The Arthroscopic Bankart Repair is an effective procedure to treat patients that have anterior shoulder instability. The majority of patients who suffer a traumatic anterior dislocation of their shoulder will tear the fibrocartilage labrum at the front of the shoulder. Many of these patients will go on to develop recurrent instability in their shoulder and keep dislocating. This will have a significant effect on the ability to participate in sport and sometimes also their work. It is the tear in the labrum that is largely responsible for allowing their shoulder to continue to dislocate.
It has been established that if only patients with a pure labral tear are treated with an arthroscopic bankart repair then the results are as high as an open repair. The aim of surgery is to return people to full normal sporting and work activities and the risk of a redislocation in this situation is less than 5% with a well-performed arthroscopic procedure.
The Arthroscopic Bankart procedure repairs this tear in the labrum and by doing so restores stability to the shoulder. This procedure can be performed either open or arthroscopically. Previously it was believed that the arthroscopic repair was not as successful as the open repair.
Patients that have torn not just the labral cartilage at the front of the shoulder but have also chipped off a segment of bone when they dislocated need a surgical procedure that will deal with the loss of bone. My preference in this situation is an arthroscopic Latarjet procedure.
The advantages of the arthroscopic procedure are a lower complication rate, and an easier postoperative recovery in terms of pain and discomfort. Arthroscopic procedures typically have lower complication rates than the similar open operation. The anatomy can be better visualised at the time of surgery and if the tear is more extensive, particularly if it extends into the posterior part of the shoulder the arthroscopic procedure allows for this to be repaired at the same time. There are no real advantages of the open Bankart repair over the arthroscopic repair other than the relative simplicity of the procedure over the more technically demanding arthroscopic procedure.
The arthroscopic Bankart repair is performed using bone anchors that are drilled into the Glenoid. The anchors that I am currently using are biocomposite anchors. They have a crystalline structure that is eventually replaced by bone. The bone anchors have sutures attached to them that are then used to tie the torn cartilage (labrum) back to where it has torn off from the anterior Glenoid. At the same time the shoulder joint capsule that has been stretched by the dislocation is sutured to the anchors further tightening the shoulder. This is termed a capsulolabral plication.