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Qu D, Fu H, Shen Y, Zhang J, Zhang D, Jiang Q, Qi C. Modified double-pulley fixation provides better reduction of bone fragments and union compared to single-point fixation in bony Bankart lesions. Knee Surg Sports Traumatol Arthrosc 2024; 32:2141-2151. [PMID: 38721628 DOI: 10.1002/ksa.12218] [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: 12/22/2023] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE The purpose of this study was to compare clinical scores and imaging outcomes of bony Bankart lesions that underwent single-point and modified double-pulley fixation after at least 2 years of follow-up. METHODS Patients who underwent surgery to treat bony Bankart injuries were included and divided into groups A and B. A total of 69 patients were included (32 in group A and 37 in group B). Patients in group A underwent arthroscopic modified double-pulley fixation and patients in group B underwent arthroscopic single-point fixation. Three-dimensional computed tomography (3D-CT) was used to assess glenoid reduction one day after surgery. Postoperative bony union was assessed using 3D-CT and multiplanar reconstruction images 6 months after surgery. Constant-Murley, Rowe rating system, visual analogue scale and University of California at Los Angeles and American Shoulder and Elbow Surgeons scores were recorded before and after surgery. RESULTS In terms of imaging measurements, there was no significant group difference in the preoperative size of the glenoid defect, the size of the bony fragment or the expected postoperative size of the glenoid defect. The sizes of the actual postoperative glenoid defects differed significantly between the groups (p = 0.027), as did the absolute difference between the expected and actual glenoid defect sizes (p < 0.001). At 6 months postoperatively, 50.0% of group A patients and 24.3% of group B patients exhibited complete bony union (p = 0.027); the rates of partial union were 37.5% and 56.8%, respectively. At the final follow-up, all clinical scores were significantly better than the preoperative scores (all p < 0.05), with no significant group differences (not significant). CONCLUSIONS The use of the modified double-pulley technique with two anchors to treat bony Bankart injuries provides a better reduction of bone fragments than single-point fixation with two anchors and was associated with a higher rate of early bone union. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Di Qu
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- Medical Department, Qingdao University, Qingdao, Shandong, China
| | - Haitao Fu
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Youliang Shen
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jing Zhang
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- Medical Department, Qingdao University, Qingdao, Shandong, China
| | - Dongfang Zhang
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Qi Jiang
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- Medical Department, Qingdao University, Qingdao, Shandong, China
| | - Chao Qi
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Zhang Y, Qin J, Li Q, Aierken A, Xue R, Chen D, Jiang Q. Simple "Door-Locking" Technique Using One Single-Row Anchor for Repairing Large Bony Bankart Lesions. Arthrosc Tech 2024; 13:102964. [PMID: 39036397 PMCID: PMC11258702 DOI: 10.1016/j.eats.2024.102964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/31/2024] [Indexed: 07/23/2024] Open
Abstract
Large bony Bankart injuries are typically stabilized using screws or plates or multiple anchors. Here, the "door-locking" technique, using a single-row anchor, can provide effective fixation for massive bony Bankart injuries. This technique offers several advantages over open fixation surgery or other techniques that use more than 2 suture anchors, including simpler surgical procedures, lower medical costs, and satisfactory clinical outcomes.
