What year did he first start coaching at Penn State?

1. What year did he first start coaching at Penn State?

2. 1950

3. What was the number of victories while on the sidelines of Penn State?

4. 62% of all Penn State Victories • 513 victories (104 as an assistant and 406 as a coach) • Total Wins for Penn State is 827

6. Shoulder Capsular Anatomy • 1. Superior Glenohumeral Ligament • 2. Middle Glenohumeral Ligament • 3. Anterior band of Inferior Glenohumeral Ligament • 4. Inferior Glenohumeral ligament complex / Axillary Pouch • 5. Posterior band of inferior glenohumeral ligament • 6 . Posterior capsule • 7. Long head of Biceps tendon • 8. Supraspinatus, Infraspinatus, Teres minor tendons • 9. Subscapularis tendon • 10. Glenoid

7. Bankart lesion

8. Bankart lesion • The Bankart lesion is a specific injury to a part of the shoulder joint called the labrum. The shoulder joint is a ball and socket joint, similar to the hip; however, the socket of the shoulder joint is extremely shallow, and thus inherently unstable.

9. Bankart lesion • To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called a labrum that forms a cup for the end of the arm bone (humerus) to move within. • This cuff of cartilage makes the shoulder joint much more stable, yet allows for a very wide range of movements (in fact, the range of movements your shoulder can make far exceeds any other joint

11. Bankart lesion • When the labrum of the shoulder joint is torn, the stability of the shoulder joint is compromised. • A specific type of labral tear is called a Bankart lesion. • A Bankart lesion occurs when an individual sustains a shoulder dislocation.

12. Bankart lesion • As the shoulder pops out of joint, it often tears the labrum, especially in younger patients. • The tear is to part of the labrum called the inferior glenohumeral ligament. When the inferior glenohumeral ligament is torn, this is called a Bankart lesion.

13. Bankart lesion • is an injury of the anterior (inferior) glenoid labrum due to repeated (anterior) shoulder dislocation. • When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it. • often accompanied by a Hill-Sachs lesion, damage to the posterior humeral head. • It is named after Arthur Sydney Blundell Bankart, an English orthopaedic surgeon, who lived from 1879-1951.

16. Bony Bankart • is a Bankart lesion that includes a fracture in of the anterior-inferior glenoid cavity of the scapula bone.

17. Bankart lesion = avulsion of the anteroinferiorcapsulolabrum. • Bony Bankart = fracture of the anteroinferiorglenoid. • Occurs in 97% of first time acute traumatic dislocations in young patients. (Taylor DC, AJSM 1997;25:306).

18. Shoulder Dislocation • Bankart lesion is a common injury. • Because the glenohumeral ligament helps maintain the shoulder in proper position, a Bankart lesion (a tear of the inferior glenohumeral ligament), will make the shoulder prone to repeat dislocation.

19. chances of a repeat dislocation after a Bankart injury? • Depend on the age of the patient. • Younger patients are most likely to sustain a Bankart injury if their shoulder dislocates, and are therefore more likely to have a repeat, or recurrent, dislocation. • Statistically, the chances of redislocating the shoulder are greater than 80% in patients younger than 30 years of age. • Over 30 years old, the chance of a repeat dislocation drops significantly.

20. Symptoms of a Bankart Lesion • a sense of instability • repeat dislocations • catching sensations • aching of the shoulder • Often patients will complain that they cannot "trust" their shoulder, fearing it may dislocate

21. Signs and Symptoms • The most common symptom of a bankart tear is pain. Following a shoulder dislocation, moderate to severe pain is felt, especially within the first several days after injury. • Popping or feelings of instability are another common problem associated with Bankart tears. Your shoulder labrum acts as a bumper for the shoulder socket, helping to keep your humerus in place. If this bumper is displaced, it allows your humerus to move too far forward and down within the joint, causing feelings of instability. • The torn portions of the labrum may also become caught within the joint, causing popping or feelings of the shoulder locking up. • Weakness of the muscles and loss of range of motion are also common symptoms associated with bankart lesions.

22. Diagnosis of a Bankart Lesion • Most young patients (under the age of 30) who sustain a shoulder dislocation will sustain a Bankart lesion; therefore, there is a high suspicion of this injury whenever a patient dislocates their shoulder. • On examination, patients will often have a sense their shoulder is about to dislocate if their arm is placed behind their head.

