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After patient selection, technical facets of arthroscopic Bankart repair also improve results

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SAN DIEGO — Orthopedists who perform arthroscopy can do a better job with Bankart repairs for traumatic anterior shoulder instability by incorporating some technical advances into their procedures, said a past president of the Arthroscopy Association of North America speaking at the association’s 2011 Annual Specialty Day Meeting.

“I think we are doing okay, but there is room for improvement,” Richard K.N. Ryu, MD, said during a shoulder instability symposium at the meeting. “If we are going to optimize outcomes, clearly patient selection is the most important factor as we make decisions.”

However, Ryu said that the highest reported failures of 13% to 20% after well-done primary repairs are often due to patient age and gender — so it is not always a technique issue.

Suggestions

To maximize the benefit of an arthroscopic primary Bankart repair for anterior shoulder instability, Ryu suggested using the lateral decubitus rather than the beach chair position. Ryu claimed the latter allows a more ergonomic capsular access. “I think this is an easier operation” done this way, he said.

“This is the money step,” Ryu continued, explaining that stripping the inferior glenohumeral ligament, particularly in patients with chronic instability, and shifting the tissue inferior to superior was essential.

Performing the repair

Furthermore, the shifted tissue should be moved into the defect. “It is not good enough simply to close the hole,” he said.

When performing the repair, Ryu recommended placing the anchor on the glenoid face and retensioning the ligament. He called that step “absolutely critical.”

He also suggested retensioning the inferior capsule, which he said often gets ignored, particularly when patients are in the beach chair position. Simply putting anchors in the front of the shoulder will not suffice, he note. But, directly accessing the inferior capsule and glenoid through a newly-placed canula and placing an inferior anchor that way “may give you an advantage in terms of better outcome,” Ryu said.

Reference:

• Ryu, RKN. Arthroscopic Bankart repair for traumatic anterior shoulder instability: Surgical techniques to optimize outcomes. Presented at the Arthroscopy Association of North America 2011 Specialty Day Meeting. Feb. 19, 2011. San Diego.

Disclosure: Ryu is on the speaker’s bureau for Mitek.

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