Recurrent Instability After Arthroscopic Bankart Reconstruction: A Systematic Review of Surgical Technical Factors

Knot-Tying versus Knotless Suture Anchors for Arthroscopic Bankart Repair: A Comparative Study

PURPOSE

This study aimed to compare the results of using knotless and knot-tying suture anchors in arthroscopic Bankart repair.

MATERIALS AND METHODS

The patients who underwent arthroscopic Bankart repair between 2011 and 2017 using knot-tying and knotless suture anchors were retrospectively reviewed. We collected demographic data, clinical scores (pain visual analogue scale), functional visual analogue scale, American Shoulder and Elbow Society scores, and Rowe score), and range of motion (ROM). Re-dislocation and subjective anterior apprehension test rates between the two techniques were also analyzed.

RESULTS

Of the 154 patients who underwent arthroscopic Bankart repair, 115 patients (knot-tying group: n=61 and knotless group: n=54) were included in this study. Of the 115 patients, 102 were male and 13 were female. The mean patient age was 27 years (range: 17-60), and the mean follow-up period was 43 months (range: 24-99). There were no significant differences in the final clinical scores and ROM between the two groups. Re-dislocation was observed in 6 (9.8%) and 4 (7.3%) patients in the knot-tying and knotless groups, respectively. Apprehension was observed in 11 (18.0%) and 12 (22.2%) patients in the knot-tying and knotless groups, respectively. There were no significant differences between the two groups in regards to re-dislocation and anterior apprehension.

CONCLUSION

Re-dislocation rates and clinical scores were similar with the use of knotless and knot-tying suture anchors in arthroscopic Bankart repair after a minimal 2 year follow-up.

Comparable clinical outcomes using knotless and knot-tying anchors for arthroscopic capsulolabral repair in recurrent anterior glenohumeral instability at mean 5-year follow-up

PURPOSE

To compare rates of recurrent instability, revision surgery and functional outcomes following arthroscopic anterior capsulolabral repair for recurrent anterior instability using knot-tying versus knotless suture anchor techniques.

METHODS

 Patients who had undergone arthroscopic anterior labrum and capsular repair for recurrent anterior glenohumeral instability using knotless anchors were identified. Those with minimum 2-year follow-up were matched (1:2) to knot-tying anchor repair patients. Rates of failure and recurrent instability were compared, as well as Visual Analog Scale (VAS), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), University of California Los Angeles (UCLA) and Rowe scores.

RESULTS

One hundred and two patients (89 males, 13 females) with a mean age of 24.3 ± 9.6 were included. Repair was performed with knotless anchors in 34 and knot-tying anchors in 68 shoulders. At mean follow-up of 4.8 ± 2.5 years, re-dislocation rates between groups were not significantly different (knotless anchor: 9% versus knot-tying group: 15%, n.s.), but the knot-tying group showed a higher re-subluxation rate (p = 0.039). 12 (18%) revisions were performed in the knot-tying group at a mean 2.9 years after surgery and 1 (3%) revision in the knotless anchors group at 1.4 years (n.s.). There was no difference in mean VAS with use (1.3 ± 1.9 versus 0.8 ± 1.5, n.s.), SANE scores (91.8 ± 12.7 versus 92.0 ± 11.0, n.s.), QuickDASH scores (4.1 ± 5.5 versus 3.0 ± 6.5, n.s.), UCLA Shoulder Score (32.5 ± 3.6 versus 33.2 ± 3.1, n.s.), or Rowe scores (90.5 ± 18.5 versus 92.2 ± 16.6, n.s.) between knotless and knot-tying groups, respectively. VAS at rest was higher in the knotless group (0.7 ± 1.5 vs 0.1 ± 0.4, p = 0.021).

CONCLUSIONS

Knotless anchors demonstrated similar rates of re-dislocation and revision surgery, and lower rates of recurrent subluxation, compared to knot-tying anchors. Patients achieved good-to-excellent functional outcomes. This supports the efficacy of knotless anchors as an alternative to knot-tying anchors for arthroscopic anterior labral repair of recurrent anterior shoulder dislocation.

