Transglenoid Suture Research Articles

Arthroscopic Bankart repair: modified transglenoid sutures versus suture anchors more than 5 years: a retrospective study

Introduction Arthroscopic Bankart repair is a common procedure for treatment of recurrent traumatic anterior shoulder dislocation all over the world. Different studies compared the outcome of transglenoid sutures after different modifications with the outcome of suture anchors and they found no significant difference between the two procedures. Objective The aim of this study was to compare the long-term results of the modified transglenoid sutures through two holes and the use of suture anchors . Patients and methods Seventy patients were included in this study (42 for the transglenoid group and 28 for the second group). The mean follow-up period for the first (transglenoid) group was 7.19 years (range 5–11) and for the second (anchor) group 6.93 years (range 5–12). Results There is a significant difference in both groups between the preoperative and postoperative Rowe scores (P=0.000), while there is insignificance when comparing the two groups. Six patients (14.3%) in the transglenoid group suffered from recurrence of instability (two dislocations and four subluxations). Two of them needed second operation (open Laterjet procedure). In the anchor group, four (14.2%) patients suffered recurrence of symptoms of instability (two dislocations and two subluxations). Two of them required second operation. One patient of the first group suffered infection related to the sutures and the knot that required removal of the suture material. Conclusion Modified transglenoid suture technique is quietly equal to the repair with suture anchors for treatment of recurrent traumatic anterior shoulder instability.

Open Bankart Repair: Where do We Stand Now?

The operative treatment for recurrent traumatic anterior shoulder dislocation is classified as an anatomical or non-anatomical technique. The anatomical technique was first described for more than 80 years ago by Dr. Arthur. S. B. Bankart.The anatomic reconstructionThe non-anatomic reconstructionBankart repair the Bristow-Latarjet procedure,the Eden-Hybinette procedure,the Magnusson-Stack procedure,the Putti-Platt procedure,the Weber Osteotomy procedure. Up to date, Bankart repair still is the most common procedure performed to treat recurrent anterior dislocation of the shoulder joint with Bankart lesion, the anterior-inferior labral disruption, namely as the most common pathology observed in 85% of those patients.2 At the earlier year, many orthopedic surgeons favored the open Bankart procedure for its reliable long term follow up result. Hence, open Bankart has been historically considered the gold standard in the treatment of shoulder instability.Open Bankart repair was previously a standard care, resulting in recurrence rates below 10%.3 Advocates of open Bankart surgery argue that a more anatomic and secure repair is reliably accomplished. However, arthroscopic shoulder stabilization methods have also evolved significantly during the past 25 years. Initially, there was an early disappointment for the high failure rates for arthroscopic Bankart repair as great as 49% for its trans-glenoid suturing and 23% for its bio-absorbable tack fixation.4 However, suture anchor came or should I say “save the day” and reduce the failure rates to 8 – 11% combined with capsular plication.5 United States’s data showed that arthroscopic Bankart repairs are increasingly used, from 71.2% of all cases in 2004 to 89% in 2009.6 Given the ceiling effect of a surgical learning curve in the last decade, the recurrence and failures rate should have been substantially decreased. These numbers have led to the suggestion that, could it be that arthroscopic Bankart repair with suture anchors is our ”blue ribbon” in this “competition”? Should we say ”abandon ship” now to open Bankart repair?A recent meta-analysis of open versus arthroscopic shoulder stabilization comparing 2 recent decades (the past 20 years) demonstrated there was no significant difference in improvements achieved for clinical outcomes and external rotation deficits.7 The recurrence rate for open Bankart surgery remained resolutely consistent at 10.7% (at the past 20 years) and 10.6% (at the past 10 years). The glory of arthroscopic surgery that has been taught for generations in orthopedic surgery is the ability to recon the additional intra-articular pathology with lower surgical morbidity, improved cosmesis and decreased pain. However, the earlier one can be mostly encountered by the advanced imaging system used these days. Hence, I would like to say, open Bankart surgery is considered not a history lesson and may be worthy to revisit.References Bankart ASB. The pathology and treatment of recurrent dislocation of the shoulder joint. British Journal of Surgery 1938; 26: 7. DOI: 10.1002/bjs.18002610104.Rowe CR, Patel D and Southmayd WW. The Bankart procedure: a long-term end-result study. J Bone Joint Surg Am 1978; 60: 1-16. 1978/01/01.Rowe CR, Zarins B and Ciullo JV. Recurrent anterior dislocation of the shoulder after surgical repair. Apparent causes of failure and treatment. J Bone Joint Surg Am 1984; 66: 159-168. 1984/02/01.Freedman KB, Smith AP, Romeo AA, et al. Open Bankart repair versus arthroscopic repair with transglenoid sutures or bioabsorbable tacks for Recurrent Anterior instability of the shoulder: a meta-analysis. Am J Sports Med 2004; 32: 1520-1527. 2004/08/18. DOI: 10.1177/0363546504265188.Brophy RH and Marx RG. The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy 2009; 25: 298-304. 2009/02/28. DOI: 10.1016/j.arthro.2008.12.007.Zhang AL, Montgomery SR, Ngo SS, et al. Arthroscopic versus open shoulder stabilization: current practice patterns in the United States. Arthroscopy 2014; 30: 436-443. 2014/02/25. DOI: 10.1016/j.arthro.2013.12.013.Hohmann E, Tetsworth K and Glatt V. Open versus arthroscopic surgical treatment for anterior shoulder dislocation: a comparative systematic review and meta-analysis over the past 20 years. J Shoulder Elbow Surg 2017; 26: 1873-1880. 2017/07/10. DOI: 10.1016/j.jse.2017.04.009.

