Transglenoid Technique Research Articles

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.

A combined transglenoid and suture anchor technique for bony Bankart lesions

We present a modified hybrid technique that is a combination of a transglenoid and suture anchor technique. Three-dimensional CT reconstruction is indicated for patients with bony fragments larger than 10 mm. First, a transglenoid technique is performed to reduce the bony fragment and then a suture anchor technique is performed to achieve a stable fixation. This combined technique is a useful arthroscopic procedure for the easy reduction and stable fixation of bony Bankart lesions.

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.

Arthroscopic stabilization for traumatic anterior dislocation of the shoulder: suture anchor fixation versus transglenoid technique

BackgroundThe purpose of this study was to evaluate and compare the clinical results of arthroscopic capsulolabral reconstruction using arthroscopic transglenoid fixation and a suture anchor fixation for anterior dislocation of the shoulder. MethodsFrom December 1999 to September 2006, 46 patients who underwent arthroscopic capsulolabral reconstruction for their anterior dislocation of the shoulder were enrolled, and their surgical outcomes were retrospectively evaluated. In group A (26 patients), the procedure was performed with Caspari’s transglenoid technique. In group B (20 patients), the capsulolabral reconstruction was done using the suture anchor method. The postoperative assessment including American Shoulder and Elbow Surgeons’ (ASES) scores, recurrent instability, the level of return to previous sports activity, and satisfaction with the treatment were compared between the two groups. Statistical analysis was performed using Student’s t-test, chi-squared analysis, and a Pearson correlation coefficient. ResultsThere were significant differences in ASES scores (group A 76.8 vs. group B 85.5), satisfaction with the surgery (group A 6.5 vs. group B 8.2 — out of 10) and in the level of return to previous sports activity (group A 7.2 vs. group B 8.3 — out of 10) at last follow-up. Recurrent instability occurred in 7 patients in group A (26.9%) and in two cases in group B (10.0%). ConclusionsThe arthroscopic capsulolabral reconstruction using a suture anchor was a more reliable treatment option (in regard to satisfaction, functional recovery, and recurrent instability) than the transglenoid fixation technique for anterior dislocation of the shoulder.

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.

Arthroscopic Bankart Repair and Rotator Interval Plication by Transglenoid Technique: Preliminary Report

Purpose: To evaluate the clinical results of arthroscopic Bankart repair and rotator interval plication by the transglenoid technique on Traumatic Unidirectional Bankart Surgery (TUBS) with concomitant rotator interval widening. Materials and Methods: From May 2002 to May 2003, 13 cases who underwent arthroscopic Bankart repair and rotator interval plication by the transglenoid technique were studied, out of the 14 cases that were diagnosed as TUBS with concomitant rotator interval widening. Follow up period was at least 1 year. Results were evaluated by Rowe score before and after surgery. Results: All the cases were male. Nine cases were on the right shoulder and 4 on the left. The mean age was 22 years old (range, 14-26 years old). The mean duration from injury to operation was 4.3 (range, 1.3-10) years. The Rowe score was improved from 58.3 to 86.4 (p=0.00). Overall outcomes were excellent in 10 cases, good in 2 and fair in 1 at final follow up. There was no sulcus sign in any of the cases at the last follow up, and redis location did not appear in any of the cases during the follow up period. Conclusion: In the treatment of TUBS with concomitant rotator interval widening, arthroscopic Bankart repair and rotator interval plication by the transglenoid technique have made good results.

Arthroscopic labrum refixation for post-traumatic anterior shoulder instability: Suture anchor versus transglenoid fixation technique

The aim of this retrospective study was to compare recurrence rates following transglenoid labrum refixation or fixation using the suture anchor (FASTak, Arthrex, Naples, FL) technique. Additionally, parameters that apparently influence the rate of redislocation were investigated. There were 163 patients with post-traumatic anterior shoulder instability treated with an arthroscopic labrum refixation; 108 patients (66.3%) were stabilized with the transglenoid suture technique (group I) and 55 patients (33.7%) with the suture anchor (FASTak) technique (group II). The average follow-up was 4.5 years (range, 2.0 to 7.9 years) in group I and 3.2 years (range, 2.0 to 5.0 years) in group II. The Rowe score increased from a preoperative average of 35.0 points in group I and 35.4 points in group II to a postoperative average of 68.3 points in group I and 84.6 points in group II (P < .01). There was recurrence in 35 patients (32.4%) in group I and 9 patients (16.4%) in group II (P < .05). All incidents of redislocation occurred during the first 21 postoperative months; 58.4% of the patients (n = 63) in group I and 16.4% of the patients in group II (n = 9) had to reduce their sporting activity (P < .001). Independent of the type of surgery, there was a significant correlation of the postoperative rate of redislocation and age (P < .001), number of preoperative dislocations (P < .01), and degree of labrum lesion (P < .001). No correlation with the rate of redislocation was shown for gender, handedness, dislocation-operation interval, degree of Hill-Sachs lesion, or number of transglenoid sutures or anchors. Concerning post-traumatic anterior shoulder instability, the arthroscopic labrum reconstruction with the suture anchor (FASTak) technique was superior to the transglenoid technique but has not yet achieved the level of success obtained by open surgery. With fewer than 5 preoperative redislocations after a first traumatic shoulder dislocation, the arthroscopic treatment is recommended. In cases of more frequent preoperative dislocations, open surgery in combination with a capsular shift should be performed.

Arthroscopic treatment of multidirectional instability

Multidirectional instability of the shoulder, described by Neer and Foster, has been treated surgically with the inferior capsular shift procedure. The small number of reports on mid-term outcomes indicate that good to excellent results have been obtained in 75% to 100% of cases. Arthroscopic treatment of multidirectional instability has been previously dascribed. The purpose of this study was to review the results of the arthroscopic capsular shift procedure with a minimum follow-up of 2 years. A retrospective study was performed on 25 patients who underwent an arthroscopic capsular shift performed with the transglenoid technique between January 1990 and December 1993. All patients had earlier not responded to an extensive course of physical therapy. Excluded from the study were patients who had undergone a previous arthroscopic capsular shift or any other procedure, arthroscopic or open, for the shoulder. Average patient age was 26.4 years. There were 20 male and 5 female patients. Sixteen of the affected shoulders involved the dominant extremity. All patients had a history of asymptomatic subluxation that slowly progressed to symptomatic subluxation. Eleven patients had a history of dislocation. Thirteen patients were athletes who were symptomatic in their chosen sport, whereas the other patients were symptomatic in activities of daily living. All patients were examined while they were under anesthesia and had positive results on the sulcus test in abduction with associated anterior instability, posterior instability, or both. Followup evaluation was performed with patient interview and examination. All 25 patients were available for follow-up, which occurred an average of 60 months (range 36 to 80 months) after operation. Three patients had episodes of instability after the operation. The average Bankart score was 95 (range of 50 to 100). All but 1 patient had regained full symmetric range of motion by follow-up. Twenty-one (88%) patients had a satisfactory result according to the Neer system. Results of treatment with the arthroscopic capsular shift procedure for multidirectional instability of the shoulder appear to be comparable to those of the open inferior copsular shift.