LEVEL OF EVIDENCE

III.

Recurrent Instability after Arthroscopic Glenoid Labral Repair with a Minimum of Three Points of Fixation: Do the Number of Anchors or Fixation Points Correlate to Outcomes?

INTRODUCTION

The goal of this study was to evaluate the recurrence rate of instability following arthroscopic Bankart repairs in regard to the number and types of fixation utilized. A Bankart lesion is a tear in the anteroinferior capsulolabral complex within the shoulder, occurring in association with an anterior shoulder dislocation. These injuries can result in glenoid bone loss, decreased range of motion, and recurrent shoulder instability. Successful repair of these lesions has been reported in the literature with repair constructs that have three points of fixation. However, the definition of "one point of fixation" is yet to be fully elucidated.

MATERIALS AND METHODS

A consecutive series of arthroscopically repaired Bankart lesions were evaluated pertaining to the points of fixation required to achieve shoulder stability. This included the number, position, and types of anchors used. Patients consented to complete a series of surveys at a minimum of two years postoperatively. The primary outcome was to determine recurrent instability via the UCLA Shoulder Score, the ROWE Shoulder Instability Score, and the Oxford Shoulder Score. A secondary outcome included pain on a Visual Analog Scale (VAS).

RESULTS

There were 116 patients reviewed, 46 patients achieved three points of fixation in their surgical repair via two anchors and 70 patients achieved a similar fixation with three or more anchors. There was no significant difference in the mean age, gender, or body mass index (BMI). Patients receiving two anchors demonstrated recurrent instability 8.7% of the time (4 of 46 patients). Patients who received three or more anchors demonstrated recurrent instability 8.6% of the time (6 of 70 patients). Overall, there was no statistical significance between the number/types of anchors used. Between the two cohorts, there was no statistically significant difference found between VAS, ROWE, UCLA, and Oxford Scores. There was a significant difference in pain reported on the VAS scale with an average VAS score of 0.43 versus 2.5 in those without and with recurrent instability respectively.

CONCLUSION

Contention still exists surrounding the exact definition of "a point of fixation" in arthroscopic Bankart repairs. Three-point constructs can be created through a variety of combinations including anchors and sutures, ultimately achieving the goal of a stable shoulder.

Comparison between all-suture and biocomposite anchors in the arthroscopic treatment of traumatic anterior shoulder instability: A retrospective cohort study

Purpose

Suture anchors have revolutionized arthroscopic surgery, enabling direct soft tissue-to-bone repair. There are many types of anchors still used in arthroscopic shoulder operations. We sought to compare the clinical outcome of all-suture and biocomposite anchors when used in arthroscopic Bankart repair for patients suffering from anterior shoulder instability.

Methods

A single-center retrospective cohort study of 30 patients (mean age: 26.6 years, SD: 8.8 years, male/female ratio: 5/1, mean follow up: 28 months, SD: 23.8, range: 12-92) with anterior shoulder instability was conducted. Patients were divided into 2 groups based upon the type of suture anchors used for the Bankart repair: group A (14 patients) used only all-suture anchors and group B (16 patients) used only biocomposite anchors. Outcomes reported were postoperative dislocations, positive shoulder apprehension test, self-reported sense of shoulder instability, return to activities of daily living, return to sports, patient satisfaction and complications. Patient reported outcome measures (PROMs) used were the Rowe Score for Instability, Constant Shoulder Score, Walch Duplay Score, The American Shoulder and Elbow Surgeons (ASES) Shoulder Score, Oxford Shoulder Instability Score and external rotation at 90° of arm abduction, external rotation at 0° of arm abduction, forward flexion, abduction, adduction and internal rotation.

