1
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Simmer Filho J, Kautsky RM. Limites da artroscopia na instabilidade anterior do ombro. Rev Bras Ortop 2021; 57:14-22. [PMID: 35198104 PMCID: PMC8856842 DOI: 10.1055/s-0041-1731357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/15/2021] [Indexed: 10/26/2022] Open
Abstract
ResumoMuito se discute sobre os limites do tratamento da instabilidade anterior do ombro por artroscopia. O avanço no entendimento das repercussões biomecânicas das lesões bipolares sobre a estabilidade do ombro, bem como na identificação de fatores relacionados ao maior risco de recidiva têm nos ajudado a definir, de forma mais apurada, os limites do reparo por via artroscópica.Ressaltamos a importância de diferenciação entre perda óssea por erosão da glenoide (POAG) e fraturas da borda da glenoide, pois o prognóstico do tratamento diverge entre essas formas de falha óssea da glenoide. Neste contexto, entendemos que há três tipos de falha óssea: a) Bankart ósseo (fratura); b) combinada; e c) POAG, e abordaremos as opções de tratamento sugerido em cada situação.Até há pouco tempo, a escolha do método cirúrgico era norteada basicamente pelo grau de acometimento ósseo. Com a evolução do conhecimento, da biomecânica das lesões bipolares e do conceito do glenoid track (trilho da glenoide), o ponto de corte da lesão crítica, vem sendo alterado com tendência de queda. Além das falhas ou perdas ósseas, outras variáveis foram adicionadas e tornaram a decisão mais complexa, porém um pouco mais objetiva.O presente artigo de atualização tem como objetivo fazer uma breve revisão da anatomia com as principais lesões encontradas na instabilidade; abordar detalhes importantes na técnica cirúrgica artroscópica, em especial nos casos complexos, e trazer as evidências atuais sobre os assuntos de maior divergência, buscando guiar o cirurgião na tomada de decisão.
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2
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Baron JE, Duchman KR, Hettrich CM, Glass NA, Ortiz SF, Baumgarten KM, Bishop JY, Bollier MJ, Bravman JT, Brophy RH, Carpenter JE, Cox CL, Feeley BT, Frank RM, Grant JA, Jones GL, Kuhn JE, Lansdown DA, Benjamin Ma C, Marx RG, McCarty EC, Miller BS, Neviaser AS, Seidl AJ, Smith MV, Wright RW, Zhang AL, Wolf BR. Beach Chair Versus Lateral Decubitus Position: Differences in Suture Anchor Position and Number During Arthroscopic Anterior Shoulder Stabilization. Am J Sports Med 2021; 49:2020-2026. [PMID: 34019439 DOI: 10.1177/03635465211013709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic shoulder capsulolabral repair using glenoid-based suture anchor fixation provides consistently favorable outcomes for patients with anterior glenohumeral instability. To optimize outcomes, inferior anchor position, especially at the 6-o'clock position, has been emphasized. Proponents of both the beach-chair (BC) and lateral decubitus (LD) positions advocate that this anchor location can be consistently achieved in both positions. HYPOTHESIS Patient positioning would be associated with the surgeon-reported labral tear length, total number of anchors used, number of anchors in the inferior glenoid, and placement of an anchor at the 6-o'clock position. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS This study was a cross-sectional analysis of a prospective multicenter cohort of patients undergoing primary arthroscopic anterior capsulolabral repair. Patient positioning in the BC versus LD position was determined by the operating surgeon and was not randomized. At the time of operative intervention, surgeon-reported labral tear length, total anchor number, anchor number in the inferior glenoid, and anchor placement at the 6-o'clock position were evaluated between BC and LD cohorts. Descriptive statistics and between-group differences (continuous: t test [normal distributions], Wilcoxon rank sum test [nonnormal distributions], and chi-square test [categorical]) were assessed. RESULTS In total, 714 patients underwent arthroscopic anterior capsulolabral repair (BC vs LD, 406 [56.9%] vs 308 [43.1%]). The surgeon-reported labral tear length was greater for patients having surgery in the LD position (BC vs LD [mean ± SD], 123.5°± 49° vs 132.3°± 44°; P = .012). The LD position was associated with more anchors placed in the inferior glenoid and more frequent placement of anchors at the 6-o'clock (BC vs LD, 22.4% vs 51.6%; P < .001). The LD position was more frequently associated with utilization of ≥4 total anchors (BC vs LD, 33.5% vs 46.1%; P < .001). CONCLUSION Surgeons utilizing the LD position for arthroscopic capsulolabral repair in patients with anterior shoulder instability more frequently placed anchors in the inferior glenoid and at the 6-o'clock position. Additionally, surgeon-reported labral tear length was longer when utilizing the LD position. These results suggest that patient positioning may influence the total number of anchors used, the number of anchors used in the inferior glenoid, and the frequency of anchor placement at the 6 o'clock position during arthroscopic capsulolabral repair for anterior shoulder instability. How these findings affect clinical outcomes warrants further study. REGISTRATION NCT02075775 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Jacqueline E Baron
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Kyle R Duchman
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Carolyn M Hettrich
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Natalie A Glass
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Shannon F Ortiz
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | -
- Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Julie Y Bishop
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Matthew J Bollier
- University of Iowa, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Jonathan T Bravman
- University of Colorado, Aurora, Colorado, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Robert H Brophy
- Washington University, St. Louis, Missouri, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - James E Carpenter
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Charles L Cox
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Brian T Feeley
- University of California, San Francisco, San Francisco, California, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Rachel M Frank
- University of Colorado, Denver, Denver, Colorado, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - John A Grant
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Grant L Jones
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - John E Kuhn
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Drew A Lansdown
- University of California, San Francisco, San Francisco, California, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - C Benjamin Ma
- University of California, San Francisco, San Francisco, California, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Eric C McCarty
- University of Colorado, Aurora, Colorado, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Bruce S Miller
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Andres S Neviaser
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Adam J Seidl
- University of Colorado, Aurora, Colorado, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Matthew V Smith
- Washington University, St. Louis, Missouri, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Rick W Wright
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Alan L Zhang
- University of California, San Francisco, San Francisco, California, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Brian R Wolf
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
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3
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Posterior Labral Injury and Glenohumeral Instability in Overhead Athletes: Current Concepts for Diagnosis and Management. J Am Acad Orthop Surg 2020; 28:628-637. [PMID: 32732654 DOI: 10.5435/jaaos-d-19-00535] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Posterior glenohumeral instability in overhead athletes presents a unique set of challenges for both diagnosis and treatment. Although a great deal of attention has been focused on the management of injuries to the biceps-labrum complex and rotator cuff in throwers, comparatively less has been written about posterior glenohumeral instability within this unique cohort. Historically, posterior instability has been observed secondary to either acute trauma or repetitive microtrauma, usually among collision athletes, weight lifters, and rowers. However, posterior glenohumeral instability resulting from pathology of the posterior capsulolabral tissues in throwers is a different entity, and the clinical assessment begins with an accurate differentiation between adaptive capsular laxity and labral injury with pathologic instability. Some posterior capsule labrum tears confirmed on arthroscopy will require nothing more than débridement. However, for more extensive lesions, surgical treatment must balance the necessity to repair torn capsulolabral tissues with the tendency to over constrain the shoulder. The literature provides mixed results regarding the likelihood of overhead athletes with posterior glenohumeral instability and labral injury treated surgically returning to their preinjury level of sport performance.