A pulled sutures technique for bony Bankart lesion

In an attempt to present a new surgical technique for arthroscopic bony Bankart fixation, the authors developed the pulled sutures technique. In executing the new method, the authors first passed several non-absorbable sutures through labroligamentous tissue with displaced articular fragment by mimicking transglenoid suture technique. Aimed at achieving a safe and stable fixation, using a knotless anchor rather than transglenoid suture, was deployed. Overall, this pulled sutures technique was shown to be effective with the result of direct reduction, stable, and safe fixation for bony Bankart's lesion.

Modified transglenoid sutures for bankart repair for the treatment of recurrent anterior shoulder instability

BackgroundRecurrent shoulder dislocation is a challenging orthopedic problem. Bankart lesion is the main pathological abnormality in cases of traumatic anterior shoulder dislocation. Many procedures have been performed for treatment, both open and arthroscopic. Transglenoid sutures were used in the past before the use of the anchors.ObjectivesThe aim of this study was to evaluate the results of the modified transglenoid sutures for recurrent anterior shoulder instability.Patients and methodsNineteen patients, with a mean age of 25.4 years (range 20-44 years), had been treated by a modified technique using 2-3 labral sutures using #5 PDS sutures and passing the ends of the sutures through two holes in the glenoid, the first at 4 o'clock on the right side (8 o'clock on the left) and the second at 1 o'clock on the right side (11 o'clock on the left), and tied over the soft tissue and the bone bridge through a small posterior skin incision. They were followed up for a mean of 39.2 months (range 24-54 months).ResultsThe mean Rowe score was changed from 27.9 preoperatively to 96.8 postoperatively. All patients were satisfied by the final results of the operation. This procedure reduced the cost of the operation.ConclusionThe transglenoid suture technique with the modification is suitable for the treatment of recurrent traumatic shoulder instability, especially in developing societies. However, this is still a preliminary study and it should be conducted on more patients.

