Treatment of Bankart Lesions in Traumatic Anterior Instability of the Shoulder: A Randomized Controlled Trial Comparing Arthroscopy and Open Techniques (original) (raw)
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Bankart repair in traumatic anterior shoulder instability
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2002
The purpose of this study was to compare the results of open and arthroscopic Bankart repair using suture anchors in traumatic anterior glenohumeral instability. Variables measured were recurrence rate, range of motion, and return to preinjury activity. Type of Study: Case control study. Methods: Eighty-nine shoulders in 88 patients with traumatic unilateral anterior shoulder instability were evaluated using Rowe and University of California Los Angeles scores, recurrence, return to activity, and range of motion by an independent examiner at an average of 39 months after either an arthroscopic or open Bankart repair using suture anchors. The arthroscopic technique included a minimum of 3 anchors in most patients and a routine incorporation of capsular plication and proximal shift. Of the 89 shoulders, 30 shoulders (30 patients) underwent open Bankart repair and 59 shoulders (58 patients) underwent arthroscopic Bankart repair. Results: Twenty-six shoulders (86.6%) in the open repair group showed excellent or good results, and 54 (91.5%) shoulders in the arthroscopic repair group showed excellent or good results. The arthroscopic group revealed slightly higher scores in the Rowe (P ϭ .041) and UCLA scores (P ϭ .026). Two patients (6.7%) in the open repair group and 2 (3.4%) in the arthroscopic repair group had experienced at least 1 episode of redislocation after the surgery. One patient (3.3%) in the open repair group and 4 (6.8%) in the arthroscopic repair group demonstrated mild apprehension. The overall residual instability was 10% in the open repair group and 10.2% in the arthroscopic repair group. There were no significant differences in the loss of external rotation and return to prior activity between the 2 groups (P Ͼ .05). Residual instability occurred more frequently in patients with fewer anchors. Conclusions: Arthroscopic suture anchor capsulorraphy showed similar results to the open Bankart procedure.
Functional results of arthroscopic bankart’s Repair (ABR) in bankart’s lesion of the shoulder
International Journal of Orthopaedics Sciences, 2018
Background: Shoulder pain due to shoulder instability is a disabilitating cause in patients aged 15 to 40 years who are active. Shoulder instability in the anterior direction is most commonly due to post traumatic shoulder dislocation. The basic cause is a Bankart lesion which has historic significance. Treament has evolved from open surgery which is vast, extensive to minimally invasive arthroscopic surgery nowadays most commonly preferred by patients all over as well as surgeons, with good to excellent results. Materials and Methods: A total of 48 patients were included in the study. The age of the patients varied from 17 to 44 years with a mean of 27.31 years. There were 45 males and 3 females in our study. This study was Prospective and Retrospective study Conducted at our working place between July 2008 to April 2010. The University of California and Los Angeles (UCLA) shoulder rating scale is used to assess the functional outcomes of the patients operated with ABR. Results: In our series of 48 patients were having preoperative instability ,out of which 37% patients were improved in terms of no postoperative instability. Two patients with fair UCLA scores at 6 months or later had poor compliance with physiotherapy protocol. There was no case of anchor pull out around the shoulder or same shoulder revision surgery for anterior glenohumeral instability. Conclusion: Arthroscopic Bankart repair (ABR)is a safe, effective, cosmetic treatment method with good clinical outcomes, excellent postoperative shoulder motion and low recurrence rates.
