Arthroscopic Management of Shoulder Instability: Bankart Repair

Abstract

Owing largely to the work of Turkel et al,¹ it is known that the inferior glenohumeral ligament functions as the primary static restraint limiting anterior glenohumeral translation in the abducted shoulder. In addition, Howell and Galinat² have reported that the anteroinferior glenoid labrum, as an anatomic and histologic fibrous extension of the inferior glenohumeral ligament, contributes approximately 50% of the total concavity of the relatively flat glenoid fossa. Habermeyer and Schuller³ have reported results of transducer studies indicating that the intact glenoid labrum functions similarly to the rim of a suction cup, creating a vacuum effect in the loaded shoulder that may assist the rotator cuff in centering the humeral head within the glenoid fossa through the active range of motion. In the presence of a Bankart lesion defined as an avulsion of the anteroinferior glenoid labrum from the glenoid rim, or a periosteal avulsion of the inferior glenohumeral ligament from the inferior scapular neck (Perthes variant), the functions of both the inferior glenohumeral ligament and glenoid labrum are lost. For these reasons, procedures performed for traumatic anterior glenohumeral instability associated with a Bankart lesion should address this primary pathology. Restoration of the labrum to the glenoid rim and repair of the inferior glenohumeral ligament complex to its anatomic origin are the goals of surgical reconstruction. Open Bankart repair has received widespread acceptance because it achieves both goals and yields high success rates in longterm follow-up.^4,5 However, technical difficulties related to exposure and creation of the anterior glenoid rim suture holes have limited the popularity of open Bankart repair. As a result of these technical problems, Luckey⁶ in 1949, Viek and Bell⁷ in 1959, and Reider and Inglis⁸ in 1982 reported modified methods for open Bankart repair that facilitate capsular fixation by transglenoid suture placement via anterior-to-posterior passage of smooth pins across the scapular neck. The techniques described in this chapter are modifications of the open Luckey-Viek-Reider method of Bankart suture repair performed under arthroscopic control.⁹ We will describe our latest method of arthroscopic Bankart repair using FASTak (Arthrex, Inc., Naples, FL) suture anchors.