Previously, we conducted a multi-center, double-blinded randomized controlled trial comparing arthroscopic Bankart repair with and without remplissage. The end point for the randomized controlled trial was two years post-operative, providing support for the benefits of remplissage in the short term in reducing recurrent instability. The aim of this study was to compare the medium term (3 to 9 years) outcomes of patients previously randomized to have undergone isolated Bankart repair (NO REMP) or Bankart repair with remplissage (REMP) for the management of recurrent anterior glenohumeral instability. The rate of recurrent instability and instances of re-operation were examined. The original study was a double-blinded, randomized clinical trial with two 1:1 parallel groups with recruitment undertaken between 2011 and 2017. For this medium-term study, participants were reached for a telephone follow-up in 2020 and asked a series of standardized questions regarding ensuing instances of subluxation, dislocation or reoperation that had occurred on their shoulder for which they were randomized. Descriptive statistics were generated for all variables. “Failure” was defined as occurrence of a dislocation. “Recurrent instability” was defined as the participant reporting a dislocation or two or more occurences of subluxation greater than one year post-operative. All analyses were undertaken based on intention-to-treat whereby their data was analyzed based on the group to which they were originally allocated. One-hundred and eight participants were randomized of which 50 in the NO REMP group and 52 in the REMP group were included in the analyses in the original study. The mean number of months from surgery to final follow-up was 49.3 for the NO REMP group and 53.8 for the REMP group. The rates of re-dislocation or failure were 8% (4/52) in the REMP group at an average of 23.8 months post-operative versus 22% (11/50) in the NO REMP at an average of 16.5 months post-operative. The rates of recurrent instability were 10% (5/52) in the REMP group at an average of 24 months post-operative versus 30% (15/50) in the NO REMP group at an average of 19.5 months post-operative. Survival curves were significantly different favouring REMP in both scenarios. Arthroscopic Bankart repair combined with remplissage is an effective procedure in the treatment of patients with an engaging Hill-Sachs lesion and minimal glenoid bone loss (<15%). Patients can expect favourable rates of recurrent instability when compared with isolated Bankart repair at medium term follw-up

Aims. The aims of this study were to validate the minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds for Western Ontario Shoulder Instability Index (WOSI), Rowe score, American Shoulder and Elbow Surgeons (ASES), and visual analogue scale (VAS) scores following arthroscopic Bankart repair, and to identify preoperative threshold values of these scores that could predict the achievement of MCID and PASS. Methods. A retrospective review was conducted on 131 consecutive patients with anterior shoulder instability who underwent arthroscopic Bankart repair between January 2020 and January 2023. Inclusion criteria required at least one episode of shoulder instability and a minimum follow-up period of 12 months. Preoperative and one-year postoperative scores were assessed. MCID and PASS were estimated using distribution-based and anchor-based methods, respectively. Receiver operating characteristic curve analysis determined preoperative patient-reported outcome measure thresholds predictive of achieving MCID and PASS. Results. MCID thresholds were determined as 169.6, 6.8, 7.2, and 1.1 for WOSI, Rowe, ASES, and VAS, respectively. PASS thresholds were calculated as ≤ 480, ≥ 80, ≥ 87, and ≤ 1 for WOSI, Rowe, ASES, and VAS, respectively. Preoperative thresholds of ≥ 760 (WOSI) and ≤ 50 (Rowe) predicted achieving MCID for WOSI score (p < 0.001). Preoperative thresholds of ≤ 60 (ASES) and ≥ 2 (VAS) predicted achieving MCID for VAS score (p < 0.001). A preoperative threshold of ≥ 40 (Rowe) predicted achieving PASS for Rowe score (p = 0.005). Preoperative thresholds of ≥ 50 (ASES; p = 0.002) and ≤ 2 (VAS; p < 0.001) predicted achieving PASS for the ASES score. Preoperative thresholds of ≥ 43 (ASES; p = 0.046) and ≤ 4 (VAS; p = 0.024) predicted achieving PASS for the VAS. Conclusion. This study defined MCID and PASS values for WOSI, Rowe, ASES, and VAS scores in patients undergoing arthroscopic Bankart repair. Higher preoperative functional scores may reduce the likelihood of achieving MCID but increase the likelihood of achieving the PASS. These findings provide valuable guidance for surgeons to counsel patients realistically regarding their expectations. Cite this article: Bone Joint J 2024;106-B(10):1118–1124

