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

  • Lee, Byung-Ill (Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital) ;
  • Kim, Byoung-Min (Department of Orthopedic Surgery, Konkuk University Chungju Hospital) ;
  • Kho, Duk-Hwan (Department of Orthopedic Surgery, Konkuk University Chungju Hospital) ;
  • Kim, Hyeung-June (Department of Orthopedic Surgery, Konkuk University Chungju Hospital)
  • Received : 2017.07.05
  • Accepted : 2017.07.30
  • Published : 2017.09.30

Abstract

Background: Arthroscopic fixations for large and comminuted bony Bankart lesions are technically difficult. We developed an arthroscopic multiple pulled suture (MPS) technique to restore large and comminuted bony Bankart lesions. Methods: Ten patients (mean age, 49.8 years; range, 31-79 years) underwent bony Bankart repair using the illustrated MPS technique and were then followed for a mean of 27.3 months. A plain radiograph series and three-dimensional computed tomography scans were taken at the initial clinical evaluation and 3 months postoperatively. Outcome measurements included the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, University of California at Los Angeles (UCLA) score, and subjective patient satisfaction, along with surgical complications. Results: Union of an osseous fragment with the glenoid rim was confirmed in all patients on a computed tomography scan 3 months after operation. The osseous fragment was restored to proper articular congruence and reduction. The affected shoulder was stable in nine of the 10 patients. One patient presented with a redislocation after a sports injury 3 years postoperatively. The ASES, Rowe, and UCLA scores improved at the final evaluation, and median patient satisfaction at the final follow-up was 9 of 10 points (range, 6-10 points). Conclusions: The arthroscopic MPS technique for bony Bankart lesions with large or comminuted osseous fragments was a relatively easy and safe method for stable fixation of the osseous fragment. Therefore, the arthroscopic MPS technique resulted in good restoration of stability with high patient satisfaction and low complication rates.