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Affiliation(s)
- Yu Zhang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, PR China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
| | - Jianghui Qin
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, PR China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
| | - Qiangqiang Li
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, PR China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
| | - Aikeremu Aierken
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, PR China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
| | - Rong Xue
- Department of Orthopedic Surgery, Xinghua People’s Hospital, Xinghua Jiangsu, PR China
| | - Dongyang Chen
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, PR China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
| | - Qing Jiang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, PR China
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
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Ji X, Ye L, Hua Y, Zhou X. Arthroscopic repair with transosseous sling-suture technique for acute and chronic bony Bankart lesions. Asia Pac J Sports Med Arthrosc Rehabil Technol 2023; 34:9-14. [PMID: 37744966 PMCID: PMC10511304 DOI: 10.1016/j.asmart.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Background Failure to fix the fractured fragment can result in bony fragment resorption and consequent glenoid bone loss. Current arthroscopic repair techniques might lead to insecure fixation and refracture. The purpose of this study was to evaluate the effectiveness of the transosseous sling-suture technique for bony Bankart lesions, and to compare the clinical outcomes for acute and chronic bony Bankart lesions treated with this technique. Methods A retrospective case series consisting of 46 patients with bony fracture of the glenoid rim following traumatic injury was identified from May 2015 to August 2020. The patients were divided into the acute lesion group and the chronic lesion group according to the time from first injury to surgery. The size of bone fragment was used to group the patients into the small and the medium sized fragment groups. All the patients underwent arthroscopic repairs using the transosseous sling-suture technique. Preoperative and postoperative evaluations including Rowe score, West Ontario Shoulder Instability Index (WOSI), Visual Analogue Scale (VAS) for pain scores, ROMs and number of dislocations were recorded. No significant differences were found in the comparisons of postoperative ROMs ang functional outcomes regarding between the small and the medium sized fragment groups. Results No dislocations occurred for both groups postoperatively. At the last follow-up, all the ROMs (including anterior flexion, abduction, external rotation and internal rotation at the side), the Rowe score, the WOSI score and the VAS score for pain in the both groups were significantly improved compared to the preoperative evaluations (all Ps < 0.001). In the comparisons between the acute and the chronic lesion groups, significantly greater anterior flexion (158.9 ± 8.9° vs. 153.0 ± 6.4°, P = 0.037), abduction (167.7 ± 10.1° vs. 161.0 ± 7.0°, P = 0.035) and external rotation at the side (88.3 ± 6.4° vs. 83.5 ± 5.5°, P = 0.024) were found in the acute lesion group. The comparisons of the Rowe score (86.0 ± 7.5 vs. 87.5 ± 10.6, P = 0.319), the WOSI score (223.5 ± 56.3 vs. 185.0 ± 79.9, P = 0.062), the VAS score for pain (0.4 ± 0.2 vs. 0.3 ± 0.2, P = 0.324) and the internal rotation at the side (74.6 ± 13.2° vs. 80.5 ± 11.1°, P = 0.116) between these two groups did not demonstrate significant differences between the two groups. Conclusion This arthroscopic transosseous sling-suture repair technique for shoulder anterior instability with acute and chronic bony Bankart lesion can restore joint stability, improve clinical outcomes and range of motion postoperatively. The acute bony Bankart lesion using the current technique can produce better range of motion compared to the chronic lesion. Study design Retrospective case series; Level of evidence, 4.
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Affiliation(s)
- Xiaoxi Ji
- Sports Medicine Center of Fudan University, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Shanghai, China
| | - Lingchao Ye
- Department of Sports Medicine, Orthopedics, Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang Province, China
| | - Yinghui Hua
- Sports Medicine Center of Fudan University, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Shanghai, China
| | - Xiaobo Zhou
- Department of Sports Medicine, Orthopedics, Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang Province, China
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Moroder P, Paksoy A, Siegert P, Thiele K, Lacheta L, Akgün D. The Independent Double-Row (IDR) Bony Bankart Repair Technique. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:538-543. [PMID: 35196739 DOI: 10.1055/a-1753-9883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A displaced anterior glenoid rim fracture, the so-called bony Bankart lesion, occurs after a traumatic shoulder dislocation resulting from a high energy trauma and is associated with recurrent shoulder instability. Different surgical techniques have been described in the literature to address this pathology, including open reduction and fixation, as well as arthroscopic transosseous, and single-row or double-row approaches with the use of suture anchors. However, there is currently no gold standard of treatment and the stability of fixation and the healing of the bony fragment are still a concern. The purpose of this report was to introduce an arthroscopic independent double-row (IDR) bony Bankart repair technique for fixation of large glenoid fractures.