Aims. The factors that predispose to recurrent instability and revision stabilization procedures after arthroscopic Bankart repair for anterior glenohumeral instability remain unclear. We sought to determine the rate and risk factors associated with ongoing instability in patients undergoing arthroscopic Bankart repair for instability of the shoulder. Materials and Methods. We used the Statewide Planning and Research Cooperative System (SPARCS) database to identify patients with a diagnosis of anterior instability of the shoulder undergoing arthroscopic Bankart repair between 2003 and 2011. Patients were followed for a minimum of three years. Baseline demographics and subsequent further surgery to the ipsilateral shoulder were analyzed. Multivariate analysis was used to identify independent risk factors for recurrent instability. Results. A total of 5719 patients were analyzed. Their mean age was 24.9 years (. sd.  9.3); 4013 (70.2%) were male. A total of 461 (8.1%) underwent a further procedure involving the ipsilateral shoulder at a mean of 31.5 months (. sd.  23.8) postoperatively; 117 (2.1%) had a closed reduction and 344 (6.0%) had further surgery. Revision arthroscopic Bankart repair was the most common subsequent surgical procedure (223; 65.4%). Independent risk factors for recurrent instability were: age < 19 years (odds ratio 1.86), Caucasian ethnicity (hazard ratio 1.42), bilateral instability of the shoulder (hazard ratio 2.17), and a history of closed reduction(s) prior to the initial repair (hazard ratio 2.45). Revision arthroscopic Bankart repair was associated with significantly higher rates of ongoing persistent instability than revision open stabilization (12.4% vs 5.1%, p = 0.041). Conclusion. The incidence of a further procedure being required in patients undergoing arthroscopic Bankart repair for anterior glenohumeral instability was 8.1%. Younger age, Caucasian race, bilateral instability, and closed reduction prior to the initial repair were independent risk factors for recurrent instability, while subsequent revision arthroscopic Bankart repair had significantly higher rates of persistent instability than subsequent open revision procedures. Cite this article: Bone Joint J 2018;100-B:324–30

Aims. Patients with recurrent anterior dislocation of the shoulder commonly have an anterior osseous defect of the glenoid. Once the defect reaches a critical size, stability may be restored by bone grafting. The critical size of this defect under non-physiological loading conditions has previously been identified as 20% of the length of the glenoid. As the stability of the shoulder is load-dependent, with higher joint forces leading to a loss of stability, the aim of this study was to determine the critical size of an osseous defect that leads to further anterior instability of the shoulder under physiological loading despite a Bankart repair. Patients and Methods. Two finite element (FE) models were used to determine the risk of dislocation of the shoulder during 30 activities of daily living (ADLs) for the intact glenoid and after creating anterior osseous defects of increasing magnitudes. A Bankart repair was simulated for each size of defect, and the shoulder was tested under loading conditions that replicate in vivo forces during these ADLs. The critical size of a defect was defined as the smallest osseous defect that leads to dislocation. Results. The FE models showed a high risk of dislocation during ADLs after a Bankart repair for anterior defects corresponding to 16% of the length of the glenoid. Conclusion. This computational study suggests that bone grafting should be undertaken for an anterior osseous defect in the glenoid of more than 16% of its length rather than a solely soft-tissue procedure, in order to optimize stability by restoring the concavity of the glenoid

We report the outcome of a modified Bankart procedure using suture anchors in 31 patients (31 shoulders) with a mean follow-up of 11 years (10 to 15). The mean age of the patients was 28 years (16 to 39). At follow-up, the mean Rowe score was 90 points (66 to 98) and the Constant score was 96 points (85 to 100). A total of 26 shoulders (84%) had a good or excellent result. The rate of recurrence varied between 6.7% and 9.7% and depended on how recurrence was defined. Two patients had a significant new injury at one and nine years, respectively after operation. The overall rate of instability (including subluxations) varied between 12.9% and 22.6%. All patients returned to work, with 29 (94%) resuming their pre-operative occupation and level of activity. Mild radiological osteoarthritis was seen in nine shoulders (29%) and severe osteoarthritis in one. We conclude that the open modified Bankart procedure is a reliable surgical technique with good long-term results