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4
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Arthroscopic stabilisation for shoulder instability. J Clin Orthop Trauma 2020; 11:S402-S411. [PMID: 32523301 PMCID: PMC7275285 DOI: 10.1016/j.jcot.2019.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 12/11/2022] Open
Abstract
Since its first description over 30 years ago arthroscopic stabilisation has evolved. With improvements in knowledge, surgical techniques and materials technology, arthroscopic bankart repair has become the most widely used method for treating patients with symptomatic anterior shoulder instability. These procedures are typically performed in a younger, high demand patient population after a primary dislocation or to treat recurrent instability. A thorough clinical evaluation is required in the clinic setting not only to fully understand the injury pattern but also consider patient expectations prior to embarking on surgery. Diagnostic imaging will aid the clinician in determining the soft tissue pathology as well as assessing bone loss, which facilitates surgical decision-making. Selected patients may benefit from adjunctive procedures such as a remplissage for an "engaging" Hill-sachs lesion. This review will focus on the indications, pre-operative considerations, surgical techniques and outcomes of arthroscopic stabilisation.
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5
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Ernat JJ, Yheulon CG, Shaha JS. Arthroscopic Repair of 270- and 360-Degree Glenoid Labrum Tears: A Systematic Review. Arthroscopy 2020; 36:307-317. [PMID: 31708356 DOI: 10.1016/j.arthro.2019.07.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/09/2019] [Accepted: 07/22/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To review the current literature available and evaluate the efficacy of arthroscopic repair of 270° and 360° labral tears, as well as the complication rates associated with such. In addition, we intend to investigate whether consistent clinical findings can be observed in these patients. METHODS This review is registered in the PROSPERO database. The MEDLINE, Cochrane Library, Scopus, and EMBASE databases were queried, and additional searches were performed manually. Studies that reported outcomes after arthroscopic repair of a minimum of 270° of glenoid labrum were included. Technique articles, repairs of less than 270°, studies on atraumatic multidirectional instability, and studies that lacked observable outcomes were excluded. RESULTS In total, 3031 studies/documents were identified from database and manual searching. Screening, removal of duplicates, and assessment for inclusion/exclusion criteria resulted in 6 level IV studies for review. History and physical examination, as well as advanced imaging findings, were variable across studies. All studies reported satisfactory outcomes at short- to mid-term follow-up, although there was heterogeneity in type of outcomes used. Return to sport ranged from 75% to 100%. Complication rates ranged from 10% to 30%. Notably, recurrence of instability and need for secondary surgery occurred in up to 15% of patients. CONCLUSIONS The current literature suggests that although clinical and radiographic variability exist in the diagnosis of 270° and 360° glenoid labrum tears, successful outcomes and return to work/sport can be achieved with arthroscopic management at an average minimum follow-up of 1 year. These figures, however, are limited by heterogenous studies containing small numbers of patients. Complications occur in up to 30% of cases, including an instability recurrence rate of up to 15%. LEVEL OF EVIDENCE Systematic review of Level IV evidence.
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Affiliation(s)
- Justin J Ernat
- Blanchfield Army Community Hospital. Fort Campbell, Kentucky, U.S.A..
| | | | - James S Shaha
- Landstuhl Regional Medical Center, Landstuhl, Germany
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6
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Petrera M, Ogilvie-Harris DJ, Theodoropoulos JS, Chahal J, Wasserstein D, Veillette C, Linda D, Dwyer T. Inter-surgeon variability in the identification of clock face landmarks when placing suture anchors in arthroscopic Bankart repair. Shoulder Elbow 2019; 11:419-423. [PMID: 32269601 PMCID: PMC7094062 DOI: 10.1177/1758573218797964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/30/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The accuracy of surgeons in utilizing the clock face method for anchor placement has never been investigated. Our hypothesis was that shoulder arthroscopy surgeons would be able to place suture anchors at predetermined positions with accuracy and reliability. METHODS Ten cadaveric shoulders were used. Five fellowship-trained shoulder arthroscopy surgeons were directed to place a suture anchor at 3:30, 4:30, and 5:30 clock in two shoulders each. The position of the anchors was determined with computed tomography. The accuracy of placement was calculated and data analyzed with one-way analysis of variance. The intraclass correlation coefficients were calculated. RESULTS The overall accuracy was 57%. The accuracy of anchor placement at the 3:30 position was 40% (average position 2:24 o'clock), it was 50% at the 4:30 position (average position 3:42 o'clock) and 80% at the 5:30 position (average position 5:03 o'clock). No statistical difference in accuracy between the placement of the superior, middle, and inferior anchors (p = 0.145) was seen. The intraclass correlation coefficient for inter-surgeon reliability was 0.4 (fair) while the intraclass correlation coefficient for intra-surgeon reliability was 0.6 (moderate). DISCUSSION The findings of this study suggest a moderate degree of accuracy and fair to moderate inter- and intra-surgeon reliability when using the clock face system to guide anchor placement.