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Affiliation(s)
- Philipp Moroder
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Alp Paksoy
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Paul Siegert
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Kathi Thiele
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Lucca Lacheta
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Doruk Akgün
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
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Kim JH, Koo BK, Ku KH, Kim MS. No difference in biomechanical properties of simple, horizontal mattress, and double row repair in Bankart repair: a systematic review and meta-analysis of biomechanical studies. BMC Musculoskelet Disord 2023; 24:765. [PMID: 37759194 PMCID: PMC10536762 DOI: 10.1186/s12891-023-06864-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Arthroscopic Bankart repair is the most common procedure in patients with anterior shoulder instability. Various repair techniques using suture anchors have been used to improve the strength of fixation and surgical outcomes in arthroscopic Bankart surgery. However, evidence regarding which method is superior is lacking. This systematic review and meta-analysis study was designed to compare the biomechanical results of simple versus horizontal mattress versus double-row mattress for Bankart repair. METHODS A systematic search of the MEDLINE, Embase, and Cochrane Library databases was performed to identify comparative biomechanical studies comparing the simple, horizontal mattress, and double-row techniques commonly used in Bankart repair for anterior shoulder instability. Biomechanical results included the ultimate load to failure, stiffness, cyclic displacement, and mode of failure after the ultimate load. The methodological quality was assessed based on the Quality Appraisal for Cadaveric Studies (QUACS) scale for biomechanical studies. RESULTS Six biomechanical studies comprising 125 human cadavers were included in this systematic review. In biomechanical studies comparing simple and horizontal mattress repair and biomechanical studies comparing simple and double-row repair, there were no significant differences in the ultimate load to failure, stiffness, or cyclic displacement between the repair methods. The median QUACS scale was 11.5 with a range from 10 to 12, indicating a low risk of bias. CONCLUSION There was no biomechanically significant difference between the simple, horizontal mattress, and double-row methods in Bankart repair. Clinical evidence such as prospective randomized controlled trials should be conducted to evaluate clinical outcomes according to the various repair methods. LEVEL OF EVIDENCE Systematic review, Therapeutic level IV.
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Affiliation(s)
- Jun-Ho Kim
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Korea
| | - Bon-Ki Koo
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Korea
| | - Ki Hyeok Ku
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Korea
| | - Myung Seo Kim
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Korea.
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Mohd Nasir MN, Hussin P, Dieu Kiat RY, Abdul Kahar J. Arthroscopic Repair of Acute Bony Bankart Lesion Following a Shoulder Dislocation Using Traction Sutures and Anchors: A Case Description. Cureus 2023; 15:e39811. [PMID: 37398740 PMCID: PMC10314187 DOI: 10.7759/cureus.39811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
Management of shoulder dislocation can be challenging especially when glenoid bone fracture is involved. Bony Bankart lesion can be managed either through an open surgery or, of late, using arthroscopic technique. Arthroscopic bony Bankart repair is technically difficult, requiring specialized instruments to penetrate the bone fragment within the detached labrum. This case report describes an alternative way of doing an arthroscopic reattachment of an acute bony Bankart lesion using traction sutures, an accessory anteromedial portal and utilization of knotless anchors. A 44-year-old male technician was climbing a ladder when he slipped and fell directly on his left shoulder. Imaging revealed bony Bankart fracture with presence of ipsilateral greater tuberosity (GT) fracture and a Hill-Sachs lesion. In a right lateral position, arthroscopic reduction of the bony fragment was performed utilizing a Fibrewire® (Arthrex, Inc., Naples, FL, USA) suture as traction apparatus while securing the upper and lower tissue enveloping the bony Bankart fragment. An accessory portal was made lower down anteriorly to de-rotate the fragment, holding it in place while securing two Pushlock® (Arthrex, Inc.) anchors to the native glenoid. We then performed GT fixation using two cannulated screws. Check radiographs revealed acceptable reduction of the Bankart fragment. With careful case selection, arthroscopic repair of acute bony Bankart lesions is possible using special arthroscopic reduction maneuver and fixation technique with subsequent good outcome.
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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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Chen AZ, Greaves KM, deMeireles AJ, Fortney TA, Saltzman BM, Trofa DP. Clinical Outcomes of Arthroscopic Bony Bankart Repair for Anterior Instability of the Shoulder: A Systematic Review. Am J Sports Med 2022:3635465221094832. [PMID: 35749344 DOI: 10.1177/03635465221094832] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Individual studies reporting the clinical outcomes of arthroscopic bony Bankart repair for anterior shoulder instability have reported excellent results but have been limited by their small sample sizes. No systematic review of the literature has been performed examining the clinical outcomes of arthroscopic bony Bankart repair. PURPOSE To provide a systematic review of the literature to examine the functional outcomes, recurrence rate, and return to sports rate after arthroscopic bony Bankart repair for anterior instability of the shoulder. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of the literature based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted using the Cochrane Database of Systematic Reviews, Ovid/Embase, PubMed, and Web of Science. Studies that examined clinical outcomes after arthroscopic bony Bankart repair for anterior shoulder instability were included. Data pertaining to study characteristics and design, patient demographic characteristics, and clinical results, including functional outcomes, recurrence rate, and return to sports, were collected. The results from the studies were pooled, and weighted means and overall rates were calculated. RESULTS In total, 21 studies with 769 patients were included for analysis. Most patients were male (91.7%), the mean age was 26.7 years (range, 12-71 years), and the mean follow-up was 42.7 months (range, 6-120 months). The most commonly reported functional outcome score was the Rowe score (12 studies), which improved on average from 41.9 preoperatively to 90.8 postoperatively. The rate of recurrent instability was reported by all 21 studies, and the overall recurrence rate was 11.9% (88/738). Return to sports after arthroscopic bony Bankart repair was reported by 11 studies, with a pooled return to sports rate of 91.0% (264/290). CONCLUSION Arthroscopic bony Bankart repair for anterior shoulder instability resulted in improvements in functional outcomes, a low rate of recurrent instability, and a high rate of return to sports. Although these findings are extremely promising, future prospective studies with larger sample sizes are needed to further evaluate the clinical outcomes of arthroscopic bony Bankart repair.
