Archives of Orthopaedic and Trauma Surgery

, Volume 135, Issue 3, pp 369–382 | Cite as

Structural and clinical integrity of the rotator cuff in athletes after arthroscopic Bankart repair using the three-portal technique

  • T. Stein
  • J. Buckup
  • T. Efe
  • R. von Eisenhart-Rothe
  • R. Hoffmann
  • E. Zimmermann
  • F. Welsch
Arthroscopy and Sports Medicine



Muscular recovery of structural integrity after arthroscopic Bankart repair using the para- and trans-musculotendinous three-portal technique has not been investigated.

Materials and methods

Twenty-seven athletes [mean age 26.9 years, (group 1; G1)] were prospectively and longitudinally monitored after arthroscopic Bankart repair using the three-portal technique by magnetic resonance imaging (MRI) and specific clinical muscular testing. The muscular integrity was assessed at the subscapularis (SSC) for the para-tendinous anteroinferior portal, the supraspinatus (SSP) for the trans-tendinous suprabicipital portal, and the infraspinatus (ISP) for the trans-tendinous posterior portal. Muscular atrophy was assessed by standardized ratios of transverse and vertical diameters for the SSC and ISP, as defined by cross-sectional area ratios for the SSP. Fatty infiltration was assessed by signal intensity analysis for the upper and lower SSC, SSP, and upper ISP as a ratio with the lower ISP. These parameters were analyzed for pre-operative (T0), 1-year (T1), and 2-year status (T2), and compared to 27 healthy volunteers [mean age 29.4 years, (group 2, G2)].


The structural integrity assessments were performed after 14.8 (T1) and 32.0 months (T2). The SSC analysis revealed no muscular impairments in the upper and lower portions between T0 and T2 or compared to G2. MRI analysis for SSP and ISP showed full muscular recovery without any changes between T0 and T2 or deficits compared to G2. The number of pre-operative dislocations had no influence on the muscular integrity. MR analysis detected signs of overuse syndrome in 15 % at T0, 41 % at T1, and 63 % at T2; 77, 22, and 26 % of patients at T0, T1, and T2, respectively, were symptomatic.


Arthroscopic Bankart repair using the three-portal technique prevents full muscular integrity for para-tendinous anteroinferior portals at the SSC, the trans-tendinous suprabicipital portal through the SSP, and the trans-tendinous portal through the ISP.


Muscular integrity Fatty infiltration Arthroscopic Bankart repair Rehabilitation Muscular atrophy MRI 



The authors thank for the assistance of Dr. rer. med. Hanns Ackermann for analyzing the data. The authors appreciate the support performing the MR imaging of all medical technical assistants of the Department for Diagnostic and Interventional Radiology of our hospital and our Department assistants, Brigitte Mack and Gamze Tercan for assistance in collecting the data. The Magnetic Resonance Imaging was partially financed by third-party funds; the names of implants and company remain anonymous.

Conflict of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • T. Stein
    • 1
    • 5
  • J. Buckup
    • 1
  • T. Efe
    • 3
  • R. von Eisenhart-Rothe
    • 4
  • R. Hoffmann
    • 2
  • E. Zimmermann
    • 5
  • F. Welsch
    • 1
  1. 1.Department of Sporttraumatology, Knee- and Shoulder-SurgeryBerufsgenossenschaftliche Unfallklinik Frankfurt am MainFrankfurt am MainGermany
  2. 2.Department of Trauma and Orthopedic SurgeryBerufsgenossenschaftliche Unfallklinik Frankfurt am MainFrankfurt am MainGermany
  3. 3.Department of Orthopaedics and RheumatologyUniversity Hospital MarburgMarburgGermany
  4. 4.Clinic of Orthopedics and TraumatologyTechnical UniversityMunichGermany
  5. 5.Department of Sports ScienceUniversity of BielefeldBielefeldGermany

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