Arthroscopic three-point double-row repair for acute bony Bankart lesions

Abstract

After mobilizing anteroinferior osseous Bankart lesion from the glenoid neck, a suture anchor loaded with differently colored non-absorbable braided sutures is placed on the medial edge in the glenoid neck along the rim fracture through the anterior-inferior trans-subscapularis tendon portal. Two same-colored suture limbs on the anchor are then pulled through the labrum using PDS suture shuttling simultaneously. These steps are repeated for the others suture limbs. The two same-color suture limbs located inferiorly are retrieved using the trans-subscapularis tendon portal. Both suture strands are threaded through the eyelet of a PushLock anchor on the distal end of the driver. The anchor is advanced into the pilot hole completely. These steps are repeated for a second anchor at the upper edge of the fracture in the glenoid rim using the anterior portal. This technique confers effective, firm fixation of the bony Bankart lesion by three-point fixation without the suture material crossing the glenoid cavity.

ORV Arthroscopic Transosseous Bony Bankart Repair

“…Suture also remains along the glenolabral articular surface, increasing the risk for abrasion. [14][15][16][17][18][19] Optimal fixation requires maximizing the healing potential without sacrificing fixation. We advocate bone preservation with stable fixation for repair through a transosseous approach to fixation.…”

“…This has generated substantial awareness concerning bone preservation and precipitated a number of innovative techniques, ranging from screw fixation to multiple configurations of suture repair. 2,[12][13][14][15][16][17][18][19] We present an arthroscopic transosseous technique that we developed at Orthopaedic Research of Virginia that provides anatomic reduction, compressive fixation, and reinforces capsulolabral stability to maximize osseous union and reduce capsular volume.…”

Arthroscopic Repair of Chronic Bony Bankart Lesion Using a Low Anterior Portal

“…9,10 Improving the insertion angle also improves the fixation strength of the anchor. 11 If a lesion of 20% to 30% the width of the glenoid is present, arthroscopic repair of the bony Bankart lesion is preferable to repair of the soft-tissue lesion alone.…”

“…1,4,12 Satisfactory results have been reported after arthroscopic repairs with suture anchors in both acute 4 and chronic bony Bankart lesions. 7 Kim et al 9 have reported the use of the "trans-scapular" portal for the repair of the bony Bankart lesion with a 3-point technique, with a suture anchor placed medial to the fracture with the suture wrapped around the fragment and inserted into a knotless anchor similar the anchors we used. The technique of Kim et al is similar to that of the suture bridge or double-row technique of Millett and Braun.…”

“…The low anterior portal improves access to the anterior-inferior aspect of the glenoid and the angle of approach for anchor placement and suture passage. 9,10 In our opinion, training and experience may be barriers to widespread use of arthroscopic techniques for repair of the bony Bankart lesion and may also require specialized equipment not available to all surgeons.…”