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Rajagopalan S, Chodavarapu MN, Kambhampati SB, Chinta SK, Kamineni S. Anterior Labrum Periosteal Sleeve Avulsion Lesions of the Shoulder: A Scoping Review. Orthop J Sports Med 2024; 12:23259671241258198. [PMID: 39183972 PMCID: PMC11344249 DOI: 10.1177/23259671241258198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/01/2024] [Indexed: 08/27/2024] Open
Abstract
Background Anterior labrum periosteal sleeve avulsion (ALPSA) lesion of the shoulder is defined as a labral avulsion with an intact periosteum of the glenoid neck resulting in medial malattachment of the labrum, which is both nonanatomic and nonfunctional. It is relatively rare compared with Bankart lesions, and its results are usually reported in combination with other anterior labroligamentous lesions in the literature. Purpose To (1) assess the size and scope of the literature on ALPSA lesions, (2) highlight the importance of this lesion, and (3) distinguish between ALPSA and Bankart lesions in diagnostic and treatment strategies. Study Design Scoping review; Level of evidence, 4. Methods The PubMed, Scopus, Embase, and Google Scholar databases were searched with the keywords "ALPSA,""anterior labrum periosteal sleeve avulsion,""anterior labral periosteal sleeve avulsion," and "anterior labroligamentous periosteal sleeve avulsion" lesion. Duplicate articles and those that did not meet the inclusion criteria were excluded, resulting in the identification of 42 relevant articles. Their references were analyzed for further data curation. Results This scoping review demonstrated that ALPSA lesions are difficult to clinically identify. Magnetic resonance angiography in the adduction internal rotation position is the most sensitive and specific imaging modality for identification. Optimal views are the anterosuperior portal for accurate identification and the anteroinferior portal for surgical repair during arthroscopy. Treatment begins with correctly identifying the labrum, in contradistinction to dense reactive fibrous tissue, and reattaching the labrum to the correct anatomic glenoid footprint. Chronic lesions with bone loss require either bone block or soft tissue augmentation procedures. Conclusion There is paucity of exclusive literature on ALPSA lesions. It is important to distinguish this lesion from the Bankart lesion as it is associated with worse outcomes. The higher failure rates of ALPSA lesion repair indicate that the current repair techniques require further refinement to improve the outcomes to the standard of Bankart lesions.
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Affiliation(s)
| | | | | | | | - Srinath Kamineni
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
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Cheng X, Wang H, Jiang Y, Shao Z, Cui G. The New Double-row Bankart Repair Recovered Shoulder Stability without Excessive Motion Limitation: A Case-Control Study with Single-row Bankart Repair. Orthop Surg 2024; 16:1073-1078. [PMID: 38488263 PMCID: PMC11062857 DOI: 10.1111/os.14032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVES Bankart lesion is one of the most common lesions of the glenohumeral joint. Several double-row suture methods were reported for Bankart repair, which could provide more stability, yet more motion limitation and complications. Therefore, we introduced a new double-row Bankart repair technique, key point double-row suture which used one anchor in the medial line. The purpose of this article is to investigate the clinical outcomes of this new method and to compare it with single-row suture. METHODS Seventy-eight patients receiving key point double-row suture or single-row suture from October 2010 to June 2014 were collected retrospectively. The basic information including gender, age, dominant arm, and number of episodes of instability was collected. Before surgery, the glenoid bone loss was measured from the CT scan. The visual analogue scale, American shoulder and elbow surgeons, the University of California at Los Angeles shoulder scale, and subjective shoulder value were valued before surgery and at the last follow-up. RESULTS Forty-four patients (24 patients receiving single-row suture and 20 patients receiving key point double-row suture) were followed up successfully. The follow-up period was 9.2 ± 1.1 years (range, 7.8-11.4 years). At the last follow-up, no significant differences were detected for any of the clinical scores. The recurrence rate was 12.5% for the single-row group and 10% for the double-row group, respectively (p = 0.795) 14 patients (31.8%) in the single-row group and nine patients (26.5%) in the double-row group were tested for active range of motion. A statistically significant difference was found only for the internal rotation at 90° abduction (48.9° for single-row and 76.7° for key point double-row, p = 0.033). CONCLUSION The key point double-row sutures for Bankart lesions could achieve similar long-term outcomes compared with single-row suture, and one medial anchor did not result in a limited range of motion. The low recurrence rate and previous biomechanical results also indicate the key point double-row suture is a reliable method.
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Affiliation(s)
- Xu Cheng
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Hangle Wang
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Yanfang Jiang
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Zhenxing Shao
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
| | - Guoqing Cui
- Department of Sports MedicinePeking University Third Hospital, Institute of Sports Medicine of Peking UniversityBeijingChina
- Beijing Key Laboratory of Sports InjuriesBeijingChina
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of EducationBeijingChina
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Itoigawa Y, Uehara H, Koga A, Morikawa D, Kawasaki T, Shiota Y, Maruyama Y, Ishijima M. Arthroscopic Bankart repair with additional footprint fixation using the double-row technique at the 4 o'clock position anatomically restored the capsulolabral complex and showed good clinical results. Knee Surg Sports Traumatol Arthrosc 2022; 30:3827-3834. [PMID: 35428941 DOI: 10.1007/s00167-022-06974-9] [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: 09/10/2021] [Accepted: 03/29/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the clinical outcome and magnetic resonance imaging (MRI) findings after arthroscopic Bankart repair with additional double anchor footprint fixation (DAFF) at the 4 o'clock position, where the native footprint is widest anatomically, for recurrent anterior shoulder instability. METHODS Forty-two patients (mean age 27.0 years) with recurrent anterior shoulder instability and without severe glenoid bone defects underwent arthroscopic Bankart repair with additional DAFF at the 4 o'clock position. Using three standard portals, single-row repair was performed at the 2, 3, and 5 o'clock positions, and DAFF with the suture bridging technique was conducted at the 4 o'clock position. MRI was performed preoperatively and at 6 months postoperatively. Patients with follow-up periods of ≥1 year were included in the present study and clinically evaluated at the final follow-up. The morphology at the 2 and 4 o'clock positions on radial MRI slices was compared between the preoperative and 6-month postoperative scans, and the footprint of the repaired capsulolabral complex at 6 months postoperatively was compared between the 2 and 4 o'clock positions. RESULTS The average follow-up period was 19.5 ± 6.2 months. The rates of dislocation recurrence and positive apprehension test results were 2.4 and 4.8%, respectively. External rotation was restricted by 3.5°. The University of California at Los Angeles and Rowe scores at the final follow-up were 34.5 ± 1.0 points and 97.2 ± 5.7 points, respectively, representing significant improvements over the preoperative scores (p < 0.01). Although the capsulolabral complex at 6 months postoperatively was firmly repaired at both the 2 and 4 o'clock positions compared to its preoperative state, the footprint of the restored capsulolabral complex was wider at the 4 o'clock position than at the 2 o'clock position (p < 0.01). CONCLUSIONS Additional DAFF at the 4 o'clock position improved the glenohumeral stability and function of the shoulder joint. This study suggests that this technique is a reliable and useful treatment for shoulder instability. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yoshiaki Itoigawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.