Purpose: The purpose of this study is to examine the rate of Buford complex in a consecutive series of patients with arthroscopic Bankart repair and to evaluate the postoperative outcome compared to a group of patients without this anatomical variation. Material and Method: The surgical findings of 138 consecutive shoulder arthroscopies for Bankart lesions were prospective evaluated between January 2005 and January 2007; the mean of age was 25 years old (range 14–52). The criteria used to establish the diagnosis of Buford Complex included: cordlike middle glenohumeral ligament inserted in the superior labrum and attached to the biceps tendon, and complete absence of anterosuperior labrum. Postoperative outcomes were evaluated with Rowe score. Results: Five out of 138 patients (3.6%) presented a Buford complex associated to a Bankart lesion. Four of these patients (80%) presented a type II SLAP lesion. The follow up was 28 months (range 19–40 months). In the group of patients with the Buford complex the Rowe score had a mean of 75 points (range:45–95), 2 patients (40%) presented re-dislocation whereas in the other group the Rowe score had a mean 88 points (range: 25–100) and 9 cases (6.5%) had re-dislocation (P< 0.05). Conclusion: The rate of complex of Buford associated to Bankart lesion was of 3.6%. The presence of complex of Buford in our series was associated to worse functional postoperative outcomes

Aims of the study: The purpose of this paper was to evaluate the long term results of the open Bankart procedure for an anterior shoulder instability in heterogenic non selected patients. Material and Methods: Hundred and seventy seven patients were operated on at our instutution using open Bankart technique without using suture anchors, between 1993 and 2002. Hundred and sixty nine patients were evaluated. Average follow up was nine years and seven months (4–13 years). Average age at the time of operation was 27 (15 – 67). 89 % of shoulders had more than 3 dislocations, 60 % had more than 10 and 37 % more than 20 dislocations. American Shoulder and Elbow Society Scoring System and Constant Scoring System were used for assessment. Results: 155 patients (92 %) had Bankart lesion and 150 patients (89%) had Hill-Sachs lesion. Five patients (2.9%) had redislocation of the operated shoulder caused by new trauma, two of them underwent reoperation. 164 patients were satisfied and very satisfied with the results. None of patients needed a shoulder arthroplasty because of symptomatic osteoarthritis. Average Constant score was 92 and American Shoulder and Elbow Society Scoring System was 90. Average loss of external rotation in adduction was 6 degrees and loss of external rotation in 90 degrees abduction was 3 degrees comparing to contra lateral shoulder. Discussion/Conclusion: The Bankart procedure for anterior shoulder instability gives reliable long-term results

Aims: The aim of this study is to compare open Bankart procedure and arthroscopic extra-articular stabilization of the shoulder in patients with anterior instability. Material and Methods: 236 patients with recurrent anterior shoulder instability were treated surgically between 1992 and 2002. Open Bankart procedure was performed in 177 patients, mean age 29 years (range 17–67), and arthroscopic extra-articular stabilization in 59 patients, mean age 27 years (range 14–45). Single surgeon was performed all surgery. Follow-up for open surgery was from 2 to10 years, and for arthroscopic stabilization from 12 to 60 months. Results: Constant score for Bankart procedure was 90 points and for arthroscopic stabilization was 96 points. Five patients (2.8%) had re-dislocation after open procedure and three patients (5,1%) after arthroscopic stabilization. Conclusion: Open Bankart is more reliable than arthroscopic stabilisation of the shoulder. However, arthroscopic stabilisation has more advantages; better ROM, better function and cosmesis, lesser morbidity and small violation of normal anatomy

