Date post: | 20-Jun-2015 |
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Arthroscopic Bankart’s repair - Are we using too many anchors?
Dr. Sunit Hazra
R G KAR MEDICAL COLLEGE KOLKATA , WEST BENGAL
INTRODUCTION :
Arthroscopic Bankart’s procedure has
established itself as gold standard in
traumatic recurrent shoulder dislocation.
The uppermost point of fixation of labrum
should be the attachment site of anterior
border of inferio glenohumeral ligament.
Inferior
glenohumeral
ligament is the key
stabiliser.
The anchors
should be placed at
anteroinferior
quadrant of
glenoid.
We calculated the number of anchors
required in Indian people using a fixed
distance of 5 mm between 2 anchors.
The glenoid surface was divided into 4 quadrants.
QUADRANTS OF GLENOID
The length of anteroinferior
quadrants of cadaveric scapula
were measured .
MEASUREMENT OF QUADRANTS
The length of antero inferior quadrant in “mm” was divided by 5.
The average
value was calculated.
RESULTS :
In this study length of antero inferior quadrant is measured in 40 cadaveric scapular specimen .
Each of which is divided by 5.
Minimum length 9.5 mm & maximum length 13 mm.(11.2)
The average value was 2.2 with the range (1.9-2.6).
Based on above data evaluation done on 20 patients undergoing arthroscopic bankart’s repair using 2 -3 anchors.
CLINICAL ANALYSIS :
Average age of those patient was 26 (16-46).
Patients were evaluated over a period of 1.5 yrs.
All patients had chronic anterior instability on clinical examination and Bankart’s lesion on Arthroscopy.
Bankart repair was performed using 2-3 bioabsorbable Lupine anchor with Orthocord
Post operative hospital stay ranged from 1-2 nights. Arm sling was used for 2 weeks after which progressive physiotherapy was commenced.
Evaluation done with Modified ROWE SCORE.
POST OPERATIVE PAIN(12 months)
PAIN(Max -10)
PATIENT
PERCENTAGE
(1) N0 pain(10) 16 80
(2) Moderate pain (5)
4 20
(3) Severe pain (0) 0
POST OPERATIVE STABILITY(12months)
STABILITY(Max-30)
PATIENT PERCENTAGE
(1) Neg. apprehension test /No subluxation(30)
15 75
(2) Neg. apprehension test /discomfort with Abduction /ext. rotation(15)
3 15
(3) Positive apprehension(00)
2 10
POST OPERATIVE MOTION(12 months)
MOTION (Max-10)
PATIENT
PERCENTAGE
(1) Full(10) 13 65
(2) ≤25% loss in any plane (5)
5 25
(3) ≥25% loss in any plane (0)
2 10
POST OPERATIVE FUNCTION(12 months)
3 15
FUNCTION(Max-50) PATIENT PERCENTAGE
(1) No limit/Throw /Return to Sport(50)
13 65
(2)No Limit/Return, not same(40)
5 25
(3)No Limit/No Return(35) 2 10
(4)Moderate Limit /No Return (20)
0 0
(5)Marked limitation /no work overhead(0)
0 0
MODIFIED ROWE SCORE
70
5
0
25
Results were excellent in 70%, good in 5% and fair in 15% & poor in 10 %.No patient developed recurrence.
RESULTS PATIENT NO PERCENTAGE
Excellent(90-100)
14 70
Good(75-89) 1 5
Fair(50-74) 3 15
Poor(0-49) 2 10
CADAVERIC IMAGES
Per operative
POST OP EVALUATION
POST OP 2WK POST OP 6 MONTH
DISCUSSION :
The most commonly used number of anchors, as
reported by the literature, is 3[1]
The normal anatomical variant observed in many
people showing gap at anterosuperior quadrant
prompted us to only fix the inferior quadrant showing
good clinical results.
1. van der Linde JA, van Kampen DA, Terwee CB, Dijksman LM, Kleinjan G, Willems WJ. Long-term results after arthroscopic shoulder stabilization using suture anchors: an 8- to 10-year follow-up. Am J Sports Med 2011;39:2396-403
From our cadaveric study, we found that
the antero-inferior length of Indian scapula
is approximately 11.5 mm so the number of
anchor required is 2.2.
Fixation with 2-3 anchors showed excellent
result in 70%, good in 5% and fair in 15% &
poor in 10 %.No patient developed
recurrence.
CONCLUSION :
Indian patients have smaller scapula, so,
the number of anchor required to fix
inferior glenohumeral ligament should be
less.
So we conclude that even in patients with
Bankart lesions 2-3 anchor should be
sufficient.