Arthroscopic versus open treatment of Bankart lesion of the shoulder: A prospective randomized study
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2004
The purpose of this study was to compare the results of arthroscopic and open repair of isolated Bankart lesions of the shoulder using metallic suture anchors. Type of Study: Prospective randomized clinical study. Methods: Sixty patients with traumatic anterior shoulder instability underwent a surgical repair of an isolated Bankart lesion. The patients were divided into 2 groups of 30 patients each. In group 1, an arthroscopic repair was performed, and in group 2, an open procedure was performed. The groups were homogeneous for gender, age, dominance, number of dislocations, time elapsed between first dislocation and surgery, and pathologic findings. In all cases of both groups, the lesion was repaired using metallic suture anchors carrying nonabsorbable braided sutures. Postoperative rehabilitation was the same for the 2 groups. Two years' follow-up evaluation included Constant and Rowe shoulder scores. Statistical analysis of data was performed using an unpaired t test (significance for P Ͻ .05). Results: No recurrence of dislocation of the involved shoulder has been reported in either group. Follow-up Constant and Rowe scores of the 2 groups were not significantly different. The only significant difference seen between the 2 groups was for range of motion evaluation with the Constant score. The mean value for group 1 (39.6 Ϯ 0.8) was significantly greater (P ϭ .017) than that for group 2 (37.8 Ϯ 2.0). Conclusions: Arthroscopic repair with suture anchors is an effective surgical technique for the treatment of an isolated Bankart lesion. Open repair does not offer a significantly better 2-year result in terms of stability, and furthermore, can negatively affect the recovery of full range of motion of the shoulder. Level of Evidence: Level I.
Current reviews in musculoskeletal medicine, 2017
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. 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. 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 repai...
Journal of Evidence Based Medicine and Healthcare, 2015
BACKGROUND: Shoulder instability and its treatment were described even in ancient times by the Greek and Egyptian physicians. Evidence of shoulder dislocation has been found in archaeological and paleopathological examinations of human shoulders several thousand years old. 1 Many techniques have been described in literature for treatment of recurrent shoulder dislocation. Arthroscopic repair of Bankart's lesion using suture anchors is a noble technique. A suture anchor is a tiny screw with a thread attached to it. The screw is inserted into the bone over the glenoid rim while the sutures hold onto the labral tissue. These anchors provide a stable base for reattachment of the capsulolabral complex. We conducted a study on evaluation of long term effect of arthroscopic repair of Bankart's lesion using suture anchors and compared our results with other studies published in literature. MATERIALS & METHODS: Since June 2012, arthroscopic Bankart's repair using suture anchors was performed on 35 patients, who presented with recurrent anterior dislocation of shoulder. 34 man and 1 woman patients were included in the study. METHOD OF COLLECTION OF DATA: Adult patients with recurrent dislocations of shoulder with. INCLUSION CRITERIA: All patients >15 years but <60 years of age, with post traumatic recurrent dislocation of the shoulder with Bankart lesion. No. of dislocations >=2. EXCLUSION CRITERIA: Age group <15 & >60 years. Clinical evidence of multidirectional instability. Surgery of injured shoulder before 1 st episode of traumatic shoulder dislocation. Number of dislocations <2. Generalised ligamentous laxity. Presence of neuromuscular disorders. Presence of other comorbid conditions. Majority of patients were in the age group between 17 years to 49years, with mean age of 27.43 years. Most patients were young active individuals in the age group of 25 to 35 years. 20 patients (57%) were involved in significant occupation requiring overhead activity such as students with sporting activities, agriculturists. 21(60%) patients had their Right shoulder involved, rest 14(40%) patients had Left shoulder involved. The mean follow-up period was 12 months (range 8-28 months). The patients were evaluated by visual analogue score (VAS), ROWE's score at final follow-up. RESULTS: 34/35 patient's regained almost preoperative range of forward flexion at the last follow-up. Preoperative scores were compared with the most recent follow-up scores for all variables with the help of paired t test. All patients had significant improvement in visual analogue score and ROWE's score. In the preoperative period 18(51.43%) patients had full range and 14(48.57%) patient had painful/limited terminal range of motion, as regards external rotation with arm at the side (ER1). And 07(20%) patients had 0-65º, 22(62.85%) patients had 0-70º, 3(8.57%) patient had 0-70º with pain at terminal range of motion, 3(8.57%) of patients had full range of motion, as regards external rotation at 90º abduction (ER2). At the last follow-up, 33/35(94.28%) patients had full range of ER1 & 32/35(91.42%) patients had full range of ER2.