| | - Hirohisa Uehara
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Akihisa Koga
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Daichi Morikawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Takayuki Kawasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yuki Shiota
- Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Yuichiro Maruyama
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
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Arner JW, Cooper JD, Elrick BP, Rakowski DR, Ruzbarsky JJ, Horan MP, Millett PJ. Outcomes of Arthroscopic Anterior Labroligamentous Periosteal Sleeve Avulsion Lesions: A Minimum 2-Year Follow-up. Am J Sports Med 2022; 50:1512-1519. [PMID: 35416079 DOI: 10.1177/03635465221090902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions can occur in recurrent anterior shoulder instability, which may lead to the labrum scarring medially to the glenoid. ALPSA lesions have also been associated with greater preoperative dislocations, larger Hill-Sachs lesions, and greater degrees of glenoid bone loss. Therefore, patients with these lesions have historically had a higher failure rate after repair, with nearly double the recurrent instability rate compared with those undergoing standard arthroscopic Bankart repair. PURPOSE To compare minimum 2-year outcomes of arthroscopic mobilization and anatomic repair of ALPSA lesions with those after standard arthroscopic Bankart repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Consecutive patients who underwent arthroscopic repair of ALPSA lesions were matched in a 1-to-3 fashion to patients who underwent standard Bankart repair by age, sex, number of previous ipsilateral shoulder instability surgical procedures, and number of anchors used. Patient-reported outcome (PRO) scores were compared preoperatively and postoperatively (American Shoulder and Elbow Surgeons [ASES]; 12-Item Short Form Health Survey [SF-12] Physical Component Summary [PCS]; Single Assessment Numeric Evaluation [SANE]; shortened version of Disabilities of the Arm, Shoulder and Hand; and satisfaction). Recurrent instability, on- versus off-track Hill-Sachs lesion, and reoperation rates were analyzed. RESULTS A total of 100 shoulders (25 ALPSA and 75 Bankart) with an overall mean age of 25.7 years were evaluated. Patients in the ALPSA group demonstrated significant improvements in the ASES (preoperative, 74.8; postoperative, 89.7; P = .041) and SF-12 PCS (preoperative, 46.9; postoperative, 53.4; P = .021) scores but not the SANE score (preoperative, 65.2; postoperative, 75.3; P = .311). Patients in the Bankart group had significant improvements in all outcome scores at final follow-up: ASES (preoperative, 67.1; postoperative, 90.3), SANE (preoperative, 58.0; postoperative, 85.7), and SF-12 PCS (preoperative, 45.3; postoperative, 52.9) (all P < .001). There were no significant differences in PRO scores between the groups preoperatively or postoperatively (P > .05). The median satisfaction for the ALPSA group was 10 of 10 and for the Bankart group it was 9 of 10 (P = .094). There was a significantly higher rate of recurrent dislocation in the ALPSA group (8/25 [32.0%]) compared with the Bankart group (10/75 [13.3%]) (P = .040). Additionally, 5 patients (20.0%) in the ALPSA group underwent revision surgery at a mean of 5.6 years, and 8 patients (10.7%) in the Bankart group underwent revision surgery at a mean of 4.4 years (P = .311). CONCLUSION Despite improvements in the recognition of and surgical techniques for ALPSA lesions, they still lead to significantly higher postoperative dislocation rates; however, no differences in PRO scores were found. These findings highlight the importance of early surgical interventions in anterior shoulder instability with the hope of lessening recurrent instability and the risk of developing an ALPSA lesion, as well as careful assessment of the quality of soft tissues and other risk factors for recurrence when considering what type of shoulder stabilization procedure to perform.
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Affiliation(s)
- Justin W Arner
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | | | - Joseph J Ruzbarsky
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | | | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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On-the-Edge Anchor Placement May Be Protective Against Glenoid Rim Erosion After Arthroscopic Bankart Repair Compared to On-the-Face Anchor Placement. Arthroscopy 2022; 38:1099-1107. [PMID: 34715278 DOI: 10.1016/j.arthro.2021.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE This retrospective study aimed to compare the effects of 2 different anchoring placements on glenoid rim erosion after arthroscopic Bankart repair (ABR). METHODS Shoulders that underwent ABR from January 2013 to July 2020 were divided into 2 groups according to anchor placement (on-the-face, group F; on-the-edge, group E). We retrospectively calculated the percent change of glenoid width (Δ) on the first postoperative computed tomography scan (CT; performed within 6 months) and second postoperative CT (performed at 6 to 12 months) relative to the width on the preoperative CT and compared percent changes between the 2 groups. Also, we investigated the influence of preoperative glenoid structures (normal, erosion, bony Bankart) and the postoperative recurrence rate. RESULTS We examined 225 shoulders in 214 patients (group F, n = 151; group E, n = 74). At first CT, anchoring placement was significantly associated with postoperative decrease of glenoid width (group F, -7.6% ± 7.9%; group E, -0.1% ± 9.7%; P < .0001). The difference between groups F and E was significant in shoulders with a preoperative glenoid defect (bony Bankart, -6.6% ± 8.8% vs 2.5% ± 11.2%, respectively; P < .0001; erosion, -6.6% ± 6.2% vs -2.6% ± 5.3%, respectively; P = .03). In 112 shoulders, CT was performed twice; Δ was -6.9% ± 7.3% in group F (n = 64) and -1.7% ± 10.1% in group E (n = 48; P = .005) at the first CT and -3.2% ± 10.0% and 1.0% ± 10.6% (P = .10), respectively, at the second CT, indicating recovery of glenoid width in both groups. The postoperative recurrence rate in patients with at least 2 years' follow-up was 14.7% in group F and 14.6% in group E. CONCLUSIONS In the early stage after ABR, on-the-edge glenoid anchor placement was associated with less glenoid rim erosion than on-the-face anchor placement. LEVEL OF EVIDENCE Level III, retrospective comparative trial.
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Lacheta L, Goldenberg BT, Horan MP, Millett PJ. Posterior bony Bankart bridge technique results in reliable clinical 2-year outcomes and high return to sports rate for the treatment of posterior bony Bankart lesions. Knee Surg Sports Traumatol Arthrosc 2021; 29:120-126. [PMID: 31707434 DOI: 10.1007/s00167-019-05783-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/29/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE To introduce the arthroscopic "posterior bony Bankart bridge" repair technique, and to report clinical outcomes, patient satisfaction, recurrent instability rate, and return to sport rate. METHODS Patients who were treated for posterior bony Bankart lesions with posterior bony Bankart bridge technique and were at least 2 years out from surgery were included. Clinical outcomes were assessed prospectively by the use of the American Shoulder and Elbow Surgeons (ASES) Score, Single Assessment Numerical Evaluation (SANE) Score, Quick Disabilities of the Arm, Shoulder and Hand (DASH) Score and patient satisfaction. Return to sports rate and complications were reported. RESULTS Seven patients with a median age of 23.5 (range 17-43) and a median follow-up of 8 years (range 3-10) were included. Median time from injury to surgery was 15 days (range 3 days-2.2 years). Mean glenoid bone defect was 19% (range 11-31%). At final follow-up the median postoperative outcome scores were: ASES score 100 (range 92-100), SANE score 99 points (range 94-99) and QuickDASH 2.2 points (range 0-9). Median satisfaction of all patients was 10/10 (range 9-10). One patient reported subjective recurrent subluxations, which resolved under physical therapy. No patient underwent further surgery. No complications were noticed. At final follow-up, all patients (100%) reported that their sports participation levels were equal to their pre-injury levels. CONCLUSION The arthroscopic posterior bony Bankart bridge technique leads to reliable postoperative shoulder function and restores shoulder stability with high patient satisfaction and low complication rate in this small patient cohort for the treatment of posterior bony Bankart lesions. Also, no recurrent dislocation was observed at a minimum follow-up of at least 3 years, one patient continued to complain of subjective subluxations which resolved under physical therapy. All patients were able to return to their pre-injury sports level. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Lucca Lacheta
- Steadman Philippon Research Institute, 181 West Meadow Drive Suite 1000, Vail, CO, 81657, USA.,Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Brandon T Goldenberg
- Steadman Philippon Research Institute, 181 West Meadow Drive Suite 1000, Vail, CO, 81657, USA
| | - Marilee P Horan
- Steadman Philippon Research Institute, 181 West Meadow Drive Suite 1000, Vail, CO, 81657, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, 181 West Meadow Drive Suite 1000, Vail, CO, 81657, USA. .,The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA.
