scholarly journals Arthroscopic Acute Bony Bankart Repair in Lateral Decubitus

2020 ◽  
Vol 9 (12) ◽  
pp. e1907-e1915
Author(s):  
Nicolás A. Atala ◽  
Santiago Bongiovanni ◽  
Luciano A. Rossi ◽  
Franco De Cicco ◽  
María G. Bruchmann ◽  
...  
Keyword(s):  
Bankart Repair ◽  
Bony Bankart ◽  
Lateral Decubitus

scholarly journals Double-Row Repair Technique Provides Improved Dynamic Stabilization over Single-Row Repairs for Acute Bony Bankart Lesions

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0043
Author(s):  
Alexander Greenstein ◽  
Alexander M. Brown ◽  
Aaron Roberts ◽  
Raymond Edward Chen ◽  
Emma Knapp ◽  
...  
Keyword(s):  
External Rotation ◽  
Bankart Repair ◽  
Fixation Technique ◽  
Double Row ◽  
Single Row ◽  
Bony Bankart Lesion ◽  
Bony Bankart ◽  
Double Row Repair ◽  
Cadaveric Model ◽  
Bankart Lesions

Objectives: Previous studies of bony Bankart repair comparing single- and double-row reconstruction techniques have examined static forces required to displace the bony Bankart lesion. No studies, to date, have examined stability of bony Bankart repair with more physiologic concavity-compression model. We hypothesize the double-row fixation technique would provide superior stability and decreased displacement of a simulated bony Bankart lesion in a concavity-compression cadaveric model compared with single-row technique.Our aim was to examine the dynamic stability and ultimate displacement of single- vs double-row repair techniques for acute bony Bankart lesions Methods: Testing was performed on 13 matched pairs of glenoids with simulated bony Bankart fractures with a defect width of 25% of the glenoid diameter. Half of the fractures were repaired with a double-row technique, while the contralateral glenoids were repaired with a single-row technique. To determine dynamic biomechanical stability and ultimate step-off of the repairs a 150 N load and 2000 cycles of internal-external rotation at 1 Hz was applied to specimens to simulate standard rehabilitation protocols. Toggle was quantified throughout cycling with a coordinate measuring machine. After cyclic loading, the fracture displacement was measured. 3D spatial measurements were calculated using MATLAB. Results: The double-row technique resulted in significantly (p=0.005) less displacement (mean=342.48 µm SD=300.64 µm) than single-row technique (mean=981.84 µm, SD=640.38 µm). Ultimate fracture displacement of double-row repair was significantly less (mean=792.23 µm, SD=333.85 µm, p=0.046) after simulated rehabilitation by internal-external rotation cycling compared to single-row repair (mean=1,267.38 µm, SD=640.38 µm). Conclusion: The double-row fixation technique for arthroscopic bony Bankart repair results in superior stability throughout simulated rehabilitation and decreases ultimate displacement in a concavity-compression cadaveric model.

scholarly journals Arthroscopic Soft Tissue Stabilization for Traumatic Anterior Shoulder Instability in Elite Collision Athletes

2019 ◽  
Vol 7 (3_suppl2) ◽  
pp. 2325967119S0019
Author(s):  
Hoshika Shota ◽  
Hiroyuki Sugaya ◽  
Norimasa Takahashi ◽  
Keisuke Matsuki ◽  
Morihito Tokai ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Recurrence Rate ◽  
Shoulder Instability ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Bony Bankart ◽  
The Mean ◽  
Tissue Stabilization