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Affiliation(s)
- Massimo Petrera
- Division of Orthopaedic Surgery,
University
of Ottawa, Ottawa, Canada,Massimo Petrera, Division of Orthopaedics,
University of Ottawa, The Ottawa Hospital – General Campus – CCW Room 1637,
Ottawa, ON K1H 8L6, Canada.
| | - Darrell J Ogilvie-Harris
- University of Toronto Orthopaedic Sports
Medicine (UTOSM) Program, Division of Orthopaedics, Toronto Western Hospital and
Women’s College Hospital, Toronto, Canada
| | - John S Theodoropoulos
- University of Toronto Orthopaedic Sports
Medicine (UTOSM) Program, Division of Orthopaedics, Mount Sinai Hospital and Women’s
College Hospital, Toronto, Canada
| | - Jaskarndip Chahal
- University of Toronto Orthopaedic Sports
Medicine (UTOSM) Program, Division of Orthopaedics, Toronto Western Hospital and
Women’s College Hospital, Toronto, Canada
| | - David Wasserstein
- University of Toronto Orthopaedic Sports
Medicine (UTOSM) Program, Division of Orthopaedics, Sunnybrook Health Sciences
Centre, Toronto, Canada
| | - Christian Veillette
- University of Toronto Orthopaedic Sports
Medicine (UTOSM) Program, Division of Orthopaedics, Toronto Western Hospital,
Toronto, Canada
| | - Dorota Linda
- Joint Department of Medical Imaging,
University of Toronto, Toronto, Canada
| | - Tim Dwyer
- University of Toronto Orthopaedic Sports
Medicine (UTOSM) Program, Division of Orthopaedics, Mount Sinai Hospital and Women’s
College Hospital, Toronto, Canada
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7
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Bokshan SL, DeFroda SF, Gil JA, Badida R, Crisco JJ, Owens BD. The 6-O'clock Anchor Increases Labral Repair Strength in a Biomechanical Shoulder Instability Model. Arthroscopy 2019; 35:2795-2800. [PMID: 31395394 PMCID: PMC7281777 DOI: 10.1016/j.arthro.2019.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/26/2019] [Accepted: 05/03/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To characterize the additive effect of a 6-o'clock anchor in the stabilization of a Bankart lesion. METHODS Twelve cadaveric shoulders were tested on a 6-df robotic musculoskeletal simulator to measure the peak resistance force due to anterior displacement of 1 cm. The rotator cuff muscles were loaded dynamically. The test conditions consisted of the intact shoulder, Bankart lesion, Bankart repair (3-, 4-, and 5-o'clock anchors), and Bankart repair with the addition of a 6-o'clock anchor. A 13% anterior bone defect was then created, and all conditions were repeated. Repeated-measures analysis of variance was performed. RESULTS In the group with no bone loss, the addition of a 6-o'clock anchor yielded the highest peak resistance force (52.8 N; standard deviation [SD], 4.5 N), and its peak force was significantly greater than that of the standard Bankart repair by 15.8% (7.2 N, P = .003). With subcritical glenoid bone loss, the repair with the addition of a 6-o'clock anchor (peak force, 52.6 N; SD, 6.1 N; P = .006) had a significantly higher peak resistance force than the group with bone loss with a Bankart lesion (35.2 N; SD, 5.8 N). Although the 6-o'clock anchor did increase the strength of the standard repair by 6.7%, this was not statistically significant (P = .9) in the bone loss model. CONCLUSIONS The addition of a 6-o'clock suture anchor to a 3-anchor Bankart repair increases the peak resistance force to displacement in a biomechanical model, although this effect is lost with subcritical bone loss. CLINICAL RELEVANCE This study provides surgeons with essential biomechanical data to aid in the selection of the repair configuration.
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Affiliation(s)
- Steven L Bokshan
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A..
| | - Steven F DeFroda
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
| | - Joseph A Gil
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
| | - Rohit Badida
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
| | - Joseph J Crisco
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
| | - Brett D Owens
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
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8
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Liu T, Yamamoto N, Shinagawa K, Hatta T, Itoi E. Curved-guide system is useful in achieving optimized trajectory for the most inferior suture anchor during arthroscopic Bankart repair. J Shoulder Elbow Surg 2019; 28:1692-1698. [PMID: 31447122 DOI: 10.1016/j.jse.2019.03.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/27/2019] [Accepted: 03/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND A curved-drill guide system was recently introduced to achieve a better trajectory for a low anteroinferior anchor during arthroscopic Bankart repair. However, the clinical performance of such a device remains unclear. The purpose of this study was to evaluate the trajectory and position of the low anteroinferior suture anchor with use of the curved-guide system in clinical cases. METHODS We enrolled 41 cases of arthroscopic Bankart repair in this study. Of these cases, 9 were repaired using the curved drill guide whereas 32 were repaired using a conventional straight guide. Postoperative computed tomography scans were obtained, and 3-dimensional models of the scapula were reconstructed. Notable perforations of the opposite cortex by the most inferior anchors were recorded. The clock-face angle, insertion angle, and insertion distance were measured. RESULTS The anchor perforation rate in the curved-guide group (11%) was significantly lower than that in the straight-guide group (56%) (P = .02). The insertion distance in the curved-guide group was significantly shorter than that in the straight-guide group (4.0 ± 1.6 mm vs. 7.0 ± 2.4 mm, P < .01). The clock-face angle and insertion angle were significantly greater in the perforated straight-guide group than in the nonperforated groups. The percentage of anchors in the absolute safe zone (clock-face angle > 135° and < 165° and insertion angle < 100°), where no anchors perforated, was greater in the curved-guide group than the straight-guide group. CONCLUSION Compared with the conventional straight guide, the curved-guide system provides better placement of the most inferior suture anchor during arthroscopic Bankart repair.
