Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticlesTraumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: Significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion*,**
Section snippets
Materials and methods
We analyzed 194 arthroscopic Bankart repairs performed by the two of us between July 1992 and June 1998. One of us (S.S.B.) performed 43 of these surgeries between July 1992 and June 1998, and the other (J.F.DeB.) performed 151 of the surgeries between January 1994 and May 1998. This was a consecutive series of traumatic anterior instability for each author, with the following exclusions: anterior instability due to humeral avulsion of the glenohumeral ligaments (HAGL lesions) and cases with
Results
We had 21 recurrent dislocations and subluxations (14 dislocations, 7 subluxations), for a 10.8% recurrence rate. However, of those 21 recurrent dislocations and subluxations, 14 had significant bone defects (3 engaging Hill-Sachs lesions and 11 inverted-pear Bankart lesions).
We found it useful to divide our patients into 2 groups: those without significant bone defects (173 patients) and those with significant bone defects (21 patients). For the group without significant bone defects, there
Arthroscopic versus open repairs
Arthroscopic Bankart repairs remain controversial primarily because of reports of high recurrence rates, ranging up to 44% for transglenoid repairs.4, 5 However, on critical analysis of the literature, the recurrence rate is quite variable and can be very low even with transglenoid sutures.6, 7 A report on a recent series of arthroscopic suture anchor repairs8 described excellent results with only a 7% recurrence rate in an athletic population. The results in this arthroscopic suture anchor
Conclusions
- 1.
Arthroscopic Bankart repairs produce results equal to open Bankart repairs if there are no significant structural bone deficits (large engaging Hill-Sachs lesions or large bony Bankart lesions).
- 2.
Patients with significant bone deficits as defined in this study are not candidates for arthroscopic Bankart repair.
- 3.
A Hill-Sachs lesion that engages the anterior glenoid rim in a functional position of combined flexion-abduction–external rotation on dynamic arthroscopic examination is a contraindication
Acknowledgements
Acknowledgment: The authors acknowledge Chen Yuan, Ph.D., for his assistance in performing the statistical analysis for this report.
References (27)
- et al.
Arthroscopic Bankart suture repair: Technique and early results
Arthroscopy
(1987) - et al.
The rationale and technique for arthroscopic reconstruction of anterior shoulder instability using multiple sutures
Orthop Clin North Am
(1993) - et al.
Arthroscopic Bankart repair in a high demand athletic population
Arthroscopy
(1997) Arthroscopic capsulolabral repair using suture anchors
Orthop Clin North Am
(1993)Arthroscopic reconstruction of traumatic anterior instability
Oper Tech Sports Med
(1997)The anterior labroligamentous periosteal sleeve avulsion lesion: A cause of anterior instability in the shoulder
Arthroscopy
(1993)- et al.
Articular arc-length mismatch as a cause of failed Bankart repair
Arthroscopy
(2000) - et al.
Humeral avulsion of the glenohumeral ligaments as a cause of anterior shoulder instability
Arthroscopy
(1995) - et al.
Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report
J Bone Joint Surg Am
(1980) Techniques chirurgicales dans le traitement de la luxation anteriointerne recidivante de l’épaule
Lyon Chir
(1965)
Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder
J Bone Joint Surg Am
Arthroscopic Bankart suture repair
Am J Sports Med
Arthroscopic Bankart procedure: Two- to five-year followup with clinical correlation to severity of glenoid labral lesion
Am J Sports Med
Cited by (0)
- *
Address correspondence and reprint requests to Stephen S. Burkhart, M.D., 540 Madison Oak Dr, Suite 620, San Antonio, TX 78258, U.S.A.
- **
NOTE: To access the video illustration accompanying this report, visit the October on-line issue of Arthroscopy at http://www.arthroscopyjournal.org