2017 ISAKOS Biennial Congress ePoster #2016

 

Arthroscopic Treatment of Massive Cliff Style Bankart Injury in the Patient with Habitual Dislocation of Shoulder

Hong Wang, MD, Wuhan, Hubei CHINA
Chunqing Meng, Prof., Wuhan, Hubei CHINA
Xiaohong Wang, PhD, Wuhan CHINA
Saroj Rai, MD, PhD, Abu Dhabi UNITED ARAB EMIRATES
Shengyang Jin, MD, Wuhan CHINA
Zengwu Shao, Prof., Wuhan CHINA

Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, CHINA

FDA Status Not Applicable

Summary

Objective: To assess the effectiveness of arthroscopic repair of massive cliff style Bankart Lesion in the habitual dislocation of shoulder by using anchor sutures technique.

Abstract

Method: Consecutive 34 patients with habitual shoulder dislocation associated with massive Bankart Lesion were treated from May 2009 to May 2015. Among them, 29 were male and 5 were female patients with the mean age of 26.2±8.6 years (19 to 39 years). 14 patients had left sided bankart lesion and remaining 20 patients had right sided bankart lesion. All the patients complained of habitual shoulder dislocation and shoulder pain and the average number of dislocation is 3.4 times.
Surgical Procedure: Under general anaesthesia, the patient was placed in the lateral decubitus position. Examination under anaesthesia was routinely performed in all the patients. Posterior portal was created and arthroscope was inserted to the shoulder joint followed by thorough diagnostic arthroscopy. Under arthroscopy all the patients were found to have anterior and anteroinferior capsulolabral lacerations in 1 to 6 o’clock position with associated anteroinferior glenoid rim wear, soft tissue injury with humeral head cartilage wear, synovial hyperplasia, and anteroinferior labrum was avulsed and retracted to the glenoid neck from the rim giving the “falling from cliff sign”. After proper diagnostic arthroscopy two working portals anterosuperior and anteroinferior portals were made. The capsule and labrum were then mobilized and any devitalized tissues were debrided, any loose bodies were removed and full assessment of labral tear was made. Glenoid rim was prepared for biological healing which included the debridement of anterior glenoid neck all the way to the inferior with the help of shaver in oscillating mode and further abrasion was made with the help of bone rasp. Then the mobility of labrum was assessed making sure that labrum reduced to normal anatomical position. In some cases superior shifting of glenohumoral complex was necessary to restore physiological tension thus eliminating the drive-through sign. After making sure that there is sufficient bony bleeding for capsular healing, 3 anchor sutures are placed on the cartilaginous margin of glenoid rim starting from 5:30 to 2 o’clock position. Knots were tied recreating soft tissue bumper. Suture could be used as mattress suture. Loop and knot fixation was secured in order to compress the capsuloligamentous complex to provide adequate fixation. Capsular plication could be performed in some cases. No bone grafts were needed in our case series.

Results

Patients were followed up for 12 - 24 months, (mean being 15.4±5.6) months. All patients recovered well without any re-dislocation or shoulder instability. Preoperative ASES mean score71.86±15.54 (48-91.3) was significantly improve postoperatively with ASES mean score 93.66±5.91 (87-100) 1 year after the operative procedure. Paired t test showed statistically significance difference with t value=3.051 and P=0.038 (<0.05).

Conclusion

Massive bankart lesion with the intact anterior and anteroinferior labrum in the patient with habitual dislocation of shoulder can be managed arthroscopically using suture anchor and mesh suture very effectively with good clinical result. Precise clinical, radiological and diagnostic arthroscopic evaluation is very much essential to have proper judgment of extent of pathology, type and number of anchor sutures and need for bone graft use.