Paper 31: Arthroscopic Management of First-time Traumatic Anterior Shoulder Dislocation in Young Athletes: Evaluation and Results in 100 Cases with 7.4 years Follow-up

In the literature several publications show the advantages of the early arthroscopic stabilization after the first episode of traumatic shoulder dislocation. Nevertheless it is still considered by some authors a controversial topic. The purpose of this paper is a retrospective evaluation of our first 100 cases treated with arthroscopic stabilization. Between September 1989 and May 2005 100 arthroscopic stabilization of first time dislocation were performed in athletes. Mean age at surgery moment was 22 years. 78% of the patients were rugby players. Until October 1995 we used the Transglenoid suture technique in 23 cases and the others 77 cases were stabilized with Suture Anchor technique. The mean follow-up was 7.4 years (range: 3-19 years). Capsular tear with complete labrum detachment (type III lesion) was the most frequent surgical finding. Minor Bony Bankart lesions (<25%) were found in 19 cases. 75 cases (75%) of osteochondral Hill-Sachs lesions and 15 cases (15%) of bone HillSachs lesions were identified. We treated 2 cases of Humeral Avulsion of Glenohumeral ligament (HAGL) with arhtoscopic and mini open technique. According to the Rowe scale we obtained excellent and good results for 96% (74 cases) of the patients treated with the Suture Anchor Technique and in 87% (20 cases) of the patients treated with the Transglenoid technique. Return to sport was allowed after the 4th month, being at pre-injury level for all cases. The average time was 5.3 months (4-7). Many studies have shown a high percentage of redislocation after non-surgical treatment. Younger patients and practicing contact sports, over head sports or sports of high speed (snow skiing, motocross) increase this risk.

Long-term outcomes after repair of recurrent post-traumatic anterior shoulder instability: comparison of arthroscopic transglenoid suture and open Bankart reconstruction

The purpose of this study is to report long-term outcomes of the arthroscopic modified Caspari technique compared to an open capsular shift surgery to treat post-traumatic anterior shoulder recurrent instability. The hypothesis was that the open surgery group would show higher degenerative changes than to the modified Caspari technique group after a follow-up from 10 to 17 years. One hundred and ten nonrandomized consecutive patients who underwent a surgical repair of recurrent unilateral anterior shoulder instability between 1990 and 1999 were retrospectively analyzed. Eighty-two patients were available for long-term follow-up. In particular, 49 patients (59.8%) (group A) were treated with arthroscopic transglenoid modified Caspari suturing technique (mean follow-up 13.7 ± 2.2 years), whereas 33 patients (40.2%) (group B) were treated with combined open capsular shift and Bankart repair (mean follow-up 15.7 ± 2.2 years). Patients were evaluated according to the failure rate (re-dislocation), Rowe, UCLA, and Constant scores. Radiological osteoarthritis changes were ranked according to Samilson score. There were no statistically significant differences between the two groups concerning the failure rate (n.s.), Rowe (n.s.), UCLA (n.s.), and Constant (n.s.) scores. Group A: re-dislocation rate 12.5% (6 re-dislocations), Rowe 85.0 ± 22.6, UCLA 26.4 ± 4.8, and Constant 86.3 ± 16.7. Group B: re-dislocation rate 9% (3 re-dislocations), Rowe 83.2 ± 24.4, UCLA 26.9 ± 4.2, and Constant 87.4 ± 14.1. Radiographic findings of osteoarthritis: 2 severe (4%), 4 moderate (8%), and 12 mild (25%) in group A; 2 severe (6%), 4 moderate (12%), and 9 mild (27%) in group B; differences between groups were not statistically significant (n.s). The results after both techniques were good in majority of patients, with no significant differences in terms of re-dislocation and osteoarthritis development. Compared to the current literature, the recurrence rate was high in both groups. The modified Caspari technique could be an arthroscopic alternative for older, non-athletic shoulders. Therapeutic Study-Retrospective Comparative Study, Level III.