In this study we evaluated whether the Instability Severity Index Score (ISIS) and the Western Ontario Shoulder Instability Index (WOSI) could detect those patients at risk of failure following arthroscopic Bankart repair. Between April 2008 and June 2010, the ISIS and WOSI were recorded pre-operatively in 110 patients (87 male, 79%) with a mean age of 25.1 years (16 to 61) who underwent this procedure for recurrent anterior glenohumeral instability. . A telephone interview was performed two-years post-operatively to determine whether patients had experienced a recurrent dislocation and whether they had returned to pre-injury activity levels. In all, six (5%) patients had an ISIS > 6 points (0 to 9). Of 100 (91%) patients available two years post-operatively, six (6%) had a recurrent dislocation, and 28 (28%) did not return to pre-injury activity. No patient who dislocated had an ISIS > 6 (p = 1.0). There was no difference in the mean pre-operative WOSI in those who had a re-dislocation and those who did not (p = 0.99). The pre-operative WOSI was significantly lower (p = 0.02) in those who did not return to pre-injury activity, whereas the ISIS was not associated with return to pre-injury activity (p = 0.13). . In conclusion, neither the pre-operative ISIS nor WOSI predicted recurrent dislocation within two years of arthroscopic Bankart repair. Patients with a lower pre-operative WOSI were less likely to return to pre-injury activity. Cite this article: Bone Joint J 2014; 96-B:1688–92

Purpose: Although arthroscopic Bankart repair is yet an established procedure in the treatment of traumatic anterior shoulder instability, it is still not known whether it reproduces the good results of the open repair procedure. Aim of this investigation was to compare the functional and subjective outcome between open and arthroscopic Bankart repair. Material and methods: A retrospective cross sectional study design on the comparison of open and arthoscopic Bankart treatments between 1995 and 2004 was implemented at the Dresden Orthopedic Surgery Department. In this period a total of 223 patients underwent surgery due to anterior shoulder instability, among which 212 patients had posttraumatic instability. A diagnostic arthroscopy was performed in all patients, but only 40 patients with intact capsulolabral complex and without capsular laxity were treated arthroscopically, the remaining 183 patients underwent an open Bankart procedure. A total of 186 patients with posttraumatic anterior instability could be clinically re-examined within 1 to 5 years after initial surgery, among which 147 patients underwent an open and 39 patients an arthroscopic Bankart procedure. The median age of this sample was 27 years (interquartile range 21 – 37 years) at initial surgery, 21% of these patients were female. Results: After open surgery 11 of 147 patients (8%) and 6 of 39 (15%) after arthroscopic surgery reported one or more re-dislocation after initial treatment, which occurred after a mean dislocation free time of 62 versus 40 months, respectively (95% confidence intervals 59 – 65 versus 36 – 44 months). Both a univariate analysis (Logrank test p=0.012) and a multivariate Cox regression analysis (Likelihood Ratio p=0.023) confirmed a statistically significant difference in the time between initial surgery to first reluxation. 4 of the 11 re-dislocations after open and 1 of 6 after arthroscopic surgery occurred after a new accident. That makes a re-dislocation rate without new adequate trauma of 5% after open and 13% after arthroscopic treatment. ROM showed no difference between open and arthroscopic Bankart procedure for abduction and a mild difference for external rotation. 21 of 115 (18%) patients had an external rotation lag of 20° or more after open surgery versus 1 of 34 (3%) after arthroscopic treatment (Fisher p=0,027). The Rowe score demonstrated “good” or “excellent” functional results in 102 of 117 (87%) patients versus 28 of 35 (80%) patients after open versus arthroscopic treatment (Fisher p=0,285). Conclusion: In this sample arthroscopic Bankart repair demonstrated more frequently and significantly earlier re-dislocation after initial surgery than did the open treatment alternative. External rotation lags of at least 20° occured more frequently after the open procedure

Purpose of the study: There are few reports onlong-term outcome after Bankart procedure. The purpose of this study was to determine the rate of recurrent dislocation, the clinical results and the incidence of glenohumeral osteoarthritis after a minimum 10-year follow-up. Material and methods: Ninety-seven Bankart procedures were performed in 97 patients between 1972 and 1986 for treatment of anterior shoulder instability with recurrent dislocations. We retrospectively reviewed 74 patients and obtained 64 complete radioclinical evaluations for an average follow-up of 16 years. Clinical evaluation was based on the G. Walch and the Duplay group score but for easier comparisons, we also calculated the Rowe et al. score. Radiographical evaluation was established on the Samilson and Prieto classification but real glenohumeral osteoarthritis with joint narrowing was noted independently as grade four. We also studied the contralateral shoulder. Results: At last follow-up, 7 shoulders (9.5%) had recurrent dislocation, but two of them occurred subsequent to severe trauma over 18 months. Most patients (95%) were satisfied or very satisfied. Six patients (8.1%) had persistent apprehension but in some it was not due to anterior apprehension. According to the Duplay score (or the Rowe score), 25 shoulders (44.6%) had an excellent result (35/61.4%) 16 (28.6%) a good result (7/12.3%), 11 (19.7%) a fair result (11.19.3) and 4 (5.4%) a poor result (4/7%). Operated shoulders were pain free for 75% and painful for forced movements only for 25%. External rotation at 90° of abduction was reduced by 8.7 ± 15.7°. There was no limitation of internal rotation. Patients returned to preoperative sports activities at the same level for 70.9% and at a lower level for 12.7%. According to the Samilson classification, 7 (13%) of the shoulders had grade 2 and 2 (3.7%) had grade 3 glenohumeral osteoarthritis. We found 4 cases (7.4%) of real glenohumeral osteoarthritis (grade four) and 2 of these patients had contralateral osteoarthritis of a non unstable shoulder. There was no perioperative complication. Discussion: In our hands the Bankart procedure is appeared as a safe procedure with a low rate of glenohumeral osteoarthritis and a high rate of patient satisfaction