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Benefits of bone graft augmentation to arthroscopic Bankart repair for recurrent anterior shoulder instability with glenoid bone loss. Knee Surg Sports Traumatol Arthrosc 2020; 28:2325-2333. [PMID: 31667568 DOI: 10.1007/s00167-019-05746-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Glenoid bone loss contributes to recurrent instability after arthroscopic Bankart repair alone. With significant glenoid bone loss, better results have been reported after arthroscopic Bankart repair with glenoid arc reconstruction. However, no reports compare augmentation using bone graft with non-augmentation for glenoid bone loss. The purpose of this study was to assess clinical results of an arthroscopic Bankart repair with or without arthroscopic bone graft augmentation. It was hypothesized that such bone graft augmentation would restore shoulder stability, and lead to excellent outcomes. METHODS Of 552 patients treated for anterior glenohumeral instability with arthroscopic Bankart repair, 68 met this study's inclusion criteria of glenoid bone loss over 20% and follow-up of at least 2 years. Patients were divided into 2 groups based on whether with bone graft augmentation for glenoid bone loss [Group A: n = 35, median age; 21 years (range 13-72 years)], or not (Group B: n = 33, median age; 21 years (range 13-50 years)]. For grafting, either autologous iliac bone or artificial bone made of hydroxyapatite was used. Rowe score, recurrence rate, and return to sport were used to assess the results. RESULTS Mean Rowe score was 95.0 (SD 10.6) in Group A and 69.7 (SD 27.2) in Group B (p < 0.05). The recurrence rate was 2.9% (1/36) in Group A and 48.5% (16/33) in Group B (p < 0.05). Regarding contact/collision athletes, 24 were contained in Group A and 22 in Group B. Of the patients with recurrence in Group B, 13 (59.1%) were contact/collision athletes. Finally, 50% of the contact/collision sports athletes for both groups returned to their sports at the same as pre-injury level. Of the 11 patients who returned to the same level of contact/collision sports in Group B, seven returned with residual instability. Nine athletes in Group A and 3 in Group B quit their sports for personal or social reasons. CONCLUSIONS Bone graft augmentation was beneficial when used with Arthroscopic Bankart repair for recurrent anterior shoulder instability with glenoid bone loss. Especially, for recurrent anterior shoulder instability with glenoid bone loss in contact/collision sports athletes, bone graft augmentation should be strongly considered as beneficial. LEVEL OF EVIDENCE Level IV.
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Anchor placement to glenoid rim during Bankart repair recreates contact area of anterior capsulolabral complex on glenoid better than onto articular surface. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1257-1262. [PMID: 32418057 DOI: 10.1007/s00590-020-02694-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study aimed to compare the contact areas of Bankart repair with suture anchors placed on the articular surface of the glenoid versus at the rim of the glenoid because it is unclear which technique most effectively restores the footprint after Bankart repair. METHODS Ten fresh frozen cadaveric shoulders (mean age 70.7 years) were dissected. The attachment site of the capsulolabral complex from the 1 o' clock position to the 6 o'clock position was marked with ink, and the contact area of the anterior-inferior capsulolabral complex on the glenoid neck was measured using imageJ. Bankart lesions were created, and two types of Bankart repair were performed on each specimen. The suture anchors were inserted at the glenoid rim (Rim group) and onto the glenoid articular surface 2 mm from the rim (Surface group). Using pressure-sensitive films, we examined the interface contact area. RESULTS The Rim group recreated 64.9% of the native surface area, while the Surface group recreated 47.3% of the area. The Rim group recreated significantly greater contact area compared to the Surface group (P = 0.0008). CONCLUSION The anchor placement to the glenoid rim recreates the footprint of the capsulolabral complex on the anterior inferior glenoid better than the anchor placement onto the articular surface.
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Arthroscopic Fixation of an Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) of the Shoulder. Arthrosc Tech 2020; 9:e553-e558. [PMID: 32368478 PMCID: PMC7189567 DOI: 10.1016/j.eats.2020.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/02/2020] [Indexed: 02/03/2023] Open
Abstract
Anterior labroligamentous periosteal sleeve avulsions represent a diagnostic and treatment challenge. They are associated with a higher number of preoperative dislocations, as well as longer chronicity, and commonly result in a scarred and medialized labrum and periosteal sleeve complex. Anterior labroligamentous periosteal sleeve avulsion lesions therefore may be commonly overlooked. The complexity of the injury pattern has been associated with double the failure rate of standard Bankart lesions after arthroscopic repair. The purpose of this article is to describe our preferred arthroscopic technique for achieving full mobilization of the labral-periosteal complex and restore it to its anatomic location using a knotless, all-suture anchor construct.
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10
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Progression of Erosive Changes of Glenoid Rim After Arthroscopic Bankart Repair. Arthroscopy 2020; 36:44-53. [PMID: 31708354 DOI: 10.1016/j.arthro.2019.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/02/2019] [Accepted: 07/10/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate changes of the glenoid after arthroscopic Bankart repair (ABR) in patients with different preoperative glenoid structures. METHODS Patients who underwent ABR for traumatic anterior shoulder instability were retrospectively investigated. They were divided into 3 groups on the basis of preoperative glenoid structure by computed tomography (CT): normal glenoid (group N), glenoid erosion (group E), or glenoid defect associated with a bony Bankart lesion (group B). Shoulders in group B were also stratified according to the postoperative status of the bone fragment (union, nonunion, or resorbed). Postoperative changes of glenoid width (Δ) (increase: Δ ≥5%, stable: Δ >-5% to <5%, decrease: Δ ≤-5%) and the extent of glenoid bone loss were investigated by 3-dimensional CT. RESULTS A total of 186 shoulders were divided into 3 groups: group N (n = 61), group E (n = 46), and group B (n = 79). At initial postoperative CT, the glenoid width was decreased in 41 shoulders, stable in 20 shoulders, and increased in no shoulders from group N. The respective numbers were 27, 18, and 1 in group E, and 50, 22, and 7 in group B. The glenoid width was reduced in all groups (mean percent change: -8.8%, -5.9%, and -6.1%, respectively). In group B, glenoid width decreased in most of the shoulders without bone union. The glenoid bone loss on the preoperative and postoperative final CT was, respectively, 0% and 8.6% in group N (P < .0001), 9.9% and 12.4% in group E (P = .03), and 10.4% and 7.2% in group B (P = .01). Final glenoid bone loss >13.5% was recognized in 18.2% of group N, 35.7% of group E, and 21.8% of group B. CONCLUSIONS Glenoid width often decreased after ABR because of anterior glenoid rim erosion, and this change was frequent in patients with preoperative normal glenoid, glenoid erosion, or without postoperative union of a bony Bankart lesion. LEVEL OF EVIDENCE Level 3, Case-control study.
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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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12
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Itoigawa Y, Hooke AW, Sperling JW, Steinmann SP, Zhao KD, Itoi E, An KN. The effect of subscapularis muscle contraction on coaptation of anteroinferior glenohumeral ligament-labrum complex after Bankart repair. J Biomech 2019; 85:134-140. [PMID: 30691988 DOI: 10.1016/j.jbiomech.2019.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/29/2018] [Accepted: 01/10/2019] [Indexed: 11/30/2022]
Abstract
Facilitation of healing is important for the anteroinferior glenohumeral ligament-labrum complex (AIGHL-LC) after Bankart repair in shoulder dislocation. The purpose of this study was to investigate the effect of subscapularis muscle loading on contact area and contact pressure between the subscapularis and AIGHL-LC and between the glenoid bone and the AIGHL-LC following Bankart repair. Twenty-two fresh-frozen cadaveric shoulders were used. They were attached to a shoulder-positioning device to which a compression force was applied. Loads applied to the supraspinatus, infraspinatus, and teres minor tendons were held constant. The loads applied to the subscapularis tendon were set at 0, 10, 20, and 30 Newton (N). Contact pressure and area between the subscapularis and the AIGHL-LC were measured with the arm at 4 rotational positions: 60° and 30° internal, neutral, and 30° external. After the Bankart lesion was created, the contact area and pressure between the AIGHL-LC and glenoid bone were measured while Bankart repair was performed with or without loading of the subscapularis. The contact area and pressures with 10, 20, and 30 N of subscapularis loadings were significantly greater than with 0 N of subscapularis loading at 60° internal rotation and 30° external rotation (P < .05). After Bankart repair, contact area and pressure with subscapularis loading between the AIGHL-LC and glenoid bone were significantly greater than without subscapularis loading (P < .01). We conclude that isometric contraction exercises of the subscapularis might facilitate healing of the AIGHL-LC after Bankart repair.
