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Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 2, pp 155–163 | Cite as

Rotator cuff muscular integrity after arthroscopic revision of a Bankart repair

  • Johannes Buckup
  • Frederic Welsch
  • Reinhard Hoffmann
  • Philip P. Roessler
  • Karl F. Schüttler
  • Thomas Stein
Orthopaedic Surgery
  • 264 Downloads

Abstract

Introduction

Recurrent shoulder instability after arthroscopic Bankart repair is still a common complication. For primary Bankart repair studies have shown that the rotator cuff can recover completely. The ability of muscles to regenerate after arthroscopic revision Bankart repair (ARBR) has not been studied. Does the ARBR using a three-portal method allows complete muscle integrity compared with an uninjured imaging control group (ICG)?

Materials and methods

Twenty-two (1 female, 21 males) physically active patients (mean age at follow-up 28.5 ± 7.1 years; mean follow-up 27.5 months ± 8.5) were assessed. ARBR with a three-portal method was carried out in all patients according to previous primary arthroscopic stabilization of the shoulder (revision Bankart group). Muscle atrophy of the subscapularis muscle (SSC), supraspinatus muscle (SSP) and infraspinatus muscle (ISP) was assessed by making lateral and vertical measurements by magnetic resonance imaging (MRI). Fatty infiltration was detected by standardized assessment from variations in intensity. Detailed clinical examination of the rotator cuff was carried out. MRI assessment was compared with that of a control group of 22 healthy volunteers of same age and activity level (ICG).

Results

For the SSC, no muscle impairment was noted compared with the ICG [superior atrophy index (sAISSC), p = 0.439; inferior atrophy index (iAISSC), p = 0.555; superior fatty infiltration index (sFDISSC), p = 0.294; inferior fatty infiltration index (iFDISSC), p = 0.62]. In investigation of the SSP and ISP, fatty infiltration was not shown (FDISSP, p = 0.454; sFDIISP, p = 0.504), though persistent muscle atrophy was found even > 2 years after surgery compared with the ICG (AISSP, p = 0.0025; sAIISP, p = 0.0009; iAIISP, p = 0.0004).

Conclusion

ARBR using a three-portal method allowed good muscular integrity compared with the ICG, but with persistent slight muscular atrophy of the SSP and ISP.