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Affiliation(s)
- Tong Liu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kiyotsugu Shinagawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Taku Hatta
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
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9
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Lee JH, Itami Y, Hedayati B, Bitner B, McGarry MH, Lee TQ, Shin SJ. Biomechanical effects of position and angle of insertion for all-suture anchors in arthroscopic Bankart repair. Clin Biomech (Bristol, Avon) 2018; 60:45-50. [PMID: 30316165 DOI: 10.1016/j.clinbiomech.2018.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/19/2018] [Accepted: 10/01/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The biomechanical properties of all-suture anchor for labral repair depending on the insertion angle and location are lacking. The purpose of this study was to quantify the biomechanical fixation characteristics of the anchor position and insertion angle of all-suture anchors for arthroscopic Bankart repair. METHODS Twenty-four fresh frozen cadaveric glenoid were used. All-suture anchors with 1.5-mm diameter were randomly inserted at 2:30, 4:00, and 5:30 o'clock positions on the glenoid edge, with either 30°, 45° or 60° insertion angles to the mediolateral axis of the glenoid. Anchors were preloaded to 5 N and cyclically loaded from 5 N to 20 N for 10 cycles, followed by a load to failure test at 60 mm/min. Permanent, non-recoverable displacement was quantified at the end of the cyclic loading test to yield load. FINDINGS All-suture anchors implanted at the 2:30 o'clock position of the glenoid provided greater stiffness, yield load, and ultimate load than those inserted at the 4:00 and 5:30 o'clock positions, regardless of the insertion angle. Displacement at yield and ultimate load were similar among the positions and insertion angles (yield load, vs. 4:00, p = 0.01; vs. 5:30, p = 0.045; ultimate load, vs. 4:00, p < 0.01; vs. 5:30, p < 0.01). The insertion angles of 30°, 45° and 60° did not influence mechanical stability between the 4:00 and 5:30 o'clock positions. INTERPRETATION The insertion angle of all-suture anchors does not significantly affect the stability at antero-inferior quadrant of the glenoid.
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Affiliation(s)
- Jae-Hoo Lee
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Yasuo Itami
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Bobak Hedayati
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Benjamin Bitner
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopaedic Surgery, University of California, Irvine, CA, USA
| | - Sang-Jin Shin
- Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Seoul, Republic of Korea.
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10
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Rao AJ, Cvetanovich GL, Zuke WA, Low Q, Forsythe B. Arthroscopic Repair of a Circumferential 360° Labral Tear. Arthrosc Tech 2017; 6:e1131-e1136. [PMID: 29354408 PMCID: PMC5621865 DOI: 10.1016/j.eats.2017.03.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/21/2017] [Indexed: 02/03/2023] Open
Abstract
Injuries to the glenoid labrum can result in shoulder instability and pain. These lesions may occur anywhere around the glenoid labrum, and thus, the arthroscopist must be prepared to approach all aspects of the glenoid from multiple angles. The pan-labral or circumferential (360°) tear of the glenoid labrum presents a unique challenge to even the experienced arthroscopist. The extent of the lesion requires the use of accessory portals and percutaneous techniques to establish adequate visualization and to facilitate the proper trajectory for anchor placement. The pan-labral tear also demands intraoperative planning throughout the repair to ensure proper tensioning and alignment of the labrum and capsular tissue. The purposes of this article are to report a technique for repairing a pan-labral lesion and to emphasize the use of accessory portals and percutaneous techniques for complete access to the glenoid.
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Affiliation(s)
| | | | | | | | - Brian Forsythe
- Address correspondence to Brian Forsythe, M.D., Rush University Medical Center, Midwest Orthopaedics at Rush, 1611 W Harrison St, Ste 300, Chicago, IL 60612, U.S.A.Rush University Medical CenterMidwest Orthopaedics at Rush1611 W Harrison StSte 300ChicagoIL60612U.S.A.
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11
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Cuéllar A, Cuéllar R, de Heredia PB. Arthroscopic Revision Surgery for Failure of Open Latarjet Technique. Arthroscopy 2017; 33:910-917. [PMID: 27989356 DOI: 10.1016/j.arthro.2016.09.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 09/07/2016] [Accepted: 09/20/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the efficacy in treating pain, limited range of motion, and continued instability of the Latarjet open technique via the use of arthroscopy. METHODS A retrospective review of patients who underwent arthroscopic capsule plication after failure of an open Latarjet technique was performed. Revision surgery was indicated in cases of recurrent instability and associated pain. Only patients with a glenoid defect <25% were considered. The Constant and Rowe scores were administered, whereas pain was assessed with a visual analog scale before the reoperation and at 24 months after operation. Radiographs, computed tomography, and CT arthrography scans were performed. RESULTS Twelve patients met the inclusion criteria. All patients had capsular distension and consequently were subjected to a capsuloplasty. Shoulder function, stability, and pain had all improved significantly at 24 months after arthroscopic revision (P < .0001). In particular, the Constant score increased from 44.9 (standard deviation [SD] 7.10) to 89.3 (SD 12.6) points, the Rowe score improved from 49.5 (SD 10.1) to 80.9 (SD 10.9), whereas the visual analog scale pain score decreased from 6.75 (SD 1.17) to 1.38 (SD 1.06). CONCLUSIONS Primary open Latarjet with a glenoid bone defect <25% that failed due to capsular redundancy is amenable to successful treatment with arthroscopic capsuloplasty. CLINICAL RELEVANCE Arthroscopic approaches can offer a good solution for treating previously failed open Latarjet procedures. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Adrián Cuéllar
- Deparment of Traumatology and Orthopaedic Surgery of the Galdakao-Usansolo Hospital, Galdácano, Spain.
| | - Ricardo Cuéllar
- Department of Traumatology and Orthopaedic Surgery of the Donostia Universitary Hospital, San Sebastián, Spain
| | - Pablo Beltrán de Heredia
- Department of Orthopaedic Surgery, Clínic Universitary Hospital of Valladolid, Valladolid, Spain
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Cvetanovich GL, Hamamoto JT, Campbell KJ, McCarthy M, Higgins JD, Verma NN. The Use of Accessory Portals in Bankart Repair With Posterior Extension in the Lateral Decubitus Position. Arthrosc Tech 2016; 5:e1121-e1128. [PMID: 28224066 PMCID: PMC5310186 DOI: 10.1016/j.eats.2016.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/09/2016] [Indexed: 02/03/2023] Open
Abstract
The Bankart lesion, in which the anteroinferior labrum is detached from the glenoid, is the critical anatomic lesion in the majority of patients with anterior glenohumeral instability. Some patients with anterior glenohumeral instability will have Bankart lesions with posterior extension beyond the 6-o'clock position, and achieving anatomic labral repair in these cases can present a technical challenge. In our experience, the lateral decubitus position and use of accessory portals allow superior visualization of the inferior half of the glenohumeral joint for glenoid and labral preparation, anchor placement, and suture management. The use of double-loaded suture anchors at the inferior glenoid provides multiple points of fixation at this challenging location while limiting the number of anchors required. The purpose of this article is to present a simple and reproducible technique for arthroscopic repair of Bankart lesions with posterior extension, emphasizing the use of accessory 5-o'clock trans-subscapularis and 7-o'clock portals.
