Long-term Outcome of Acute versus Chronic Bony Bankart Lesions Managed Arthroscopically

Porcellini, Giuseppe; Paladini, Paolo; Campi, Fabrizio; Paganelli, Massimo

doi:10.1177/0363546507305011

Cited by 107 publications

(118 citation statements)

References 45 publications

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“…The reliability of this new tool however needs to be confirmed by specific studies as it has not yet been validated. The results concerning return to sports are similar to those reported in the literature [17,24,25,27]. Concerning apprehension, we found that, regardless of the procedure performed; about 20% of shoulders had persistent anterior apprehension (Fig.…”

Section: Discussionsupporting

confidence: 89%

The Open Latarjet Procedure Is More Reliable in Terms of Shoulder Stability Than Arthroscopic Bankart Repair

Bessière

Trojani

Carlès

et al. 2014

Clinical Orthopaedics &Amp; Related Research

238

188

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Background Arthroscopic Bankart repair and open Latarjet bone block procedure are widely considered mainstays for surgical treatment of recurrent anterior shoulder instability. The choice between these procedures depends mainly on surgeon preference or training rather than published evidence. Questions/purposes We compared patients with recurrent posttraumatic anterior shoulder instability treated with arthroscopic Bankart or open Latarjet procedure in terms of (1) frequency and timing of recurrent instability, (2) risk factors for recurrent instability, and (3) patient-reported outcomes. Methods In this retrospective comparative study, we paired 93 patients undergoing open Latarjet procedures with 93 patients undergoing arthroscopic Bankart repairs over the same period for posttraumatic anterior shoulder instability by one of four surgeons at the same center. Both groups were comparable except that patients in the Latarjet group had more glenoid lesions and more instability episodes preoperatively. Minimum followup was 4 years (mean, 6 years; range, 4-10 years). Patients were assessed with a questionnaire, including stability, Rowe score, and return to sports. Recurrent instability was defined as at least one episode of recurrent dislocation or subluxation. Return to sports was evaluated using a 0% to 100% scale that patients completed after recovery from surgery. Various risk factors for recurrent instability were also analyzed. Results At latest followup, 10% (nine of 93) in the Latarjet group and 22% (20 of 93) in the Bankart group demonstrated recurrent instability (p = 0.026; odds ratio, 0.39; 95% CI, 0.17-0.91). Ten recurrences in the Bankart group (50%) occurred after 2 years, compared to only one (11%) in the Latarjet group. Reoperation rate was 6% and 7% in the Bankart and Latarjet groups, respectively. In both groups, patients younger than 20 years had higher recurrence risk (p = 0.019). In the Bankart group, independent factors predictive for recurrence were practice of competitive sports and shoulder hyperlaxity (ie, passive external rotation [ 85°in the contralateral uninjured shoulder). Although return to sports was not different between groups, the mean Rowe score was higher in the Latarjet group (78 versus 68, p = 0.018). Conclusions Patients who had the open Latarjet procedure had less recurrent instability and better Rowe scores over a mean 6-year followup. We now perform isolated arthroscopic Bankart repair for carefully selected patients, including patients with an Instability Severity Index Score of 3 or less. Level of Evidence Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionsupporting

confidence: 89%

The Open Latarjet Procedure Is More Reliable in Terms of Shoulder Stability Than Arthroscopic Bankart Repair

Bessière

Trojani

Carlès

et al. 2014

Clinical Orthopaedics &Amp; Related Research

238

188

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“…Since then, several arthroscopic techniques using suture anchors have been reported to treat bony Bankart lesions. 12,16,29) However, there are some limitations to these techniques. For example, the suture anchor technique does not provide sufficient contact area for the fractured fragment because the suture crosses the surface of the fracture, and the bony fragment may tilt because of the one-point fixation.…”

Section: Discussionmentioning

confidence: 99%

“…An arthroscopic technique has many advantages, such as anatomic repair with a direct view, decreased invasiveness and tissue trauma, and a concomitant pathological diagnosis. Many arthroscopic methods have been used; 8,10,13,[15][16][17][18] however, they all have major limitations, including technical challenge.…”

mentioning

confidence: 99%

Clinical Results of the Arthroscopic "Multiple Pulled Suture" Technique for Large or Comminuted Bony Bankart Lesion