Results

Rates of postoperative shoulder dislocation demonstrated no significant difference between the 2 groups (p > .05). Four postoperative dislocations happened, two in each group (14.3% and 12.5% for all suture only and biocomposite only groups, respectively), with three of them being traumatic. In addition, no significant differences were observed amongst groups regarding shoulder apprehension test (group A: 85.7% vs. group B: 93.8%), sense of shoulder instability (7.1% vs. 6.3%), return to activities of daily living (group A: 85.7% vs. group B: 93.8%), return to sports (group A: 85.7% vs. group B: 87.5%), patient satisfaction (moderate level: group A 21.4% vs. group B 12.5%), and PROMs.

Conclusion

The short-term failure rate and clinical/functional outcomes of arthroscopic Bankart repair using all-suture anchors is similar to the use of biocompatible anchors.

Level of evidence

Level III, retrospective cohort study.

Functional outcome and tendon integrity of rotator cuff reconstruction after primary traumatic glenohumeral dislocation

INTRODUCTION

Rotator cuff tears (rct) subsequent to glenohumeral dislocation are relevant concomitant injuries, can lead to impaired shoulder function and increase risk of recurrent dislocation.

AIM

The aim of this study was to determine the functional outcome, recurrent dislocation rate and tendon integrity after rotator cuff repair after primary traumatic shoulder dislocation.

MATERIALS AND METHODS

In this retrospective case series, 23 patients (age 56.4 years ± 6.3) who underwent a rotator cuff reconstruction after primary traumatic shoulder dislocation with confirmed combination of full-thickness RCT and Bankart lesion were enrolled after a minimum follow-up of 2 years. Clinical outcome (age and gender adjusted Constant Murley Score (CMS), DASH, Rowe Score) (n = 23) and sonographic tendon integrity (n = 19) were studied.

RESULTS

After a mean follow-up of 58 ± 32 months, a CMS of 85.1% ± 14.7, DASH of 14.2 ± 20.5, and Rowe Score of 82.4 ± 15.2 indicated good functional outcome. In 4 of 19 patients (21.1%) a re-tear was found during sonographic evaluation. In 3 cases (13%), a revision was performed (2 × stiff shoulder, 1 × postoperative infection). One patient had a single traumatic re-dislocation (4.3%).

CONCLUSIONS

Patients undergone reconstruction of the rotator cuff following a primary traumatic shoulder dislocation can achieve good functional results and a low rate of recurrent dislocation. Postoperative tendon integrity is comparable with known data about non traumatic tears.

Arthroscopic stabilisation for shoulder instability

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.

Management of Recurrent Anterior Shoulder Instability After Surgical Stabilization in Children and Adolescents

PURPOSE OF REVIEW

Recurrent shoulder instability after stabilization is common in pediatric and adolescent athletes. The purpose of this review is to understand the risk factors that lead to failure of primary surgery and management principles in the setting of recurrent instability following surgical stabilization.

RECENT FINDINGS

Rates of recurrence after primary and revision surgical stabilization remain higher than desirable. Risk factors for failure in include glenoid and humeral bone loss, capsular or ligamentous laxity, and young age though few studies have focused specifically on the adolescent population. Arthroscopic, open, and bone block techniques have been described in this population similar to adults. Failure after a primary shoulder stabilization remains a common problem in adolescents in no small part because a high proportion of these athletes return to high levels of activity. A thorough understanding of the index procedure and patient-specific risk factors for failure are key to successful planning of revision surgery. The current literature does not allow for firm treatment recommendations in individual pediatric or adolescent athletes, but the guiding principles are similar to those in adults. Specifically, all bony and soft tissue pathology should be identified and assessed, with an understanding that simply repeating the steps of the index procedure typically results in poor outcomes, and often an "escalation" of surgical complexity is required at the time of revision. When appropriately indicated, arthroscopic or open soft tissue procedures and Latarjet coracoid transfer can be safely and successfully implemented for revision shoulder stabilization in young athletes.