Arthroscopic Bankart repair with the Suretac device for traumatic anterior shoulder instability in athletes

A biomechanical study of bankart lesion fixation - biodegradable ArthroRivet tack vs. suture repair

Bioabsorbable fixation is commonly used in soft tissue procedures performed in the shoulder. ArthroRivettrade mark tacks (referred to as rivets here), made from a copolymer of 82% poly-L-lactic acid and 18% polyglycolic acid, were developed for the Bankart procedure. Although a previous in vivo study demonstrated favorable comparison of the fixation strength and absorption characteristics of this device with that of polyglyconate bioabsorbable tacks, there have been no published biomechanical studies of this rivet in the shoulder. Fourteen shoulders were harvested from fresh-frozen cadavers of average age 74 years (46-89). Biomechanical testing was performed by measuring the energy, or work, required to anteriorly displace the humeral head 6 mm from the glenoid. Each shoulder was tested intact, vented, and before and after repair of a simulated Bankart lesion at 0, 45, and 90 degrees of abduction with and without maximal external rotation. Overall, the average work required ranged from 54.7 N-mm to 178.27 N-mm. Although the biomechanical performance of the rivet, based on resistance to anterior displacement of the humeral head, was indistinguishable from that of the suture repair, the statistical power of the test was low due to the large variance in the cadaver specimens. The results, in general, correlated well with those of previously published studies, suggesting the suitability of the bioabsorbable rivet for use in Bankart repair.

Arthroscopic labrum reconstruction with capsular shift in anterior shoulder instability: improved midterm results by using a standardized suprabicipital camera position

PURPOSE

To investigate the midterm results of a standardized arthroscopic technique for labrum reconstruction by using a third suprabicipital portal for better visualization of the anterior glenoid rim.

METHODS

Thirty-three of 36 patients treated for recurrent anterior shoulder dislocation were followed up by telephone and/or in clinical examinations. The average age of the patients (12 women and 21 men) at the time of surgery was 25.2 years, with a mean follow-up of 35 months. On average, 7.8 dislocations occurred between the first dislocation and the stabilization procedure (mean, 45.4 months).

RESULTS

Two patients suffered again from redislocations (recurrence rate 6.1%), and 3 patients had 1 or 2 subluxations (9.1%) at the time of follow-up. In the Rowe score, the patients reached 77.5 points on average; 81.8% of the patients returned to sports and leisure activities as in the time before the first dislocation, and 18.2% (6 patients) did not. Limitations for external rotation were 7.8 degrees on average postoperatively. No statistical correlation between the number of preoperative dislocations and the level of the postoperative Rowe score was found.

CONCLUSIONS

The arthroscopic labrum reconstruction with capsular shift using the 3-portal technique combined with a standardized suprabicipital camera position revealed a recurrence rate and midterm results that were close to results achieved after open procedures. The failure rate, according to the number of dislocations, was 6.1% based on the patient's satisfaction of 12.1%.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

Shoulder injuries in golf

Although often perceived as a leisurely activity, golf can be a demanding sport, which can result in injury, usually from overuse and sometimes from poor technique. The shoulder is a commonly affected site, with the lead shoulder, or the left shoulder in the right-handed golfer, particularly vulnerable to injury. A thorough understanding of the biomechanics of the golf swing is helpful in diagnosing and managing these injuries. Common shoulder problems affecting golfers include subacromial impingement, acromioclavicular arthrosis, rotator cuff tear, glenohumeral instability, and glenohumeral arthrosis. Although the majority of patients with these disorders will respond to nonsurgical treatment, including rest and a structured program of physical therapy, further benefits can be obtained with subtle modifications of the golf swing. Those golfers who fail to respond to nonsurgical management can often return to competitive play with appropriate surgical treatment.