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Affiliation(s)
- Yoshiaki Itoigawa
- Division of Orthopedic Research, Mayo Clinic, Rochester, MN, United States
| | - Alexander W Hooke
- Division of Orthopedic Research, Mayo Clinic, Rochester, MN, United States
| | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Scott P Steinmann
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Kristin D Zhao
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kai-Nan An
- Division of Orthopedic Research, Mayo Clinic, Rochester, MN, United States.
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13
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Domos P, Ascione F, Wallace AL. Arthroscopic Bankart repair with remplissage for non-engaging Hill-Sachs lesion in professional collision athletes. Shoulder Elbow 2019; 11:17-25. [PMID: 30719094 PMCID: PMC6348582 DOI: 10.1177/1758573217728414] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The present study aimed to determine whether arthroscopic remplissage with Bankart repair is an effective treatment for improving outcomes for collision athletes with Bankart and non-engaging Hill-Sachs lesions. METHODS Twenty collision athletes underwent arthroscopic Bankart repair with posterior capsulotenodesis (B&R group) and were evaluated retrospectively, using pre- and postoperative WOSI (Western Ontario Shoulder Instability), EQ-5D (EuroQOL five dimensions), EQ-VAS (EuroQol-visual analogue scale) scores and Subjective Shoulder Value (SSV). The recurrence and re-operation rates were compared to a matched group with isolated arthroscopic Bankart repair (B group). RESULTS The mean age was 25 years with an mean follow-up of 26 months. All mean scores improved with SSV of 90%. There was a mean deficit in external rotation at the side of 10°. One patient was treated with hydrodilatation for frozen shoulder. One patient had residual posterior discomfort but no apprehension in the B&R group compared to 5% persistent apprehension in the B group. In comparison, the recurrence and re-operation rates were 5% and 30% (p = 0.015), 5% and 35% (p = 0.005) in the B&R and B groups, respectively. CONCLUSIONS This combined technique demonstrated good outcomes, with lower recurrence rates in high-risk collision athletes. The slight restriction in external rotation does not significantly affect any clinical outcomes and return to play.
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Affiliation(s)
- Peter Domos
- Department of Trauma and Orthopaedics, Northern General Hospital, Sheffield, UK,Peter Domos, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
| | - Francesco Ascione
- Department of Orthopedics, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Andrew L. Wallace
- Shoulder Unit, Hospital of St John and St Elizabeth and Fortius Clinic, London, UK
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14
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Karns MR, Epperson RT, Baran S, Nielsen MB, Taylor NB, Burks RT. Revisiting the Anterior Glenoid: An Analysis of the Calcified Cartilage Layer, Capsulolabral Complex, and Glenoid Bone Density. Arthroscopy 2018; 34:2309-2318. [PMID: 30078426 DOI: 10.1016/j.arthro.2018.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 03/02/2018] [Accepted: 03/03/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE In this cadaveric study, we aim to define the basic anatomy of the anterior glenoid with attention to the relationships of calcified cartilage, capsulolabral complex, and osseous morphology of the anterior glenoid. METHODS Seventeen cadaveric glenoid specimens (14 male, 3 female, mean age 53.9 ± 10) were imaged with micro-computed tomography (CT) and embedded in poly-methyl-methacrylate. Specimens were included for final analysis only if the entire glenoid articular cartilage, labrum, capsule, and biceps insertion were pristine and without evidence of injury, degeneration, or damage during the preparation process. Group 1 members (n = 9) were axially sectioned through 3 to 9 o'clock and 4 to 8 o'clock; group 2 members (n = 8) were radially sectioned through 3, 4, 5, and 9 o'clock. A scanning electron microscope (SEM) analysis quantified the percentage of bone within a 5 × 2.5 mm region at the glenoid rim. Micro-CT, SEM, and light microscopy evaluated the capsulolabral complex and calcified fibrocartilage. RESULTS A 7 ± 2.1 mm region of calcified fibrocartilage at 4 o'clock was identified from the articular face to the medial glenoid neck supporting the overlying capsulolabral footprint and was >3× thicker at the articular attachment (316 ± 153 μm) versus the glenoid neck (92 ± 66 μm). At 3 to 9 o'clock and 4 to 8 o'clock 79.2% ± 5.4% and 75.2% ± 7.8% of the glenoid osseous width was covered with articular cartilage. The labrum accounted for 13.1% ± 3.4% of the glenoid width at 4 o'clock. SEM analysis demonstrated decreased glenoid bone density at 3, 4, and 5 o'clock (P ≤ .015) and no difference (P = .448) at 9 o'clock versus central subchondral bone. CONCLUSIONS The capsulolabral footprint contributes significantly to the glenoid face, inserts directly adjacent to the articular cartilage, and extends medially along the glenoid neck. A layer of calcified fibrocartilage lies immediately beneath the capsulolabral footprint and is 3× thicker at the articular insertion compared with the glenoid neck. Lastly, there is a bone density gradient at the anterior-inferior rim versus the central subchondral bone. CLINICAL RELEVANCE Arthroscopic Bankart repair has been reported to have a significant failure rate in many settings. It is felt that reproducing anatomy with the repair could help improve outcomes. Based on this study's findings, an arthroscopic Bankart technique that most closely reproduces native anatomy and potentially optimizes soft-tissue healing could be performed. This includes removal of 1 to 2 mm of articular cartilage from the glenoid face with anchor placement at this location to appropriately reposition the capsulolabral complex.
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Affiliation(s)
- Michael R Karns
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A..
| | - R Tyler Epperson
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, U.S.A.; George E. Wahlen Department of Veterans Affairs, Salt Lake City, Utah, U.S.A
| | - Sean Baran
- Western Orthopaedics, Denver, Colorado, U.S.A
| | - Mattias B Nielsen
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, U.S.A.; George E. Wahlen Department of Veterans Affairs, Salt Lake City, Utah, U.S.A
| | - Nicholas B Taylor
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, U.S.A.; George E. Wahlen Department of Veterans Affairs, Salt Lake City, Utah, U.S.A
| | - Robert T Burks
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, U.S.A
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15
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Functional outcome of arthroscopic double row repair for Bankart lesion. J Orthop 2018; 15:792-797. [PMID: 30013290 DOI: 10.1016/j.jor.2018.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction The shoulder joint is the most common major joint to dislocate. Population aged younger than 20 years, recurrent dislocation rates have been reported to be as high as 90%. For those individuals that continue to experience dislocations surgery is often a good decision. The goal of the Bankart surgery is to reconnect the torn labrum to the glenoid fossa. Double-row Bankart repair can both achieve anatomic reduction and enhance fixation stability. The purpose of our study is to assess the clinical outcome of arthroscopic double row repair. Methods 49 cases with Bankart lesion operated by double row repair were studied. Functional outcome and retear were assessed after at least 6 months of surgery using scores and MRI. Results Significant improvement in functional outcome after repair by double row Bankart repair. No retear or redislocation seen. Conclusion Double row repair technique improves function of shoulder significantly and potentially minimizes future re-injury or recurrence risk.
