Die arthroskopische extraartikuläre Bankart-Operation

Abstract

The arthroscopic extraarticular Bankart procedure tries to imitate the open Bankart procedure. An anterior-inferior transmuscular approach through the subscapular muscle permits to implant self-locking tacks into the anterior inferior third of the glenoid rim. The extraarticular location of the implants makes a superomedial capsular shift possible, if required. A total of 257 arthroscopic repairs following traumatic recurrent anterior shoulder dislocation have been carried out between 1992 and 1996. 177 patients were treated only with bioabsorbable Suretac device. Clinical and radiological follow up was possible in 165 patients. According to the Rowe score 69.7% were classified as excellent, 10.9% as good, 9.7% fair and 9.7% poor. Postoperative complications: the recurrence rate was 9.7%, allergic reactions representing a foreign body reaction to the synthetic material were seen in 5 cases (3%) and a frozen shoulder in 6 cases 3.6%). 61% of the patients involved in overhead or contact sports returned to their preoperative sport activities.

Operative Management of Anterior Glenohumeral Instability

“…The presented arthroscopic technique tries to imitate the open Bankart procedure [8,10,11]. The key of this arthroscopic technique, insertion of the implants at the anteroinferior glenoid rim (region of the lesion) and a superomedial shift, can be reached by an anteroinferior transmuscular portal.…”

“…However, this arthroscopic technique provides a stabile, functionally postoperative outcome in a minimal invasive way, but there are some disadvantages and limitations. You may be confronted with intraoperative problems [7,8], as breakage and bending of the guidewire, fracture and loss of implants or cut through the capsule of the implant (6 mm Suretac without spikes), bulging out of the glenoid cartilage in case of too lateral implantation of the implants. This means that an appropriate training status of two shoulder surgeons is recommended, not only to perform this arthroscopic technique, but also to have knowledge of intraoperative problems as well as to find intraoperative solutions [8].…”

“…You may be confronted with intraoperative problems [7,8], as breakage and bending of the guidewire, fracture and loss of implants or cut through the capsule of the implant (6 mm Suretac without spikes), bulging out of the glenoid cartilage in case of too lateral implantation of the implants. This means that an appropriate training status of two shoulder surgeons is recommended, not only to perform this arthroscopic technique, but also to have knowledge of intraoperative problems as well as to find intraoperative solutions [8]. To avoid intraoperative complications using the Suretac device, a refixation of the capsule-labral complex with the use of suture anchor may be a proper alternative.…”

“…In the arthroscopic group also patients with shoulder demanding sports were affected [8,10]. A significantly large population of patients with postoperative recurrences had preoperatively no or only a small Bankart lesion and capsule laxity.…”

Reluxationen nach arthroskopischer Labrumrefixation mittels Fadenankern bei traumatischer ventraler Schulterluxation

“…Diese beinhaltete eine Beurteilung der Schultergelenksfunktion mit den Kriterien Schmerzen, Bewegungsumfang, und Stabilita Èt sowie eine subjektive Einscha Ètzung der Schulterfunktion durch die Patienten. Die Ergebnisse dieser Nachuntersuchung wurden nach dem Rowe-Zarins-Score [35] zusammengefaût, der in Untersuchungen zu Ergebnissen nach arthroskopischen schulterstabilisierenden Operationen weit verbreitet ist [8,12,40,44,46]. In der Bewertung der Score-Ergebnisse wurden mehr als 89 Punkte als sehr gut, 89±75 Punkte als gut, 74±51 Punkte als ma Èûig und weniger als 51 Punkte als schlecht bewertet [15,31,32,34].…”