnosis. The capsulolabral and ligamentous injuries are more common at the athletic group while the non-athletic population are more prone to rotator cuff tendons injury.

Beyond the Cuff: MR Imaging of Labroligamentous Injuries in the Athletic Shoulder.

Shoulder disease is common in the athletic population and may arise as a consequence of a single traumatic episode or multiple repeated events. Associated labroligamentous injuries can result in substantial disability. Specific athletic and occupational activities result in predictable injury patterns. Imaging in general and magnetic resonance (MR) imaging, in particular, are vital in establishing the correct diagnosis and excluding common mimicking conditions, to ensure timely and appropriate management. In this review, the utility of MR imaging and MR arthrography will be explored in evaluation of shoulder disease, taking into account normal variants of the labroligamentous complex. Subsequently, broad categories of labral lesions and instability, external and internal impingement, as well as nerve entrapment syndromes, will be discussed, while emphasizing their imaging findings in the clinical context and illustrating key features. More recent concepts of internal impingement and secondary subacromial impingement will also be clarified.

The shoulder.

The shoulder.

The added value of ABER position for the detection and classification of anteroinferior labroligamentous lesions in MR arthrography of the shoulder

PurposeThe purpose of this study is to compare MR arthrography in abduction and external rotation (ABER) position with conventional MR arthrography in neutral position for the detection and further classification of anteroinferior labroligamentous lesions. Materials and methodsTwo hundred and twenty-nine cases of shoulder MR arthrography with subsequent arthroscopy were retrospectively evaluated. All MR arthrograms in ABER position and neutral position were independently assessed by two radiologists who were blinded to the arthroscopic findings. Sensitivities and specificities of both positions for detection and further categorization of anteroinferior labroligamentous lesions were calculated and compared using paired McNemar test. K values were calculated to quantify the level of interobserver agreement. ResultsAt arthroscopy, 24 Bankart lesions, 59 ALPSA lesions, 39 Perthes lesions, 8 GLAD lesions, 4 ALIPSA lesions, 31 nonclassifiable lesions and 60 intact anteroinferior complexes were found. The sensitivity of MR arthrography in ABER position for detecting anteroinferior labroligamentous lesions was significantly higher than that of in neutral position (92.7–94.5% versus 81.8–83%, P<0.05). For the detection rate of the mentioned 6 subtypes of lesions, only the Perthes lesions had significant improvement in ABER position when compared with conventional MR arthrography (observer 1, 61.5–87.2%, P=0.006; observer 2, 69.2–92.3%, P=0.004). MR arthrography in ABER position was more effective in identifying of Perthes lesions (66.7–74.4% versus 35.9–40%, P<0.05) while the conventional MR arthrography was more effective in accurate diagnose of ALPSA lesions (74.6–78.0% versus 54.2–55.9%, P<0.05). No statistically significant difference of the diagnostic accuracy was found between the two positions for Bankart lesions, GLAD lesions, and ALIPSA lesions. ConclusionMR arthrography in ABER position has more added value on detection of Perthes lesions in evaluation of anteroinferior labroligamentous complex tear.

Die Ruhigstellung der Schulter in Außenrotation nach traumatischer Erstluxation – Was kann man seinen Patienten zumuten? Eine retrospektive Patientenbefragung

Immobilisation in external rotation has become a new option in the therapy of the traumatically dislocated shoulder. Brace comfort and patient's satisfaction with this kind of conservative treatment are evaluated in a retrospective survey. 34 patients with a traumatic first-time anterior shoulder dislocation were immobilised in an external rotation brace for three weeks. Afterwards they were asked to complete a questionnaire regarding brace comfort and how they managed their daily life with one arm immobilised in external rotation. 29 questionnaires could be evaluated. 26 patients (90%) were satisfied with the new therapy. 24 patients (83%) would prefer the conservative treatment in an external rotation brace in case of another dislocation under similar circumstances. The impact of the brace therapy on daily live was reasonable. 79% of the patients (23) wore the brace more than 20 hours daily (average 22 hours, min.15, max. 24 hours). Despite the uncomfortable arm position during immobilisation the therapy in an external rotation brace showed a high acceptance. In addition to previous results regarding reposition of the labroligamentous complex it appears to be proven a suitable therapy for first-time traumatic anterior shoulder dislocation.