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Affiliation(s)
- Aaron Z Chen
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Kaylre M Greaves
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Alirio J deMeireles
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Thomas A Fortney
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute (MSKI), Charlotte, North Carolina, USA
| | - David P Trofa
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
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Kuptniratsaikul S, Itthipanichpong T, Thamrongskulsiri N. Arthroscopic Bony Bankart Repair Using Suture Suspension to Increase Bone Contact Area. Arthrosc Tech 2022; 11:e681-e686. [PMID: 35493030 PMCID: PMC9052085 DOI: 10.1016/j.eats.2021.12.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/14/2021] [Indexed: 02/03/2023] Open
Abstract
Bony Bankart lesions are anteroinferior glenoid rim fractures associated with capsulolabral tears. Untreated bony Bankart lesion can cause recurrent dislocation. So, the large bony Bankart lesions should be treated by anatomical reduction and stabilization. This Technical Note describes an arthroscopic bony Bankart lesion repair using suture suspension to increase contact area to gain more contact area and tissue compression to maximize the stability of the repair.
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Affiliation(s)
| | | | - Napatpong Thamrongskulsiri
- Address correspondence to Napatpong Thamrongskulsiri, M.D., Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
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10
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Wermers J, Schliemann B, Raschke MJ, Michel PA, Heilmann LF, Dyrna F, Sußiek J, Frank A, Katthagen JC. Glenoid concavity has a higher impact on shoulder stability than the size of a bony defect. Knee Surg Sports Traumatol Arthrosc 2021; 29:2631-2639. [PMID: 33839898 PMCID: PMC8298230 DOI: 10.1007/s00167-021-06562-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Surgical treatment of shoulder instability caused by anterior glenoid bone loss is based on a critical threshold of the defect size. Recent studies indicate that the glenoid concavity is essential for glenohumeral stability. However, biomechanical proof of this principle is lacking. The aim of this study was to evaluate whether glenoid concavity allows a more precise assessment of glenohumeral stability than the defect size alone. METHODS The stability ratio (SR) is a biomechanical estimate of glenohumeral stability. It is defined as the maximum dislocating force the joint can resist related to a medial compression force. This ratio was determined for 17 human cadaveric glenoids in a robotic test setup depending on osteochondral concavity and anterior defect size. Bony defects were created gradually, and a 3D measuring arm was used for morphometric measurements. The influence of defect size and concavity on the SR was examined using linear models. In addition, the morphometrical-based bony shoulder stability ratio (BSSR) was evaluated to prove its suitability for estimation of glenohumeral stability independent of defect size. RESULTS Glenoid concavity is a significant predictor for the SR, while the defect size provides minor informative value. The linear model featured a high goodness of fit with a determination coefficient of R2 = 0.98, indicating that 98% of the SR is predictable by concavity and defect size. The low mean squared error (MSE) of 4.2% proved a precise estimation of the SR. Defect size as an exclusive predictor in the linear model reduced R2 to 0.9 and increased the MSE to 25.7%. Furthermore, the loss of SR with increasing defect size was shown to be significantly dependent on the initial concavity. The BSSR as a single predictor for glenohumeral stability led to highest precision with MSE = 3.4%. CONCLUSION Glenoid concavity is a crucial factor for the SR. Independent of the defect size, the computable BSSR is a precise biomechanical estimate of the measured SR. The inclusion of glenoid concavity has the potential to influence clinical decision-making for an improved and personalised treatment of glenohumeral instability with anterior glenoid bone loss.
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Affiliation(s)
- Jens Wermers
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany.
| | - Benedikt Schliemann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Philipp A Michel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Lukas F Heilmann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Felix Dyrna
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Julia Sußiek
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Andre Frank
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - J Christoph Katthagen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
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