Johannes E Plath1, Matthias J Feucht2, Robert Bangoj3, Frank Martetschläger3, Klaus Wörtler4, Gernot Seppel3, Mohamed Aboalata5, Thomas Tischer6, Andreas B Imhoff3, Stephan Vogt7. 1. Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany; Department of Trauma Surgery, Klinikum Augsburg, Augsburg, Germany. Electronic address: johannes.plath@gmail.com. 2. Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany; Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Freiburg, Germany. 3. Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany. 4. Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany. 5. Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany; Department of Orthopedic Surgery and Traumatology, Mansoura University, Mansoura, Egypt. 6. Department of Orthopedics, Rostock University Hospital, Rostock, Germany. 7. Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany; Department of Sports Orthopedics, Hessing Klinik, Augsburg, Germany.
Abstract
PURPOSE: The purpose of this study was to evaluate the outcome, return to sporting activity, and postoperative articular cartilage and bony morphology of shoulders that underwent arthroscopic suture anchor repair of bony Bankart lesions. METHODS: The inclusion criteria for this retrospective study were anterior glenoid rim fractures after traumatic shoulder instability that were treated with arthroscopic suture anchor repair. Patients were surveyed by a questionnaire including sport-specific outcome, Rowe score, Western Ontario Shoulder Instability Index, and Oxford Instability Score. Three-tesla magnetic resonance imaging could be performed in 30 patients to assess osseous integration, glenoid reconstruction, and signs of osteoarthritis. RESULTS: From November 1999 to April 2010, 81 patients underwent an anterior bony Bankart repair in our department (50 arthroscopic suture anchor repairs, 5 arthroscopic screw fixations, and 26 open repairs). The 55 arthroscopic repairs comprised a consecutive cohort of patients treated by a single surgeon. Of the 50 patients in the suture anchor group, 45 (90%) were available for evaluation. At 82 ± 31 months postoperatively, the mean Rowe score was 85.9 ± 20.5 points, the mean Western Ontario Shoulder Instability Index score was 89.4% ± 14.7%, and the mean Oxford Instability Score was 13.6 ± 5.4 points. Compared with the contralateral shoulder, all scores showed a significantly reduced outcome (P < .001, P < .001, and P < .001, respectively). A redislocation occurred in 3 patients (6.6%). Regarding satisfaction, 35 patients (78%) were very satisfied, 9 (20%) were satisfied, and 1 was partly satisfied. Overall, 95% of patients returned to any sporting activity after surgery. The number of sports disciplines (P < .001), duration (P = .005), level (P = .02), and risk category (P = .013) showed a significant reduction compared with the pretrauma condition. However, only 19% of patients reported that shoulder complaints were the reason for the reduction in activity. Nonunion occurred in 16.6%, with a higher frequency in patients with chronic lesions (P = .031). Anatomic reduction was achieved in 72%, the medial step-off in patients with nonanatomic reduction averaged 1.8 ± 0.9 mm, and the remaining glenoid defect size averaged 6.8% ± 7.3%. Full-thickness cartilage defects of the anterior glenoid were detected in 70% of patients. CONCLUSIONS: Arthroscopic suture anchor repair may enable an anatomic reduction of bony Bankart lesions with no or only minimal articular steps and provides successful midterm outcomes concerning clinical scores, recurrence, and patient satisfaction. The return to activity is limited for various, mostly non-shoulder-related causes. Chronic lesions may have an inferior healing potential; therefore early surgical stabilization of acute Bankart fragments is suggested to avoid possible nonunion. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
PURPOSE: The purpose of this study was to evaluate the outcome, return to sporting activity, and postoperative articular cartilage and bony morphology of shoulders that underwent arthroscopic suture anchor repair of bony Bankart lesions. METHODS: The inclusion criteria for this retrospective study were anterior glenoid rim fractures after traumatic shoulder instability that were treated with arthroscopic suture anchor repair. Patients were surveyed by a questionnaire including sport-specific outcome, Rowe score, Western Ontario Shoulder Instability Index, and Oxford Instability Score. Three-tesla magnetic resonance imaging could be performed in 30 patients to assess osseous integration, glenoid reconstruction, and signs of osteoarthritis. RESULTS: From November 1999 to April 2010, 81 patients underwent an anterior bony Bankart repair in our department (50 arthroscopic suture anchor repairs, 5 arthroscopic screw fixations, and 26 open repairs). The 55 arthroscopic repairs comprised a consecutive cohort of patients treated by a single surgeon. Of the 50 patients in the suture anchor group, 45 (90%) were available for evaluation. At 82 ± 31 months postoperatively, the mean Rowe score was 85.9 ± 20.5 points, the mean Western Ontario Shoulder Instability Index score was 89.4% ± 14.7%, and the mean Oxford Instability Score was 13.6 ± 5.4 points. Compared with the contralateral shoulder, all scores showed a significantly reduced outcome (P < .001, P < .001, and P < .001, respectively). A redislocation occurred in 3 patients (6.6%). Regarding satisfaction, 35 patients (78%) were very satisfied, 9 (20%) were satisfied, and 1 was partly satisfied. Overall, 95% of patients returned to any sporting activity after surgery. The number of sports disciplines (P < .001), duration (P = .005), level (P = .02), and risk category (P = .013) showed a significant reduction compared with the pretrauma condition. However, only 19% of patients reported that shoulder complaints were the reason for the reduction in activity. Nonunion occurred in 16.6%, with a higher frequency in patients with chronic lesions (P = .031). Anatomic reduction was achieved in 72%, the medial step-off in patients with nonanatomic reduction averaged 1.8 ± 0.9 mm, and the remaining glenoid defect size averaged 6.8% ± 7.3%. Full-thickness cartilage defects of the anterior glenoid were detected in 70% of patients. CONCLUSIONS: Arthroscopic suture anchor repair may enable an anatomic reduction of bony Bankart lesions with no or only minimal articular steps and provides successful midterm outcomes concerning clinical scores, recurrence, and patient satisfaction. The return to activity is limited for various, mostly non-shoulder-related causes. Chronic lesions may have an inferior healing potential; therefore early surgical stabilization of acute Bankart fragments is suggested to avoid possible nonunion. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
Authors: Johannes E Plath; Tim Saier; Matthias J Feucht; Philipp Minzlaff; Gernot Seppel; Sepp Braun; Daniel Hatch; Andreas B Imhoff Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-03-13 Impact factor: 4.342
Authors: Rebecca Griffith; Nickolas Fretes; Ioanna K Bolia; Iain R Murray; John Meyer; Alexander E Weber; Seth C Gamradt; Frank A Petrigliano Journal: Orthop J Sports Med Date: 2021-08-06