Arthroscopic Osseous Bankart Repair for Chronic Recurrent Traumatic Anterior Glenohumeral Instability

BACKGROUND: A chronic osseous Bankart lesion has traditionally been treated with soft-tissue repair and/or open bone-grafting for a large glenoid defect. We developed an arthroscopic method of osseous reconstruction of the glenoid without bone-grafting. The purpose of this study was to evaluate the postoperative outcomes of our technique for chronic recurrent traumatic anterior glenohumeral instability. METHODS: A consecutive series of forty-two shoulders in forty-one patients with chronic recurrent traumatic glenohumeral instability underwent an arthroscopic osseous Bankart repair. All shoulders were evaluated preoperatively with three-dimensionally reconstructed computed tomography, which confirmed an osseous fragment at the anteroinferior portion of the glenoid. The average bone loss in the glenoid was 24.8% (range, 11.4% to 38.6%), and the average fragment size was 9.2% (range, 2.1% to 20.9%) of the glenoid fossa. In all shoulders, a displaced osseous fragment, firmly attached to the labroligamentous complex, was separated from the glenoid neck before reduction and fixation in the optimal position with use of suture anchors. All patients were assessed with use of the scoring systems of Rowe et al. and the University of California at Los Angeles preoperatively and at the final evaluation. RESULTS: The mean duration of follow-up was thirty-four months. At that time, thirty-nine of the forty-two shoulders were rated as having a good or excellent result. The mean Rowe score improved from 33.6 points preoperatively to 94.3 points postoperatively (p < 0.01). The mean score on the University of California at Los Angeles system improved from 20.5 points preoperatively to 33.6 points at the final evaluation (p < 0.01). The average passive external rotation was 75° with the arm at the side and 93° with the arm at 90° of abduction. Two patients had a reinjury. Eventually, thirty-five of thirty-seven patients who were active participants in sports returned to the sport they had played before the injury. CONCLUSIONS: Arthroscopic osseous Bankart repair with use of suture anchors yields a successful outcome even in shoulders with a chronic large glenoid defect.

Arthroscopic Osseous Bankart Repair for Chronic Recurrent Traumatic Anterior Glenohumeral Instability

A chronic osseous Bankart lesion has traditionally been treated with soft-tissue repair and/or open bone-grafting for a large glenoid defect. We developed an arthroscopic method of osseous reconstruction of the glenoid without bone-grafting. The purpose of this study was to evaluate the postoperative outcomes of our technique for chronic recurrent traumatic anterior glenohumeral instability. A consecutive series of forty-two shoulders in forty-one patients with chronic recurrent traumatic glenohumeral instability underwent an arthroscopic osseous Bankart repair. All shoulders were evaluated preoperatively with three-dimensionally reconstructed computed tomography, which confirmed an osseous fragment at the anteroinferior portion of the glenoid. The average bone loss in the glenoid was 24.8% (range, 11.4% to 38.6%), and the average fragment size was 9.2% (range, 2.1% to 20.9%) of the glenoid fossa. In all shoulders, a displaced osseous fragment, firmly attached to the labroligamentous complex, was separated from the glenoid neck before reduction and fixation in the optimal position with use of suture anchors. All patients were assessed with use of the scoring systems of Rowe et al. and the University of California at Los Angeles preoperatively and at the final evaluation. The mean duration of follow-up was thirty-four months. At that time, thirty-nine of the forty-two shoulders were rated as having a good or excellent result. The mean Rowe score improved from 33.6 points preoperatively to 94.3 points postoperatively (p < 0.01). The mean score on the University of California at Los Angeles system improved from 20.5 points preoperatively to 33.6 points at the final evaluation (p < 0.01). The average passive external rotation was 75 degrees with the arm at the side and 93 degrees with the arm at 90 degrees of abduction. Two patients had a reinjury. Eventually, thirty-five of thirty-seven patients who were active participants in sports returned to the sport they had played before the injury. Arthroscopic osseous Bankart repair with use of suture anchors yields a successful outcome even in shoulders with a chronic large glenoid defect.