Is the transglenoid suture technique recommendable for recurrent shoulder dislocation? A minimum 5-year follow-up in 59 non-athletic shoulders

The aim of this retrospective study is to compare the clinical outcomes following arthroscopic Bankart repair employing the transglenoid technique versus suture anchors in non-athletic shoulders of patients 30 years or older at the time of surgery. Fifty-nine consecutive patients who were available for a minimum of 5 years follow-up after arthroscopic Bankart repair were included. The transglenoid technique was employed in 27 patients whose age and follow-up period were 37 years (range 30-58) and 82 (range 61-109) months. Suture anchor was used in 32 patients whose age and follow-up period were 38 years (range 30-62) and 72 months (range 65-89). The Rowe scores of the transglenoid and suture anchor groups were 90 (range 35-100) and 90 (range 35-100), respectively, and there was no statistically significant difference between the two groups (p > 0.05). The Constant score of both groups was 92 (range 64-100) and 95 (range 62-100) without a significant difference (p > 0.05). Moreover, there were no significant differences between the recurrence rates (7%-transglenoid, 6%-suture anchor) (p > 0.05) and positive apprehension signs (7%-transglenoid, 3%-suture anchor) (p > 0.05). In non-athletes over 30-years-old, the results of the transglenoid technique in arthroscopic Bankart repair were comparable to those of the suture anchor. We suggest that the transglenoid technique is a viable alternative for older, non-athletic shoulder if the suture anchors are not available.

Isolated suprascapular nerve injury below the spinoglenoid notch after SLAP repair

Suprascapular nerve neuropathy is frequently reported as being caused by a cyst of the spinoglenoid notch of the scapula. It can be also caused by a complication of open surgical procedures requiring dissection of the posterior shoulder joint. The transglenoid suture technique for the Bankart repair can injure the suprascapular nerve if the drilling is performed too deep and without sufficient caution. We describe a case of isolated infraspinatus atrophy due to suprascapular nerve injury below the spinoglenoid notch by improper anchor insertion during the superior labral anterior posterior (SLAP) repair.

Determination of Anterior Labral Repair Stress During Passive Arm Motion in a Cadaveric Model

The actual forces encountered at the labrum after anterior labral repair have yet to be quantified. The purpose of this study was to determine the amount of force experienced at the glenoid-labrum interface with passive range of motion after an isolated Bankart repair and Bankart repair with capsular shift. In 12 fresh-frozen cadaveric shoulders, anterior-inferior labral tears were created and then instrumented with a modified load cell. The labral lesions were repaired with either an anatomic "labral only" technique or a labral repair along with a capsular shift by use of a transglenoid technique. Shoulders were then taken through a series of movements (forward flexion, abduction, external rotation, and abduction and then external rotation) simulating passive range-of-motion rehabilitation while force measurements were taken. Maximum force (in Newtons) on the simulated repairs was recorded. The forces experienced at the labrum showed a statistically significant difference between the group that underwent anatomic "labral only" repair and the group that underwent labral repair with capsular shift. The greatest mean force experienced (17.7 N) was in shoulders undergoing the labral repair with capsular shift with the arm in abduction and external rotation. In a transglenoid suture repair technique, the forces experienced at the repair site were significantly less than those determined by previous authors to be necessary to result in failure of the Bankart repair. The results of this study show that the forces experienced at the glenoid-labrum interface are higher when a capsular shift is included with a labral repair as opposed to labral repair alone. This difference was statistically significant. These data suggest that early postoperative rehabilitation may safely allow greater passive range of motion than is presently accepted.

