Arthroscopic Bankart Procedure: Two- to Five-Year Followup With Clinical Correlation to Severity of Glenoid Labral Lesion

Abstract

We report our results using the arthroscopic Bankart technique described by Morgan (transglenoid suture) on 60 consecutive patients with anterior instability. All had detachment of the glenoid labrum at surgery. Forty-seven patients were available for final followup, which ranged from 2 to 5 years. Of these patients, 18 had experienced recurrent dislocation and 3 had experienced episodes of subluxation after surgery, for an overall failure rate of 42%. Partway into the study, we began to correlate severity of glenoid labral lesion with outcome. We classified the labral lesion in 37 patients using stringent criteria at the time of surgery. Followup among these patients averaged 37 months. Of 22 cases of simple detachment of the labrum with no other significant lesion (Type II labrum), there was one failure (4.5%). Of the 15 cases with significant or complete degeneration of the glenoid labrum-inferior glenohumeral ligament complex (Types IV or V labra), 13 failed (87%). Of the patients without recurrent instability, loss of external rotation averaged 1.5 degrees, strength was 5+/5+ in abduction and external rotation. Average postoperative function was 94% of preinjury levels subjectively, and most patients were able to return to previous activities, including throwing and other overhead sports. Our findings indicate that rates of redislocation after this arthroscopic Bankart procedure correlate directly with the degree of glenoid labrum-inferior glenohumeral ligament complex lesion.

Anterior instability of the shoulder after trauma

“…Abnormalities commonly encountered at re-exploration after failed arthroscopic or open repair include an unhealed Bankart lesion, 77,81 humeral avulsion of the glenohumeral ligaments, 82,83 extensive glenoid erosion or deficiency from a bony Bankart lesion, 38,84,85 excessive capsular laxity, 81,86 a defect of the rotator interval, 87 an engaging Hill-Sachs lesion 38,39 and reduced retroversion of the head of the humerus or excessive retroversion of the glenoid cavity. 88 Several additional factors have been associated with recurrent instability after arthroscopic stabilisation including a younger age at surgery, 59,89 non-compliance with post-operative immobilisation, 84,90 early return to contact sport, 86,91 absence or deficiency of the capsulolabral complex and poor inferior glenohumeral ligaments, 86,92 and multiple episodes of instability before stabilisation. 80,93 The wide variation in the rates of recurrence after arthroscopic stabilisation may also be a reflection of the inherent technical difficulty in performing these procedures.…”

Labrum repair combined with arthroscopic reduction of capsular volume in shoulder instability

“…Green and Christensen operated on 60 patients with a follow-up of 40 months and reported a relapse rate of 42%. There was inferior glenohumeral ligament insufficiency in the relapsing cases [10]. In these procedures capsular volume increase is not repaired, which probably is related to the unfavourable results.…”

Avaliação funcional do reparo artroscópico da instabilidade anterior recidivante do ombro

“…Arthroscopic capsulorrhaphy with staples presented a high rate of complications and lack of success (17)(18)(19) . Transglenoid arthroscopic suture presented variable results (20)(21)(22)(23)(24)(25) . Usually, this technique presents results that are inferior to open Bankart repair, although Savoie et al (24) reported achieving acceptable results with this technique.…”