Keywords

Muscular integrity Arthroscopic revision of Bankart repair Rehabilitation Muscular atrophy 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Arce G, Arcuri F, Ferro D, Pereira E (2011) Is selective arthroscopic revision beneficial for treating recurrent anterior shoulder instability? Clin Orthop Relat Res.  https://doi.org/10.1007/s11999-011-2001-0 PubMedCentralGoogle Scholar
  2. 2.
    Boileau P, Richou J, Lisai A, Chuinard C, Bicknell RT (2009) The role of arthroscopy in revision of failed open anterior stabilization of the shoulder. Arthroscopy 25:1075–1084.  https://doi.org/10.1016/j.arthro.2009.04.073 CrossRefPubMedGoogle Scholar
  3. 3.
    Boileau P, Villalba M, Hery JY, Balg F, Ahrens P, Neyton L (2006) Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Jt Surg Am 88:1755–1763.  https://doi.org/10.2106/JBJS.E.00817 CrossRefGoogle Scholar
  4. 4.
    Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology part I: pathoanatomy and biomechanics. Arthroscopy 19:404–420.  https://doi.org/10.1053/jars.2003.50128 CrossRefPubMedGoogle Scholar
  5. 5.
    Butt U, Rashid MS, Temperley D, Crank S, Birch A, Freemont AJ, Trail IA (2016) Muscle regeneration following repair of the rotator cuff. Bone Jt J 98-B:1389–1394.  https://doi.org/10.1302/0301-620X.98B10.37231 CrossRefGoogle Scholar
  6. 6.
    Fabbriciani C, Milano G, Demontis A, Fadda S, Ziranu F, Mulas PD (2004) Arthroscopic versus open treatment of Bankart lesion of the shoulder: a prospective randomized study. Arthroscopy 20:456–462CrossRefPubMedGoogle Scholar
  7. 7.
    Franceschi F, Longo UG, Ruzzini L, Rizzello G, Maffulli N, Denaro V (2008) Arthroscopic salvage of failed arthroscopic Bankart repair: a prospective study with a minimum follow-up of 4 years. Am J Sports Med 36:1330–1336.  https://doi.org/10.1177/0363546508314403 CrossRefPubMedGoogle Scholar
  8. 8.
    Friedman LG, Griesser MJ, Miniaci AA, Jones MH (2014) Recurrent instability after revision anterior shoulder stabilization surgery. Arthroscopy 30:372–381.  https://doi.org/10.1016/j.arthro.2013.11.019 CrossRefPubMedGoogle Scholar
  9. 9.
    Gamulin A, Pizzolato G, Stern R, Hoffmeyer P (2002) Anterior shoulder instability: histomorphometric study of the subscapularis and deltoid muscles. Clin Orthop Relat Res 398:121–126CrossRefGoogle Scholar
  10. 10.
    Gigis I, Heikenfeld R, Kapinas A, Listringhaus R, Godolias G (2014) Arthroscopic versus conservative treatment of first anterior dislocation of the shoulder in adolescents. J Pediatr Orthop 34:421–425.  https://doi.org/10.1097/BPO.0000000000000108 CrossRefPubMedGoogle Scholar
  11. 11.
    Habermeyer P, Gleyze P, Rickert M (1999) Evolution of lesions of the labrum-ligament complex in posttraumatic anterior shoulder instability: a prospective study. J Shoulder Elbow Surg 8:66–74CrossRefPubMedGoogle Scholar
  12. 12.
    Ho AG, Gowda AL, Michael Wiater J (2016) Evaluation and treatment of failed shoulder instability procedures. J Orthop Traumatol.  https://doi.org/10.1007/s10195-016-0409-8 PubMedPubMedCentralGoogle Scholar
  13. 13.
    Kibler WB (1998) The role of the scapula in athletic shoulder function. Am J Sports Med 26:325–337CrossRefPubMedGoogle Scholar
  14. 14.
    Kibler WB, McMullen J (2003) Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg 11:142–151CrossRefPubMedGoogle Scholar
  15. 15.
    Krueger D, Kraus N, Pauly S, Chen J, Scheibel M (2011) Subjective and objective outcome after revision arthroscopic stabilization for recurrent anterior instability versus initial shoulder stabilization. Am J Sports Med 39:71–77.  https://doi.org/10.1177/0363546510379336 CrossRefPubMedGoogle Scholar
  16. 16.
    Labriola JE, Jolly JT, McMahon PJ, Debski RE (2004) Active stability of the glenohumeral joint decreases in the apprehension position. Clin Biomech (Bristol, Avon) 19:801–809.  https://doi.org/10.1016/j.clinbiomech.2004.05.008 CrossRefGoogle Scholar
  17. 17.
    Labriola JE, Lee TQ, Debski RE, McMahon PJ (2005) Stability and instability of the glenohumeral joint: the role of shoulder muscles. J Shoulder Elbow Surg 14:32S–38S.  https://doi.org/10.1016/j.jse.2004.09.014 CrossRefPubMedGoogle Scholar
  18. 18.
    Merolla G, De Santis E, Campi F, Paladini P, Porcellini G (2010) Supraspinatus and infraspinatus weakness in overhead athletes with scapular dyskinesis: strength assessment before and after restoration of scapular musculature balance. Musculoskeletal surgery 94:119–125.  https://doi.org/10.1007/s12306-010-0082-7 CrossRefPubMedGoogle Scholar
  19. 19.
    Murray IR, Goudie EB, Petrigliano FA, Robinson CM (2013) Functional anatomy and biomechanics of shoulder stability in the athlete. Clin Sports Med 32:607–624.  https://doi.org/10.1016/j.csm.2013.07.001 CrossRefPubMedGoogle Scholar
  20. 20.