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16
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Yousif MJ, Bicos J. Biomechanical Comparison of Single- Versus Double-Row Capsulolabral Repair for Shoulder Instability: A Review. Orthop J Sports Med 2017; 5:2325967117742355. [PMID: 29230427 PMCID: PMC5718312 DOI: 10.1177/2325967117742355] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: The glenohumeral joint is the most commonly dislocated joint in the body. Failure rates of capsulolabral repair have been reported to be approximately 8%. Recent focus has been on restoration of the capsulolabral complex by a double-row capsulolabral repair technique in an effort to decrease redislocation rates after arthroscopic capsulolabral repair. Purpose: To present a review of the biomechanical literature comparing single- versus double-row capsulolabral repairs and discuss the previous case series of double-row fixation. Study Design: Narrative review. Methods: A simple review of the literature was performed by PubMed search. Only biomechanical studies comparing single- versus double-row capsulolabral repair were included for review. Only those case series and descriptive techniques with clinical results for double-row repair were included in the discussion. Results: Biomechanical comparisons evaluating the native footprint of the labrum demonstrated significantly superior restoration of the footprint through double-row capsulolabral repair compared with single-row repair. Biomechanical comparisons of contact pressure at the repair interface, fracture displacement in bony Bankart lesion, load to failure, and decreased external rotation (suggestive of increased load to failure) were also significantly in favor of double- versus single-row repair. Recent descriptive techniques and case series of double-row fixation have demonstrated good clinical outcomes; however, no comparative clinical studies between single- and double-row repair have assessed functional outcomes. Conclusion: The superiority of double-row capsulolabral repair versus single-row repair remains uncertain because comparative studies assessing clinical outcomes have yet to be performed.
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Affiliation(s)
| | - James Bicos
- Beaumont Health, Royal Oak, Michigan, USA.,Michigan Orthopedic Surgeons-Performance Orthopedics, Bingham Farms, Michigan, USA.,Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan, USA
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17
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DeFroda S, Bokshan S, Stern E, Sullivan K, Owens BD. Arthroscopic Bankart Repair for the Management of Anterior Shoulder Instability: Indications and Outcomes. Curr Rev Musculoskelet Med 2017; 10:442-451. [PMID: 28971317 PMCID: PMC5685957 DOI: 10.1007/s12178-017-9435-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Arthroscopic Bankart repair is commonly utilized for shoulder stabilization in patients with anterior shoulder instability with minimum glenoid bone loss. The purpose of this review is to provide the indications, surgical technique, complications, and recent outcomes in arthroscopic Bankart repair for shoulder instability. RECENT FINDINGS Improvements in arthroscopic techniques have led to better patient outcomes, as well as an improved understanding of the pathoanatomy of instability. More recent studies have shown that one of the potential failures of primary arthroscopic repair may be due to unaddressed bone loss. This underscores the importance of evaluating glenoid bone loss and proper patient selection for this procedure to ensure successful outcome. When indicated, arthroscopic stabilization is the treatment of choice for many surgeons due to its lower morbidity and low overall complication rate. Future work must focus on longer-term outcomes in patients undergoing arthroscopic Bankart repair, as well as the clinical outcomes of new fixation techniques, augmentation techniques, and the effect of glenoid bone loss in outcome.
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Affiliation(s)
- Steven DeFroda
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy Street, Providence, RI, 02903, USA.
| | - Steven Bokshan
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy Street, Providence, RI, 02903, USA
| | - Evan Stern
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy Street, Providence, RI, 02903, USA
| | | | - Brett D Owens
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, 593 Eddy Street, Providence, RI, 02903, USA
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18
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Brown M, Wallace A, Lachlan A, Alexander S. Arthroscopic Soft Tissue Procedures for Anterior Shoulder Instability. Open Orthop J 2017; 11:979-988. [PMID: 29114337 PMCID: PMC5646175 DOI: 10.2174/1874325001711010979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 10/26/2016] [Accepted: 10/28/2016] [Indexed: 12/24/2022] Open
Abstract
Background: Arthroscopy has rapidly transformed the treatment of anterior shoulder instability over the past 30 years. Development of arthroscopic equipment has permitted the investigation and diagnosis of the unstable shoulder, and fixation methods have evolved to promote arthroscopy from an experimental procedure to one of first-line mainstream treatment. Methods: Key research papers were reviewed to identify the fundamental principles in patient diagnosis and appropriate selection for arthroscopic treatment. The evolution of arthroscopy is described in this article to facilitate the understanding of current treatment. Results: Accurate diagnosis of the shoulder instability subtype is essential prior to selection for surgery. Different surgical techniques are described to address different pathology within the glenohumeral joint related to instability and the appropriate method should be selected accordingly to optimise outcome. Conclusion: Anterior shoulder instability can be treated successfully using arthroscopic surgery, but the surgeon must treat each patient as an individual case and recognise the different subtypes of instability, the associated pathological lesions and the limitations of arthroscopy. The article concludes with a suggested algorithm for the treatment of anterior shoulder instability.
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Affiliation(s)
- Mathew Brown
- Fortius Clinic Central 17 Fitzhardinge Street London W1H 6EQ UK
| | - Andrew Wallace
- Fortius Clinic Central 17 Fitzhardinge Street London W1H 6EQ UK
| | - Andrew Lachlan
- Fortius Clinic Central 17 Fitzhardinge Street London W1H 6EQ UK
| | - Susan Alexander
- Fortius Clinic Central 17 Fitzhardinge Street London W1H 6EQ UK
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19
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Judson CH, Voss A, Obopilwe E, Dyrna F, Arciero RA, Shea KP. An Anatomic and Biomechanical Comparison of Bankart Repair Configurations. Am J Sports Med 2017; 45:3004-3009. [PMID: 28777665 DOI: 10.1177/0363546517717671] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Suture anchor repair for anterior shoulder instability can be performed using a number of different repair techniques, but none has been proven superior in terms of anatomic and biomechanical properties. Purpose/Hypothesis: The purpose was to compare the anatomic footprint coverage and biomechanical characteristics of 4 different Bankart repair techniques: (1) single row with simple sutures, (2) single row with horizontal mattress sutures, (3) double row with sutures, and (4) double row with labral tape. The hypotheses were as follows: (1) double-row techniques would improve the footprint coverage and biomechanical properties compared with single-row techniques, (2) horizontal mattress sutures would increase the footprint coverage compared with simple sutures, and (3) repair techniques with labral tape and sutures would not show different biomechanical properties. STUDY DESIGN Controlled laboratory study. METHODS Twenty-four fresh-frozen cadaveric specimens were dissected. The native labrum was removed and the footprint marked and measured. Repair for each of the 4 groups was performed, and the uncovered footprint was measured using a 3-dimensional digitizer. The strength of the repair sites was assessed using a servohydraulic testing machine and a digital video system to record load to failure, cyclic displacement, and stiffness. RESULTS The double-row repair techniques with sutures and labral tape covered 73.4% and 77.0% of the footprint, respectively. These percentages were significantly higher than the footprint coverage achieved by single-row repair techniques using simple sutures (38.1%) and horizontal mattress sutures (32.8%) ( P < .001). The footprint coverage of the simple suture and horizontal mattress suture groups was not significantly different ( P = .44). There were no significant differences in load to failure, cyclic displacement, or stiffness between the single-row and double-row groups or between the simple suture and horizontal mattress suture techniques. Likewise, there was no difference in the biomechanical properties of the double-row repair techniques with sutures versus labral tape. CONCLUSION Double-row repair techniques provided better coverage of the native footprint of the labrum but did not provide superior biomechanical properties compared with single-row repair techniques. There was no difference in footprint coverage or biomechanical strength between the simple suture and horizontal mattress suture repair techniques. CLINICAL RELEVANCE Although the double-row repair techniques had no difference in initial strength, they may improve healing in high-risk patients by improving the footprint coverage.