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Affiliation(s)
| | | | | | | | | | - Nikhil N. Verma
- Address correspondence to Nikhil N. Verma, M.D., Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Midwest Orthopaedics at Rush, 1611 W. Harrison St., Suite 300, Chicago, IL 60612, U.S.A.Department of Orthopaedic SurgeryDivision of Sports MedicineRush University Medical CenterMidwest Orthopaedics at Rush1611 W. Harrison St.Suite 300ChicagoIL60612U.S.A.
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Sugaya H, Takahashi N. Arthroscopic Osseous Bankart Repair in the Treatment of Recurrent Anterior Glenohumeral Instability. JBJS Essent Surg Tech 2016; 6:e26. [PMID: 30233919 DOI: 10.2106/jbjs.st.16.00005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Anterior glenohumeral instability associated with an anterior-inferior fracture of the glenoid (osseous Bankart lesion) can be treated successfully with arthroscopic, rather than open, surgical repair, or fixation of the osseous fragment. Indications & Contraindications Step 1 Patient Positioning Place the patient in the beach-chair position and examine both shoulders for laxity after induction of general anesthesia with an interscalene block. Step 2 Portal Placement Create a standard posterior viewing portal and anterior and anterosuperior working portals. Step 3 Mobilization Separate the displaced osseous fragment associated with the labroligamentous complex from the glenoid neck and mobilize the labroligamentous complex together with the fragment up to the 7 o'clock or 7:30 position (in a right shoulder). Step 4 Inferior Labrum Repair Perform an inferior labrum repair by inserting 2 suture anchors at the anteroinferior part of the glenoid face. Step 5 Osseous Fragment Fixation Fix the osseous fragment by passing the sutures either through or around the fragment with use of a bone penetrator, or Bone Stitcher, while stabilizing the labrum and fragment with a large grasper. Step 6 Augmentation Procedures Rotator interval closure, done with the arm in >60° of external rotation, is the most frequently performed augmentation procedure. Results A consecutive series of 46 patients with an osseous Bankart lesion who demonstrated >15% glenoid bone loss underwent osseous Bankart repair, which was performed regardless of the fragment size, between January 2005 and December 20061. Pitfalls & Challenges
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Affiliation(s)
- Hiroyuki Sugaya
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, Hasama, Funabashi, Japan
| | - Norimasa Takahashi
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, Hasama, Funabashi, Japan
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Kitayama S, Sugaya H, Takahashi N, Matsuki K, Kawai N, Tokai M, Ohnishi K, Ueda Y, Hoshika S, Kitamura N, Yasuda K, Moriishi J. Clinical Outcome and Glenoid Morphology After Arthroscopic Repair of Chronic Osseous Bankart Lesions: A Five to Eight-Year Follow-up Study. J Bone Joint Surg Am 2015; 97:1833-43. [PMID: 26582613 DOI: 10.2106/jbjs.n.01033] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthroscopic osseous Bankart repair for shoulders with chronic recurrent anterior instability has been reported as an effective procedure with promising short-term outcomes. However, to date, we know of no report describing longer-term outcomes and glenoid morphologic change. The purpose of the present study was to report intermediate to long-term outcomes and glenoid morphologic change after arthroscopic osseous Bankart repair in patients with substantial glenoid bone loss. METHODS A consecutive series of eighty-five patients with traumatic anterior glenohumeral instability associated with a chronic osseous Bankart lesion underwent arthroscopic repair from January 2005 through December 2006. Forty-six patients with bone loss of >15% of the inferior glenoid diameter relative to the assumed inferior circle regardless of the fragment size were selected as candidates for this study. Thirty-eight patients (83%), including thirty-four male and four female patients, with a mean age of 23.4 years (range, fifteen to thirty-six years) at the time of surgery, were available for final follow-up at a mean of 6.2 years (range, 5.0 to 8.1 years) after surgery. RESULTS One patient had a redislocation during a traffic accident five months after surgery before obtaining an osseous union. The mean Rowe score and the mean Western Ontario Shoulder Instability Index improved significantly from 30.7 points preoperatively to 95.4 points postoperatively and from 26.5% to 81.5%, respectively. Although the mean preoperative fragment size was measured as only 4.7%, the mean glenoid bone loss improved from 20.4% preoperatively to -1.1% postoperatively. CONCLUSIONS Arthroscopic osseous Bankart repair is an effective primary treatment for shoulders with substantial glenoid bone loss as it provides successful outcomes without recurrence of instability once osseous union is obtained. Glenoid morphology can be normalized during the intermediate to long-term postoperative period, even in shoulders with a smaller fragment.
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Affiliation(s)
- Soichiro Kitayama
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi 2740822, Japan. E-mail address for H. Sugaya:
| | - Hiroyuki Sugaya
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi 2740822, Japan. E-mail address for H. Sugaya:
| | - Norimasa Takahashi
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi 2740822, Japan. E-mail address for H. Sugaya:
| | - Keisuke Matsuki
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi 2740822, Japan. E-mail address for H. Sugaya:
| | - Nobuaki Kawai
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi 2740822, Japan. E-mail address for H. Sugaya:
| | - Morihito Tokai
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi 2740822, Japan. E-mail address for H. Sugaya:
| | - Kazutomo Ohnishi
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi 2740822, Japan. E-mail address for H. Sugaya:
| | - Yusuke Ueda
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi 2740822, Japan. E-mail address for H. Sugaya:
| | - Shota Hoshika
- Shoulder and Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi 2740822, Japan. E-mail address for H. Sugaya:
| | - Nobuto Kitamura
- Department of Sports Medicine and Joint Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 0608638, Japan. E-mail address for N. Kitamura: . E-mail address for K. Yasuda:
| | - Kazunori Yasuda
- Department of Sports Medicine and Joint Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 0608638, Japan. E-mail address for N. Kitamura: . E-mail address for K. Yasuda:
| | - Joji Moriishi
- Ichikawa Clinic, Funabashi Orthopaedic Hospital, 1-10-1-206 Ichikawa-minami, Ichikawa 2720033, Japan. E-mail address:
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Agrawal V, Pietrzak WS. Triple labrum tears repaired with the JuggerKnot™ soft anchor: Technique and results. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2015; 9:81-9. [PMID: 26288537 PMCID: PMC4528288 DOI: 10.4103/0973-6042.161440] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose: The 2-year outcomes of patients undergoing repair of triple labrum tears using an all-suture anchor device were assessed. Materials and Methods: Eighteen patients (17 male, one female; mean age 36.4 years, range: 14.2-62.3 years) with triple labrum tears underwent arthroscopic repair using the 1.4 mm JuggerKnot Soft Anchor (mean number of anchors 11.5, range: 9-19 anchors). Five patients had prior surgeries performed on their operative shoulder. Patients were followed for a mean of 2.0 years (range: 1.6-3.0 years). Constant–Murley shoulder score (CS) and Flexilevel scale of shoulder function (FLEX-SF) scores were measured, with preoperative and final postoperative mean scores compared with a paired Student's t-test (P < 0.05). Magnetic resonance imaging (MRI) was also performed at final postoperative. Results: Overall total CS and FLEX-SF scores increased from 52.9 ± 20.4 to 84.3 ± 10.7 (P < 0.0001) and from 29.3 ± 4.7 to 42.0 ± 7.3 (P < 0.0001), respectively. When divided into two groups by whether or not glenohumeral arthrosis was present at the time of surgery (n = 9 each group), significant improvements in CS and FLEX-SF were obtained for both groups (P < 0.0015). There were no intraoperative complications. All patients, including contact athletes, returned to their preinjury level of sports activity and were satisfied. MRI evaluation revealed no instances of subchondral cyst formation or tunnel expansion. Anchor tracts appeared to heal with fibrous tissue, complete bony healing, or combined fibro-osseous healing. Conclusion: Our results are encouraging, demonstrating a consistent healing of the anchor tunnels through arthroscopic treatment of complex labrum lesions with a completely suture-based implant. It further demonstrates a meaningful improvement in patient outcomes, a predictable return to activity, and a high rate of patient satisfaction. Level of Evidence: Level IV case series.