    Nebelung W, Jaeger A, Wiedemann E (2002) Rationales of arthroscopic shoulder stabilization. Arch Orthop Trauma Surg 122:472–487.  https://doi.org/10.1007/s00402-002-0423-6 CrossRefPubMedGoogle Scholar
  21. 21.
    Nofsinger C, Browning B, Burkhart SS, Pedowitz RA (2011) Objective preoperative measurement of anterior glenoid bone loss: a pilot study of a computer-based method using unilateral 3-dimensional computed tomography. Arthroscopy 27:322–329.  https://doi.org/10.1016/j.arthro.2010.09.007 CrossRefPubMedGoogle Scholar
  22. 22.
    Owens BD, Harrast JJ, Hurwitz SR, Thompson TL, Wolf JM (2011) Surgical trends in Bankart repair: an analysis of data from the American Board of Orthopaedic Surgery certification examination. Am J Sports Med 39:1865–1869.  https://doi.org/10.1177/0363546511406869 CrossRefPubMedGoogle Scholar
  23. 23.
    Patel RV, Apostle K, Leith JM, Regan WD (2008) Revision arthroscopic capsulolabral reconstruction for recurrent instability of the shoulder. J Bone Jt Surg Br 90:1462–1467.  https://doi.org/10.1302/0301-620X.90B11.21072 CrossRefGoogle Scholar
  24. 24.
    Potzl W, Thorwesten L, Gotze C, Garmann S, Steinbeck J (2004) Proprioception of the shoulder joint after surgical repair for Instability: a long-term follow-up study. Am J Sports Med 32:425–430CrossRefPubMedGoogle Scholar
  25. 25.
    Scheibel M, Habermeyer P (2008) Subscapularis dysfunction following anterior surgical approaches to the shoulder. J Shoulder Elbow Surg 17:671–683.  https://doi.org/10.1016/j.jse.2007.11.005 CrossRefPubMedGoogle Scholar
  26. 26.
    Scheibel M, Nikulka C, Dick A, Schroeder RJ, Popp AG, Haas NP (2007) Structural integrity and clinical function of the subscapularis musculotendinous unit after arthroscopic and open shoulder stabilization. Am J Sports Med 35:1153–1161CrossRefPubMedGoogle Scholar
  27. 27.
    Schroder RJ, Scheibel M, Tsynman A, Magosch P, Habermeyer P (2006) Magnetic resonance analysis of the subscapularis muscle after open anterior shoulder stabilization. Rofo 178:706–712.  https://doi.org/10.1055/s-2006-926684 CrossRefPubMedGoogle Scholar
  28. 28.
    Spatschil A, Landsiedl F, Anderl W, Imhoff A, Seiler H, Vassilev I, Klein W, Boszotta H, Hoffmann F, Rupp S (2006) Posttraumatic anterior-inferior instability of the shoulder: arthroscopic findings and clinical correlations. Arch Orthop Trauma Surg 126:217–222CrossRefPubMedGoogle Scholar
  29. 29.
    Stein T, Buckup J, Efe T, von Eisenhart-Rothe R, Hoffmann R, Zimmermann E, Welsch F (2015) Structural and clinical integrity of the rotator cuff in athletes after arthroscopic Bankart repair using the three-portal technique. Arch Orthop Trauma Surg 135:369–382.  https://doi.org/10.1007/s00402-015-2158-1 CrossRefPubMedGoogle Scholar
  30. 30.
    Stein T, Buckup J, Mehling AP, Hoffmann R, Efe T, von Eisenhart-Rothe R, Welsch F (2014) Restoration of joint congruency and the glenoidal labrum after arthroscopic revision Bankart repair: a MRI match-paired analysis comparing primary Bankart repair and the uninjured labrum. Arch Orthop Trauma Surg 134:1121–1134.  https://doi.org/10.1007/s00402-014-1990-z CrossRefPubMedGoogle Scholar
  31. 31.
    Stein T, Mehling AP, Reck C, Buckup J, Efe T, Hoffmann R, Jager A, Welsch F (2011) MRI assessment of the structural labrum integrity after Bankart repair using knotless bio-anchors. Knee Surg Sports Traumatol Arthrosc 19:1771–1779.  https://doi.org/10.1007/s00167-011-1407-2 CrossRefPubMedGoogle Scholar
  32. 32.
    Urayama M, Itoi E, Sashi R, Minagawa H, Sato K (2003) Capsular elongation in shoulders with recurrent anterior dislocation. Quantitative assessment with magnetic resonance arthrography. Am J Sports Med 31:64–67CrossRefPubMedGoogle Scholar
  33. 33.
    Ward SR, Hentzen ER, Smallwood LH, Eastlack RK, Burns KA, Fithian DC, Friden J, Lieber RL (2006) Rotator cuff muscle architecture: implications for glenohumeral stability. Clin Orthop Relat Res 448:157–163.  https://doi.org/10.1097/01.blo.0000194680.94882.d3 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Johannes Buckup
    • 1
  • Frederic Welsch
    • 2
  • Reinhard Hoffmann
    • 1
  • Philip P. Roessler
    • 3
  • Karl F. Schüttler
    • 4
  • Thomas Stein
    • 2
    • 5
  1. 1.Department of Trauma and Orthopaedic SurgeryBerufsgenossenschaftliche Unfallklinik Frankfurt am MainFrankfurt am MainGermany
  2. 2.Department of Sports traumatology, Knee- and Shoulder-SurgeryBerufsgenossenschaftliche Unfallklinik Frankfurt am MainFrankfurt am MainGermany
  3. 3.Department of Orthopaedics and Trauma SurgeryUniversity Hospital BonnBonnGermany
  4. 4.Department of Orthopaedics and RheumatologyUniversity Hospital MarburgMarburgGermany
  5. 5.Department of Sports ScienceUniversity of BielefeldBielefeldGermany

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