Arthroscopic Bankart’s repair - Are we using too many anchors?

Dr. Sunit Hazra

R G KAR MEDICAL COLLEGE KOLKATA , WEST BENGAL

INTRODUCTION :

Arthroscopic Bankart’s procedure has

established itself as gold standard in

traumatic recurrent shoulder dislocation.

The uppermost point of fixation of labrum

should be the attachment site of anterior

border of inferio glenohumeral ligament.

Inferior

glenohumeral

ligament is the key

stabiliser.

The anchors

should be placed at

anteroinferior

quadrant of

glenoid.

We calculated the number of anchors

required in Indian people using a fixed

distance of 5 mm between 2 anchors.

The glenoid surface was divided into 4 quadrants.

QUADRANTS OF GLENOID

The length of anteroinferior

quadrants of cadaveric scapula

were measured .

MEASUREMENT OF QUADRANTS

The length of antero inferior quadrant in “mm” was divided by 5.

The average

value was calculated.

RESULTS :

In this study length of antero inferior quadrant is measured in 40 cadaveric scapular specimen .

Each of which is divided by 5.

Minimum length 9.5 mm & maximum length 13 mm.(11.2)

The average value was 2.2 with the range (1.9-2.6).

Based on above data evaluation done on 20 patients undergoing arthroscopic bankart’s repair using 2 -3 anchors.

CLINICAL ANALYSIS :

Average age of those patient was 26 (16-46).

Patients were evaluated over a period of 1.5 yrs.

All patients had chronic anterior instability on clinical examination and Bankart’s lesion on Arthroscopy.

Bankart repair was performed using 2-3 bioabsorbable Lupine anchor with Orthocord

Post operative hospital stay ranged from 1-2 nights. Arm sling was used for 2 weeks after which progressive physiotherapy was commenced.

Evaluation done with Modified ROWE SCORE.

POST OPERATIVE PAIN(12 months)

PAIN(Max -10)

PATIENT

PERCENTAGE

(1) N0 pain(10) 16 80

(2) Moderate pain (5)

4 20

(3) Severe pain (0) 0

POST OPERATIVE STABILITY(12months)

STABILITY(Max-30)

PATIENT PERCENTAGE

(1) Neg. apprehension test /No subluxation(30)

15 75

(2) Neg. apprehension test /discomfort with Abduction /ext. rotation(15)

3 15

(3) Positive apprehension(00)

2 10

POST OPERATIVE MOTION(12 months)

MOTION (Max-10)

PATIENT

PERCENTAGE

(1) Full(10) 13 65

(2) ≤25% loss in any plane (5)

5 25

(3) ≥25% loss in any plane (0)

2 10

POST OPERATIVE FUNCTION(12 months)

3 15

FUNCTION(Max-50) PATIENT PERCENTAGE

(1) No limit/Throw /Return to Sport(50)

13 65

(2)No Limit/Return, not same(40)

5 25

(3)No Limit/No Return(35) 2 10

(4)Moderate Limit /No Return (20)

0 0

(5)Marked limitation /no work overhead(0)

0 0

MODIFIED ROWE SCORE

70

5

0

25

Results were excellent in 70%, good in 5% and fair in 15% & poor in 10 %.No patient developed recurrence.

RESULTS PATIENT NO PERCENTAGE

Excellent(90-100)

14 70

Good(75-89) 1 5

Fair(50-74) 3 15

Poor(0-49) 2 10

CADAVERIC IMAGES

Per operative

POST OP EVALUATION

POST OP 2WK POST OP 6 MONTH

DISCUSSION :

The most commonly used number of anchors, as

reported by the literature, is 3[1]

The normal anatomical variant observed in many

people showing gap at anterosuperior quadrant

prompted us to only fix the inferior quadrant showing

good clinical results.

1. van der Linde JA, van Kampen DA, Terwee CB, Dijksman LM, Kleinjan G, Willems WJ. Long-term results after arthroscopic shoulder stabilization using suture anchors: an 8- to 10-year follow-up. Am J Sports Med 2011;39:2396-403

From our cadaveric study, we found that

the antero-inferior length of Indian scapula

is approximately 11.5 mm so the number of

anchor required is 2.2.

Fixation with 2-3 anchors showed excellent

result in 70%, good in 5% and fair in 15% &

poor in 10 %.No patient developed

recurrence.

CONCLUSION :

Indian patients have smaller scapula, so,

the number of anchor required to fix

inferior glenohumeral ligament should be

less.

So we conclude that even in patients with

Bankart lesions 2-3 anchor should be

sufficient.