1 / 32

Arthroscopic Bankart Repair: Techniques and Outcomes

Learn about the historical background, current understandings, surgical goals, advantages, selection criteria, and detailed surgical techniques of arthroscopic Bankart repair. Explore key factors for optimal surgery and potential mitigating factors in the process.

roscoe
Download Presentation

Arthroscopic Bankart Repair: Techniques and Outcomes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ARTHROSCOPIC BANKART REPAIR T. Andrew Israel, MD Luther Midelfort Orthopaedic & Sports Medicine Center

  2. ARTHROSCOPIC BANKART REPAIR • Historical Considerations • Current Understandings • Surgical Goals • Advantages of Arthroscopic vs Open • Selection Criteria-preop & intraop • Surgical Technique • Results

  3. HISTORICAL CONSIDERATIONS • Traditionally, open Bankart gold standard with recurrence <5% • Arthroscopic repair initially presented with great enthusiasm by developers but results could not be duplicated • Limited understanding of pathology • Poor patient selection • Technically demanding techniques

  4. CURRENT UNDERSTANDINGS • Firm appreciation spectrum of instability and range of pathology • Better teaching of basic arthrosopic techniques • Appreciation of the value of arthroscopy as outpatient surgical technique • Improved technical skills

  5. SURGICAL GOALS • Anatomic reconstruction • Reconstruction which approximates an open repair • Ability to manage Bankart lesion and capsular laxity • Immediate strength of repair

  6. ADVANTAGES OF ARTHROSCOPIC VS OPEN • Faster(for some surgeons) • Less pain for patient • Better cosmesis • Better ROM(not shown by some studies) • Ability to manage comorbid pathology-SLAP, OA, RCT • Less expensive than open repair

  7. PREOPERATIVE SELECTION CRITERIA • Traumatic instability(subluxation or dislocation) • Minimal bony lesion(s) • Discrete Bankart lesion • No generalized ligamentous laxity

  8. INTRAOPERATIVE SELECTION CRITERIA OPTIMAL FACTORS • Discrete Bankart lesion • Robust capsuloligamentous tissue • No Bony Bankart lesion • No significant loss of articular surface(glenoid or humeral head)

  9. INTRAOPERATIVE SELECTION CRITERTA MITIGATING FACTORS • Capsular laxity • ALPSA(Anterior Labral Periosteal Sleeve Avulsion Injury) • Bony Bankart lesion

  10. SURGICAL TECHNIQUE • Position • Portal placement • Identify pathology • Mobilize capsulolabral tissue • Glenoid preparation • Anchor placement • Suture retrieval • Knot tying

  11. POSITION • Lateral decubitus • Allows for traction • Improved exposure to glenohumeral joint

  12. PORTAL PLACEMENT • Standard posterior portal • Antero-superior scope portal • Antero-inferior working portal • Avoid crowding of anterior portals • Clear cannulas allow visualization of sutures and anchors

  13. IDENTIFY PATHOLOGY • Bankart lesion • Quality of capsulolabral tissue • Concomitant SLAP lesion • Rotator cuff injuries • Injury to articular surfaces

  14. MOBILIZE CAPSULOLABRAL TISSUE • Arthroscopic elevators • Mitek VAPR • Strip off capsulolabral sleeve to muscle of subscapularis

  15. GLENOID PREPARATION • Decorticate juxta-articular scapular neck • Curette • Rasp • Shaver

  16. ANCHOR PLACEMENT • Place first anchor as low as possible • At or on the articular cartilage margin • Metal or biodegradable • Prefer minimum of 3 anchors • Pass sutures and tie knots before next anchor placement

  17. SUTURE RETRIEVAL • Many options • Devices which perforate capsule and retrieve the suture • Devices which shuttle the suture through the tissue • Prefer suture relay technique as it reduces trauma to suture & allows for easier shift from inferior to superior

  18. KNOT TYING • Perfect knots • Perfect knots • Flawlessly perfect knots

  19. RESULTS Gartsman, JBJS, 2000 • 53 arthroscopic Bankart repairs • Mean age 32 yrs • 44 males & 9 females • 33 month follow-up • 34/38 athletes return to sport • 4/53 recurrent instability(7.5%)

  20. CASE PRESENTATION

  21. CASE J.H. • 24 male RHD plumber • Traumatic left anterior shoulder dislocation @ age 15 during football • Rx nonoperatively with sling, PT, etc. • Recurrent dislocations during recreational softball @ age 23 and 24

  22. PHYSICAL EXAM • AROM 175/175, 65/75, T12/T10 • 5/5 power abduction & external rotation • 2+ anterior/inferior laxity with endpoint • Positive Jobe’s anterior apprehension/relocation test • Negative sulcus sign

  23. SHOULDER ANATOMY

  24. SURGERY

  25. SUMMARY • Arthroscopic techniques here to stay • Pt expectations & economic pressures driving application of these techniques • % performed arthroscopically will increase over time(more resident & fellow education) • Techniques & implants/devices will improve over time

More Related