The Effect of Subcritical Bone Loss and Exposure on Recurrent Instability After Arthroscopic Bankart Repair in Intercollegiate American Football

Dickens, Jonathan; Owens, Brett D.; Cameron, Kenneth L.; DeBerardino, Thomas M.; Masini, Brendan D.; Peck, Karen Y.; Svoboda, Steven J.

doi:10.1177/0363546517704184

Cited by 131 publications

(113 citation statements)

References 32 publications

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“…Their investigation of 50 athletes found a rate of 5.31 cases of recurrent instability per 1000 athlete exposures for subjects with greater than 13.5% GBL. There were no episodes of recurrence in athletes with < 13.5% GBL in 72,000 athlete exposures [18]. The authors concluded that arthroscopic Bankart repair was a reliable procedure in American football players with up to 13.5% GBL.…”

Section: Indications/contraindicationsmentioning

confidence: 82%

Arthroscopic Bankart Repair for the Management of Anterior Shoulder Instability: Indications and Outcomes

DeFroda

Bokshan

Stern

et al. 2017

Curr Rev Musculoskelet Med

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Purpose of Review Arthroscopic Bankart repair is commonly utilized for shoulder stabilization in patients with anterior shoulder instability with minimum glenoid bone loss. The purpose of this review is to provide the indications, surgical technique, complications, and recent outcomes in arthroscopic Bankart repair for shoulder instability. Recent Findings Improvements in arthroscopic techniques have led to better patient outcomes, as well as an improved understanding of the pathoanatomy of instability. More recent studies have shown that one of the potential failures of primary arthroscopic repair may be due to unaddressed bone loss. This underscores the importance of evaluating glenoid bone loss and proper patient selection for this procedure to ensure successful outcome. Summary When indicated, arthroscopic stabilization is the treatment of choice for many surgeons due to its lower morbidity and low overall complication rate. Future work must focus on longer-term outcomes in patients undergoing arthroscopic Bankart repair, as well as the clinical outcomes of new fixation techniques, augmentation techniques, and the effect of glenoid bone loss in outcome.

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Section: Indications/contraindicationsmentioning

confidence: 82%

Arthroscopic Bankart Repair for the Management of Anterior Shoulder Instability: Indications and Outcomes

DeFroda

Bokshan

Stern

et al. 2017

Curr Rev Musculoskelet Med

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“…While thresholds have been defined ranging from 13.5-17.3%, there is a paucity of literature regarding the effects of various suture anchor configurations in anterior bone loss. [16][17][18] This is particularly true for Bankart repairs with the utilization of a 6 o'clock anchor, a rapidly evolving technique in arthroscopic labral surgery. Inferior glenoid anchor placement is believed to enhance the bumper effect of the labrum and to improve shoulder stability by providing a reliable inferior to superior capsular shift during arthroscopic stabilization.…”

Section: Introductionmentioning

confidence: 99%

The 6-O'clock Anchor Increases Labral Repair Strength in a Biomechanical Shoulder Instability Model

Bokshan

DeFroda

Gil

et al. 2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Background: Arthroscopic Bankart repair is currently the most utilized technique in the surgical management of symptomatic anterior shoulder instability. Despite a growing body of literature regarding optimal repair configurations, little is known about inferior suture anchor placement (6 o'clock position). Methods: 12 cadaveric shoulders were tested on a 6 DOF robotic musculoskeletal simulator to measure the peak resistance force due to anterior displacement of 1 cm. The rotator cuff muscles were loaded during testing to simulate physiological conditions. Test conditions consisted of the intact shoulder, Bankart lesion, Bankart repair (3, 4, and 5 o'clock anchors), and Bankart repair with addition of a 6 o'clock anchor. A 13% anterior bone defect was then and all conditions were repeated. Repeated measures ANOVA was used to test for significant differences among groups. Results: In the no bone loss group, the addition of a 6 o'clock anchor yielded the highest peak resistance force (52.8N, SD: 4.5N) and was significantly greater than the standard Bankart repair by 15.8% (7.2N, p = 0.003). With 13% bone loss from the anterior glenoid, both the standard Bankart repair (peak force 49.3N, SD: 6.1N, p = 0.02) and repair with the addition of the 6 o'clock anchor (peak force 52.6N, SD: 6.1N, p = 0.006) had a significantly higher peak resistance force compared to the bone loss with Bankart lesion group (35.2N, SD: 5.8N). While the 6 o'clock anchor did increase the strength of the standard repair by 6.7%, this was not statistically significant (p = 0.9) in the bone loss model. Conclusions: The addition of a 6 o'clock suture anchor to a "standard" Bankart repair increases the peak resistance force to displacement (no bone loss), although this additional strength is lost with creation of a subcritical anterior glenoid bone defect. Clinical Relevance: This study provides surgeons with essential biomechanical data to aid in the selection of repair configuration. The six o'clock anchor does not enhance repair strength in a subcritical bone loss model.

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“…9 The critical clinical threshold for glenoid bone loss has yet to be determined because some authors have found increased failure rates and lower functional outcomes after arthroscopic Bankart repair in patients with as low as 13.5% glenoid width loss. 10,11 Similar research has evaluated what constitutes a significant Hill-Sachs lesion; however, there is not yet a clear answer, with ranges of bone loss between 37.5% and 65% having been reported. 8,12 In the presence of significant glenoid bone loss, various bone-block methods have been used, most commonly the open Latarjet procedure.…”

mentioning

confidence: 99%

Combined All-arthroscopic Hill-Sachs Remplissage, Latarjet, and Bankart Repair in Patients With Bipolar Glenohumeral Bone Loss

Saliken

Lavoué

Trojani

et al. 2017

Arthroscopy Techniques

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Patients presenting with recurrent shoulder instability and bipolar glenohumeral bone loss are at risk of failed standard soft-tissue repair techniques. Even isolated bony-stabilization procedures such as the Latarjet or remplissage technique may not provide sufficient stability in the face of combined bone loss. We use a combined all-arthroscopic remplissage, Latarjet, and Bankart repair for patients with significant combined glenohumeral bone loss and/or in the revision setting. This allows reconstruction of both the Hill-Sachs and glenoid bone defects and repair of the capsulolabral complex in a minimally invasive manner. Furthermore, the use of cortical-button fixation of the coracoid bone graft may reduce the risk of hardware-related complications while still achieving excellent bone union.

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The Effect of Subcritical Bone Loss and Exposure on Recurrent Instability After Arthroscopic Bankart Repair in Intercollegiate American Football

Abstract: Arthroscopic stabilization of anterior shoulder instability in American football players with <13.5% glenoid bone loss provides reliable outcomes and low recurrence rates.

Cited by 131 publications

References 32 publications

Arthroscopic Bankart Repair for the Management of Anterior Shoulder Instability: Indications and Outcomes

Arthroscopic Bankart Repair for the Management of Anterior Shoulder Instability: Indications and Outcomes

The 6-O'clock Anchor Increases Labral Repair Strength in a Biomechanical Shoulder Instability Model

Combined All-arthroscopic Hill-Sachs Remplissage, Latarjet, and Bankart Repair in Patients With Bipolar Glenohumeral Bone Loss

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