Arthroscopic bankart repair for unidirectional shoulder instability.

A successful arthroscopic Bankart repair for unidirectional shoulder instability requires careful patient selection and, to the extent possible, the restoration of normal anatomy. The patient's goals and anticipated demands are important considerations. A patient who participates in an overhead sport requires not only a stable shoulder but also a full range of shoulder motion. An athlete who engages in a contact or collision sport, however, may tolerate a mild loss of motion provided the shoulder is stable. Compared with an open procedure, an arthroscopic repair provides the opportunity to retain the most normal postoperative range of motion and function. Other considerations include patient age, which often relates to overall tissue laxity, and the number of previous instability episodes, which correlates with the severity of pathology (in particular, capsulolabral strain, glenoid chondromalacia, and bony deficiency of the glenoid or posterior humeral head). The magnitude of bone loss, particularly for the anterior glenoid, can make an arthroscopic repair inadvisable. Accurate portal placement, glenoid preparation, anchor insertion, and suture passage are key components of the arthroscopic technique, but the most important overall goal is the secure restoration of capsulolabral tissue tension. Secondary posteroinferior laxity, partial rotator cuff tears, labral disorders, and articular cartilage pathology may also require treatment.