Isolated Teres Minor Atrophy: Manifestation Of Quadrilateral Space Syndrome or Traction Injury to the Axillary Nerve?

This article prospectively determines through magnetic resonance imaging (MRI) the incidence of isolated teres minor atrophy and its gender and age distribution, and documents associated findings related to the rotator cuff, labroligamentous complex, and quadrilateral space. Two hundred seventeen consecutive shoulder MRI examinations performed over a 3-month period were prospectively reviewed and evaluated for isolated teres minor atrophy. Twelve (5.5%) patients had non-compressive isolated teres minor atrophy. Ninety-two percent (n=11) of these patients had rotator cuff or labroligamentous complex tears. No patients had an associated mass within the quadrilateral space. The average patient age was 60 years and 11 of the 12 patients were male. Isolated teres minor atrophy on MRI is most commonly seen in older patients who do not fit the expected clinical presentation of quadrilateral space syndrome. The anatomical relationship of the teres minor nerve to the joint capsule and the frequency of associated shoulder injuries in these patients raises the possibility of an association between humeral decentering and teres minor atrophy. Quadrilateral space syndrome would appear to be a very rare cause of isolated teres minor atrophy.

Anterior Shoulder Instability: Accuracy of MR Arthrography in the Classification of Anteroinferior Labroligamentous Injuries

To retrospectively evaluate the accuracy of magnetic resonance (MR) arthrography in the classification of anteroinferior labroligamentous injuries by using arthroscopy as the reference standard. Ethical committee approval and informed consent were obtained. MR arthrograms obtained in 205 patients, including a study group of 104 patients (74 male and 30 female; mean age, 28.2 years) with arthroscopically proved labroligamentous injuries and a control group of 101 patients (65 male and 36 female; mean age, 31.4 years) with intact labroligamentous complex, were reviewed in random order. MR arthrograms were analyzed for the presence and type (Bankart, anterior labral periosteal sleeve avulsion [ALPSA], Perthes, glenolabral articular disruption [GLAD], or nonclassifiable lesion) of labroligamentous injuries by two radiologists in consensus. Results were compared with arthroscopic findings. Sensitivity, specificity, accuracy, and corresponding 95% confidence intervals for the detection and classification of anteroinferior labroligamentous lesions with MR arthrography were calculated. At arthroscopy, 104 anteroinferior labroligamentous lesions were diagnosed, including 44 Bankart lesions, 22 ALPSA lesions, 12 Perthes lesions, and three GLAD lesions. Twenty-three labral lesions were nonclassifiable at arthroscopy, all of which occurred after a history of chronic instability. Nineteen (83%) of these 23 lesions were also nonclassifiable at MR arthrography. With arthroscopy used as the reference standard, labroligamentous lesions were detected and correctly classified at MR arthrography with sensitivities of 88% and 77%, specificities of 91% and 91%, and accuracies of 89% and 84%, respectively. Bankart, ALPSA, and Perthes lesions were correctly classified in 80%, 77%, and 50% of cases, respectively. The three GLAD lesions were all correctly assessed. MR arthrography is accurate in enabling classification of acute and chronic anteroinferior labroligamentous injuries, although correct interpretation of Perthes lesions remains difficult.