Introduction. The Bankart lesion is the most common form of labro-ligamentous injury in patients with traumatic dislocations of the shoulder. Various methods have been described each with its own advantages and disadvantages. We describe 5-year results of arthroscopic Bankart repair using knotless anchors. Patients and Methods. There were 38 patients, with involvement of the dominant arm in 28 patients. Recurrent dislocation was the most common indication in 21 patients, followed by first dislocation in 9 patients and second dislocation in 8 patients. All patients were done under general anesthesia and regional block in beach-chair position. Standard portals were used and repair done using 2.9 mm pushlock knotless anchors (Arthrex®). Patients had sling for 4 weeks and followed by a strict physiotherapy rehab protocol. Patients were followed up at 6 weeks and 3 monthly thereafter. Results. Only one patient had symptoms of recurrent instability, but was not keen on further surgery. Two patients had limitation of external rotation to 10 degrees. The mean Carter-Rowe score was 77.3. 90% of patients were happy to recommend surgery. Conclusion. Arthroscopic Bankart repair appears to produce good mid-term results for patients with shoulder instability

Background: There is a huge controversy regarding the period of immobilization after Bankart stabilisation. This ranges from 2 days to 5 weeks for open repair and from 3 to 6 weeks for arthroscopic Bankart repair. We believe it is inappropriate to immobilise the operated shoulder after Bankart repair. In our study all the patients were allowed to use their arm, the same day, pain permitting. No restrictions were imposed for the type and range of movement for those who had open repair. With arthroscopic repair they were asked to limit their shoulder abduction upto 45-degreee and external rotation to neutral. Method: In this retrospective study (1998–2003) we have analyzed the outcome of mobilisation of operated shoulder on the same day.43 primary stabilisations were performed by the senior author.one patient was uncontactble. We reviewed the records of 42 patients. Subsequently the General Practitioners were contacted to collect information about these patients and the patients were contacted, if needed. Out of 42 patients 34 were males and 8 females. 35 patients had an average of 7 episodes of anterior shoulder dislocations (range 2–25), 7 had unstable shoulder pre-operatively.30 had open repair, 12 had arthroscopic stabilisation. The average follow-up is 3.5years(1–6 years). Result: 41 patients did hot have any further episode of frank anterior shoulder dislocation and they had returned to their previous level of activities. Only one patient injured his operated shoulder year later while playing football. He underwent arthroscopic capsular shrinkage for traumatic deformation of the capsular and inferior glenohumeral ligament. Conclusion: In primary straightforward Bankart stabilisation, same day mobilisation does not increase the risk of anterior shoulder dislocation