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Affiliation(s)
| | - Andreas Voss
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Elifho Obopilwe
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Felix Dyrna
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Robert A Arciero
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Kevin P Shea
- University of Connecticut Health Center, Farmington, Connecticut, USA
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20
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Marco SM, Lafuente JLÁ, Ibán MAR, Heredia JD. Controversies In The Surgical Management Of Shoulder Instability: Associated Soft Tissue Procedures. Open Orthop J 2017; 11:989-1000. [PMID: 28979603 PMCID: PMC5612025 DOI: 10.2174/1874325001711010989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 10/24/2016] [Accepted: 10/28/2016] [Indexed: 01/02/2023] Open
Abstract
Background: The glenohumeral joint is a ball-and-socket joint that is inherently unstable and thus, susceptible to dislocation. The traditional and most common anatomic finding is the Bankart lesion (anterior-inferior capsule labral complex avulsion), but there is a wide variety of anatomic alterations that can cause shoulder instability or may be present as a concomitant injury or in combination, including bone loss (glenoid or humeral head), complex capsule-labral tears, rotator cuff tears, Kim´s lesions (injuries to the posterior-inferior labrum) and rotator interval pathology. Methods: A review of articles related to shoulder anatomy and soft tissue procedures that are performed during shoulder instability arthroscopic management was conducted by querying the Pubmed database and conclusions and controversies regarding this injury were exposed. Results: Due to the complex anatomy of the shoulder and the large range of movement of this joint, a wide variety of anatomic injuries and conditions can lead to shoulder instability, specially present in young population. Recognizing and treating all of them including Bankart repair, capsule-labral plicatures, SLAP repair, circumferential approach to pan-labral lesions, rotator interval closure, rotator cuff injuries and HAGL lesion repair is crucial to achieve the goal of a stable, full range of movement and not painful joint. Conclusion: Physicians must be familiarized with all the lesions involved in shoulder instability, and should be able to recognize and subsequently treat them to achieve the goal of a stable non-painful shoulder. Unrecognized or not treated lesions may result in recurrence of instability episodes and pain while overuse of some of the techniques previously described can lead to stiffness, thus the importance of an accurate diagnosis and treatment when facing a shoulder instability.
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Affiliation(s)
- Santos Moros Marco
- Hospital MAZ - Orthopaedics and trauma surgery Avda Academia General Militar nº74, Zaragoza 50015, Spain
| | - José Luis Ávila Lafuente
- Hospital MAZ - Orthopaedics and trauma surgery Avda Academia General Militar nº74, Zaragoza 50015, Spain
| | - Miguel Angel Ruiz Ibán
- Hospital MAZ - Orthopaedics and trauma surgery Avda Academia General Militar nº74, Zaragoza 50015, Spain
| | - Jorge Diaz Heredia
- Hospital MAZ - Orthopaedics and trauma surgery Avda Academia General Militar nº74, Zaragoza 50015, Spain
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21
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Abstract
BACKGROUND Bony deficiency of the anteroinferior glenoid rim as a result of a dislocation can lead to recurrent glenohumeral instability. These lesions, traditionally treated by open techniques, are increasingly being treated arthroscopically as our understanding of the pathophysiology and anatomy of the glenohumeral joint becomes clearer. Different techniques for arthroscopic management have been described and continue to evolve. While the success of the repair is surgeon dependent, the recent advances in arthroscopic shoulder surgery have contributed to the growing acceptance of arthroscopic reconstruction of glenoid bone defects to restore stability. QUESTIONS/PURPOSES The purpose of this study was to describe arthroscopic surgical management options for patients with glenohumeral osseous lesions and instability. METHODS A comprehensive search of PubMed, Cochrane, and Medline was conducted to identify eligible studies. The reference lists of identified articles were then screened. Both technique articles and long-term outcome studies evaluating arthroscopic management of glenohumeral lesions were included. RESULTS Studies included for final analysis ranged from Level II to V evidence. Technique articles include suture anchor fixation of associated glenoid rim fractures, arthroscopic reduction and percutaneous fixation of greater tuberosity fractures, arthroscopic filling ("remplissage") of the humeral Hill-Sachs lesion, and an all-arthroscopic Latarjet procedure. The overall redislocation rate varied but was consistently <10% with a low complication rate. CONCLUSION Management of glenohumeral instability can be challenging but more recent advances in arthroscopic techniques have provided improved means of treating this diagnosis. This manuscript provides a comprehensive review of the arthroscopic treatment of osseous instability of the shoulder. It provides an in depth look at the various treatment options and describes techniques for each.
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22
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Aboalata M, Halawa A, Basyoni Y. The Double Bankart Bridge: A Technique for Restoration of the Labral Footprint in Arthroscopic Shoulder Instability Repair. Arthrosc Tech 2017; 6:e43-e47. [PMID: 28373939 PMCID: PMC5368097 DOI: 10.1016/j.eats.2016.08.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 08/29/2016] [Indexed: 02/03/2023] Open
Abstract
It has been proved by many researchers in the last few years that arthroscopic capsulolabral repair is an efficient method for surgical management of anteroinferior shoulder instability. Different arthroscopic techniques using different fixation devices and constructs have been described in the literature, but the suture anchors were the most used implants to shift the inferiorly displaced capsulolabral complex and fix it to the glenoid. In the majority of these techniques, the anchors concentrate the load at specific points (e.g., at 3 or 4 interrupted points over the glenoid directly opposite the anchors) without putting direct pressure on the area of the labral footprint that is between the anchors. We describe here a technique using 2 standard suture anchors inferiorly in conjunction with a knotless suture anchor (e.g., 3.5 mm PushLock, Arthrex, Naples, FL) superiorly. No additional separate sutures or suture tapes are required other than those already loaded in the inferior 2 anchors, which are used to compress the capsulolabral complex to the glenoid in the areas between the suture anchors, producing a uniform pressure that may contribute to better healing.
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Affiliation(s)
- Mohamed Aboalata
- Upper Limb Unit, Orthopaedic Surgery and Trauma Department, Mansoura University, Mansoura, Egypt,Address correspondence to Mohamed Aboalata, M.D., Lecturer of Orthopaedic Surgery, Upper Limb Unit, Orthopaedic Surgery and Trauma Department, Mansoura University, Elgomhuria Street 62, Mansoura, Dakahlia, Egypt.Lecturer of Orthopaedic SurgeryUpper Limb UnitOrthopaedic Surgery and Trauma DepartmentMansoura UniversityElgomhuria Street 62MansouraDakahliaEgypt
| | | | - Yehia Basyoni
- Orthopaedic Department, Mansoura University, Mansoura, Egypt
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23
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McDonald LS, Thompson M, Altchek DW, McGarry MH, Lee TQ, Rocchi VJ, Dines JS. Double-Row Capsulolabral Repair Increases Load to Failure and Decreases Excessive Motion. Arthroscopy 2016; 32:2218-2225. [PMID: 27209626 DOI: 10.1016/j.arthro.2016.03.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 03/20/2016] [Accepted: 03/21/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Using a cadaver shoulder instability model and load-testing device, we compared biomechanical characteristics of double-row and single-row capsulolabral repairs. We hypothesized a greater reduction in glenohumeral motion and translation and a higher load to failure in a mattress double-row capsulolabral repair than in a single-row repair. METHODS In 6 matched pairs of cadaveric shoulders, a capsulolabral injury was created. One shoulder was repaired with a single-row technique, and the other with a double-row mattress technique. Rotational range of motion, anterior-inferior translation, and humeral head kinematics were measured. Load-to-failure testing measured stiffness, yield load, deformation at yield load, energy absorbed at yield load, load to failure, deformation at ultimate load, and energy absorbed at ultimate load. RESULTS Double-row repair significantly decreased external rotation and total range of motion compared with single-row repair. Both repairs decreased anterior-inferior translation compared with the capsulolabral-injured condition, however, no differences existed between repair types. Yield load in the single-row group was 171.3 ± 110.1 N, and in the double-row group it was 216.1 ± 83.1 N (P = .02). Ultimate load to failure in the single-row group was 224.5 ± 121.0 N, and in the double-row group it was 373.9 ± 172.0 N (P = .05). Energy absorbed at ultimate load in the single-row group was 1,745.4 ± 1,462.9 N-mm, and in the double-row group it was 4,649.8 ± 1,930.8 N-mm (P = .02). CONCLUSIONS In cases of capsulolabral disruption, double-row repair techniques may result in decreased shoulder rotational range of motion and improved load-to-failure characteristics. CLINICAL RELEVANCE In cases of capsulolabral disruption, repair techniques with double-row mattress repair may provide more secure fixation. Double-row capsulolabral repair decreases shoulder motion and increases load to failure, yield load, and energy absorbed at yield load more than single-row repair.
