Anterior Shoulder Instability Treatment with BLS Method

  • Roman Brzóska
  • Hubert Laprus


Arthroscopic Bankart repair in treatment of shoulder instability is associated with a high prevalence rate of instability recurrence. The extracapsular stabilization of the glenohumeral joint with enhancement of anterior wall soft tissues could be an alternative and more efficient procedure, especially in case of anterior glenoid bone loss or anterior wall insufficiency. Following this point of view, novel anterior extracapsular stabilization technique—Between glenohumeral Ligaments and Subscapularis tendon (BLS)—was introduced.

Its effectiveness was checked retrospectively by assessing patients with anterior shoulder instability who underwent surgical treatment with a novel arthroscopic BLS technique between 2008 and 2016. A positive outcome was defined as full restoration of joint stability. To evaluate clinical results, pre-operative range of ER and IR measured in 90° of abduction was compared with ER and IR range measured at final follow-up in that same shoulder position. Constant Score and Walch–Duplay Score were also calculated.

A total of 150 patients underwent arthroscopic BLS surgery. During the study period, 50 patients were lost to follow-up, leaving 100 patients for final analysis. At final assessment, 86 patients (86%) were categorized as having a positive outcome, with full restoration of joint stability. Recurrence of shoulder instability was observed in 14 (14%) patients including 6 (6%) cases following major trauma. The frequency of failure was higher in patients with a more severe GBL and with greater baseline range of ER. There was no statistically relevant limitation of external and internal rotation.

The BLS technique has been shown to be an effective way of treatment of anterior shoulder instability for patients without significant glenoid bone loss. It was also shown that this technique does not decrease shoulder range of motion.


Anterior instability Glenoid bone loss BLS Bankart repair 


  1. 1.
    Bankart AS. Recurrent or habitual dislocation of the shoulder. BMJ. 1923;2:1132–3.CrossRefGoogle Scholar
  2. 2.
    Fabbriciani C, Milano G, Demontis A, Fadda S, Ziranu F, Mulas PD. Arthroscopic versus open treatment of Bankart lesion of the shoulder: a prospective randomized study. Arthroscopy. 2004;20:456–62.CrossRefGoogle Scholar
  3. 3.
    Flinkkilä T, Knape R, Sirniö K, Ohtonen P, Leppilahti J. Long-term results of arthroscopic Bankart repair: Minimum 10 years of follow-up. Knee Surg Sports Traumatol Arthrosc. 2018;26:94–9.CrossRefGoogle Scholar
  4. 4.
    Privitera DM, Bisson LJ, Marzo JM. Minimum 10-year follow-up of arthroscopic intra-articular Bankart repair using bioabsorbable tacks. Am J Sports Med. 2012;40:100–7.CrossRefGoogle Scholar
  5. 5.
    Owens BD, DeBernandino TM, Nelson BJ, Thurman J, Cameron KL, Taylor DC, et al. Long-term follow-up of acute arthroscopic repair for initial anterior shoulder dislocations in young athletes. Am J Sports Med. 2009;37:669–73.CrossRefGoogle Scholar
  6. 6.
    Brzoska R, Blasiak A, Hldaki W, Streit JJ, Toussaint B, Solecki W. Arthroscopic Bankart repair using extracapsular suture between the glenohumeral ligaments and subscapularis tendon (BLS technique): a technical note. Tech Shoulder Surg. 2012;13:86–9.CrossRefGoogle Scholar
  7. 7.
    Brzóska R, Laprus H, Michniowski P, et al. Novel and effective arthroscopic extracapsular stabilization technique for anterior shoulder instability-BLS. Knee Surg Sports Traumatol Arthrosc. 2019;27(12):3897–904. Scholar
  8. 8.
    Yamamoto N, Itoi E, Abe H, Minagawa H, Seki N, Shimada Y, Okada K. Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: a new concept of glenoid track. J Shoulder Elbow Surg. 2007;16:649–56.CrossRefGoogle Scholar
  9. 9.
    Purchase RJ, Wolf EM, Hobgood ER, Pollock ME, Smalley CC. Hill-Sachs “remplissage”: an arthroscopic solution for the engaging Hill-Sachs lesion. Arthroscopy. 2008;24:723–6.CrossRefGoogle Scholar
  10. 10.
    Franceschi F, Papalia R, Del Buono A, Vasta S, Maffulli N, Denaro V. Glenohumeral osteoarthritis after arthroscopic Bankart repair for anterior instability. Am J Sports Med. 2011;39:1653–9.CrossRefGoogle Scholar
  11. 11.
    Kavaja L, Pajarinen J, Sinisaari I, Savolainen V, Björkenheim J-M, Haapamäki V, et al. Arthrosis of glenohumeral joint after arthroscopic Bankart repair: a long-term follow-up of 13 years. J Shoulder Elbow Surg. 2012;21:350–5.CrossRefGoogle Scholar
  12. 12.
    Kowalsky MS, et al. Evaluation of suture abrasion against rotator cuff tendon and proximal humerus bone. Arthroscopy. 2008;24(3):329–34.CrossRefGoogle Scholar
  13. 13.
    Maiotti M, Massoni C, Russo R, Schroter S, Zanini A, Bianchedi D. Arthroscopic subscapularis augmentation of Bankart repair in chronic anterior shoulder instability with bone loss less than 25% and capsular deficiency: clinical multicenter study. Arthroscopy. 2017;33:902–9.CrossRefGoogle Scholar
  14. 14.
    Owens BD, Burns TC, Campbell SE, et al. Simple method of glenoid bone loss calculation using ipsilateral magnetic resonance imaging. Am J Sports Med. 2013;41:622–4.CrossRefGoogle Scholar
  15. 15.
    Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: Significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy. 2000;16:677–94.CrossRefGoogle Scholar
  16. 16.
    Griffith JF, Antonio GE, Tong CW, Ming CK. Anterior shoulder dislocation: quantification of glenoid bone loss with CT. Am J Roentgenol. 2003;180:1423–30.CrossRefGoogle Scholar
  17. 17.
    Griffith JF, Antonio GE, Yung PS, et al. Prevalence, pattern, and spectrum of glenoid bone loss in anterior shoulder dislocation: CT analysis of 218 patients. Am J Roentgenol. 2008;190:1247–54.CrossRefGoogle Scholar
  18. 18.
    Shaha JS, Cook JB, Song DJ, Rowles DJ, Bottoni CR, Shaha SH, Tokish JM. Redefining “critical” bone loss in shoulder instability: functional outcomes worsen with “subcritical” bone loss. Am J Sports Med. 2015;43:1719–25.CrossRefGoogle Scholar

Copyright information

© ESSKA 2020

Authors and Affiliations

  • Roman Brzóska
    • 1
  • Hubert Laprus
    • 1
  1. 1.St Luke’s HospitalBielsko-BiałaPoland

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