Biomechanical stability of an arthroscopic anterior capsular shift and suture anchor repair in anterior shoulder instability: a human cadaveric shoulder model

Abstract

It was hypothesized that an arthroscopic Bankart repair with suture anchors supplies sufficient anterior shoulder stability, which cannot be improved by an additional capsular shift. In an experimental biomechanical human cadaver study, we tested ten fresh human cadaver shoulders in a robot-assisted shoulder simulator. External rotation and glenohumeral translation were measured at 0 degrees and 80 degrees of glenohumeral abduction. All measurements were performed under the following conditions: on the non-operated shoulder; following the setting of three arthroscopic portals; following an arthroscopic anterior capsular shift; following a simulated Bankart lesion; and following an arthroscopic Bankart repair. The application of three arthroscopic portals resulted in a significant increase of the anterior (P = 0.01) and antero-inferior translation (P = 0.03) at 0 degrees and 80 degrees abduction, as well as an increase in external rotation at 80 degrees abduction (P = 0.03). Capsular shift reduced external rotation (P = 0.03), but did not significantly decrease translation. Simulating anterior shoulder instability, glenohumeral translation significantly increased, ranging from 50 to 279% of physiological translation. Arthroscopic shoulder stabilization resulted in a decrease of translation in all tested directions to approximately physiologic levels. External rotation in 0 degrees abduction was thus decreased significantly (P = 0.003) to an average of 19 degrees . The study proved that an arthroscopic anterior capsular shift in a cadaveric model decreases external rotation without a significant influence on glenohumeral translation. Arthroscopic shoulder stabilization with suture anchors thus sufficiently restores increased glenohumeral translation, but also decreases external rotation in neutral abduction. An anatomic reconstruction of the Bankart lesion without overconstraining of the antero-inferior capsule should therefore be the aim in arthroscopic anterior shoulder stabilization.

The results of Bankart repair without capsular plication in patients with recurrent traumatic anterior shoulder dislocation

“…26 Postoperative recurrence of shoulder dislocation is evaluated as treatment failure. In previous studies, recurrence rates have been published ranging from 4% to 17%.…”

Can capsular plication compensate the lack of one suture anchor in an arthroscopic three suture anchor Bankart repair? A comparative study

“…Generally, arthroscopic Bankart repair is a standard method for most of the traumatic recurrent anterior shoulder instabilities. Some surgeons prefer adding capsular plication or shift to the arthroscopic Bankart repair, to reduce capsular volume and to achieve a more stable shoulder 12, 13, 14, 15, 16. In recent series with arthroscopic labral Bankart repair, recurrence rates are ranging from 4% to 30% but the effect of additional capsular intervention to outcomes is still unclear 3, 4, 17, 18, 19.…”

Teaching simulated arthroscopic Bankart repair: residents’ assessment at the Annual Shoulder Course

“…The position and number of anchors have been shown to influence clinical outcomes, and mastering this skill contributes to treatment efficacy. [14][15][16][17][18][19] Senior residents and shoulder clinical fellows improved their knowledge of arthroscopic Bankart lesion repair and their performance of a simulated repair on a dry surgical model. Residents may benefit from courses with curricula that include surgical simulation to both teach and assess surgical skill acquisition, in combination with didactic or small group sessions and cadaveric laboratories.…”

“…Based on literature review, the course committee determined the ideal position: 5 o'clock (on a right shoulder), a 45° angle of insertion, and a final anchor position 2 mm below the articular surface of the glenoid. [13][14][15][16][17][18] To determine the specific error of the anchor placement measures, 3 repeated measurements were taken per specimen. The error was calculated as the difference between the measure and the ideal position (e.g., if the entry point is at 4:45 on the clock face, the error will be 5:00 -4:45 = 0:15).…”