An Anatomic and Biomechanical Comparison of Bankart Repair Configurations

Judson, Christopher H.; Voß, Andreas; Obopilwe, Elifho; Dyrna, Felix; Arciero, Robert A.; Shea, Kevin P.

doi:10.1177/0363546517717671

Cited by 16 publications

(30 citation statements)

References 22 publications

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“…Judson et al performed an anatomic and biomechanical study to determine differences in footprint restoration and mechanical properties for four suture configurations: single row with simple sutures, single row with horizontal sutures, double row with suture, double row with labral tape. 28 It was reported that double row repair restored more of the anatomic footprint than the single row techniques, however mechanical properties were not different among the two groups. 28 More relevant to our study however was anchor placement.…”

Section: Discussionmentioning

confidence: 89%

“…28 It was reported that double row repair restored more of the anatomic footprint than the single row techniques, however mechanical properties were not different among the two groups. 28 More relevant to our study however was anchor placement. For single row repairs, the authors placed anchors at the articular margin of the glenoid at the 2:30, 4, and 5-o'clock positions.…”

Section: Discussionmentioning

confidence: 89%

“…Double row anchors were placed in a "W" configuration with medial anchors placed at the 3-o'clock and 4:30 positions on the medial border of the labral footprint on the medial glenoid and the lateral anchors placed at the 2:30, 4, and 5-o'clock positions. 28 It is important to note that the authors did not investigate the usage of the 6 o'clock anchor, nor did they test for resistance to displacement, but rather load to failure of the repair construct. These authors do not find any differences in load to failure among different repair configurations.…”

Section: Discussionmentioning

confidence: 99%

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The 6-O'clock Anchor Increases Labral Repair Strength in a Biomechanical Shoulder Instability Model

Bokshan

DeFroda

Gil

et al. 2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Background: Arthroscopic Bankart repair is currently the most utilized technique in the surgical management of symptomatic anterior shoulder instability. Despite a growing body of literature regarding optimal repair configurations, little is known about inferior suture anchor placement (6 o'clock position). Methods: 12 cadaveric shoulders were tested on a 6 DOF robotic musculoskeletal simulator to measure the peak resistance force due to anterior displacement of 1 cm. The rotator cuff muscles were loaded during testing to simulate physiological conditions. Test conditions consisted of the intact shoulder, Bankart lesion, Bankart repair (3, 4, and 5 o'clock anchors), and Bankart repair with addition of a 6 o'clock anchor. A 13% anterior bone defect was then and all conditions were repeated. Repeated measures ANOVA was used to test for significant differences among groups. Results: In the no bone loss group, the addition of a 6 o'clock anchor yielded the highest peak resistance force (52.8N, SD: 4.5N) and was significantly greater than the standard Bankart repair by 15.8% (7.2N, p = 0.003). With 13% bone loss from the anterior glenoid, both the standard Bankart repair (peak force 49.3N, SD: 6.1N, p = 0.02) and repair with the addition of the 6 o'clock anchor (peak force 52.6N, SD: 6.1N, p = 0.006) had a significantly higher peak resistance force compared to the bone loss with Bankart lesion group (35.2N, SD: 5.8N). While the 6 o'clock anchor did increase the strength of the standard repair by 6.7%, this was not statistically significant (p = 0.9) in the bone loss model. Conclusions: The addition of a 6 o'clock suture anchor to a "standard" Bankart repair increases the peak resistance force to displacement (no bone loss), although this additional strength is lost with creation of a subcritical anterior glenoid bone defect. Clinical Relevance: This study provides surgeons with essential biomechanical data to aid in the selection of repair configuration. The six o'clock anchor does not enhance repair strength in a subcritical bone loss model.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The 6-O'clock Anchor Increases Labral Repair Strength in a Biomechanical Shoulder Instability Model

Bokshan

DeFroda

Gil

et al. 2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…5,6 There are various arthroscopic techniques described for shoulder stabilization which mainly focus on reconstruction of the capsulolabral complex by using intraarticular sutures with anchors. [7][8][9] The purpose of this study is to evaluate the functional outcome and recurrence rate of shoulder instability following arthroscopic Bankart repair. We will also evaluate whether the number and position of suture anchors plays a role in determining the functional outcome and whether optimal positioning of suture anchors along with meticulous surgical technique will have an influence on the functional outcome of surgery rather than the use of multiple suture anchors.…”

mentioning

confidence: 99%

Functional outcome of arthroscopic Bankart repair for anterior shoulder instability based on suture anchor configuration

