Change in labrum height after arthroscopic Bankart repair: correlation with preoperative tissue quality and clinical outcome

Park, Jin‐Young; Lee, Seung-Jun; Lhee, Sang-Hoon; Oh, Jeong-Hwan

doi:10.1016/j.jse.2012.04.009

Cited by 22 publications

(25 citation statements)

References 35 publications

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“…As such, based on the findings of this study, horizontal mattress sutures may represent a superior repair configuration in the setting of labral tearing, especially in the setting of poor labral tissue quality; however, determination of the clinical validity of this finding warrants further in vivo investigation. 28 The observed modes of failure based on suture configuration in our investigation are in slight contrast to the modes of failure reported by Nho et al, 27 where anchor pullout was observed in 100% of specimens using the suture anchor-simple stitch configuration. In contrast, they found that specimens with suture anchor-mattress suture configuration failed 80% of time at the glenolabral junction and 20% at the capsule.…”

Section: Discussioncontrasting

confidence: 88%

Differences in Failure Mode Between Simple and Mattress Suture Configuration in Arthroscopic Bankart Repairs: A Cadaveric Study

Miskovsky

Sasala

Talbot

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Traumatic anterior shoulder dislocations disrupt the anteroinferior labrum (Bankart lesion), leading to high rates of instability and functional disability, necessitating stabilization. Purpose: To investigate modes and locations of repair failure between simple and horizontal mattress suture configurations after arthroscopic Bankart repair using suture anchors in a cadaveric model. Study Design: Controlled laboratory study. Methods: A total of 48 fresh-frozen human cadaveric shoulders from 48 specimens underwent creation of Bankart lesions from either the 3:00 to 6:00 o’clock position on the right glenoid or the 6:00 to 9:00 o’clock position on the left glenoid. Shoulder laterality between specimens was alternated and randomized to either simple or mattress suture repair configurations. In each shoulder, anchors were placed on the glenoid at the 3:00, 4:30, and 6:00 o’clock positions on the right or 6:00, 7:30, and 9:00 o’clock positions on the left and were secured via standard arthroscopic knot-tying techniques. Specimens were tested in the supine anterior apprehension position using a servohydraulic testing machine that was loaded to failure, simulating a traumatic anterior dislocation. After dislocation, open inspection of specimens was performed, and failure mode and location were documented. Differences in failure mode and location were compared using nominal multivariate generalized estimating equations. Results: Simple suture repairs most frequently failed at the labrum, while mattress suture repair failed at the capsule. Regardless of configuration, repairs failed most commonly at the 3:00 o’clock position on the right shoulder and 9:00 o’clock position on the left shoulder. Compared with mattress suture repairs, simple suture repairs failed at a significantly higher rate at the 6:00 o’clock position. Conclusion: Traumatic anterior shoulder dislocation after arthroscopic Bankart repair in a cadaveric model resulted in simple suture configuration repairs failing most commonly via labral tearing compared with capsular tearing in mattress repairs. Both repair configurations failed predominately at the anterior anchor position, with simple suture repairs failing more commonly at the inferior anchor position. Clinical Relevance: Horizontal mattress suture configurations create a larger area of repair, decreasing the risk of repair failure at the labrum. The extra time required for mattress suture placement at the inferior anchor position is used effectively, resulting in lower biomechanical failure rates.

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Section: Discussioncontrasting

confidence: 88%

Differences in Failure Mode Between Simple and Mattress Suture Configuration in Arthroscopic Bankart Repairs: A Cadaveric Study

Miskovsky

Sasala

Talbot

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…There was a statistically significant assocation with predicted labral height and Rowe scores at 1 year; however, as a result of the reletively short follow-up, an asscoiation with recurrent instability could not be identified. 21 Evaluating the labral bumper height/position is very dependent on the position of the patient's arm. Kim et al found, in immediate postoperative patients, that the positioning of the arm during the scan significantly affected the position of the labral bumper and suggested that labrum height is optimized with the arm in external rotation.…”