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Affiliation(s)
- Lucas S McDonald
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York, U.S.A..
| | - Matthew Thompson
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - David W Altchek
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, VA Long Beach Health System and University of California, Irvine, Long Beach, California, U.S.A
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, VA Long Beach Health System and University of California, Irvine, Long Beach, California, U.S.A
| | - Vanna J Rocchi
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, California, U.S.A
| | - Joshua S Dines
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York, U.S.A
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Castagna A, Garofalo R, Conti M, Flanagin B. Arthroscopic Bankart repair: Have we finally reached a gold standard? Knee Surg Sports Traumatol Arthrosc 2016; 24:398-405. [PMID: 26714819 DOI: 10.1007/s00167-015-3952-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/15/2015] [Indexed: 11/26/2022]
Abstract
Traditionally, surgical stabilization of the unstable shoulder has been performed through an open incision. Arthroscopic Bankart repair with suture anchors is now widely considered the treatment of choice for anterior shoulder instability in patients who have failed conservative management. Many different factors have now been elucidated for adequate treatment of glenohumeral instability. Because of technical advances in instability repair combined with an increased understanding of factors that lead to recurrent instability, the outcomes following arthroscopic Bankart repair have significantly improved and approach those of open techniques.
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Affiliation(s)
| | - Raffaele Garofalo
- Shoulder and Elbow Unit, IRCCS Humanitas Institute, Milan, Italy
- Upper Limb Surgery Unit, F. Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Marco Conti
- Shoulder and Elbow Unit, IRCCS Humanitas Institute, Milan, Italy
| | - Brody Flanagin
- The Shoulder Center at Baylor University, Dallas, TX, USA
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Judson CH, Charette R, Cavanaugh Z, Shea KP. Anatomic and Biomechanical Comparison of Traditional Bankart Repair With Bone Tunnels and Bankart Repair Utilizing Suture Anchors. Orthop J Sports Med 2016; 4:2325967115621882. [PMID: 26779555 PMCID: PMC4710110 DOI: 10.1177/2325967115621882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Traditional Bankart repair using bone tunnels has a reported failure rate between 0% and 5% in long-term studies. Arthroscopic Bankart repair using suture anchors has become more popular; however, reported failure rates have been cited between 4% and 18%. There have been no satisfactory explanations for the differences in these outcomes. Hypothesis: Bone tunnels will provide increased coverage of the native labral footprint and demonstrate greater load to failure and stiffness and decreased cyclic displacement in biomechanical testing. Study Design: Controlled laboratory study. Methods: Twenty-two fresh-frozen cadaveric shoulders were used. For footprint analysis, the labral footprint area was marked and measured using a Microscribe technique in 6 specimens. A 3-suture anchor repair was performed, and the area of the uncovered footprint was measured. This was repeated with traditional bone tunnel repair. For the biomechanical analysis, 8 paired specimens were randomly assigned to bone tunnel or suture anchor repair with the contralateral specimen assigned to the other technique. Each specimen underwent cyclic loading (5-25 N, 1 Hz, 100 cycles) and load to failure (15 mm/min). Displacement was measured using a digitized video recording system. Results: Bankart repair with bone tunnels provided significantly more coverage of the native labral footprint than repair with suture anchors (100% vs 27%, P < .001). Repair with bone tunnels (21.9 ± 8.7 N/mm) showed significantly greater stiffness than suture anchor repair (17.1 ± 3.5 N/mm, P = .032). Mean load to failure and gap formation after cyclic loading were not statistically different between bone tunnel (259 ± 76.8 N, 0.209 ± 0.064 mm) and suture anchor repairs (221.5 ± 59.0 N [P = .071], 0.161 ± 0.51 mm [P = .100]). Conclusion: Bankart repair with bone tunnels completely covered the footprint anatomy while suture anchor repair covered less than 30% of the native footprint. Repair using bone tunnels resulted in significantly greater stiffness than repair with suture anchors. Load to failure and gap formation were not significantly different.
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Affiliation(s)
| | - Ryan Charette
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Zachary Cavanaugh
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Kevin P Shea
- University of Connecticut Health Center, Farmington, Connecticut, USA
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26
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Fabricant PD, Taylor SA, McCarthy MM, Gausden EB, Moran CJ, Kang RW, Cordasco FA. Open and Arthroscopic Anterior Shoulder Stabilization. JBJS Rev 2015; 3:01874474-201502000-00004. [PMID: 27490744 DOI: 10.2106/jbjs.rvw.n.00060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Peter D Fabricant
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Samuel A Taylor
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Moira M McCarthy
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | | | - Cathal J Moran
- Sports Surgery Clinic, Suite 17, Santry, Dublin 9, Ireland
| | - Richard W Kang
- The University of Chicago, 5841 S. Maryland Avenue, MC 3079, Chicago, IL 60637
| | - Frank A Cordasco
- Hospital for Special Surgery, Belaire Building, 525 East 71st Street, New York, NY 10021
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27
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Alexander S, Wallace AL. The "flying swan" technique: a novel method for anterior labral repair using a tensioned suture bridge. Arthrosc Tech 2014; 3:e119-22. [PMID: 24749030 PMCID: PMC3986484 DOI: 10.1016/j.eats.2013.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 09/06/2013] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic labral repair is an effective technique for most cases of traumatic shoulder instability. However, patients with anterior labroligamentous periosteal sleeve avulsion lesions frequently have multiple episodes of subluxation or dislocation and a high recurrence rate after surgery, even with modern methods of labral repair. One reason may be failure of biological healing of the labrum due to an inadequate "footprint" of contact between the capsulolabral tissue and the glenoid bone. We have developed a technique that facilitates a tensioned suture bridge between suture anchors that may improve the results of labral repair in patients with anterior labroligamentous periosteal sleeve avulsion lesions.
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Affiliation(s)
| | - Andrew L. Wallace
- Fortius Clinic, London, England,Address correspondence to Andrew L. Wallace, Ph.D., F.R.C.S., F.R.A.C.S., 17 Fitzhardinge Street, London W1H 6EQ, England.
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28
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Moran CJ, Fabricant PD, Kang R, Cordasco FA. Arthroscopic double-row anterior stabilization and bankart repair for the "high-risk" athlete. Arthrosc Tech 2014; 3:e65-71. [PMID: 24749044 PMCID: PMC3986485 DOI: 10.1016/j.eats.2013.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/15/2013] [Indexed: 02/03/2023] Open
Abstract
In addition to operative intervention for the patient with recurrent shoulder instability, current literature suggests that younger athletic patients unwilling to modify their activities may benefit from an early surgical shoulder stabilization procedure. Although open shoulder stabilization clearly has a role to play in some cases, we believe that further optimization of arthroscopic fixation techniques may allow us to continue to refine the indications for open stabilization. In particular, when an arthroscopic approach is used for capsulolabral repair in relatively high-risk groups, it may be beneficial to use a double-row repair technique. We describe our technique for shoulder stabilization through double-row capsulolabral repair of a soft-tissue Bankart lesion in the high-risk patient with shoulder instability or the patient with a small osseous Bankart lesion.