Long-term outcome of a transglenoid suture technique for anterior shoulder instability in young adults

We reviewed the outcome of arthroscopic stabilisation of anterior glenohumeral instability in young adults using the transglenoid suture technique. A questionnaire was sent to 455 consecutive patients who had undergone this procedure between 1992 and 2000. Of these, 312 patients (68.5%) with 313 affected shoulders and a mean age of 20 years (18 to 28) responded. Outcome was determined by the number of re-dislocations or, in patients who had not re-dislocated, by the disease-specific quality of life as measured by the Western Ontario Shoulder Instability index. During a mean follow-up of 6.4 years (1 to 14), 177 patients (56%) sustained a re-dislocation, including 70 who required a further operation. In 136 patients (44%) who reported neither re-dislocation nor re-operation, the index scores were good (median 90.4%; 28.9% to 100%). No significant peri- or pre-operative predictors of re-dislocation or re-operation were found. We found a high rate of re-dislocation after transglenoid suture repair in young, physically active patients.

Is arthroscopic surgery for stabilisation of chronic shoulder instability as effective as open surgery?

A systematic search of the literature published between January 1985 and February 2006 identified 62 studies which reported the results of arthroscopic procedures for chronic anterior shoulder instability or comparisons between arthroscopic and open surgery. These studies were classified by surgical technique and research methodology, and when appropriate, were included in a meta-analysis. The failure rate of arthroscopic shoulder stabilisation using staples or transglenoid suture techniques appeared to be significantly higher than that of either open surgery or arthroscopic stabilisation using suture anchors or bio-absorbable tacks. Arthroscopic anterior stabilisation using the most effective techniques has a similar rate of failure to open stabilisation after two years.

다방향 견관절 불안정성에 대한 관절경적 치료 - 경 관절와 봉합술과 관절낭 축화술을 동시에 사용한 군과 관절낭 축화술을 사용한 군의 비교 -

Abstract — Arthroscopic Treatment for Multidirectional Shoulder Instability- Comparison between Thermal Capsulorrhaphy and Transglenoid Suture with Thermal Capsulorrhaphy - Kwang-Jin Rhee, M.D., Kyung-Cheon Kim, M.D. * , Hyun-Dae Shin, M.D., Young-Mo Kim, M.D., Se-Min Woo, M.D., Ho-Sup Song, M.D., Tae-Hwan Kang, M.D., and Ki-Yong Byun, M.D. Department of Orthopedic Surgery, Chungnam National University School of medicine, Daejeon, Korea. Doonsan Byun ’ s Orthopaedic Hospital, Daejeon, Korea � Purpose : To compare the clinical results of arthroscopic transglenoid suture with thermal capsulorrhaphy and ther-mal capsulorrhaphy on multidirectional shoulder instability Materials and Methods : From January 1993 to September 2001, 23 patients who received the artrhoscopic treat-ment were the subjects and follow up period were at least 2 years. Each were subdivided as Group A(7 cases), whichtook transglenoid suture with thermal capulorrhaphy and Group B(16 cases), who took only thermal capsulorrhaphy.Clinical results were evaluated by Rowe score before and after surgery.

Suture Anchors Are Superior to Transglenoid Sutures in Arthroscopic Shoulder Stabilization

We retrospectively compared 2 groups of high-demand patients with post-traumatic anterior shoulder instability to determine whether arthroscopic stabilization was superior with transglenoid suture or suture anchors. In a retrospective comparative study we investigated the results of 246 high-demand patients, with post-traumatic anterior shoulder instability, who underwent arthroscopic capsulolabral reconstruction: 165 (mean age, 27.5 years; mean follow-up, 80 months) were evaluated after treatment with transglenoid sutures, and 81 (mean age, 26.6 years; mean follow-up, 27 months) were treated with suture anchors in a consecutive period. We compared both techniques with regard to recurrence rate, postoperative complications, range of motion, sport activity, work, and patient satisfaction. In the anchor group recurrent dislocation after surgery occurred in 7 patients (8.7%), all within 18 months postoperatively. This finding was significantly (P = .009) better than that in the transglenoid group, in which recurrent postoperative dislocation occurred in 57 patients (34%), in a period of 0 to 115 months after surgery. Postoperative complications were seen in 4 of 81 patients in the suture anchor group, whereas a significantly (P = .01) higher rate was found in the transglenoid suture group, with 36 complications in 35 of 165 patients. The data presented in this study suggest that the modern suture anchor technique results in a better outcome after shoulder stabilization, with fewer complications and lower recurrence rates, than the transglenoid repair. We conclude that the suture anchor technique should be a preferred method for arthroscopic shoulder stabilization surgery. Level III, retrospective, comparative therapeutic study.

