Arthroscopi Bankart's Repair-Dr. Sunit hazra

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1) The document discusses the optimal number of anchors needed for arthroscopic Bankart repair in Indian patients. 2) An analysis of 40 cadaveric scapulae found the average length of the anteroinferior quadrant to be 11.2 mm, indicating an average of 2.2 anchors would be needed with a 5 mm spacing. 3) A clinical study of 20 patients who underwent Bankart repair with 2-3 anchors found excellent results in 70% of patients and no recurrences at 12 months follow-up, supporting the conclusion that Indian patients require fewer anchors due to their smaller scapula size.

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.

 The length of anteroinferior quadrants of
cadaveric scapula were measured .

 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)
FUNCTION(Max-50) PATIENT PERCENTAGE
 3 15
(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
RESULTS PATIENT NO PERCENTAGE
70
5
0
25
Excellent(90-100) 14 70
Good(75-89) 1 5
Fair(50-74) 3 15
Poor(0-49) 2 10
 Results were excellent in 70%, good in 5% and fair in
15% & poor in 10 %.No patient developed
recurrence.

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.

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1. Arthroscopic Bankart’s repair - Are we using too many anchors? Dr. Sunit Hazra R G KAR MEDICAL COLLEGE KOLKATA , WEST BENGAL

2. 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.

3.  Inferior glenohumeral ligament is the key stabiliser.  The anchors should be placed at anteroinferior quadrant of glenoid.

4.  We calculated the number of anchors required in Indian people using a fixed distance of 5 mm between 2 anchors.

5.  The glenoid surface was divided into 4 quadrants.

6. QUADRANTS OF GLENOID

7.  The length of anteroinferior quadrants of cadaveric scapula were measured .

8. MEASUREMENT OF QUADRANTS

9.  The length of antero inferior quadrant in “mm” was divided by 5.  The average value was calculated.

10. RESULTS :  In this study length of antero inferior quadrant is measured in 40 cadaveric scapular specimen .  Each of which is divided by 5.

11.  Minimum length 9.5 mm & maximum length 13 mm.(11.2)  The average value was 2.2 with the range (1.9- 2.6).

12. Based on above data evaluation done on 20 patients undergoing arthroscopic bankart’s repair using 2 -3 anchors.

13. 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.

14.  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.

15. 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

16. 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

17. 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

18. POST OPERATIVE FUNCTION(12 months) FUNCTION(Max-50) PATIENT PERCENTAGE  3 15 (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

19. MODIFIED ROWE SCORE RESULTS PATIENT NO PERCENTAGE 70 5 0 25 Excellent(90-100) 14 70 Good(75-89) 1 5 Fair(50-74) 3 15 Poor(0-49) 2 10  Results were excellent in 70%, good in 5% and fair in 15% & poor in 10 %.No patient developed recurrence.

20. CADAVERIC IMAGES

21. Per operative

22.

23. POST OP EVALUATION POST OP 2WK POST OP 6 MONTH

24. 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

25.  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.

26. 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.

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