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Affiliation(s)
- Vivek Agrawal
- Department of Orthopedics, Marian University School of Medicine; The Shoulder Center, Carmel, IN 46032, USA
| | - William S Pietrzak
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
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Dwyer T, Petrera M, White LM, Chechik O, Wasserstein D, Chahal J, Veillette C, Ogilvie-Harris DJ, Theodoropoulos JS. Trans-subscapularis portal versus low-anterior portal for low anchor placement on the inferior glenoid fossa: a cadaveric shoulder study with computed tomographic analysis. Arthroscopy 2015; 31:209-14. [PMID: 25281478 DOI: 10.1016/j.arthro.2014.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 07/29/2014] [Accepted: 08/08/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the accuracy of inserting a glenoid anchor at the 5:30 clockface position using a trans-subscapularis (TSS) portal versus a low anterior (LA) portal. METHODS Five surgeons (T.D., J.C., C.V., D.J.O-H., J.S.T.) placed a single anchor in 20 fresh-frozen cadaveric shoulders. In each of 2 shoulders, surgeons used an LA portal to insert the anchor, whereas in 2 shoulders a TSS portal was used. Surgeons were directed to place the anchor at the 5:30 position at an angle 45° to the glenoid surface (axial plane) and passing perpendicular to the glenoid rim in the coronal plane. Shoulders were then dissected and computed tomographic (CT) scans obtained. Anchor position relative to the clockface was documented by 2 blinded assessors, as was the angle of insertion in the axial and coronal planes. Statistical significance was calculated with a Student t test for paired samples (confidence interval [CI], 95%; significance, P < .05). RESULTS The average deviation from the 5:30 position was 48 minutes (standard deviation [SD], 31 minutes) for the LA portal (average position, 4:42 o'clock) versus 28.5 minutes (SD, 19 minutes) for the TSS group (average position, 5:02 o'clock) (P = .15). The average angle of anchor insertion in the axial plane was 67.2° (SD, 19°) for the LA portal versus 62.8° (SD, 14°) for the TSS portal (P = .49), whereas the average angle of insertion in the coronal plane was 31.3° (SD, 14°) of inferior angulation in the LA group and 14.3° (SD, 8°) of inferior angulation in the TSS group (P = .009). Of the anchors inserted, 9 of 20 (45%) showed evidence of far-cortical perforation. No difference in cortical perforation was seen between the 2 portals, with perforation more likely with anchors inserted greater than 45° in the axial plane (8 of 20) than with those inserted less than 45° (1 of 20) (P = .02). CONCLUSIONS The use of a TSS portal improves the angle of approach to the inferior glenoid rim in comparison with an LA portal, reducing the acuity of the angle of insertion in the coronal plane. CLINICAL RELEVANCE The TSS portal is an option for surgeons performing arthroscopic Bankart repair using anchors low on the glenoid rim.
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Affiliation(s)
- Tim Dwyer
- University of Toronto Orthopaedic Sports Medicine Program, Mount Sinai Hospital and Women's College Hospital, Toronto, Ontario, Canada.