Quantitative Assessment of Glenohumeral Translation after Anterior Shoulder Dislocation and Subsequent Arthroscopic Bankart Repair

Background During the past decade, developments in arthroscopic technology have made arthroscopic repair of labral lesions feasible. However, results with the use of the transglenoid suture technique, or with the use of bioabsorbable tacks, have remained variable in the literature, and the recurrence rates are still inferior to those of open Bankart repair. Hypothesis Arthroscopic Bankart repair with suture anchors can re-create translational and rotational range of motion of the intact glenohumeral joint, and the number of preoperative dislocations has an influence on the result. Study Design Controlled laboratory study. Materials Twelve cadaveric shoulders were tested in a robot-assisted shoulder simulator. Anterior and posterior translation and external rotation were measured for intact, dislocated (shoulders were randomly selected to 1 of 3 groups, which were dislocated 1, 3, or 7 times), and repaired conditions at 0° and 90° of glenohumeral elevation. Results After shoulder dislocation, a significant increase was found in translation and rotation, confirming the creation of a traumatic shoulder instability model. Further testing of the specimen revealed that translational and rotational ranges of motion were reduced by arthroscopic Bankart repair at both testing positions. External rotation was decreased significantly at 0° and 90° of abduction. No significant differences were found between the 3 dislocation groups. Conclusion The results demonstrate a sufficient biomechanical performance of arthroscopic Bankart repair using suture anchors in a traumatic anterior shoulder instability model. With the numbers available, no relationship was found between the number of dislocations and the postoperative result concerning translational or rotational motion. Clinical Relevance Glenohumeral translation and rotation after arthroscopic Bankart repair with use of suture anchors approached near normal values, confirming the clinical success of this technique.

Arthroscopic Treatment of Glenoid Fractures

Abstract The patient was placed in the lateral decubitus position. The arthroscope was introduced through the posterior approach. The probe hook was introduced through a working cannula through the anterosuperior portal performed in an inside-out technique. The mobilization possibilities of the osteochondral fragments were then assessed. The use of a shaver was always necessary to clean the fracture site and evacuate clots. A nonabsorbable suture was passed through the labrum and the capsule tissue of the displaced articular fragment in its superior edge. The first suture was used as a traction stitch and allowed replacing the fragment in its original position and maintaining it during the placement of others sutures. A hole was made in the anterosuperior edge of the nonfractured glenoid and then a long drill was passed backward according to the transglenoid suture technique of Caspari or Morgan. Stitches were passed through the glenoid to the infraspinatus fossa. When articular congruity was judged satisfactory, the stitches were tied on the fascia of the infraspinatus muscle. The patients were immobilized in a sling for 3 weeks.

Bankart 병변과 SLAP 병변에서 경견관절와 술식시 Guide Pin 출구의 분석

Purpose: To Analyze the exit site of pin inserted at the anterior glenoid rim in the reconstruction of the Bankart lesion and SLAP lesion using transglenoid suture technique. Materials and Methods: In the twenty adult right cadeveric scapula, insertions of pin were performed using guide at the position of 1, 2, 3 O'clock of glenoid rim. We measured the exit site of dorsal surface of the scapula by medial distance from sagittal plane of lateral border of scapular spine and the vertical distance from posterior border of the scapular spine. Results: When the pin was inserted caudally within 10 degree, at the position of 1, 2, 3 O'clock, the medial distance from lateral border of the scapula is averaged 29.4, 19.2, 34.0 mm respectively and the vertical distance from posterior border of the scapular spine is averaged 15.0, 18.6, 17.2 mm respectively. When the pin was inserted caudally within 20-30 degree, the medial distance is averaged 14.6, 14.2, 15.8 mm respectively and the vertical distance is averaged 31.6, 31.9, 32.1 mm respectively. Conclusion: When the pin was inserted caudally within ten degrees using the guide, the pin exit appeared at the more medial side of the base of scapular spine and the more inferior of scapular spine. This can make the firm suture tied over scapular spine during repair SLAP and the Bankart lesion, and also prevent the injury of suprascapular nerve.