To prospectively evaluate patient outcome in terms of stability, function and satisfaction following an arthroscopic anterior Bankart repair in order to identify patient characteristics, surgical technique or instrumentation linked to poor outcomes. These findings can then be used to refine selection criteria such that patient benefit from the shoulder instability repair is maximised. Between April 2002 and June 2004 thirty-seven arthroscopic anterior Bankart lesion repairs were performed by a single orthopaedic surgeon. Data on concomitant shoulder pathology, surgical technique utilised and instrumentation used was recorded for each patient. Reoccurrence rate, patient satisfaction and range of motion were evaluated pre-operatively, and then six weeks, three months, six months, twelve months and twenty-four months post-operatively. Four of thirty-seven patients (10.8%) experienced at least one post-operative reoccurrence defined as a subluxation or dislocation. There was a statistically significant association between the presence of an inverted pear-shaped glenoid and increased incidence of reoccurrence (p < 0.05). Patients’ satisfaction with their shoulders increased significantly from 43% pre-operatively to 71% at the two-year follow-up, as measured by the Western Ontario Shoulder Instability (WOSI) scale. There were no significant differences in range of motion between the patients’ surgically repaired and unaffected shoulders. An arthroscopic repair of an anterior Bankart lesion can yield good-to-excellent results for the majority of patients with respect to stability, function and satisfaction. The presence an inverted pear-shaped glenoid is mostly strongly correlated with an increased incidence of reoccurrence. Patients should be screened pre-operatively to identify this bony abnormality such that it can be addressed appropriately during surgery

We evaluated the effectiveness of arthroscopic repair in patients with shoulder instability owing to a bony fragment as part of the Bankart lesion, using spiked Suretacs, sutures and anchors. Over a two-year period, we followed up 23 of 25 consecutive cases, all with a bony fragment as part of the Bankart lesion. The mean age of patients, all of whom were male, was 21 years (17 to 35). Almost all injuries were sustained playing sports. Patients were clinically evaluated at six weeks and 20 weeks postoperatively and interviewed telephonically. Full arthroscopic examination was performed in a lateral decubitus position. The affected capsular structures and labrum, with its attached bony fragment, were fully mobilised. The bony fragment was always attached to the capsular structures, with labral ring intact. We used a spiked Suretac anchor to reattach the bony fragment to its original anatomical position, and Mitek anchors and no. 1 Ticron sutures for individual reattachment of the capsule and ligaments. Postoperatively patients were immobilised in a shoulder sling for six weeks. Early restricted active and passive movements were advised. Patients routinely received postoperative physical and biokinetic rehabilitation. The mean follow up period was 16 months (5 to 29). There was no redislocation or subjective instability. This technique yields excellent results, but because it is technically difficult should be used only by experienced shoulder arthroscopists with thorough knowledge of pathological shoulder anatomy

Purpose of the study: The purpose of this study was to determine the feasibility and reproducibility of a new arthroscopic procedure combining a Bristow-Latarjet lock with Bankart reinsertion of the lambrum. Material and methods: Forty-seven consecutive patients with significant bone defects in the glenoid and a deficient capsule were treated arthroscopically: arthroscopic Bankart had failed in six. The procedure was performed exclusively arthroscopically using a special instrumentation: after its osteotomy and identification of the axiallary nerve, the coracoids was passed through the subcapular muscle with its tendon; the block was fixed on the scapular neck after 90° lateral rotation so as to prolong the natural concavity of the glenoid. Anchors and sutures were then used to refix the capsule and the labrum onto the glenoid border, leaving the block in an extra-articular position. Follow-up included a physical examination and standard x-rays at 45, 90 and 180 days; 31 patients had a postoperative scan. Three independent operators read the images. Results: The procedure was completed arthroscopically in 41 of 47 patients (8%); conversion to a deltopectoral approach was required for six patients (12%). The axillary nerve was successfully identified in all shoulders. The block had a subequatorial position in 98% (46/47 shoulders) and equatorial in one. The block was tangent to the surface of the glenoid in 92% (43/47), lateral in one (2%) and too medial (> 5mm) in three (6%). One patient presented an early fracture of the block and five patients exhibited block migration; there was a partial lysis of the block in two patients. The final rate of nonunion of the block was 13% (6/47). Fractures, migrations and non-unions were related to technical errors: screws too short (unicortical) and/or poorly centred in the block. Conclusion: Our results show that arthroscopic transfer of the coracoids to the scapular neck is a safe and successful operation. The rate of correctly positioned healed blocks was equivalent or superior to conventional techniques. The complications observed show that the arthroscopic block technique is difficult with a long learning curve

