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Arthroscopic repair of combined Bankart and SLAP lesions: operative techniques and clinical results.

Cho HL, Lee CK, Hwang TH, Suh KT, Park JW - Clin Orthop Surg (2010)

Bottom Line: We compared the results with the isolated Bankart lesion.VAS for pain was decreased from preoperative 4.9 to postoperative 1.9.There were no specific complication and no significant limitation of motion more than 10 degree at final follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Good Samsun Hospital, Busan, Korea.

ABSTRACT

Background: To evaluate the clinical results and operation technique of arthroscopic repair of combined Bankart and superior labrum anterior to posterior (SLAP) lesions, all of which had an anterior-inferior Bankart lesion that continued superiorly to include separation of the biceps anchor in the patients presenting recurrent shoulder dislocations.

Methods: From May 2003 to January 2006, we reviewed 15 cases with combined Bankart and SLAP lesions among 62 patients with recurrent shoulder dislocations who underwent arthroscopic repair. The average age at surgery was 24.2 years (range, 16 to 38 years), with an average follow-up period of 15 months (range, 13 to 28 months). During the operation, we repaired the unstable SLAP lesion first with absorbable suture anchors and then also repaired Bankart lesion from the inferior to superior fashion. We analyzed the preoperative and postoperative results by visual analogue scale (VAS) for pain, the range of motion, American Shoulder and Elbow Surgeon (ASES) and Rowe shoulder scoring systems. We compared the results with the isolated Bankart lesion.

Results: VAS for pain was decreased from preoperative 4.9 to postoperative 1.9. Mean ASES and Rowe shoulder scores were improved from preoperative 56.4 and 33.7 to postoperative 91.8 and 94.1, respectively. There were no specific complication and no significant limitation of motion more than 10 degree at final follow-up. We found the range of motions after the arthroscopic repair in combined lesions were gained more slowly than in patients with isolated Bankart lesions.

Conclusions: In recurrent dislocation of the shoulder with combined Bankart and SLAP lesion, arthroscopic repair using absorbable suture anchors produced favorable clinical results. Although it has technical difficulty, the concomitant unstable SLAP lesion should be repaired in a manner that stabilizes the glenohumeral joint, as the Bankart lesion can be repaired if the unstable SLAP lesion is repaired first.

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Related in: MedlinePlus

Arthroscopic image of the combined Bankart and superior labrum anterior to posterior lesion showing (A) inferiorly displaced superior labrum with significant fraying (right shoulder, from posterior viewing portal) and (B) medially displaced superior and anteroinferior labral complex (right shoulder, from anterior working portal).
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Figure 3: Arthroscopic image of the combined Bankart and superior labrum anterior to posterior lesion showing (A) inferiorly displaced superior labrum with significant fraying (right shoulder, from posterior viewing portal) and (B) medially displaced superior and anteroinferior labral complex (right shoulder, from anterior working portal).

Mentions: Surgery was performed with each patient placed in a beach-chair position at an angle of 70° to the floor under general anesthesia. A posterior portal was first established to identify intraarticular lesions. An anterior portal was created lateral to the coracoid process. Next, an anterosuperior portal was made at the anterolateral corner of the acromion for the repair of the anterior SLAP lesion and a port of Wilmington portal was created at a site 1 cm anterior and 1 cm lateral to the posterolateral corner of the acromion for the repair of the posterior SLAP lesion (Fig. 2). A 5.5 mm cannula (Linvatec, Largo, FL, USA) was inserted through the anterior portal and an instrument was passed through this cannula to observe the extent of a Bankart lesion and the presence of a SLAP lesion (Fig. 3). Before the repair of the SLAP lesion, we observed that anatomical reduction of the anteroinferiorly and medially displaced anteroinferior labrum could be obtained with tension when trial reduction of the superior labrum was performed with a probe (Fig. 4). With labral tissues of the SLAP lesion completely separated, the labrum was abraded with a burr until bleeding of the subchondral bone was evident. Then, the anteroinferior labral tissues were released from the articular surface and the labrum was abraded, until bleeding of the subchondral bone was noted. An anchor insertion area was marked with arthroscopic forceps on superior glenoid and SLAP lesion repair using absorbable anchors was started. A bone drill was inserted through the anterior portal and a hole was created at an angle of 45° from the edge of the glenoid with 1 to 2 mm of interval. The lowest anchor portal in the right shoulder was made below the 5 o'clock position and the suture ran superiorly. The suture was passed using a suture hook through the capsulolabral complex from a point 5 mm inferior to the lowest anchor. Finally, knot tying was performed with the inferior glenohumeral ligament pulled superiorly by arthroscopic forceps to make the anteroinferior labral complex displaced superiorly and then firm fixation was examined with probe (Fig. 5). In all cases, we used an average of 5.2 absorbable Panaloc® (Mitek, Norwood, MA, USA) anchors. Suture loop shuttle technique using a No. 2 Nylon suture was performed to prevent the suture strand from being twisted and the Samsung Medical Center knot was made (Fig. 6).