The effectiveness of arthroscopic versus open shoulder stabilization in the management of traumatic anterior glenohumeral instability

Objectives The objective of this systematic review is to compare the effect of arthroscopic stabilization with open surgical stabilization for the management of traumatic anterior glenohumeral instability. We aim to address the following questions that are of clinical interest: 1. Is arthroscopic stabilization equally effective as open surgical stabilization in the management of anterior glenohumeral instability for: a. The general population? b. Population sub-groups? 2. Are there any differences in the outcome of various arthroscopic techniques (suture anchors, bioabsorbable tacks, transglenoid sutures and metallic fixators) for shoulder stabilization, compared with open surgical stabilization? 3. What factors and prognostic indicators are considered when deciding between arthroscopic versus open surgical stabilization for the management of anterior glenohumeral instability? Criteria for considering studies for this review Types of participants Patients with traumatic anterior glenohumeral instability, confirmed by one or more of the following: a history of trauma precipitating anterior dislocation/subluxation, radiological evidence, clinical examination, examination under anaesthesia (EUA) and arthroscopy will be included. By definition, traumatic anterior glenohumeral instability may include first-time dislocators as well as patients with recurrent dislocations, subluxation or a positive apprehension test. Patient groups that are specifically 40 years and older will be excluded from the study because of a higher rate of associated rotator cuff pathology within this age-group. Patients with multidirectional instability and any other concomitant shoulder pathology will also be excluded to eliminate potential confounding factors that could affect the outcome of the stabilization procedures for the management of traumatic anterior glenohumeral instability. Types of interventions Interventions will include all types of arthroscopic shoulder stabilization techniques such as suture anchors, bioabsorbable tacks, transglenoid sutures and metallic fixators, with or without additional suture plication of the capsule, compared with open surgical shoulder stabilization techniques, for the management of traumatic anterior glenohumeral instability. Studies that applied non-anatomical surgical procedures i.e. Putti-Platt, Bristow will be excluded because, they do not correct the underlying pathological lesion; they alter normal shoulder kinematics; have high complication rates and are infrequently performed in clinical practice today. Types of outcome measures A minimum follow-up period of 2 years will be TRUNCATED AT 350 WORDS

Open Bankart Repair versus Arthroscopic Repair with Transglenoid Sutures or Bioabsorbable Tacks for Recurrent Anterior Instability of the Shoulder

Background In published comparative studies, it remains unknown if arthroscopic techniques for performing Bankart repair for anterior shoulder instability equal the success of open repair. Hypothesis The current literature supports a lower rate of recurrent instability after open Bankart repair compared to arthro-scopic repair with bioabsorbable tacks or transglenoid sutures. Study Design Meta-analysis. Methods A Medline search identified all randomized controlled trials or cohort studies that directly compared open repair to arthroscopic techniques of Bankart repair for traumatic, unilateral, recurrent anterior instability. Data collected from each study included patient demographics, surgical technique, rehabilitation, outcome, and complications. Results Six studies met all inclusion criteria. There were 172 patients in the arthroscopic group (90 patients with transglenoid sutures, 77 patients with arthroscopic tacks, and 5 patients with suture anchors) and 156 patients in the open group. The groups were similar in demographic characteristics. When comparing the arthroscopic to the open group, there was a significantly higher rate of recurrent dislocation (12.6% vs 3.4%; P = .01) and total recurrence (recurrent dislocation or subluxation) (20.3% vs 10.3%; P = .01). In addition, there was a higher proportion of patients with an excellent or good postoperative Rowe score in the open group (88%) than in the arthroscopic group (71%) (P = .01). Conclusions Arthroscopic Bankart repair using transglenoid sutures or bioabsorbable tacks results in a higher rate of recurrence of instability compared to open techniques. Studies comparing open repair to newer arthroscopic techniques using suture anchor fixation and capsular plication are necessary.