The aim of this study was to use motion analysis to study a surgeon’s learning curve for an arthroscopic Bankart repair on a training model in a skills laboratory. Six fellowship trained lower limb surgeons unfamiliar with advanced shoulder arthroscopy performed an arthroscopic Bankart repair on an ALEX shoulder model. Standardised training was given and then an electromagnetic tracking system used to objectively assess hand movements, distance travelled by hands and time taken while the surgeons performed the technique. The arthroscopic repair was repeated three times on four consecutive occasions by each surgeon giving a total of 72 repair episodes. Analysis revealed improvement of all outcome parameters with less hand movements, less distance travelled and less time to complete the task. This study objectively demonstrates a learning curve for arthroscopic Bankart suture in a skills laboratory. It indicates the potential benefits of practicing aspects of arthroscopic techniques in a skills centre on appropriately selected models

Purpose: To present the technique and the results of simultaneous arthroscopic reconstruction of Bankart and SLAP lesions in patients with anterior shoulder instability. Method: We performed shoulder arthroscopy in 95 patients aged 16–38 years (mean age:24,8) suffering anterior shoulder instability. Preoperative evaluation included clinical assessment, x-rays, MRI-arthrogram and examination under anaesthesia in comparison to the healthy shoulder. SLAP lesion was fixed using metallic suture anchors (FASTAK 2,4mm x 11,7 mm-Arthrex).The anchor was inserted in a 45° direction relative to the glenoid level. Bankart lesion was reconstructed using 2–3 bioabsorbable suture anchors (Panalok-Mitek J& J).The arthroscope was inserted through standard posterior, anterosuperior and anteroinferior portals while a posterolateral portal (portal of Whilrnington) was created for SLAP lesion repair. Patients’ average follow-up was 22 months (range, 18–30 months) and the results were evaluated using the ASES score. Results: SLAP lesion was found in 13 patients: 6 pat.-type II (46%), 3 pat.-type I (23%), 2 pat.-type IV (15%), 1pat.-type III (7,6%) and 1 pat with a complex lesion. Of these patients 10 had also co-existed Bankart lesion. In 2 patients Hill-Sachs lesion was found while degenerative rotator cuff changes existed in 3 patients. While performing clinical evaluation anterior instability signs and symptoms were apparent with the patients complaining also for discomfort and crepitus during overhead activities. MRI preoperative sensitivity for SLAP lesion diagnosis was 59% while specificity and Positive predictive value were 90% and 76% respectively. Shoulder function and the overall ASES score improved from 44 pre-op. to 96 post-op. Conclusion: Combined Bankart and SLAP lesions are uncommon in non-throwing patients with anterior instability. Arthroscopic suture anchors fixation ensures early and reliable rehabilitation. MRI arthrography study by a skeletal radiologist predicts to a high rate diagnosis

Aims

Extensive literature exists relating to the management of shoulder instability, with a more recent focus on glenoid and humeral bone loss. However, the optimal timing for surgery following a dislocation remains unclear. There is concern that recurrent dislocations may worsen subsequent surgical outcomes, with some advocating stabilization after the first dislocation. The aim of this study was to determine if the recurrence of instability following arthroscopic stabilization in patients without significant glenoid bone loss was influenced by the number of dislocations prior to surgery.

The purpose of this study was to report the results of the vertical apical suture Bankart lesion repair. Fifty-nine patients (52 men and seven women) with a mean age of twenty-seven years (range, 16–53 years) underwent this procedure. The mean duration of instability was 4 years and mean follow-up was 42 months (minimum of two years). A laterally based T-shape capsular incision is performed with the horizontal component directed towards the glenoid neck and into the Bankart lesion. A vertical apical suture through the superior and inferior flaps of the Bankart lesion, tighten the anterior structures to allow them to snug onto the convex decorticated surface of the anterior glenoid. At final review, according to the system of Rowe et al., 94.9% (56 patients) had a rating of good or excellent. Three patients had a recurrent dislocation due to further trauma. The mean loss of forward elevation was 1 degree, external rotation with the arm at the side was 2.4 degrees and external rotation in 90 degrees abduction was 2.2 degrees. Of forty-four patients participating in sport, thirty-five (79.5%) returned to the same sport at the same level of activity, even returned to the same sport at a reduced level of activity and two patients did not return to sport. The vertical apical suture repair offers a 94.9 percent success rate in terms of stability, a maintained range of motion and a 79.5% return to pre-injury level of sporting activity. It is technically less demanding than the Bankart procedure. All sutures used are absorbable. Complications related to non-absorbable implants and absorbable anchors and tacks are avoided