Lee

Kim

Kho

et al. 2017

Clinics in Shoulder and Elbow

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Background: Arthroscopic fixations for large and comminuted bony Bankart lesions are technically difficult. We developed an arthroscopic multiple pulled suture (MPS) technique to restore large and comminuted bony Bankart lesions. Methods: Ten patients (mean age, 49.8 years; range, 31-79 years) underwent bony Bankart repair using the illustrated MPS technique and were then followed for a mean of 27.3 months. A plain radiograph series and three-dimensional computed tomography scans were taken at the initial clinical evaluation and 3 months postoperatively. Outcome measurements included the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, University of California at Los Angeles (UCLA) score, and subjective patient satisfaction, along with surgical complications. Results: Union of an osseous fragment with the glenoid rim was confirmed in all patients on a computed tomography scan 3 months after operation. The osseous fragment was restored to proper articular congruence and reduction. The affected shoulder was stable in nine of the 10 patients. One patient presented with a redislocation after a sports injury 3 years postoperatively. The ASES, Rowe, and UCLA scores improved at the final evaluation, and median patient satisfaction at the final follow-up was 9 of 10 points (range, 6-10 points). Conclusions: The arthroscopic MPS technique for bony Bankart lesions with large or comminuted osseous fragments was a relatively easy and safe method for stable fixation of the osseous fragment. Therefore, the arthroscopic MPS technique resulted in good restoration of stability with high patient satisfaction and low complication rates. (Clin Shoulder Elbow 2017;20(3):138-146)

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“…[2][3][4][5] The existence of numerous methods is evidence that there is still no established method for surgery.In the 2000s, new methods utilizing suture anchors were designed. However, this technique could not provide sufficient contact area for the fractured fragment because the suture crossed the surface of the fracture and the bony fragment could tilt because of the one-point fixation.…”

mentioning

confidence: 99%

“…[2][3][4][5] The existence of numerous methods is evidence that there is still no established method for surgery.…”

mentioning

confidence: 99%

EDITORIAL : Is the Arthroscopic "Multiple Pulled Suture" Technique a Good Solution for Large or Comminuted Bony Bankart Lesions

Kim

2017

Clinics in Shoulder and Elbow

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Numerous surgical procedures have been developed since restoration of the anterior-inferior glenoid was raised as an important factor for restoring the stability of the shoulder joint 1) after acute or chronic shoulder dislocation. [2][3][4][5] The existence of numerous methods is evidence that there is still no established method for surgery.In the 2000s, new methods utilizing suture anchors were designed. However, this technique could not provide sufficient contact area for the fractured fragment because the suture crossed the surface of the fracture and the bony fragment could tilt because of the one-point fixation. To solve this problem, Millett et al. 6) developed the "bony Bankart bridge" procedure;however, this method was technically too difficult. Bauer et al. 7)later introduced the transglenoid technique for arthroscopic repair, which is simpler than techniques using suture anchors, but less accurate due to suture fixation on the fascia of the infraspinatus muscle. Lee et al. 8) modified the transglenoid technique to devise a so-called pulled sutures technique. Their study investigated the multiple pulled suture (MPS) technique in 10 patients with bony Bankart lesions and found excellent clinical and radiological results. Moreover, indirect fixation induced by ligamentotaxis was theoretically described in the discussion section of their study. In their study, 3-dimensionalcomputed tomography scans performed at 3 months postoperation showed union in all patients. However, it is not known whether this method will have the same effect on all large or comminuted bony Bankart lesions. As stated in their paper, if the condition of the capsulolabral complex and the periosteum were poor, the arthroscopic MPS technique could not be performed because it is difficult to induce a ligamentotaxis effect when periosteum damage is severe. Therefore, it is very important to confirm the condition of soft tissues around the bony fragment including the periosteum, using magnetic resonance arthrogram.The MPS technique involves the fixation of MPS onto the 2 or 10 o'clock position on the glenoid with one Pushlock (Arthrex) anchor, a knotless suture anchor. This technique seems to have advantages, such as being simple and more economical than other conventional surgery methods that use an average of four or more suture anchors. Conversely, this method relies on one knotless suture anchor to sustain all of the tension. If this fixation fails, adverse results are obvious. Therefore, the quality of the glenoid bone should be guaranteed so that it can withstand this one suture anchor with excessive tension. In addition, the quality of the soft tissue should be ensured because MPS will be performed on the labroligamentous complex.In this study, 7 out of 10 cases were Bigliani type I lesions and 7 out of 10 cases were first time dislocations. These factors suggest that most patients in this study had better bone quality and capsulolabral complex quality when compared to patients with chronic dislocations, resulting in solid res...

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Long-term Outcome of Acute versus Chronic Bony Bankart Lesions Managed Arthroscopically

Abstract: An arthroscopic procedure using suture anchors appears to enable successful treatment of acute bony Bankart lesions. Chronic lesions had less favorable outcomes.

Cited by 107 publications

References 45 publications

The Open Latarjet Procedure Is More Reliable in Terms of Shoulder Stability Than Arthroscopic Bankart Repair

The Open Latarjet Procedure Is More Reliable in Terms of Shoulder Stability Than Arthroscopic Bankart Repair

Clinical Results of the Arthroscopic "Multiple Pulled Suture" Technique for Large or Comminuted Bony Bankart Lesion

EDITORIAL : Is the Arthroscopic "Multiple Pulled Suture" Technique a Good Solution for Large or Comminuted Bony Bankart Lesions

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