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

Abstract

ObjectiveThe aim of this study was to compare the complication rates and clinical results of labral repair with two suture anchors and capsular plication, and labral repair with three suture anchor fixation in artroscopic Bankart surgery.MethodsSixty-nine patients (60 males, 9 females; mean age: 28.2 ± 7.8 years (range: 16–50)) who had undergone arthroscopic repair of a labral Bankart lesion were evaluated. Group A underwent an arthroscopic Bankart repair with three knotless suture anchors, while group B underwent a modified arthroscopic Bankart repair with two knotless suture anchors and an additional capsular plication procedure. The mean follow-up was 52.5 months. Constant Shoulder Score (CSS), Rowe Score (RS), modified UCLA Shoulder Score (mUSS) and range of motion (ROM) were used as outcome measures.ResultsIn both groups, a significant improvement was detected in functional outcomes at postoperative last follow-up compared to the preoperative period. No statistically significant difference was found (p > 0.05) in clinical scores (CSS; Group A: 89.7, Group B: 80.2) (RS; Group A: 88.2, Group B: 80.2) (mUSS; Group A: 26.3, Group B: 25.7) external rotation loss (At neutral; Group A: 4.5°, Group B: 5.2°. At abduction; Group A: 4.3°, Group B: 5.7°) and recurrence rates (Group A: 13.3%, Group B: 20.8%). Although the difference was not statistically significant, the recurrence rate was higher in group B (20.8%), compared to group A (13.3%), despite the shorter average follow-up time of group B (p = 0.417).ConclusionsArthroscopic repair of labral Bankart lesions with both techniques showed good functional outcomes and stability at the latest follow-up. Higher recurrence rate despite the shorter average follow-up of group B suggests that two anchor usage might not be sufficient for Bankart repair in terms of better stability and less recurrence risk.Level of evidenceLevel III, Therapeutic Study.

A comparative study on use of two versus three double-loaded suture anchors in arthroscopic Bankart repair

“…However, some studies have also reported that capsular plication does not lead to loss of external rotation. [8,31,32] In our study, there was no significant difference between the two groups after capsular plication and no significant external rotation loss was observed in any of the patients. [28] One of the main limitations of the present study is that the number of cases is relatively small.…”

“…[27] Similar biomechanical studies were conducted with single-loaded and double-loaded anchors. [10] Aydin et al [8] found that recurrence was higher in the group in which two knotless suture anchors were used. In this study, the authors found no significant difference between the two groups in terms of functional outcomes.…”

“…[15,16] In recent years, different techniques and suture types have been used to reduce the number of suture anchors in arthroscopic Bankart repair. [8,[17][18][19][20][21][22][23] Successful results have been reported in arthroscopic Bankart repair using purse string technique using a single knotless suture. [16,17] Similarly, in comparative clinical and biomechanical studies performing Bankart repair using double-loaded suture anchors, successful results were obtained by using less suture anchors.…”

Arthroscopic Bankart Repair With Middle Glenohumeral Ligament Augmentation For The Treatment of Recurrent Anterior Shoulder Instabilities

“…However, in delayed cases with repetitive dislocations, the anterior labrum is degenerated, which results in a lack of viable soft tissue to reconstruct the labral anatomy. In such cases, where labrum can't be repaired, the capsular plication is performed to restore stability [2].…”

“…The joint capsule and glenoid labrum are severely retracted in chronic cases with numerous recurrent dislocations, which results in insu cient viable soft tissue for capsular plication [2,3]. We have proposed that labral repair with Middle Glenohumeral ligament (MGHL) augmentation could be done to reconstruct anterior stability.…”