23. Bankart Clinical Evaluation • Occurs following traumatic dislocation. May have clicking or popping with shoulder motion. • Apprehension Test: examiner applies anteriorly directed force to the humeral head with the shoulder in abduction and external rotation. Positive result is the patient felling that the shoulder is going to dislocate. • Relocation Test: posteriorly directed force is applied to the humeral head with patient in abduction and external rotation (Apprhension Test position). Positive result is relief of the feeling of impending dislocation. • Load and shift: • Sulcus sign: distraction force is applied to the arm with the patient seated with are at the side. The magnitude of displaced and any apprehension sensations are compared to the contralateral limb. Any abnormalities indicated inferior instability. • Evaluate axillary nerve function

24. Rotatory Stress Test • -was developed to reliably test for anterior instability of of the shoulder; • in most cases, the test will identify a Bankart Lesion, but on occassion the test will pick up a Hagl lesion (avulsion of IGHL);

25. test begins on normal side; - w/ the arm supported in the surgeon's axilla, and one hand translates the shoulder anteriorly; - the shoulder is then abducted and externally rotated; - the shoulder is again translated anteriorly; - w/ a normal inferior glenohumeral ligament, anterior translation should decrease markedly;

27. Xray / Diagnositc Tests • A/P and Lateral view in the plane of the scapula, and axillary view. Generally normal. • West Point view: patient prone with arm in 90° abduction and neutral rotation. Xray beam is directed 25° posterior to the horizontal plane and 25° medial to the vertical plane. Useful for evaluating the anterior glenoid rim / bony bankart lesions. • Hill-Sachs lesion: impression fracture of the posterosuperior aspect of the humeral head, produced by contact with the anteroinferiorglenoid when dislocated. Hill-Sachs lesion is demonstrated on plain AP radiograph in internal rotation. • CT scan is best to evaluate bony anatomy and should be considered for the recurrent dislocator suspected of having a large Hill-Sachs or bony Bankart lesion. • MRI arthrogram (gadolinium): the anterior and posterior labrum are best seen on axial images and appear as dark triangular structures. Bankart lesions appear as a loss of the normal triangular shape or contrast material may extend between the labrum and glenoid( acute injuries.) Chronic injuries may scar down to the glenoid and be difficult to see by MRI.

28. X-Rays • X-rays are sometimes normal, but they may show an injury to the bone called a Hill-Sachs lesion. • This is a divot of bone that was injured when the shoulder dislocation occurred. A MRI may also be obtained in patients who are suspected of having a Bankart lesion. • Bankart lesions do not always show up well on MRI scans. • When a MRI is performed with an injection of contrast, a Bankart lesion is much more likely to be seen.

29. Radiographs: • - West Point Axillary View: may identify bony Bankhart; • - Stryker Notch

31. Classification / Treatment • Consider primaryAnterior instability repair for hightly athletic young (<25y/o) patients with MRI confirmed Bankart lesions. • Bony Bankart Lesion: -If >25% of the glenoid is involved in a bony-Bankart lesion (anterior rim fracture) the joint will be unstable without ORIF of the bony lesion, or bone grafting the defect. (Bigliani LU, AJSM 1998;26:41) • -Glenoid bone loss (inverted pear glenoid) can be assessed arthroscopically. A 25% reduction in the length from the anterior glenoid to the bare spot in the center of the glenoid compared to the distance from the posterior rim to the bare spot indicates glenoid deficiency and the need for ORIF of the bony lesion, or bone grafting the defect. (Burkhart SS, Arthroscopy 2002;18:488) • -Arthroscopic repair techniques: (Sugaya H, JBJS 2006;88Am:159), (Millett PJ, Arthroscopy 2008), • -Chronic Anterior Instability with Glenoid deficiency: Glenoid deficiency greater than 25% generally requires treatment (bone grafting vs coracoid transfer). Treatment options = Latarjet procedure (Allain J, JBJS 1998;80:841), (Burkart S, AJSM), Tricortical iliac crest great (Warner JJ, AJSM 2006:34:205), Open anterior soft tissue stabilization [large defects loose @7ºER] (Pagnani M, JBJS 2008;36A:1805). • Engaging Hill-Sachs lesions: consider grafting defect arthrscopically using synthetic bone plugs (Smith& Nephew), or Arthroscopic Hill-Sachs remplissage with arthroscopic posterior capsulodesis and infraspinatustenodesis. (AAOSNow June2007).

32. Associated Injuries / Differential Diagnosis • Hill-Sachs lesion: impression fracture ot the humeral articular surface caused by translation of the humeral head over the glenoid rim. Found in @85% of anterior dislocations. If >25% of the articular surface is involved allograft or autograft bone graft to repair the defect is indicated • SLAP • RTC Tear • Shoulder Instability • HAGL lesion • ALPSA: anterior labroligamentous periosteal sleeve avulsion; medializedBankart with medial displacement of the torn anterior labrum. • Perthes lesion: nondisplacedlabral tear • GLAD lesion: glenolabral articular disruption: nondisplaced anterior labral tear associated with articular cartilage injury.

33. Treatment • There are two general options for the treatment of a Bankart lesion. • One option is to allow the arm to rest, and the inflammation to subside with the use of a sling. • This is usually followed by physical therapy to regain motion of the extremity. • The potential downside of this option is that people who dislocate a shoulder once are much more likely to dislocate the shoulder again.

