The arthroscopic Bankart operation: a 10-year follow-up study

Arthroscopic posterior capsulolabral repair grants adequate outcomes in shoulders with posterior instability without glenoid cartilage lesions

INTRODUCTION

Posterior capsulolabral repair (posterior Bankart) is effective to restore shoulder stability and relieve pain, though a recent meta-analysis reported recurrent instability in 9.5% of patients, and that only 62.7% were able to resume sports. The purpose of this study was to assess the outcomes of arthroscopic posterior capsulolabral repair in a population of unselected patients, in terms of recurrence of instability, clinical scores, and return to sports.

METHODS

The authors retrospectively studied a consecutive series of 22 patients that underwent posterior capsulolabral repair between 2009 and 2019. Patients were assessed before posterior capsulolabral repair and at a minimum follow-up of 24 months, in terms of subjective shoulder value (SSV), Western Ontario Shoulder Instability Index (WOSI), as well as level of sport. Following surgery, all complications, reoperations or episodes of instability were noted.

RESULTS

The cohort comprised 21 men (95%) and 1 woman (5%), aged 38.8 ± 12.5 years (range 17-61) at index surgery. Of the 20 patients that performed sports, only 2 (10%) stopped sports after surgery, while 18 resumed their main sport (90%). At a follow-up of 65.4 ± 34.8 months (range 25-146), the SSV was 85.1 ± 14.7, pain on VAS was 1.9 ± 2.1, and the Constant-Murley score was 71.6 ± 17.9. Five patients had subjective instability without dislocation (23%). Nine patients (41%) had no pain (0 points), 6 patients (27%) had mild pain (1-2 points), 4 patients (18%) had moderate pain (3 points), while 3 patients (14%) had severe pain (5-8 points).

CONCLUSION

Arthroscopic posterior capsulolabral repair prevented recurrent dislocation in patients with posterior shoulder instability at a minimum follow-up of 2 years, despite persistent pain in 32%, and subjective instability in 23%. These complications were mainly observed in patients with work-related accidents and glenoid cartilage lesions.

LEVEL OF EVIDENCE

III, case series.

Arthroscopic Bankart repair with inferior glenohumeral ligament tightening using the antegrade suture passer

Arthroscopic repair is the gold standard for treating Bankart lesions, with commonly used portals including the posterior, anterosuperior, and anteroinferior portals. The two anterior portals are established through a safe triangle created by the superior margin of the subscapularis, the inferior margin of the biceps tendon, and the anterior superior edge of the glenoid cavity. However, the disadvantage of this conventional method is that it can lead to crowding of the instruments at the rotator interval, making it difficult to handle. The inferior glenohumeral ligament (IGHL) and its bands play a major role in the pathophysiology of glenohumeral instability. Restoration of the capsular tension by tightening the anterior band of the IGHL is an integral part of a successful Bankart repair, achieved by suturing the labrum at the 6 o'clock position to an anchor placed at the 5 o'clock position of the glenoid, creating a south-to-north capsulolabral shift. Traditionally, this is done using a curved suture passer (Lasso). However, taking a bite using the Lasso through the anteroinferior portal is difficult.

Patients Report A Positive Experience on Social Media After Bankart Repair

Purpose

The purpose of this cross-sectional study was to analyze publicly available posts on Instagram and Twitter to gain an understanding of patients’ perspectives regarding Bankart injuries and repair.

Methods

Public posts on Instagram and Twitter were queried from June 1, 2019, to June 1, 2020, with the following hashtags: #Bankart #Bankartrepair #Bankartlesion #labrumrepair #labralrepair #shoulderdislocation. Posts that did not contain those hashtags were excluded. In addition, posts that included that hashtag but displayed content unrelated to Bankart repair were excluded. A binary categorical system was used for media format (picture or video), perspective (patient, family or friend, physician, hospital or physical therapy group, professional organization, news media, or industry), timing (preoperative, postoperative, nonoperative), tone (positive, negative, or neutral), content (surgical site, hospital or surgeon, imaging, rehabilitation, activities of daily living [ADLs], return to work, surgical instruments, or education), post popularity (number of likes), and geographic location.

Results

1,154 Instagram posts were identified. 722/1,154 posts (62.6%) were made by patients. 600 (52.0%) of the post tones were positive, 407 (35.3%) were neutral, and 667 (57.8%) were postoperative. The most common content included in Instagram posts were ADLs (577; 50.0%), education (233; 20.2%), and rehabilitation (226; 19.6%). Overall, posts had an average of 117 likes and had geotags from 49 different countries. 155 tweets were identified, 92 of which (59.4%) were made by physicians, 113 (72.9%) were neutral, 127 (81.9%) were nonoperative, and the most common type of content posted was education (130; 83.9%). Overall, posts on Twitter had an average of 3.2 likes and had geotags from 4 different countries.

Conclusions

Instagram posts were made mostly by patients postoperatively and focused on ADLs. The tone of the Instagram posts indicates that a majority of patients have a positive experience with Bankart repair. The majority of tweets were made by physicians and provided educational information with a neutral tone.

Clinical Relevance

Exploring patient's experiences with Bankart repair on social media provides insight into their overall experience with the surgery. The majority of patients reported a positive experience.