| | - Massimo Petrera
- University of Toronto Orthopaedic Sports Medicine Program, Mount Sinai Hospital and Women's College Hospital, Toronto, Ontario, Canada
| | - Lawrence M White
- University of Toronto Orthopaedic Sports Medicine Program, Mount Sinai Hospital and Women's College Hospital, Toronto, Ontario, Canada
| | - Ofir Chechik
- University of Toronto Orthopaedic Sports Medicine Program, Mount Sinai Hospital and Women's College Hospital, Toronto, Ontario, Canada
| | - David Wasserstein
- University of Toronto Orthopaedic Sports Medicine Program, Mount Sinai Hospital and Women's College Hospital, Toronto, Ontario, Canada
| | - Jaskarndip Chahal
- University of Toronto Orthopaedic Sports Medicine Program, Mount Sinai Hospital and Women's College Hospital, Toronto, Ontario, Canada
| | - Christian Veillette
- University of Toronto Orthopaedic Sports Medicine Program, Mount Sinai Hospital and Women's College Hospital, Toronto, Ontario, Canada
| | - Darrell J Ogilvie-Harris
- University of Toronto Orthopaedic Sports Medicine Program, Mount Sinai Hospital and Women's College Hospital, Toronto, Ontario, Canada
| | - John S Theodoropoulos
- University of Toronto Orthopaedic Sports Medicine Program, Mount Sinai Hospital and Women's College Hospital, Toronto, Ontario, Canada
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Frank RM, Mall NA, Gupta D, Shewman E, Wang VM, Romeo AA, Cole BJ, Bach BR, Provencher MT, Verma NN. Inferior suture anchor placement during arthroscopic Bankart repair: influence of portal placement and curved drill guide. Am J Sports Med 2014; 42:1182-9. [PMID: 24576744 DOI: 10.1177/0363546514523722] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND During arthroscopic Bankart repair, inferior anchor placement is critical to a successful outcome. Low anterior anchors may be placed with a standard straight guide via midglenoid portal, with a straight guide with trans-subscapularis placement, or with curved guide systems. Purpose/ HYPOTHESIS To evaluate glenoid suture anchor trajectory, position, and biomechanical performance as a function of portal location and insertion technique. It is hypothesized that a trans-subscapularis portal or curved guide will improve anchor position, decrease risk of opposite cortex breach, and confer improved biomechanical properties. STUDY DESIGN Controlled laboratory study. METHODS Thirty cadaveric shoulders were randomized to 1 of 3 groups: straight guide, midglenoid portal (MG); straight guide, trans-subscapularis portal (TS); and curved guide, midglenoid portal (CG). Three BioRaptor PK 2.3-mm anchors were inserted arthroscopically, with an anchor placed at 3, 5, and 7 o'clock. Specimens were dissected with any anchor perforation of the opposite cortex noted. An "en face" image was used to evaluate actual anchor position on a clockface scale. Each suture anchor underwent cyclic loading (10-60 N, 250 cycles), followed by a load-to-failure test (12.5 mm/s). Fisher exact test and mixed effects regression modeling were used to compare outcomes among groups. RESULTS Anchor placement deviated from the desired position by 9.9° ± 11.4° in MG specimens, 11.1° ± 13.8° in TS, and 13.1° ± 14.5° in CG. After dissection, opposite cortex perforation at 5 o'clock occurred in 50% of MG anchors, 0% of TS, and 40% of CG. Of the 90 anchors tested, 17 (19%) failed during cyclic loading, with a similar failure rate across groups (P = .816). The maximum load was significantly higher for the 3-o'clock anchors when compared with the 5-o'clock anchors, regardless of portal or guide (P = .021). For the 5-o'clock position, there were significantly fewer "out" anchors in the TS group versus the CG or MG group (P = .038). There was no statistically significant difference in maximum load among groups at 5 o'clock. CONCLUSION Accuracy in suture anchor placement during arthroscopic Bankart repair can vary depending on both portal used and desired position of anchor. The results of the current study indicate that there was no difference in ultimate load to failure among anchors inserted via a midglenoid straight guide, midglenoid curved guide, or percutaneous trans-subscapularis approach. However, midglenoid portal anchors drilled with a straight or curved guide and placed at the 5-o'clock position had significant increased risk of opposite cortex perforation compared with trans-subscapularis percutaneous insertion, with no apparent biomechanical detriment. CLINICAL RELEVANCE The findings from this study will facilitate improved understanding of risks and benefits of several techniques for arthroscopic shoulder instability treatment with regard to suture anchor fixation.
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Affiliation(s)
- Rachel M Frank
- Rachel M. Frank, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 200, Chicago, IL 60612, USA.
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Bruce B, Gupta A, Hussey K, Butty D, Cole BJ. Arthroscopic Bankart Repair With Knotless Anchors in the Lateral Decubitus Position. OPER TECHN SPORT MED 2013. [DOI: 10.1053/j.otsm.2013.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Harris JD, Romeo AA. Arthroscopic Management of the Contact Athlete with Instability. Clin Sports Med 2013; 32:709-30. [DOI: 10.1016/j.csm.2013.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gupta AK, McCormick FM, Abrams GD, Harris JD, Bach BR, Romeo AA, Verma NN. Arthroscopic bony bankart fixation using a modified sugaya technique. Arthrosc Tech 2013; 2:e251-5. [PMID: 24265994 PMCID: PMC3834646 DOI: 10.1016/j.eats.2013.02.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 02/27/2013] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic fixation of bony Bankart lesions in the setting of anterior shoulder instability has had successful long-term results. Key factors such as patient positioning, portal placement, visualization, mobilization of bony/soft tissues, and anatomic reduction and fixation are crucial to yield such results. We present a modified Sugaya technique that is reproducible and based on such key principles. This technique facilitates ease of anchor and suture placement to allow for anatomic reduction and fixation.
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Affiliation(s)
- Anil K. Gupta
- Address correspondence to Anil K. Gupta, M.D., M.B.A., Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, U.S.A.
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Cvetanovich GL, McCormick F, Erickson BJ, Gupta AK, Abrams GD, Harris JD, Romeo AA, Bach BR, Provencher MT. The posterolateral portal: optimizing anchor placement and labral repair at the inferior glenoid. Arthrosc Tech 2013; 2:e201-4. [PMID: 24265983 PMCID: PMC3834628 DOI: 10.1016/j.eats.2013.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 02/15/2013] [Indexed: 02/03/2023] Open
Abstract
The Bankart lesion is considered the critical lesion in anterior shoulder instability, in which the anteroinferior glenoid labrum separates from the glenoid rim. Technical advances in arthroscopy have ushered in a shift from open to arthroscopic Bankart repair. When one is performing an arthroscopic Bankart repair, proper portal placement is critical for success in labral preparation and anchor placement. Frequently, standard anterior portals are insufficient for inferior glenoid anchor placement and suture shuttling. The posterolateral portal-located 4 cm lateral to the posterolateral corner of the acromion-simplifies and improves anchor placement, trajectory, and anatomic capsulolabral repair of the inferior glenoid. We present our preferred technique for capsulolabral repair of the inferior glenoid.
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Affiliation(s)
- Gregory L. Cvetanovich
- Rush Sports Medicine, Midwest Orthopaedics, Chicago, Illinois, U.S.A.,Address correspondence to Gregory L. Cvetanovich, M.D., The Orthopedic Building at Rush University Medical Center, 1611 W Harrison St, Ste 201, Chicago, IL 60612, U.S.A.
| | - Frank McCormick
- Rush Sports Medicine, Midwest Orthopaedics, Chicago, Illinois, U.S.A
| | | | - Anil K. Gupta
- Rush Sports Medicine, Midwest Orthopaedics, Chicago, Illinois, U.S.A
| | - Geoff D. Abrams
- Rush Sports Medicine, Midwest Orthopaedics, Chicago, Illinois, U.S.A
| | - Joshua D. Harris
- Rush Sports Medicine, Midwest Orthopaedics, Chicago, Illinois, U.S.A
| | - Anthony A. Romeo
- Rush Sports Medicine, Midwest Orthopaedics, Chicago, Illinois, U.S.A
| | - Bernard R. Bach
- Rush Sports Medicine, Midwest Orthopaedics, Chicago, Illinois, U.S.A
| | - Matthew T. Provencher
- Sports Medicine Department, Naval Medical Center San Diego, San Diego, California, U.S.A
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Abstract
The authors describe an arthroscopic surgical technique for posterior capsulolabral repair using standard portals while patients are in the beach-chair position. The technique is unique in that the suture anchors are inserted from a superior-to-inferior direction instead of the traditional posterolateral-to-anteromedial direction. It involves the use of a posterolateral or mid-lateral portal through the rotator cuff for suture anchor insertion while viewing from the standard anterior portal. The technique avoids the risk of articular cartilage damage or glenoid rim fracture due to skiving during suture anchor insertion from a posterior or accessory posterior portal.
