Arthroscopic Bankart’s repair

History 26 yrs old male , Right handed individual ,

computer programmer by profession , recreational sportsman , presented with Recurrent episodes of instability of Right shoulder for 6yrs.

Episodes 10/year. Last episode 1 week back. Treated with CR.

History Tenderness anterior aspect . Wasting of

Deltoid , Positive Hamilton ruler test. All ROM restricted and painfull . Apprehension present . No evidence of multidirection, sulcus sign present.

MRI done– Bankart’s lesion. Posteromedial Hillsach’s lesion.

MR Arthrogram

Bankart’s lesion Postero-medial

Hillsach’s lesion

What is Bankart’s ?

Capsulo-labral avulsion of the Anterior capsule from the Glenoid.

Procedure

Examination under Anaesthesia

Anterior drawer’s grade 2+. Sulcus sign grade 2.

Arthroscopic Bankart’s repair

Bankart’s lesion extending from 2 to 5 ‘O’ clock position. Inferior capsule lax.

Glenoid

Post-operative Radiogram

Immobilisation in arm sling for 3 wks. Passive and active assisted at 3 wks. Abduction only to 90. No ER. At 6 wks full Rom and rotator strengthening.

Advantages of Ascopic stabilisation. Smaller skin incisions. Complete inspection of joint. Ability to treat all intraarticular

lesions. Ability to access all areas of GH joint. Less soft tissue dissection. Preservation of ER.

T.Neviaser identified ALPSA(anterior labroligamentous periosteal sleeve avulsion) in anterior-inferior GH instability.

High failure rates in previous ascopic repairs due to technical factors- medial repair of anterior labrum.

failure to treat ALPSA, SLAP, rotator interval, capsular tensioning.

Neer’s concepts GH instability in multiple directions Correction of all 3 symptomatic

directions is necessary. Scoring systems used- American

shoulder and elbow surgeons shoulder index , constant scoring systems.

Indications- persistant shoulder pain from GH instability that has not responded to 6 mnths of non-opretive treatment.

Factors to be considered; age, severity of initial trauma, reduction method, arm dominance, activity level, sports , desired level of activity, instability, radiographic finding’s.

Contraindications- who demonstrate GH instability , voluntary muscular contractions , emotional instability, Glenoid defects more thyan 4 mm.

Hill-S-sach’s lesion engaging the anterior Glenoid.