34. Initial Treatment • for a shoulder dislocation is centered around the R.I.C.E. principles, as well as immobilization of the shoulder to allow the tissues to heal. Labral tears are considered a secondary problem with shoulder dislocations. • If you have a dislocation, you will most likely have to have the shoulder reduced or put back into place by a physician. You will be given a sling to wear, and may be referred for an MRI. • MRI of the shoulder will often show damage to the joint capsule, but it may not pick up on a labral tear. That is why many surgeons order an MRI Arthrogram. • This procedure involves injection of a dye into the shoulder joint and then an MRI to see if any of the dye escapes from the shoulder capsule. • If you have a labral tear, the area that is torn will allow the dye to move out of the shoulder joint. Although MRI Arthrograms are much better to find labral tears than a regularr MRI, there is still a good chance that you may have a negative MRI but still have a tear.

35. Is surgery after an initial dislocation recommended? • Some orthopedic surgeons recommend surgery to repair a Bankart lesion after a shoulder dislocation in young athletes. • The usual treatment is a period of rest, followed by aggressive physical therapy. • Then a gradual return to activities. If the shoulder dislocates again, surgery is usually considered. • However, some orthopedic surgeons will repair a Bankart lesion after one dislocation in young athletes. • Because the chance of repeat dislocation is so high, especially in athletes who participate in contact sports, this type of immediate Bankart repair can be justified.

36. Surgery or no Surgery • there is no reason why surgery cannot be delayed, and physical therapy can be attempted. • It is important to remember that a Bankart repair is a significant surgery, and recovery is not easy. Physical therapy can be attempted, but the patient must understand that a repeat dislocation is possible. • The only concern is that a Bankart repair takes AT LEAST six months to heal, and many patients want to return to activity as soon as possible, without worrying about a repeat dislocation. • Patients over 30 generally do not need surgery unless repeat dislocations become a problem.

37. Surgery • When surgery is performed, the torn labrum of the Bankart lesion is reattached to the socket of the shoulder. • The results of surgery are usually very good, with over 90% of patients returning to their activities without any further dislocations. • More and more commonly this surgery is being performed arthroscopically; however, there are indications in some patients who should have a Bankart repair performed through a standard incision.

38. Anatomy • Labral functions: origin of many capsuloligamentous structures, increases the depth of the glenoid socket, facilitates the cavity-compression mechanism. • Blood supply: the labrum receives its blood supply from the suprascapular artery, circumflex scapular branch of the subscapular artery, and the posterior circumflex humeral artery. • Anterior band of the IGHL is the primary restraint to anterior translation at 90° abduction. • Buford complex is a normal labral variation. • Perthes lesion = nondisplaced tear of the anteroinferior labrum held in position by an intact medial scapular periosteum. • APLSA lesion = anterior labroligamentous periosteal sleeve avulsion, similar to Perthes lesion except labrum is displaced. (Neviaser TJ, Arthroscopy 1993;9:17). • HAGL lesion = humeral avulsion of the glenohumeral ligaments.

39. Bankart Complications • Recurrent instability, Hardware failure, Anchor pull-out, Infection, Stiffness, CRPS, Nerve or vascular injury, Chondrolysis, Hematoma, Chondral Injury, inability to return to sport, incomplete relief of pain, and Arthritis • Recurrent instability / failure • Hardware failure / Anchor pull-out • Infection • Stiffness • CRPS • Nerve injury: Axillary nerve, Brachial plexus • Fluid Extravasation: • Chondrolysis: though to be related to heat from electo cautery or radiofrequency probes used during capsular release or capsular shrinkage. • Hematoma • Chondral Injury / arthritis

40. Follow-up Care • Post-Op:Shoulder immobilizer. Begin pendelum ROM, elbow/wrist/hand exercises immediately. • 7-10 Days: continue shoulder immobilizer for 4-6weeks. Start Physical therapy, active assist and active ROM; No external rotation past 40 degrees for 6 weeks. • 6 Weeks: discontinue shoulder immobilizer. Progress with strengthening exercises. • 3 Months: Progess with ROM and strengthening, start sport specific training. • 6 Months: Return to sport if patient has full ROM, near full strength and no apprehension. • Anterior Instability Rehab Protocol. • Shoulder Outcome measures • Outcomes: 90% excellent or good results, 10% recurrent instability . Average ASES score = 92 of 100 points. Patient satisfaction = 8.9 on a 10-point visual analog scale. (Carreira DS, AJSM 2006;34:771). 11% recurrence for collision/contact athletes (Mazzoca AD, AJSM 2005;33:52).

41. Rehabilitation • After a shoulder dislocation, conservative shoulder rehabilitation that focuses on restoring your range of motion, strength, and shoulder function is a good idea. The goal is to try to avoid surgery if possible. • Depending on the severity of your injury, you may be able to avoid surgery with proper rest and rehab. However, if you have a Bankart lesion or other labral tear, you may have instability and require labral repair surgery. • Make sure that you follow your physicians instructions after your injury and go through rehabilitation to restore your shoulder back to normal. • Summary • A Bankart lesion is a type of labral tear that occurs in the inferior and anterior portion of the glenoid labrum. It is very common with shoulder dislocations. An MRI Arthrogram is the best way to determine if you have a bankart tear. Rest and rehabilitation are the keys to recovery, however many times this injury requires surgical intervention to return your shoulder to normal.

42. Hagl Lesion: • avulsion of inferior ligament from the humerus;