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Arthroscopic Bankart repair with additional footprint fixation using the double-row technique at the 4 o'clock position anatomically restored the capsulolabral complex and showed good clinical results

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate the clinical outcome and magnetic resonance imaging (MRI) findings after arthroscopic Bankart repair with additional double anchor footprint fixation (DAFF) at the 4 o’clock position, where the native footprint is widest anatomically, for recurrent anterior shoulder instability.

Methods

Forty-two patients (mean age 27.0 years) with recurrent anterior shoulder instability and without severe glenoid bone defects underwent arthroscopic Bankart repair with additional DAFF at the 4 o’clock position. Using three standard portals, single-row repair was performed at the 2, 3, and 5 o’clock positions, and DAFF with the suture bridging technique was conducted at the 4 o’clock position. MRI was performed preoperatively and at 6 months postoperatively. Patients with follow-up periods of ≥1 year were included in the present study and clinically evaluated at the final follow-up. The morphology at the 2 and 4 o’clock positions on radial MRI slices was compared between the preoperative and 6-month postoperative scans, and the footprint of the repaired capsulolabral complex at 6 months postoperatively was compared between the 2 and 4 o’clock positions.

Results

The average follow-up period was 19.5 ± 6.2 months. The rates of dislocation recurrence and positive apprehension test results were 2.4 and 4.8%, respectively. External rotation was restricted by 3.5°. The University of California at Los Angeles and Rowe scores at the final follow-up were 34.5 ± 1.0 points and 97.2 ± 5.7 points, respectively, representing significant improvements over the preoperative scores (p < 0.01). Although the capsulolabral complex at 6 months postoperatively was firmly repaired at both the 2 and 4 o’clock positions compared to its preoperative state, the footprint of the restored capsulolabral complex was wider at the 4 o’clock position than at the 2 o’clock position (p < 0.01).

Conclusions

Additional DAFF at the 4 o’clock position improved the glenohumeral stability and function of the shoulder joint. This study suggests that this technique is a reliable and useful treatment for shoulder instability.

Level of evidence

IV.

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Acknowledgements

The authors would like to thank Enago (www.enago.jp) for the English language review. We thank Dr. Tomoki Wada and Dr. Yoshinori Gonda for their technical assistance.

Funding

This study was supported (in part) by a Grant‐in‐Aid for Young Scientists (No: 18K18371).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan

    Yoshiaki Itoigawa, Hirohisa Uehara, Akihisa Koga, Daichi Morikawa & Yuichiro Maruyama

  2. Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan

    Takayuki Kawasaki & Muneaki Ishijima

  3. Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, Tokyo, Japan

    Yuki Shiota

Authors
  1. Yoshiaki Itoigawa
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  2. Hirohisa Uehara
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  3. Akihisa Koga
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  4. Daichi Morikawa
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  5. Takayuki Kawasaki
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  7. Yuichiro Maruyama
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  8. Muneaki Ishijima
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Contributions

YI: First author and corresponding author who contributed for all of this study; HU: Data acquisition; AK; Analysis of data; DM: Study design and data acquisition; TK: Analysis of data and data acquisition; YS: Data acquisition; YM: Conception of study and Interpretation of data; MI: Interpretation of data and Study design.

Corresponding author

Correspondence to Yoshiaki Itoigawa.

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We have no potential conflict of interest.

Ethical approval

The patients signed an informed consent form approved by the Institutional Review Board at Juntendo university (Juntendo University Urayasu Hospital, No. 30-017).

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The patients provided written informed consent approved by the Institutional Review Board at Juntendo university.

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Itoigawa, Y., Uehara, H., Koga, A. et al. Arthroscopic Bankart repair with additional footprint fixation using the double-row technique at the 4 o'clock position anatomically restored the capsulolabral complex and showed good clinical results. Knee Surg Sports Traumatol Arthrosc 30, 3827–3834 (2022). https://doi.org/10.1007/s00167-022-06974-9

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