Ballal¹,

Jayakumar

2020

Int J Res Orthop

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Background: The objective of the study was to evaluate the functional outcome of arthroscopic Bankart repair for anterior shoulder instability to assess whether the number and position of suture anchors plays a role in determining the functional outcome.Methods: This was a prospective study on 32 patients operated with arthroscopic Bankart repair between December 2017 to April 2019. Pre-op and regular follow-up scores were measured at 1 month, 3 months and 6 months post-op using Rowe score and American Shoulder and Elbow Surgeons score to assess functional outcome.Results: Mean age of the study group was 24.5±6.9 years. Functional outcome as determined by Rowe score and ASES score at 6 months follow-up were found to be 90.5±7.2 and 85.9±14.1 respectively when compared to the pre-op scores of 23.2±8.2 and 47.9±5.7 respectively; all of which showed highly significant functional improvement with highly significant reduction in visual analog scale (VAS) pain score. Patients had no recurrent dislocations with mean external rotation limitation of 5o. 25 (78.1%) patients had two suture anchors inserted and 7 (21.9%) patients had multiple (>2) anchors; and when analysis was done, there was no statistically significant difference between number of suture anchors used with respect to the functional scores.Conclusions: We conclude that arthroscopic Bankart repair is a useful and successful procedure. Patient identification and selection remains the key in determining the success of repair. Meticulous surgical technique and correct positioning of suture anchors may help in reducing the number of anchors without compromising on the final functional outcome, thereby reducing the economic burden on patients.

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“…As a consequence, the custom shoulder simulator allowed the anteroinferior capsule to be more uniformly loaded during the next phase of the testing protocol, which would not have been possible with a single nonadjustable soft tissue clamp that has been used in other studies. 5 , 12 Specimens were kept moist using a normal saline spray throughout the testing protocol.…”

Section: Methodsmentioning

confidence: 99%

Ability to Retension Knotless Suture Anchors: A Biomechanical Analysis of Simulated Bankart Lesions

LeVasseur

Mancini

Williams

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Knotless suture anchors are gaining popularity in arthroscopic glenohumeral labral repairs. The ability to retension knotless designs after initial anchor placement has been reported; however, no studies have quantified this claim or investigated the biomechanical consequence of retensioning. Purpose/Hypothesis: To determine whether knotless and knotted suture anchors have biomechanical or anatomic differences with regard to labral repairs and to determine whether retensioning of knotless suture anchors affects capsular tension, labral height, and capsular shift. We hypothesized that retensioning of knotless anchors would result in improved capsular tension compared with conventional knotted suture anchors. Study Design: Controlled laboratory study. Methods: A total of 18 fresh-frozen cadaveric shoulders with a mean age of 56 years were dissected to the capsule and disarticulated at the humeral capsular insertion. The scapula was potted and placed in a custom shoulder simulator to tension the capsule via braided sutures localized to the anteroinferior glenohumeral ligament. Specimens were randomized into 3 groups: (1) Knotted (KT), (2) Knotless with end retensioning (KLend), and (3) Knotless with stepwise retensioning (KLstepwise). All repairs were completed using all-suture anchors placed at the 5-, 4-, and 3-o’clock positions. KLstepwise was used to simulate an intraoperative technique. Resultant mean capsular tension under 5 mm of displacement (subfailure loading) was measured for each anchor placement and retensioning step. Labral height and capsular shift were measured using a MicroScribe digitizer. Results: The intact, defect, 1-anchor, 2-anchor, and 3-anchor tensions were not significantly different between the KT and KLend groups. For the latter, retensioning of all knotless anchors increased capsular tension by 2.1 N compared with its 3-anchor state, although this was not statistically significant ( P = .081). The KLstepwise group explored an alternative method to retension the capsule using knotless anchors, with similar final capsular tensions compared with the other groups. All repairs had similar improvements in capsulolabral height and superior capsular shift. Conclusion: Knotted and knotless suture anchors provided similar overall restorations in anteroinferior glenohumeral ligament tension. However, knotless devices were capable of small but statistically insignificant improvements in capsular tension with retensioning. Clinical Relevance: Retensioning of knotless anchors allows the surgeon to tighten regions of the glenohumeral capsule that remain lax after repair.

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An Anatomic and Biomechanical Comparison of Bankart Repair Configurations

Abstract: Although the double-row repair techniques had no difference in initial strength, they may improve healing in high-risk patients by improving the footprint coverage.

Cited by 16 publications

References 22 publications

The 6-O'clock Anchor Increases Labral Repair Strength in a Biomechanical Shoulder Instability Model

The 6-O'clock Anchor Increases Labral Repair Strength in a Biomechanical Shoulder Instability Model

Functional outcome of arthroscopic Bankart repair for anterior shoulder instability based on suture anchor configuration

Ability to Retension Knotless Suture Anchors: A Biomechanical Analysis of Simulated Bankart Lesions

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