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Affiliation(s)
- Shital N Parikh
- Division of Orthopedic Surgery , Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA.
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Inferior anchor cortical perforation with arthroscopic Bankart repair: a cadaveric study. Arthroscopy 2013; 29:31-6. [PMID: 23276411 DOI: 10.1016/j.arthro.2012.08.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 08/08/2012] [Accepted: 08/08/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The aims of this study were to evaluate the incidence of anchor penetration of the far cortex of the glenoid neck after arthroscopic Bankart repair and to compare the biomechanical properties of anchors in the 4- and 5:30- to 6-o'clock positions on the glenoid. METHODS Twelve (6 matched pairs) fresh-frozen human cadaveric shoulders were used to simulate arthroscopic Bankart repair in the lateral decubitus position. The most inferior anchor (5:30 to 6 o'clock) and that above it (4 o'clock) were inserted via the anteroinferior portal on the glenoid using the standard technique. After both anchor insertions, anchor perforation of the glenoid far cortex was identified. Biomechanical properties were measured to determine cyclic displacement of anchors at 100 and 500 cycles, stiffness, yield load, and ultimate failure strength. RESULTS All 12 suture anchors (100%) at 5:30 to 6 o'clock penetrated throughout the far cortex, whereas only 4 anchors (33%) at 4 o'clock did so (P = .005). The mean distance the anchor tip traveled into far cortex was significantly longer at 5:30 to 6 o'clock than at 4 o'clock (6.8 ± 1.6 mm v 2.0 ± 1.6 mm, P = .001). In terms of mechanical strength, anchors at 5:30 to 6 o'clock had greater 100- and 500-cycle mean displacements than those at 4 o'clock (3.0 ± 0.5 mm v 2.5 ± 0.3 mm, P = .018 for 100 cycles; 3.5 ± 0.7 mm v 2.8 ± 0.3 mm, P = .018 for 500 cycles), although no differences in ultimate failure strength after cyclic loading were found between 2 positions (133.4 ± 40.3 and 133.7 ± 29.2 N, respectively; P = .985). CONCLUSIONS For arthroscopic Bankart repair, insertion of the most inferior anchor via the anteroinferior portal with standard technique, in the lateral decubitus position, carries a high risk of perforating the inferior far cortex of the glenoid (100% in our study). This may result in mechanical weakness of the most inferior repair specifically in the early postoperative period. CLINICAL RELEVANCE Perforation of the glenoid far cortex by the most inferior anchor and its mechanical weakness should be taken into consideration. Further study is needed to improve surgical technique to place the most inferior anchor in an optimal position by arthroscopy.
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The current issue: clinical shoulder, knee, wrist, hip, and cost-effectiveness analysis. Arthroscopy 2011; 27:1313-6. [PMID: 21955391 DOI: 10.1016/j.arthro.2011.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 07/07/2011] [Indexed: 02/02/2023]
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Tischer T, Vogt S, Kreuz PC, Imhoff AB. Arthroscopic anatomy, variants, and pathologic findings in shoulder instability. Arthroscopy 2011; 27:1434-43. [PMID: 21871774 DOI: 10.1016/j.arthro.2011.05.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 04/22/2011] [Accepted: 05/31/2011] [Indexed: 02/02/2023]
Abstract
Shoulder instability is a common diagnosis that often requires surgical treatment. A detailed knowledge of the shoulder anatomy and its stabilizing structures is of utmost importance for successful treatment of shoulder instabilities. Identifying anatomic variants (e.g., sublabral hole, meniscoid labrum, cordlike middle glenohumeral ligament, and Buford complex) and distinguishing them from pathologic findings may be especially difficult, as shown by the high interobserver variability. Over the last decade, basic research and arthroscopic surgery have improved our understanding of the shoulder anatomy and pathology. In the context of shoulder instability, injuries of the glenoid (bony Bankart), injuries of the glenoid labrum superiorly (SLAP) or anteroinferiorly (e.g., Bankart, anterior labroligamentous periosteal sleeve avulsion, and Perthes), capsular lesions (humeral avulsion of the glenohumeral ligament), accompanying cartilage lesions (Hill-Sachs, glenolabral articular disruption), and rotator interval and pulley lesions, as well as signs of dynamic instability impingement (posterior-superior impingement, anterior-superior impingement) can be exactly diagnosed (magnetic resonance imaging with intra-articular gadolinium, arthroscopy) and treated (arthroscopy). Therefore the purpose of this article is to review the current literature concerning shoulder anatomy/pathology related to shoulder stability/instability to improve clinical diagnosis and surgical treatment of our patients.
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Affiliation(s)
- Thomas Tischer
- Department of Orthopaedic Surgery, University of Rostock, Rostock, Germany
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[Advances in arthroscopic capsular labrum repair in ventral shoulder instability]. DER ORTHOPADE 2010; 40:31-4, 36-40. [PMID: 21181399 DOI: 10.1007/s00132-010-1677-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Current data show that the majority of patients in Germany with shoulder instability caused by soft tissue lesions are treated arthroscopically. The published redislocation rates in retrospective studies are less than 10%. Currently most surgeons prefer to use special strong suture materials and bioabsorbable suture anchors with a trend for knotless anchors. Some authors have published special techniques for labrum repair including double row fixation to increase the pull out force of the sutures but further prospective studies are necessary to prove whether these techniques can reduce the redislocation rate. In cases of extended anterior pouch of the capsule and in non-traumatic instability, capsular plication and interval closure can be indicated. There are still no clear objective parameters concerning indications or amount of plication and interval closure.
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