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

Abstract

PurposeTo 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. MethodsForty‐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. ResultsThe 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). ConclusionsAdditional 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 evidenceIV.

The New Double‐row Bankart Repair Recovered Shoulder Stability without Excessive Motion Limitation: A Case–Control Study with Single‐row Bankart Repair

“…One of the advantages of our research was that it is a long‐term comparative study. Similar to our technique, Itoigawa et al 9 . also reported a new suture method called 4 o'clock double anchor footprint fixation (DAFF).…”

“…Similar to our technique, Itoigawa et al . 9 also reported a new suture method called 4 o'clock double anchor footprint fixation (DAFF). The difference was they used mattress sutures while bridge sutures were used in our study.…”

Arthroscopic suture bridge fixation for acute bony Bankart with anterior glenohumeral instability: a case report and narrative review

“…Itoigawa et al in 2022 looked at the double-row technique at the 4’oclock position of 42 patients ( 23 ). Of the 42 patients, 30 were involved in sports: 12 were recreational athletes, 17 were competitive athletes and 1 was a professional athlete.…”

“…Itoigawa et al found that 30 of the patients analyzed were athletes and all returned to their previous level of sport ( 23 ).…”

“…Itoigawa et al assessed the ROM of the patients and found a mean FF of 171.5, an ER of 63.9, an IR of TH 6, an AbdIR of 71.2, and an AbdER of 87.8. One patient (2%), who was a baseball player, had recurrent instability ( 23 ). When assessing the glenoid footprint on MRI showed an improved footprint at both the 2 and 4 o’clock positions adding to the inherent stability of the repaired bony Bankart lesion.…”