Arthroscopic Bony Bankart Repair Using Suture Suspension to Increase Bone Contact Area

Kuptniratsaikul, Somsak; Itthipanichpong, Thun; Thamrongskulsiri, Napatpong

doi:10.1016/j.eats.2021.12.024

Cited by 8 publications

(9 citation statements)

References 18 publications

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“…The desired result would be union of the fragment to the native glenoid to maintain shoulder stability. There are various techniques described in the literature for arthroscopic bony Bankart repair, with some authors utilizing specialized instruments [5,7] while others suggested double-row anchor configuration [5][6][7]. Cadaveric and biomechanical studies found superior strength with the usage of double-row anchor fixation [8,9].…”

Section: Discussionmentioning

confidence: 99%

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Arthroscopic Repair of Acute Bony Bankart Lesion Following a Shoulder Dislocation Using Traction Sutures and Anchors: A Case Description

Nasir¹,

Hussin²,

Kiat³

et al. 2023

Cureus

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Management of shoulder dislocation can be challenging especially when glenoid bone fracture is involved. Bony Bankart lesion can be managed either through an open surgery or, of late, using arthroscopic technique. Arthroscopic bony Bankart repair is technically difficult, requiring specialized instruments to penetrate the bone fragment within the detached labrum. This case report describes an alternative way of doing an arthroscopic reattachment of an acute bony Bankart lesion using traction sutures, an accessory anteromedial portal and utilization of knotless anchors. A 44-year-old male technician was climbing a ladder when he slipped and fell directly on his left shoulder. Imaging revealed bony Bankart fracture with presence of ipsilateral greater tuberosity (GT) fracture and a Hill-Sachs lesion. In a right lateral position, arthroscopic reduction of the bony fragment was performed utilizing a Fibrewire® (Arthrex, Inc., Naples, FL, USA) suture as traction apparatus while securing the upper and lower tissue enveloping the bony Bankart fragment. An accessory portal was made lower down anteriorly to de-rotate the fragment, holding it in place while securing two Pushlock® (Arthrex, Inc.) anchors to the native glenoid. We then performed GT fixation using two cannulated screws. Check radiographs revealed acceptable reduction of the Bankart fragment. With careful case selection, arthroscopic repair of acute bony Bankart lesions is possible using special arthroscopic reduction maneuver and fixation technique with subsequent good outcome.

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Section: Discussionmentioning

confidence: 99%

“…(6) The use of an accessory portal and reduction tool such as the switching stick to hold the fragment in place while the anchors are being deployed. (7) Careful protection of the fixation during the post-operative period using a neutralwedge brace for six weeks while union takes place.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Repair of Acute Bony Bankart Lesion Following a Shoulder Dislocation Using Traction Sutures and Anchors: A Case Description

Nasir¹,

Hussin²,

Kiat³

et al. 2023

Cureus

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“…Two suture bridges are utilized between the suture anchors to increase contact with the glenoid fragment, and to increase bony contact and healing compared with other all-arthroscopic techniques. Even in the context of more novel techniques for bony Bankart repair, such as flexible drilling for transosseous repair, suture suspension to increase bone contact area, or transosseous sling-suture techniques, all-arthroscopic double row suture bridge remains a viable approach ( 16 - 19 ).…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic suture bridge fixation for acute bony Bankart with anterior glenohumeral instability: a case report and narrative review