Arthroscopic Versus Open Reconstruction of the Shoulder in Patients with Isolated Bankart Lesions
The American Journal of Sports Medicine, 1996
We compared open and arthroscopic stabilizations of true Bankart lesions in patients with traumatic, unidirectional anterior glenohumeral dislocations. The 27 patients were men (age range, 18 to 56 years) who were involved in recreational sports. One group (15 patients) had elected an arthroscopic Bankart repair; the other group (12 patients) had chosen open stabilization with a standard deltopectoral approach. Patients were followed up 17 to 42 months after surgery by examination, radiographs, and interviews. In the open repair group, 1 of the 12 patients experienced a subluxation in the follow-up period, but no patients had dislocations or reoperations. In the arthroscopic group, 5 of 15 patients had experienced subluxation or dislocation; of these 5 patients, 2 underwent reoperation. The arthroscopic group had significantly worse results in satisfaction, stability, apprehension, and loss of forward flexion in the operated limb. In summary, the arthroscopic procedure did not significantly improve function; instead, it produced an increased failure rate compared with the open procedure. Therefore, we believe that open stabilization remains the procedure of choice for patients with true Bankart lesions.
Indian Journal of Orthopaedics, 2012
Background: The Bankart lesion represents the most common form of labro-ligamentous injury in patients with traumatic dislocations of the shoulder leading to shoulder instability. We report the clinical outcome of arthroscopic repair of Bankart lesion in 50 patients. Materials and Methods: Sixty fi ve patients with posttraumatic anterior dislocation of shoulder were treated by arthroscopic repair from Jan 2005 to Nov 2008. Fifty patients, with an average age of 26.83 years (range 18-45 years), were reviewed in the study. The average followup period was 27 months (range 24-36 months). University of California Los Angeles shoulder rating scale was used to determine the outcome after surgery. The recurrence rates, range of motion, as well as postoperative function and return to sporting activities were evaluated. Results: Thirty six patients (72.0%) had excellent results, whereas seven patients (14.0%) had good results. The mean pre-and postoperative range of external rotation was 80.38° and 75.18°, respectively. Eighty-six percent patients had stability compared with the normal sided shoulder and were able to return to sports. There were no cases of redislocation observed in this study; however, three cases had mild laxity of the joint. Conclusion: Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent postoperative shoulder motion and low recurrence rates.
Knee Surgery, Sports Traumatology, Arthroscopy, 2012
Purpose The purpose of this study is to report long-term outcomes of the arthroscopic modified Caspari technique compared to an open capsular shift surgery to treat posttraumatic anterior shoulder recurrent instability. The hypothesis was that the open surgery group would show higher degenerative changes than to the modified Caspari technique group after a follow-up from 10 to 17 years. Methods One hundred and ten nonrandomized consecutive patients who underwent a surgical repair of recurrent unilateral anterior shoulder instability between 1990 and 1999 were retrospectively analyzed. Eighty-two patients were available for long-term follow-up. In particular, 49 patients (59.8%) (group A) were treated with arthroscopic transglenoid modified Caspari suturing technique (mean follow-up 13.7 ± 2.2 years), whereas 33 patients (40.2%) (group B) were treated with combined open capsular shift and Bankart repair (mean follow-up 15.7 ± 2.2 years). Patients were evaluated according to the failure rate (re-dislocation), Rowe, UCLA, and Constant scores. Radiological osteoarthritis changes were ranked according to Samilson score. Results There were no statistically significant differences between the two groups concerning the failure rate (n.s.), Rowe (n.s.), UCLA (n.s.), and Constant (n.s.) scores. Group A: re-dislocation rate 12.5% (6 re-dislocations), Rowe 85.0 ± 22.6, UCLA 26.4 ± 4.8, and Constant 86.3 ± 16.7. Group B: re-dislocation rate 9% (3 re-dislocations), Rowe 83.2 ± 24.4, UCLA 26.9 ± 4.2, and Constant 87.4 ± 14.1. Radiographic findings of osteoarthritis: 2 severe (4%), 4 moderate (8%), and 12 mild (25%) in group A; 2 severe (6%), 4 moderate (12%), and 9 mild (27%) in group B; differences between groups were not statistically significant (n.s).