Objectives: Surgical options for shoulder instability in collision athletes remain controversial. Although arthroscopic soft tissue stabilization is widely accepted treatment for traumatic anterior shoulder instability, many surgeons prefer coracoid transfer such as Latarjet procedure for collision athletes with or without glenoid defect due to potential high recurrence rate after arthroscopic soft tissue Bankart repair (ABR). In the meantime, Hill-Sachs remplissage (HSR) has been gaining popularity as an effective arthroscopic augmentation procedure. Since 2002, we performed rotator interval closure (RIC) as an augmentation in addition to ABR or arthroscopic bony Bankart repair (ABBR) for collision athletes and obtained satisfactory outcome. However, teen players demonstrated higher recurrence rate compared to twenties and thirties. Therefore, from 2012, we performed HSR as an additional augmentation for teen players besides ABR/ABBR and RIC. The purpose of this study was to assess the outcomes after arthroscopic stabilization in collision athletes who underwent shoulder stabilization under our treatment strategy. Methods: Between 2012 through 2015, 95 consecutive collision athletes underwent shoulder stabilization. Among those, only 2 patients (2%) underwent arthroscopic bony procedure for poor capsular integrity. Among the remaining 93 patients who underwent soft tissue stabilization, 65 were available for minimum 2-year follow-up (70%). Therefore, subjects consisted of 65 players including 54 rugby and 11 American football players (Table 1). There were 13 national top league, 24 collegiate, 21 junior or senior high school, and 7 recreational players. The mean age at surgery was 20 years (range, 16-36). The mean follow-up was 37 months (range, 24-64). We retrospectively reviewed intraoperative findings and surgical procedures using patient records including surgical reports and videos. We also investigated functional outcome and recurrence rate. Pre- and postoperative Rowe scores were compared using paired t test. Results: Preoperative 3DCT of the glenoid demonstrated bony Bankart (fragment type) in 43 players (66%), attritional type in 16 (25%), and normal glenoid in 6 (9%). Mean glenoid bone loss was 15% (range, 0-25) and all of the glenoid with more than 10% bone loss retained bony fragment. All 65 players demonstrated Bankart lesion and 15 had concomitant SLAP lesion (23%) which required to be repaired. In addition, 5 players demonstrated capsule tear (8%), which were also repaired. Twenty-four players (36%) underwent ABR or ABBR with RIC and forty one players (64%) underwent ABR or ABBR combined with HSR (Table 1). The mean Rowe score significantly improved after surgery from 65 (range, 55-75) to 92 (range, 65-100) (P < .001). Recurrence appeared in 2 cases (3%), both of which were junior or senior high school players who underwent ABR with HSR. Ten national top league players who underwent ABR with RIC had no recurrence. Conclusion: Soft tissue stabilization combined with selective augmentation procedures for traumatic shoulder instability in collision athletes demonstrated satisfactory outcomes with extremely low recurrence rate. Since the incidence of having bony Bankart lesion in collision athletes was very high, arthroscopic bony Bankart repair worked in many patients even with significant glenoid bone loss. Further, Hill-Sachs remplissage seemed to be effective additional augmentation especially in young collision athletes. [Table: see text]

scholarly journals Arthroscopic Soft Tissue Stabilization for Traumatic Anterior Shoulder Instability in Elite Collision Athletes: Is it Sufficient?

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0027
Author(s):  
Hoshika Shota ◽  
Hiroyuki Sugaya ◽  
Norimasa Takahashi ◽  
Keisuke Matsuki ◽  
Morihito Tokai ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Recurrence Rate ◽  
Shoulder Instability ◽  
Bankart Repair ◽  
Bony Bankart ◽  
The Mean ◽  
Tissue Stabilization ◽  
Mean Time

Objectives: Surgical options for shoulder instability in collision athletes remain controversial. Although arthroscopic soft tissue stabilization is widely accepted treatment for shoulder instability, many surgeons prefer coracoid transfer for collision athletes with or without glenoid defect due to potential high recurrence rate after arthroscopic soft tissue Bankart repair (ABR). In the meantime, Hill-Sacks remplissage (HSR) has been gaining popularity as an effective arthroscopic augmentation procedure. Since 2002, we performed rotator interval closure (RIC) as an augmentation in addition to ABR or arthroscopic bony Bankart repair (ABBR) for collision athletes and obtained satisfactory outcome. However, teen players demonstrated higher recurrence rate compared to twenties and thirties. Therefore, from 2012, we performed HSR as an additional augmentation for teen players besides ABR/ABBR and RIC. The purpose of this study was to assess the outcomes after arthroscopic stabilization in collision athletes who underwent shoulder stabilization under our treatment strategy. Methods: Between 2012 through 2015, 95 consecutive collision athletes underwent shoulder stabilization. Among those, only 2 patients (2%) underwent arthroscopic bony procedure for poor capsular integrity. Among the remaining 93 patients who underwent soft tissue stabilization, 65 were available for minimum 2 year follow-up (70%). Therefore, subjects consisted of 65 players including 54 rugby and 11 American football players (Table 1). There were 13 national top league, 24 collegeate, 21 junior or senior high school, and 7 recreational players. The mean age at surgery was 20 years (range, 16-36). The mean follow-up was 37 months (range, 24-64). We retrospectively reviewed intraoperative findings and surgical procedures using patient records including surgical reports and videos. We also investigated the mean time for sports return, functional outcome and recurrence rate. Pre- and postoperative Rowe scores were compared using paired t test. Results: Preoperative 3DCT of the glenoid demonstrated bony Bankart (fragment type) in 43 players (66%), attritional type in 16 (25%), and normal glenoid in 6 (9%). Mean glenoid bone loss was 15% (range, 0-25) and all of the glenoid with more than 10% bone loss retained bony fragment (Table 2). All 65 players demonstrated Bankart lesion and 15 had concomitant SLAP lesion (23%) which required repair. In addition, 5 players demonstrated capsule tear (8%), which were also repaired. Twenty four players (36%) underwent ABR or ABBR with RIC and forty one players (64%) underwent ABR or ABBR combined with HSR (Table 1).The mean time for sports return was 7 months (range, 4-13) after surgery. The mean Rowe score significantly improved after surgery from 65 (range, 55-75) to 92 (range, 65-100) (P < .001). Recurrence appeared in 2 cases (3%), both of which were junior or senior high school players who underwent ABR with HSR. Conclusion: Soft tissue stabilization combined with selective augmentation procedures for shoulder instability in collision athletes demonstrated satisfactory outcomes with low recurrence rate. Since the incidence of having bony Bankart lesion in collision athletes was very high, arthroscopic bony Bankart repair worked in many patients even with significant glenoid bone loss. Further, HSR seemed to be effective additional augmentation especially in young collision athletes. [Table: see text][Table: see text]