Keywords

References

  1. Bankart AS. Recurrent or habitual dislocation of the shoulderjoint. Br Med J. 1923;2(3285):1132-3. https://doi.org/10.1136/bmj.2.3285.1132
  2. Griffith JF, Antonio GE, Yung PS, et al. Prevalence, pattern, and spectrum of glenoid bone loss in anterior shoulder dislocation: CT analysis of 218 patients. AJR Am J Roentgenol. 2008; 190(5):1247-54. https://doi.org/10.2214/AJR.07.3009
  3. Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am. 2003;85(5):878-84. https://doi.org/10.2106/00004623-200305000-00016
  4. Yamamoto N, Muraki T, Sperling JW, et al. Stabilizing mechanism in bone-grafting of a large glenoid defect. J Bone Joint Surg Am. 2010;92(11):2059-66. https://doi.org/10.2106/JBJS.I.00261
  5. Fujii Y, Yoneda M, Wakitani S, Hayashida K. Histologic analysis of bony Bankart lesions in recurrent anterior instability of the shoulder. J Shoulder Elbow Surg. 2006;15(2):218-23. https://doi.org/10.1016/j.jse.2005.06.006
  6. Bauer T, Abadie O, Hardy P. Arthroscopic treatment of glenoid fractures. Arthroscopy. 2006;22(5):569.e1-6. https://doi.org/10.1016/j.arthro.2006.01.003
  7. Cameron SE. Arthroscopic reduction and internal fixation of an anterior glenoid fracture. Arthroscopy. 1998;14(7):743-6. https://doi.org/10.1016/S0749-8063(98)70102-1
  8. Kim SJ, Kim TW, Moon HK, Chang WH. A combined transglenoid and suture anchor technique for bony Bankart lesions. Knee Surg Sports Traumatol Arthrosc. 2009;17(12):1443-6. https://doi.org/10.1007/s00167-009-0845-6
  9. Kavanagh BF, Bradway JK, Cofield RH. Open reduction and internal fixation of displaced intra-articular fractures of the glenoid fossa. J Bone Joint Surg Am. 1993;75(4):479-84. https://doi.org/10.2106/00004623-199304000-00001
  10. Kokubu T, Nagura I, Mifune Y, Kurosaka M. Arthroscopic bony bankart repair using double-threaded headless screw: a case report. Case Rep Orthop. 2012;2012:789418.
  11. Millett PJ, Braun S. The "bony Bankart bridge" procedure: a new arthroscopic technique for reduction and internal fixation of a bony Bankart lesion. Arthroscopy. 2009;25(1):102-5. https://doi.org/10.1016/j.arthro.2008.07.005
  12. Porcellini G, Campi F, Paladini P. Arthroscopic approach to acute bony Bankart lesion. Arthroscopy. 2002;18(7):764-9. https://doi.org/10.1053/jars.2002.35266
  13. Sugaya H, Kon Y, Tsuchiya A. Arthroscopic repair of glenoid fractures using suture anchors. Arthroscopy. 2005;21(5):635.
  14. Aulicino PL, Reinert C, Kornberg M, Williamson S. Displaced intra-articular glenoid fractures treated by open reduction and internal fixation. J Trauma. 1986;26(12):1137-41. https://doi.org/10.1097/00005373-198612000-00017
  15. Millett PJ, Horan MP, Martetschlager F. The "bony Bankart bridge" technique for restoration of anterior shoulder stability. Am J Sports Med. 2013;41(3):608-14. https://doi.org/10.1177/0363546512472880
  16. Porcellini G, Paladini P, Campi F, Paganelli M. Long-term outcome of acute versus chronic bony Bankart lesions managed arthroscopically. Am J Sports Med. 2007;35(12):2067-72. https://doi.org/10.1177/0363546507305011
  17. Anderl W, Kriegleder B, Heuberer PR. All-arthroscopic implant-free iliac crest bone grafting: new technique and case report. Arthroscopy. 2012;28(1):131-7. https://doi.org/10.1016/j.arthro.2011.10.027
  18. Savoie FH 3rd, Miller CD, Field LD. Arthroscopic reconstruction of traumatic anterior instability of the shoulder: the Caspari technique. Arthroscopy. 1997;13(2):201-9. https://doi.org/10.1016/S0749-8063(97)90155-9
  19. Lee BI, Choi HS, Min KD, et al. A pulled sutures technique for bony Bankart lesion. Eur J Orthop Surg Traumatol. 2014;24(4):641-5. https://doi.org/10.1007/s00590-013-1227-9
  20. Burkhart SS, Debeer JF, Tehrany AM, Parten PM. Quantifying glenoid bone loss arthroscopically in shoulder instability. Arthroscopy. 2002;18(5):488-91. https://doi.org/10.1053/jars.2002.32212
  21. Chuang TY, Adams CR, Burkhart SS. Use of preoperative three-dimensional computed tomography to quantify glenoid bone loss in shoulder instability. Arthroscopy. 2008;24(4):376-82. https://doi.org/10.1016/j.arthro.2007.10.008
  22. Gerber C, Nyffeler RW. Classification of glenohumeral joint instability. Clin Orthop Relat Res. 2002;(400):65-76.
  23. Bigliani LU, Newton PM, Steinmann SP, Connor PM, Mcllveen SJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med. 1998;26(1):41-5. https://doi.org/10.1177/03635465980260012301
  24. Rowe CR, Zarins B. Recurrent transient subluxation of the shoulder. J Bone Joint Surg Am. 1981;63(6):863-72. https://doi.org/10.2106/00004623-198163060-00001
  25. Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy. 2000;16(7):677-94. https://doi.org/10.1053/jars.2000.17715
  26. Bushnell BD, Creighton RA, Herring MM. Bony instability of the shoulder. Arthroscopy. 2008;24(9):1061-73. https://doi.org/10.1016/j.arthro.2008.05.015
  27. Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg Am. 2000;82(1):35-46. https://doi.org/10.2106/00004623-200001000-00005
  28. Marcacci M, Zaffagnini S, Petitto A, Neri MP, Iacono F, Visani A. Arthroscopic management of recurrent anterior dislocation of the shoulder: analysis of technical modifications on the Caspari procedure. Arthroscopy. 1996;12(2):144-9. https://doi.org/10.1016/S0749-8063(96)90002-X
  29. Sugaya H, Moriishi J, Kanisawa I, Tsuchiya A. Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability. Surgical technique. J Bone Joint Surg Am. 2006;88 Suppl 1 Pt 2:159-69. https://doi.org/10.2106/00004623-200609001-00001
  30. van Oostveen DP, Schild FJ, van Haeff MJ, Saris DB. Suture anchors are superior to transglenoid sutures in arthroscopic shoulder stabilization. Arthroscopy. 2006;22(12):1290-7. https://doi.org/10.1016/j.arthro.2006.07.006
  31. Kandziora F, Jager A, Bischof F, Herresthal J, Starker M, Mittlmeier T. Arthroscopic labrum refixation for post-traumatic anterior shoulder instability: suture anchor versus transglenoid fixation technique. Arthroscopy. 2000;16(4):359-66. https://doi.org/10.1016/S0749-8063(00)90079-3

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  1. Is the Arthroscopic "Multiple Pulled Suture" Technique a Good Solution for Large or Comminuted Bony Bankart Lesions vol.20, pp.3, 2017, https://doi.org/10.5397/cise.2017.20.3.115