St. Jeor,

Mason,

Glover

et al. 2024

Ann Joint

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Background and Objective Anterior shoulder dislocations can result in acute glenoid rim fractures that compromise the bony stability of the glenohumeral joint. Adequate fixation of these fractures is required to restore stability, decrease shoulder pain, and facilitate return to activity. The double-row suture bridge is a relatively novel fixation technique, first described in 2009, that accomplishes internal fixation with sufficient stability using an all-arthroscopic technique to restore the glenoid footprint. A 40-year-old female with recurrent anterior shoulder instability in the setting of seizure disorder was found to have a bony Bankart lesion of 25% to 30% with a concomitant superior labral tear. The patient was treated with a double-row bony Bankart bridge and labral repair. At six months follow-up, she has progressed to a full recovery with no recurrence. Methods A search was conducted in May 2023 in PubMed, EMBASE, and CINAHL with the search terms bony Bankart, bone Bankart, osseous Bankart, acute, bridge, suture bridge, double row. Key Content and Findings Double-row suture bridge repairs result in improvement in shoulder function as determined by ASES (93.5), QuickDASH (4.5), SANE (95.9), and SF-12 (55.6). The overall recurrence rate of anterior instability after a bony Bankart bridge repair is 8%. When examining the return to prior level of function, 81.4% of patients were able to do so with only 7.9% of patients reporting significant modifications to their activity level. In mid-term results, double row suture bridge demonstrates similar outcomes to other all-arthroscopic fixation methods of bony Bankart injuries. Importantly, bony Bankart bridge remains a viable option for critical glenoid lesions over the 20% cutoff used in other all arthroscopic techniques. Biomechanically, the double-row suture bridge offers distinct benefits over its single-row counterpart including increased compression, reduced displacement, and reduced step-off. Conclusions Although there is limited data, the studies discussed and the demonstrative case show the potential benefit of all-arthroscopic double-row suture bridge fixation including increased compression, decreased displacement, and a lower complication rate in patients with large bony Bankart lesions traditionally requiring bony augmentation. However, more robust studies are necessary to determine the long-term success of the double-row suture bridge.

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“…Millett et al first introduced the “bony Bankart bridge” double‐row technique for anterior shoulder instability with a large sized bony Bankart fragment [11]. Since then, several surgical techniques for double‐row anchor fixation of glenoid fragments have been introduced to restore bony Bankart lesions or anterior glenoid fracture fragments [7, 9, 24, 27]. However, a double‐row technique for anterior glenoid fracture is still technically demanding because of difficulty in the approach for the medial side of the glenoid and management of the fragments.…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic double-row bridge fixation provided satisfactory shoulder functional restoration with high union rate for acute anterior glenoid fracture

Park

Lee

2023

Knee Surg Sports Traumatol Arthrosc

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PurposeTo introduce a novel surgical technique for arthroscopic reduction and double‐row bridge fixation using trans‐subscapularis tendon portal for anterior glenoid fracture and to evaluate the clinical and radiological outcomes. MethodsA total of 22 patients who underwent arthroscopic reduction and double‐row bridge fixation for an acute anterior glenoid fracture were retrospectively evaluated. Arthroscopic surgery was performed using four portals including a trans‐subscapularis tendon portal. All patients underwent 3D‐CT preoperatively and one day and one year postoperatively to evaluate the fracture fragment size, reduction status, and presence of fracture union. To evaluate the degree of fragment displacement, articular step‐off and medial fracture gap were measured using 3D‐CT. Clinical outcomes were assessed based on the ASES and Constant scores. Postoperative glenohumeral joint arthritis was evaluated using plain radiographs with the Samilson and Prieto classification. ResultsThe average preoperative fracture fragment size was 25.9 ± 5.6%. Articular step‐off (preoperative: 6.0 ± 3.3 mm, postoperative one day: 1.1 ± 1.6 mm, P < 0.001) and medial fracture gap (preoperative: 5.2 ± 2.6 mm, postoperative one day: 1.9 ± 2.3 mm, P < 0.001) were improved after surgery. On the postoperative one year 3D‐CT, 20 patients achieved complete fracture union, and two patients showed partial union. Postoperative glenohumeral joint arthritis was observed in four patients. At the last visit, the ASES score was 91.8 ± 7.0 and the Constant score was 91.6 ± 7.0. ConclusionArthroscopic reduction and double‐row bridge fixation using a trans‐subscapularis tendon portal for acute anterior glenoid fracture achieved satisfactory clinical outcomes and anatomical reduction as demonstrated by a low degree of articular step‐off and medial fracture gap. Level of evidenceLevel IV.

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Arthroscopic Bony Bankart Repair Using Suture Suspension to Increase Bone Contact Area

Cited by 8 publications

References 18 publications

Arthroscopic Repair of Acute Bony Bankart Lesion Following a Shoulder Dislocation Using Traction Sutures and Anchors: A Case Description

Arthroscopic Repair of Acute Bony Bankart Lesion Following a Shoulder Dislocation Using Traction Sutures and Anchors: A Case Description

Arthroscopic suture bridge fixation for acute bony Bankart with anterior glenohumeral instability: a case report and narrative review

Arthroscopic double-row bridge fixation provided satisfactory shoulder functional restoration with high union rate for acute anterior glenoid fracture

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