Arthroscopic repair of combined Bankart and SLAP lesions: operative techniques and clinical results.

Cho HL, Lee CK, Hwang TH, Suh KT, Park JW - Clin Orthop Surg (2010)

Arthroscopic image of the combined Bankart and superior labrum anterior to posterior lesion showing (A) inferiorly displaced superior labrum with significant fraying (right shoulder, from posterior viewing portal) and (B) medially displaced superior and anteroinferior labral complex (right shoulder, from anterior working portal).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2824094&req=5

Figure 3: Arthroscopic image of the combined Bankart and superior labrum anterior to posterior lesion showing (A) inferiorly displaced superior labrum with significant fraying (right shoulder, from posterior viewing portal) and (B) medially displaced superior and anteroinferior labral complex (right shoulder, from anterior working portal).
Mentions: Surgery was performed with each patient placed in a beach-chair position at an angle of 70° to the floor under general anesthesia. A posterior portal was first established to identify intraarticular lesions. An anterior portal was created lateral to the coracoid process. Next, an anterosuperior portal was made at the anterolateral corner of the acromion for the repair of the anterior SLAP lesion and a port of Wilmington portal was created at a site 1 cm anterior and 1 cm lateral to the posterolateral corner of the acromion for the repair of the posterior SLAP lesion (Fig. 2). A 5.5 mm cannula (Linvatec, Largo, FL, USA) was inserted through the anterior portal and an instrument was passed through this cannula to observe the extent of a Bankart lesion and the presence of a SLAP lesion (Fig. 3). Before the repair of the SLAP lesion, we observed that anatomical reduction of the anteroinferiorly and medially displaced anteroinferior labrum could be obtained with tension when trial reduction of the superior labrum was performed with a probe (Fig. 4). With labral tissues of the SLAP lesion completely separated, the labrum was abraded with a burr until bleeding of the subchondral bone was evident. Then, the anteroinferior labral tissues were released from the articular surface and the labrum was abraded, until bleeding of the subchondral bone was noted. An anchor insertion area was marked with arthroscopic forceps on superior glenoid and SLAP lesion repair using absorbable anchors was started. A bone drill was inserted through the anterior portal and a hole was created at an angle of 45° from the edge of the glenoid with 1 to 2 mm of interval. The lowest anchor portal in the right shoulder was made below the 5 o'clock position and the suture ran superiorly. The suture was passed using a suture hook through the capsulolabral complex from a point 5 mm inferior to the lowest anchor. Finally, knot tying was performed with the inferior glenohumeral ligament pulled superiorly by arthroscopic forceps to make the anteroinferior labral complex displaced superiorly and then firm fixation was examined with probe (Fig. 5). In all cases, we used an average of 5.2 absorbable Panaloc® (Mitek, Norwood, MA, USA) anchors. Suture loop shuttle technique using a No. 2 Nylon suture was performed to prevent the suture strand from being twisted and the Samsung Medical Center knot was made (Fig. 6).

Bottom Line: We compared the results with the isolated Bankart lesion.VAS for pain was decreased from preoperative 4.9 to postoperative 1.9.There were no specific complication and no significant limitation of motion more than 10 degree at final follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Good Samsun Hospital, Busan, Korea.

ABSTRACT

Background: To evaluate the clinical results and operation technique of arthroscopic repair of combined Bankart and superior labrum anterior to posterior (SLAP) lesions, all of which had an anterior-inferior Bankart lesion that continued superiorly to include separation of the biceps anchor in the patients presenting recurrent shoulder dislocations.

Methods: From May 2003 to January 2006, we reviewed 15 cases with combined Bankart and SLAP lesions among 62 patients with recurrent shoulder dislocations who underwent arthroscopic repair. The average age at surgery was 24.2 years (range, 16 to 38 years), with an average follow-up period of 15 months (range, 13 to 28 months). During the operation, we repaired the unstable SLAP lesion first with absorbable suture anchors and then also repaired Bankart lesion from the inferior to superior fashion. We analyzed the preoperative and postoperative results by visual analogue scale (VAS) for pain, the range of motion, American Shoulder and Elbow Surgeon (ASES) and Rowe shoulder scoring systems. We compared the results with the isolated Bankart lesion.

Results: VAS for pain was decreased from preoperative 4.9 to postoperative 1.9. Mean ASES and Rowe shoulder scores were improved from preoperative 56.4 and 33.7 to postoperative 91.8 and 94.1, respectively. There were no specific complication and no significant limitation of motion more than 10 degree at final follow-up. We found the range of motions after the arthroscopic repair in combined lesions were gained more slowly than in patients with isolated Bankart lesions.

Conclusions: In recurrent dislocation of the shoulder with combined Bankart and SLAP lesion, arthroscopic repair using absorbable suture anchors produced favorable clinical results. Although it has technical difficulty, the concomitant unstable SLAP lesion should be repaired in a manner that stabilizes the glenohumeral joint, as the Bankart lesion can be repaired if the unstable SLAP lesion is repaired first.

Show MeSH
Related in: MedlinePlus