Clinical Results of the Arthroscopic "Multiple Pulled Suture" Technique for Large or Comminuted Bony Bankart Lesion

Lee, Byung Ill; Kim, Byoung Min; Kho, Duk Hwan; Kim, Hyeung June

doi:10.5397/cise.2017.20.3.138

Cited by 2 publications

(3 citation statements)

References 29 publications

(50 reference statements)

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“…Using MRA/3D‐CT, the percentage of glenoid bone defects was measured using the best‐fit circle method [9]. In addition, the presence of bony Bankart lesions and the size of Hill–Sachs lesions were assessed [11]. Hill–Sachs lesions were measured in the coronal view at the just lower cut of the upper humerus tip and medial to the infraspinatus insertion [1, 19].…”

Section: Methodsmentioning

confidence: 99%

Microinstability characterised by small and easily overlooked anterior labral or Hill–Sachs lesions can be managed with arthroscopic anterior labral repair

Kim

Park

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Some young individuals present with shoulder pain without a deinite history or complaint of instability. However, careful history taking, physical examination, and high-quality magnetic resonance imaging may reveal evidence of instability of which the patient is unaware. Therefore, a clearer deinition of these ambiguous patients is needed. This study aimed to report the characteristics and surgical outcomes of patients with microinstability compared to those of patients with classic recurrent anterior shoulder instability. Methods From 2005 to 2018, 35 patients with microinstability (group M) underwent arthroscopic anterior labral repair (AALR) and were compared to 35 sex-and age-matched patients with classic recurrent anterior shoulder instability (group C) who also underwent AALR. Baseline characteristics, preoperative apprehension test indings, preoperative imaging for the presence of anterior labral and Hill-Sachs lesions, preoperative and postoperative (over 2 years) range of motion (ROM) and functional scores, inal complications, and patient satisfaction were analysed. ResultsThe most common chief complaints in groups M and C were pain (29/35) and both pain and instability (27/35), respectively. Only pain during the apprehension test was predominant in group M (M vs. C, 27 vs. 1, p < 0.001). High incidence of chronic repetitive injuries (26/35) and acute trauma (28/35) were observed in groups M and C, respectively. Over half of the patients in group M showed anterior labral lesions on magnetic resonance arthrography (MRA, 18/35), and 21 patients had Hill-Sachs lesions on MRA/three-dimensional computed tomography. Finally, 29 patients showed either anterior labral or Hill-Sachs lesions on preoperative imaging. The lesion severity was higher in group C than that in group M. All patients underwent AALR with/without the remplissage procedure, with no signiicant diferences in inal clinical outcomes, complications, and patient satisfaction between the groups. Conclusions Microinstability is diagnostically challenging and can be diagnosed in young patients with ambiguous shoulder pain during motion, without instability. Pain on anterior apprehension test and subtle labral and/or Hill-Sachs lesion on imaging study could be diagnostic clues. This condition can be managed with arthroscopic anterior labral repair with or without the remplissage procedure. The possibility of microinstability in young patients with shoulder pain should always be considered, and small anterior labral or Hill-Sachs lesions should be closely monitored. Level of evidence III.

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Section: Methodsmentioning

confidence: 99%

Microinstability characterised by small and easily overlooked anterior labral or Hill–Sachs lesions can be managed with arthroscopic anterior labral repair

Kim

Park

et al. 2022

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

show abstract

“…Accordingly, it is important to check the patient's history to confirm whether the dislocation is acute or chronic when considering this technique. 8) As the authors pointed out in their paper, more research subjects will be needed in the future and additional biomechanical testing should be conducted utilizing cadavers to provide more robust results.…”

mentioning

confidence: 99%

“…Bauer et al 7) later introduced the transglenoid technique for arthroscopic repair, which is simpler than techniques using suture anchors, but less accurate due to suture fixation on the fascia of the infraspinatus muscle. Lee et al 8) modified the transglenoid technique to devise a so-called pulled sutures technique. Their study investigated the multiple pulled suture (MPS) technique in 10 patients with bony Bankart lesions and found excellent clinical and radiological results.…”

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confidence: 99%

EDITORIAL : Is the Arthroscopic "Multiple Pulled Suture" Technique a Good Solution for Large or Comminuted Bony Bankart Lesions

Kim

2017

Clinics in Shoulder and Elbow

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Numerous surgical procedures have been developed since restoration of the anterior-inferior glenoid was raised as an important factor for restoring the stability of the shoulder joint 1) after acute or chronic shoulder dislocation. [2][3][4][5] The existence of numerous methods is evidence that there is still no established method for surgery.In the 2000s, new methods utilizing suture anchors were designed. However, this technique could not provide sufficient contact area for the fractured fragment because the suture crossed the surface of the fracture and the bony fragment could tilt because of the one-point fixation. To solve this problem, Millett et al. 6) developed the "bony Bankart bridge" procedure;however, this method was technically too difficult. Bauer et al. 7)later introduced the transglenoid technique for arthroscopic repair, which is simpler than techniques using suture anchors, but less accurate due to suture fixation on the fascia of the infraspinatus muscle. Lee et al. 8) modified the transglenoid technique to devise a so-called pulled sutures technique. Their study investigated the multiple pulled suture (MPS) technique in 10 patients with bony Bankart lesions and found excellent clinical and radiological results. Moreover, indirect fixation induced by ligamentotaxis was theoretically described in the discussion section of their study. In their study, 3-dimensionalcomputed tomography scans performed at 3 months postoperation showed union in all patients. However, it is not known whether this method will have the same effect on all large or comminuted bony Bankart lesions. As stated in their paper, if the condition of the capsulolabral complex and the periosteum were poor, the arthroscopic MPS technique could not be performed because it is difficult to induce a ligamentotaxis effect when periosteum damage is severe. Therefore, it is very important to confirm the condition of soft tissues around the bony fragment including the periosteum, using magnetic resonance arthrogram.The MPS technique involves the fixation of MPS onto the 2 or 10 o'clock position on the glenoid with one Pushlock (Arthrex) anchor, a knotless suture anchor. This technique seems to have advantages, such as being simple and more economical than other conventional surgery methods that use an average of four or more suture anchors. Conversely, this method relies on one knotless suture anchor to sustain all of the tension. If this fixation fails, adverse results are obvious. Therefore, the quality of the glenoid bone should be guaranteed so that it can withstand this one suture anchor with excessive tension. In addition, the quality of the soft tissue should be ensured because MPS will be performed on the labroligamentous complex.In this study, 7 out of 10 cases were Bigliani type I lesions and 7 out of 10 cases were first time dislocations. These factors suggest that most patients in this study had better bone quality and capsulolabral complex quality when compared to patients with chronic dislocations, resulting in solid res...

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Clinical Results of the Arthroscopic "Multiple Pulled Suture" Technique for Large or Comminuted Bony Bankart Lesion

Cited by 2 publications

References 29 publications

Microinstability characterised by small and easily overlooked anterior labral or Hill–Sachs lesions can be managed with arthroscopic anterior labral repair

Microinstability characterised by small and easily overlooked anterior labral or Hill–Sachs lesions can be managed with arthroscopic anterior labral repair

EDITORIAL : Is the Arthroscopic "Multiple Pulled Suture" Technique a Good Solution for Large or Comminuted Bony Bankart Lesions

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