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Bankart procedure

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Transcript

  • 1. The Classic Bankart Procedure Indications, Technique, and Results
  • 2. James P. Bradley, M. D. Joel Gonzales, M. D. Robert W. Metcalf, M. D. Memorial SunValley, Idaho 1999
  • 3. History • Perthes • Bankart • Moseley and Overgaard 1962 • Rowe
  • 4. History • Over 150 procedures described for treatment of anterior shoulder instability
  • 5. Bankart, A. S. B. • Recurrent or habitual dislocation of the shoulder-joint • British Med. J., 2:1132-1133, 1923.
  • 6. Indications • Anterior/Inferior Glenohumeral Instability • Recurrent • Post - Traumatic/ Involuntary
  • 7. • History and Physical • Positive apprehension and relocation • Bankart lesion/ Hill Sachs Indications
  • 8. “Good exposure, adequate help, and proper instruments are essential.” Carter Rowe JBJS 1978
  • 9. Approach • Skin Incision - Coracoid to axilla • Deltopectoral Approach • Low axillary for cosmesis
  • 10. Approach • Coracoid osteotomy not necessary
  • 11. Subscapularis • External rotation exposes subscapularis • Circumflex vessels at inferior border • Axillary nerve!
  • 12. Subscapularis • Careful dissection to avoid buttonholing capsule! • Begin distally and use stay sutures • OK to leave some subscap on capsule
  • 13. Capsular Incision • Arm completely externally rotated • Incise capsule just lateral to glenoid rim • Insert humeral head retractor and assess labrum
  • 14. Glenoid Preparation • Freshen bone with burr • 3 holes in glenoid rim with awl (suture anchors today)
  • 15. Repair • Lateral capsule flap sutured to rim • Medial flap imbricated over lateral flap
  • 16. Repair • Anatomic repair of subscapularis
  • 17. Carter Rowe et al. • The Bankart Procedure. A long-term end result study • JBJS 60A: 1-16, Jan 1978.
  • 18. Materials and Methods • 145 cases 1946-1976, 124 re-examined, 21 by questionnaire • Average 6 year follow up • Rowe rating scale – Stability 50 points, ROM 20 points, Function 30 points
  • 19. Results • 74% Excellent (90-100 points) • 23% Good (75-89 points) • 3% Poor • 5 Recurrences
  • 20. Results • 86/124 regained full elevation and external rotation • No evidence of degenerative changes (124/124) • No formal post op therapy
  • 21. Hovelius • Recurrent Anterior Dislocation of the Shoulder • Results after the Bankart and Putti-Platt Operations • JBJS 61A, June 1979
  • 22. Hovelius • 46 Bankarts, 9 different surgeons • Short follow up • 1 recurrence, 16 degree loss of external rotation • 42/46 “satisfied” with procedure
  • 23. Gill, Micheli et al. • Bankart Repair for Anterior Instability of the Shoulder • JBJS 79A, June 1997
  • 24. Materials and Methods • 60 Shoulders (56 patients 39m 17f) • One surgeon • 21.4 years average • Follow up 11.9 years (range 8-16 years) • ASES rating
  • 25. Results • 52/56 good to excellent
  • 26. Complications • 12 degrees mean loss of external rotation • 3 Redislocations
  • 27. Complications • Not truly an ANATOMIC repair! • Loss of ER - overtightening (Critical for overhead athletes) • Arthrosis
  • 28. Complications • Technically difficult • Violates glenoid cartilage
  • 29. Classic Bankart Procedure • Many still consider this the gold standard
  • 30. Alternatives • ACLR • Jobe • Matsen • Neer • Rockwood • Thermal Shift ?
  • 31. Older Procedures • Hot Poker • Nicola • Magnuson-Stack • Putti-Platt • Bristow-Helfet
  • 32. Older Procedures • DuToit (staple) • Eden-Hybinette • Oudard • Trillat • Latarjet • Gallie • Saha • Boytchev
  • 33. Thank you

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