ARTHROSCOPIC OSSEOUS BANKART REPAIR FOR CHRONIC RECURRENT TRAUMATIC ANTERIOR GLENOHUMERAL INSTABILITY

Background: A chronic osseous Bankart lesion has traditionally been treated with soft-tissue repair and/or open bone-grafting for a large glenoid defect. We developed an arthroscopic method of osseous reconstruction of the glenoid without bone-grafting. The purpose of this study was to evaluate the postoperative outcomes of our technique for chronic recurrent traumatic anterior glenohumeral instability. Methods: A consecutive series of forty-two shoulders in forty-one patients with chronic recurrent traumatic glenohumeral instability underwent an arthroscopic osseous Bankart repair. All shoulders were evaluated preoperatively with three-dimensionally reconstructed computed tomography, which confirmed an osseous fragment at the anteroinferior portion of the glenoid. The average bone loss in the glenoid was 24.8% (range, 11.4% to 38.6%), and the average fragment size was 9.2% (range, 2.1% to 20.9%) of the glenoid fossa. In all shoulders, a displaced osseous fragment, firmly attached to the labroligamentous complex, was separated from the glenoid neck before reduction and fixation in the optimal position with use of suture anchors. All patients were assessed with use of the scoring systems of Rowe et al. and the University of California at Los Angeles preoperatively and at the final evaluation. Results: The mean duration of follow-up was thirty-four months. At that time, thirty-nine of the forty-two shoulders were rated as having a good or excellent result. The mean Rowe score improved from 33.6 points preoperatively to 94.3 points postoperatively (p < 0.01). The mean score on the University of California at Los Angeles system improved from 20.5 points preoperatively to 33.6 points at the final evaluation (p < 0.01). The average passive external rotation was 75° with the arm at the side and 93° with the arm at 90° of abduction. Two patients had a reinjury. Eventually, thirty-five of thirty-seven patients who were active participants in sports returned to the sport they had played before the injury. Conclusions: Arthroscopic osseous Bankart repair with use of suture anchors yields a successful outcome even in shoulders with a chronic large glenoid defect. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Arthroscopic Osseous Bankart Repair for Chronic Recurrent Traumatic Anterior Glenohumeral Instability

A chronic osseous Bankart lesion has traditionally been treated with soft-tissue repair and/or open bone-grafting for a large glenoid defect. We developed an arthroscopic method of osseous reconstruction of the glenoid without bone-grafting. The purpose of this study was to evaluate the postoperative outcomes of our technique for chronic recurrent traumatic anterior glenohumeral instability. A consecutive series of forty-two shoulders in forty-one patients with chronic recurrent traumatic glenohumeral instability underwent an arthroscopic osseous Bankart repair. All shoulders were evaluated preoperatively with three-dimensionally reconstructed computed tomography, which confirmed an osseous fragment at the anteroinferior portion of the glenoid. The average bone loss in the glenoid was 24.8% (range, 11.4% to 38.6%), and the average fragment size was 9.2% (range, 2.1% to 20.9%) of the glenoid fossa. In all shoulders, a displaced osseous fragment, firmly attached to the labroligamentous complex, was separated from the glenoid neck before reduction and fixation in the optimal position with use of suture anchors. All patients were assessed with use of the scoring systems of Rowe et al. and the University of California at Los Angeles preoperatively and at the final evaluation. The mean duration of follow-up was thirty-four months. At that time, thirty-nine of the forty-two shoulders were rated as having a good or excellent result. The mean Rowe score improved from 33.6 points preoperatively to 94.3 points postoperatively (p < 0.01). The mean score on the University of California at Los Angeles system improved from 20.5 points preoperatively to 33.6 points at the final evaluation (p < 0.01). The average passive external rotation was 75 degrees with the arm at the side and 93 degrees with the arm at 90 degrees of abduction. Two patients had a reinjury. Eventually, thirty-five of thirty-seven patients who were active participants in sports returned to the sport they had played before the injury. Arthroscopic osseous Bankart repair with use of suture anchors yields a successful outcome even in shoulders with a chronic large glenoid defect.