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Affiliation(s)
| | | | | | - Frank A. Cordasco
- Address correspondence to Frank A. Cordasco, M.D., M.S., Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, U.S.A.
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29
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Chambers L, Dines JS, Altchek DW. Arthroscopic Bankart Repair in the Beachchair Position. OPER TECHN SPORT MED 2013. [DOI: 10.1053/j.otsm.2013.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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30
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Adams CR. Arthroscopic glenoid labral repair with an oblique mattress configuration. Arthrosc Tech 2013; 2:e281-3. [PMID: 24265999 PMCID: PMC3834891 DOI: 10.1016/j.eats.2013.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 03/27/2013] [Indexed: 02/03/2023] Open
Abstract
There have been several arthroscopic techniques described in the literature regarding the passage of sutures for an arthroscopic glenoid labral repair. With simple suture passage when tying knots, there is a concern of internal knot impingement, especially in the posterosuperior labrum. On the other hand, with simple suture passage with knotless technology, there is a concern of leaving the anchor hole exposed in the glenohumeral joint space, especially with anchors that are degradable over time. Whereas a horizontal mattress configuration may address these 2 issues in most cases, there is the issue of tissue cut-through with the labral tissue fibers being in the same plane as the horizontal mattress sutures. The purpose of this report is to describe the oblique mattress configuration, which allows the passage of suture through multiple labral tissue planes, covers up the anchor holes with labral tissue, and maintains the knots away from the articular surface if knots are tied.
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Affiliation(s)
- Christopher R. Adams
- Address correspondence to Christopher R. Adams, M.D., Advanced Shoulder Orthopaedics, 600 University Blvd, Ste 105, Jupiter, FL 33458, U.S.A.
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31
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Attachment of the anteroinferior glenohumeral ligament-labrum complex to the glenoid: an anatomic study. Arthroscopy 2012; 28:1628-33. [PMID: 23107249 DOI: 10.1016/j.arthro.2012.08.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 08/20/2012] [Accepted: 08/22/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the morphology of the attachment of the anteroinferior glenohumeral ligament-labrum complex (AIGHL-LC) to the anterior rim of the glenoid. METHODS Sixty-six cadaveric shoulders with a mean age of 81 years were studied. The length of the AIGHL-LC attachment in the superoinferior direction and its depth in the mediolateral direction at the 2-, 3-, 4-, and 5-o'clock positions were measured. The radial histologic sections from the center of the glenoid at the 2- and 4-o'clock positions were used for histologic examinations. RESULTS The mean length of the AIGHL-LC attachment was 11.7 mm. The mean depth was 4.7 mm (1.6 mm on the articular cartilage and 3.0 mm on the glenoid neck) at the 2-o'clock position, 6.7 mm (2.4 mm and 4.3 mm, respectively) at the 3-o'clock position, 8.4 mm (3.0 mm and 5.4 mm, respectively) at the 4-o'clock position, and 6.8 mm (2.5 mm and 4.3 mm, respectively) at the 5-o'clock position. The depth of the AIGHL-LC attachment was the greatest at the 4-o'clock position (P < .01) and the smallest at the 2-o'clock position (P < .05). Histologically, the AIGHL-LC attached to both the cartilage and bone in 52 shoulders (86.7%) at the 2-o'clock position and in 53 shoulders (88.3%) at the 4-o'clock position. CONCLUSIONS The depth of the AIGHL-LC attachment was the greatest at the 4-o'clock position and the smallest at the 2-o'clock position. At the 4-o'clock position, the AIGHL-LC attaches to both the articular cartilage and bone in 88% of shoulders whereas it attaches only to bone in 12%. CLINICAL RELEVANCE This study provides fundamental information on the AIGHL-LC attachment. Because healing of the AIGHL-LC to the articular cartilage cannot be expected, the same attachment area as to the bone and cartilage observed in normal shoulders needs to be created on the glenoid neck during Bankart repair to obtain the physiological strength of the AIGHL-LC.
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Kersten AD, Fabing M, Ensminger S, Demetropoulos CK, Cooper R, Baker KC, Anderson K. Suture capsulorrhaphy versus capsulolabral advancement for shoulder instability. Arthroscopy 2012; 28:1344-51. [PMID: 22920288 DOI: 10.1016/j.arthro.2012.04.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 04/06/2012] [Accepted: 04/11/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to test the strength of a suture capsulorrhaphy repair versus a capsulolabral repair with knotless suture anchors in a cadaveric model with anteroinferior shoulder instability. METHODS Fourteen cadaveric shoulders were tested with either a suture capsulorrhaphy to the intact labrum or a capsulolabral advancement using a knotless suture anchor into the glenoid. Specimens were translated with the shoulder in an abducted, externally rotated position to failure. RESULTS The capsulolabral advancement showed a significantly higher load to failure than did the suture capsulorrhaphy group (P = .030). CONCLUSIONS Capsulolabral advancement with suture anchors may offer greater initial strength when compared with a suture capsulorrhaphy. In the setting of shoulder instability without evidence of a labral tear, the capsulolabral advancement technique may be considered biomechanically superior. CLINICAL RELEVANCE In the setting of shoulder instability due to capsular insufficiency, the capsulolabral advancement may be considered biomechanically superior to a traditional suture capsulorrhaphy.
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Affiliation(s)
- Andrew D Kersten
- Department of Orthopaedic Surgery, William Beaumont School of Medicine, Oakland University, Royal Oak, Michigan 48073, USA
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Mauro CS, Voos JE, Hammoud S, Altchek DW. Failed anterior shoulder stabilization. J Shoulder Elbow Surg 2011; 20:1340-50. [PMID: 21831664 DOI: 10.1016/j.jse.2011.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 04/01/2011] [Accepted: 05/08/2011] [Indexed: 02/01/2023]
Affiliation(s)
- Craig S Mauro
- Burke and Bradley Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, PA 15215, USA.
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35
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Kim DS, Yoon YS, Chung HJ. Single-row versus double-row capsulolabral repair: a comparative evaluation of contact pressure and surface area in the capsulolabral complex-glenoid bone interface. Am J Sports Med 2011; 39:1500-6. [PMID: 21451167 DOI: 10.1177/0363546511399863] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite the attention that has been paid to restoration of the capsulolabral complex anatomic insertion onto the glenoid, studies comparing the pressurized contact area and mean interface pressure at the anatomic insertion site between a single-row repair and a double-row labral repair have been uncommon. PURPOSE The purpose of our study was to compare the mean interface pressure and pressurized contact area at the anatomic insertion site of the capsulolabral complex between a single-row repair and a double-row repair technique. STUDY DESIGN Controlled laboratory study. METHODS Thirty fresh-frozen cadaveric shoulders (mean age, 61 ± 8 years; range, 48-71 years) were used for this study. Two types of repair were performed on each specimen: (1) a single-row repair and (2) a double-row repair. Using pressure-sensitive films, we examined the interface contact area and contact pressure. RESULTS The mean interface pressure was greater for the double-row repair technique (0.29 ± 0.04 MPa) when compared with the single-row repair technique (0.21 ± 0.03 MPa) (P = .003). The mean pressurized contact area was also significantly greater for the double-row repair technique (211.8 ± 18.6 mm(2), 78.4% footprint) compared with the single-row repair technique (106.4 ± 16.8 mm(2), 39.4% footprint) (P = .001). CONCLUSION The double-row repair has significantly greater mean interface pressure and pressurized contact area at the insertion site of the capsulolabral complex than the single-row repair. CLINICAL RELEVANCE The double-row repair may be advantageous compared with the single-row repair in restoring the native footprint area of the capsulolabral complex.
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Affiliation(s)
- Doo-Sup Kim
- Department of Orthopaedic Surgery, Wonju College of Medicine, Wonju Christian Hospital, Yonsei University, Wonju, Korea
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