scholarly journals The Use of Accessory Portals in Bankart Repair With Posterior Extension in the Lateral Decubitus Position

2016 ◽  
Vol 5 (5) ◽  
pp. e1121-e1128 ◽  
Author(s):  
Gregory L. Cvetanovich ◽  
Jason T. Hamamoto ◽  
Kevin J. Campbell ◽  
Mark McCarthy ◽  
John D. Higgins ◽  
...  
Keyword(s):  
Lateral Decubitus Position ◽  
Bankart Repair ◽  
Posterior Extension ◽  
Lateral Decubitus

scholarly journals Arthroscopic Transosseous Bony Bankart Repair

2015 ◽  
Vol 4 (1) ◽  
pp. e47-e50 ◽  
Author(s):  
Matthew D. Driscoll ◽  
Joseph P. Burns ◽  
Stephen J. Snyder
Keyword(s):  
Bankart Repair ◽  
Bony Bankart

Chondral Damage After Arthroscopic Repair Techniques for Acute Bony Bankart Lesions: A Biomechanical Study

2021 ◽  
pp. 036354652110237
Author(s):  
Alexander S. Greenstein ◽  
Raymond E. Chen ◽  
Alexander M. Brown ◽  
Emma Knapp ◽  
Aaron Roberts ◽  
...  
Keyword(s):  
Humeral Head ◽  
Cartilage Damage ◽  
Bankart Repair ◽  
Double Row ◽  
Single Row ◽  
Chondral Damage ◽  
Bony Bankart ◽  
Cadaveric Model ◽  
Bankart Lesions ◽  
Repair Techniques

Background: Bony Bankart lesions can be encountered during treatment of shoulder instability. Current arthroscopic bony Bankart repair techniques involve intra-articular suture placement, but the effect of these repair techniques on the integrity of the humeral head articular surface warrants further investigation. Purpose: To quantify the degree of humeral head articular cartilage damage secondary to current arthroscopic bony Bankart repair techniques in a cadaveric model. Study Design: Controlled laboratory study. Methods: Testing was performed in 13 matched pairs of cadaveric glenoids with simulated bony Bankart fractures, with a defect width of 25% of the glenoid diameter. Half of the fractures were repaired with a double-row technique, while the contralateral glenoids were repaired with a single-row technique. Samples were subjected to 20,000 cycles of internal-external rotation across a 90° arc at 2 Hz after a compressive load of 750 N, or 90% body weight (whichever was less) was applied to simulate wear. Cartilage defects on the humeral head were quantified through a custom MATLAB script. Mean cartilage cutout differences were analyzed by the Wilcoxon rank-sum test. Results: Both single- and double-row repairs showed macroscopic damage. The histomorphometric analysis demonstrated that the double-row technique resulted in a significantly ( P = .036) more chondral damage (mean, 57,489.1 µm2; SD, 61,262.2 µm2) than the single-row repair (mean, 28,763.5 µm2; SD, 24,4990.2 µm2). Conclusion: Both single-row and double-row arthroscopic bony Bankart fixation techniques resulted in damage to the humeral head articular cartilage in the concavity-compression model utilized in this study. The double-row fixation technique resulted in a significantly increased cutout to the humeral head cartilage after simulated wear in this cadaveric model. Clinical Relevance: This study provides data demonstrating that placement of intra-articular suture during arthroscopic bony Bankart repair techniques may harm the humeral head cartilage. While the double-row repair of bony Bankart lesions is more stable, it results in increased cartilage damage. These findings suggest that alternative, cartilage-sparing arthroscopic techniques for bony Bankart repair should be investigated.

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