Comparison of Shoulder Stabilization Using Arthroscopic Transglenoid Sutures versus Open Capsulolabral Repairs

Background Few long-term studies have compared the efficacy of shoulder stabilization using arthroscopic or open procedures. Purpose To directly compare the outcomes of shoulder stabilization using arthroscopic transglenoid sutures versus open capsulolabral repairs. Study Design Uncontrolled retrospective review. Methods Fifty patients (30 arthroscopic and 20 open) were followed for a minimum of 5 years (mean, 68 months). Pain, motion, strength, function, stability, patient satisfaction, radiographs, and ability to return to preinjury activity levels were evaluated. Results The arthroscopic group had a 17% (5 of 30) dislocation rate and a 60% (18 of 30) rate of instability. Sixty-seven percent (6 of 9) of patients participating in collision sports had repeat instability. Eight of 18 patients with instability required open repair for persistent symptoms. There were no limitations of motion following arthroscopic stabilization. The open group had no episodes of dislocations or instability. Forty-five percent (9 of 20) had some loss of external rotation (range, 10°-40°) with a mean loss of 18. The one failure in this group had a 40° loss of external rotation and difficulty with recreational activity. No patients participating in collision sports had repeat instability. Conclusion We recommend open stabilization for patients participating in collision sports (for example, football, wrestling) or activities where better stability is required. For those participating in sports where performance may be compromised by loss of external rotation (such as swimming), newer arthroscopic techniques are recommended.

Paper #41 Arthroscopic subscapular tenodesis in shoulder multidirectional instability

Shoulder instability is a frequent pathology among athletes. It may happen with true dislocation episodes, with subluxation or mainly with symptoms related to this pathology such as pain, subachromial impingement or lesions in the rotator cuff of different grades. In this prospective study, not randomized, we propose a rational classification that allows the identification of predisposing factors and the different lesion grades in order to select a determined arthroscopic treatment, increasing in complexity and repair. 186 cases were studied in this paper, which underwent an arthroscopy for shoulder instability. 56 cases were considered for this study as they were multidirectional instabilities and the multiple factors described in this paper were analyzed in these cases. Subscapular tenodesis was performed in 21 patients as an arthroscopic technique to stabilize the articulation. We have classified these factors in four groups in order to obtain a rational orientation of the arthroscopic treatment and to decide which one should be used in each case. Subscapular tenodesis, in patients of the Group IV, was performed through arthroscopy, of the visible part of the tendon,. The fixation to the anterior side of the Labrum was carried out through a transglenoid suture. To this technique, the repair of lesions was associated according to each case, such as reinsertion of the Labrum, co-planning of the Hill-Sachs lesion, repair of the SLAP and or capsule-ligamentary shift. The average follow-up was 26.7 months (15 to 37 months). Results were excellent or very good in 15 patients (71.4%), without re-dislocation or recurrence of symptoms, 5 patients (23.81%) had regular results with a return to the sportive activity but with a decrease in performance and with symptoms that impede a competitive practice of sports and 1 patient (4.76%) had a bad result due to the re-dislocation and permanence of initial symptoms. Advances in arthroscopic techniques has allowed surgeons to be more selective and to evaluate each case in particular in order to perform more specific techniques for each particular patient. This study establishes that, in order to reach a foreseeable result, each procedure must be planned and surgeons must be trained and have the adequate technology for the treatment of instability and to produce a predictable result.