Section: Discussionmentioning

confidence: 99%

Functional outcome and the structural integrity of arthroscopic Bankart repair: a prospective trial

et al. 2014

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Background: Recurrent anterior shoulder dislocations are common in young patients with Bankart lesions. Arthroscopic repair is an established treatment; however, recurrent instability occurs in up to 35% of patients. It is unclear whether recurrence is the result of a failure of the surgical repair to heal or a repeat injury. The aim of the present pilot study was to assess radiographic healing of Bankart lesions 6 months post surgical repair and identify any correlations between radiographic findings and subsequent recurrent dislocations. Methods: Eighteen patients underwent arthroscopic Bankart repair for recurrent instability. Magnetic resonance (MR) arthrograms were obtained both pre-operatively and 6 months postoperatively. Standard T1 and T2 views were obtained along with an abduction and external rotation (ABER) view. Patients were followed for a minimum of 4 years for the risk of recurrence, and functional outcomes were obtained, including the American Shoulder and Elbow Surgeons Subjective Shoulder Scale, Ontario Shoulder Instability Index, Oxford Shoulder Instability Score and 12-Item Short Form Health Survey. Scores were correlated with pre-operative and postoperative MR findings. Results: Six of 18 patients developed recurrent instability. We could not identify correlations between reconstructed labrum (labral bumper) position, failure at suture sites and ABER findings with recurrent instability or functional outcome. Paradoxically, there was a nonstatistically significant trend for patients with no clefts between the labrum and the glenoid at any points along the repair to have worse outcomes than patients with partial or complete clefts. Conclusions: In our pilot study, MR arthrogram was used to evaluate the labrum in detail 6 months postoperatively. Despite its proven ability to detect labral lesions, we were unable to demonstrate any features on postoperative MR arthrogram that predicted either functional outcome or recurrent instability. At 6 months post operation, functional recovery and the risk of recurrence may not depend on the anatomical appearance of the labrum alone.

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“…Many surgical techniques have been described for the treatment of shoulder instability, each with different indications according to the pathological findings such as Bankart lesion 1 , ALPSA lesion, SLAP lesion, Hill-Sachs lesion, Bony Bankart 2 , PHAGL 3 and HAGL lesion 4 , as well as patient age, sex and activity level [5][6][7][8][9][10][11] . Despite the evolution of arthroscopic surgery for shoulder instability, a certain risk of recurrence exists after primary arthroscopic stabilization, even for patients aged over 22 years (6.3%) 12 .…”

Section: Introductionmentioning

confidence: 99%

Can arthroscopic revision surgery for shoulder instability be a fair option?

Giorgi

Garofalo

Tafuri

et al. 2014

MLTJ

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SummaryBackground: the aim of this study was to evaluate the role of arthroscopic capsuloplasty in the treatment of failed primary arthroscopic treatment of glenohumeral instability. Methods: we retrospectively examined at a minimum of 3-years follow-up 22 patients who underwent arthroscopic treatment between 1999 and 2007 who had recurrent anterior shoulder instability with a post-surgical failure. A statistical analysis was performed to evaluate which variable could influence the definitive result and clinical outcomes at final follow-up. A p value of less than 0.05 was considered significant. Results: we observed after revision surgery an overall failure rate of 8/22 (36.4%) including frank dislocations, subluxations and also apprehension that seriously inhibit the patient's quality of life. No significant differences were observed in the examined parameters. Conclusions: according to our outcomes we gen-

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Change in labrum height after arthroscopic Bankart repair: correlation with preoperative tissue quality and clinical outcome

Cited by 22 publications

References 35 publications

Differences in Failure Mode Between Simple and Mattress Suture Configuration in Arthroscopic Bankart Repairs: A Cadaveric Study

Differences in Failure Mode Between Simple and Mattress Suture Configuration in Arthroscopic Bankart Repairs: A Cadaveric Study

Functional outcome and the structural integrity of arthroscopic Bankart repair: a prospective trial

Can arthroscopic revision surgery for shoulder instability be a fair option?

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