An Analysis of Technical Aspects of the Arthroscopic Bankart Procedure as Performed in the United States

doi:10.1016/j.arthro.2014.05.026

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 30, Issue 10, October 2014, Pages 1246-1253

https://doi.org/10.1016/j.arthro.2014.05.026 Get rights and content

Purpose

The purpose of this study was to investigate the intersurgeon variation in technical aspects of performing an arthroscopic Bankart repair.

Methods

A unique approach with experienced equipment representatives from 3 different arthroscopic companies was used. Experienced representatives were identified by DePuy Mitek, Smith & Nephew, and Arthrex and filled out questionnaires on how their surgeons performed arthroscopic Bankart procedures. This was performed in a blinded fashion with no knowledge of the identities of the specific surgeons or representatives by us. A video on different aspects of the procedure was observed by each representative before filling out the questionnaire to help standardize responses. Data were collected using REDCap (Research Electronic Data Capture). Data were analyzed as an infrequent observation with 0% to 30% of representatives reporting the observation; sometimes, 31% to 70% reporting the observation; and often, greater than 70% of representatives reporting.

Results

Seventy-six percent of representatives had 6 or more years of arthroscopic experience. Forty-three percent of representatives reported that their surgeons use 3 portals for the procedure often. Forty-four percent reported that viewing was performed exclusively from the posterior portal while the surgeon was performing the repair. Seventy-three percent reported that the Hill-Sachs lesion was observed often, and 61% reported that the posterior labrum was evaluated often before the repair. Only 25% of representatives reported that the Bankart lesion was extensively released and mobilized often. Thirty-three percent reported 3 anchors as being used often. Seventy-five percent reported biocomposite anchors as being used often. Single-loaded anchors were reported as being used often by 47%. Eighty-one percent reported that sutures were placed in a simple fashion. Eighty-three percent reported the use of any posterior sutures or anchors for additional plication as infrequent.

Conclusions

There is significant variation in performance of the arthroscopic Bankart repair in the United States. Areas of concern include completeness of the diagnostic examination, the adequacy of capsulolabral mobilization, variation in the use of accessory portals, and inconsistent use of additional capsular or labral plication or fixation.

Section snippets

Methods

An institutional review board waiver was obtained because of the nature of the study and no identification of patients or individuals. DePuy Mitek (Raynham, MA), Smith & Nephew (Andover, MA), and Arthrex (Naples, FL) are all arthroscopic equipment companies and were contacted for their interest in identifying their own representatives throughout the United States who had the adequate experience and surgeon volume to respond to a questionnaire on arthroscopic Bankart surgical steps and

Results

Seventy-two representatives from the 3 arthroscopic equipment companies finished the questionnaire. Seventy-six percent of the representatives had 6 or more years of specific arthroscopic surgical coverage experience, 19% had 3 to 5 years, and only 4% had less than 3 years of experience. Fifty-four percent of the representatives based their responses on observing at least 15 different surgeons for the data inclusion. Although the ratio of academic versus private surgeons is not known, given the

Discussion

This survey evaluation did identify significant variation in the technical aspects of performing an arthroscopic Bankart repair in the United States. Areas of variability that could raise concern revolve around completeness of the diagnostic examination, as well as use of accessory portals for working and viewing as needed. In addition, the degree of capsulolabral mobilization and use of extra fixation points for capsulolabral fixation could be another area of important variation.

It has been

Conclusions

There is significant variation in technical aspects of performing an arthroscopic Bankart repair. Areas of potential concern are lack of completeness of the diagnostic examination, inadequate amount of capsulolabral mobilization, infrequent use of accessory portals, and lack of additional capsular plications or labral fixation.

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Cited by (11)

Arthroscopic Bankart Repair
2020, Operative Techniques in Orthopaedics
Citation Excerpt :
Furthermore, accessory portals have been described and may be necessary in some cases and should be well understood by surgeons providing comprehensive shoulder instability care. These portals, such as a posterolateral accessory portal, trans-subscapularis portal and the 5-o'clock portal are all potentially useful in achieving appropriate anchor placement around the glenoid rim.21,22 These various portal options allow surgeons to place anchors in optimal positions for Bankart repair which generally requires the inferior-most anchor to be placed in the 5:30 or 6:00-o'clock position of a right shoulder glenoid.
Anterior glenohumeral instability is among the most common conditions requiring orthopaedic care, particularly in the athletic population. The evaluation and management of anterior instability is dependent on many factors and a thorough understanding of each component of the patient's instability is necessary to achieve an optimal outcome. Patient factors including age, activity level, sport and number of instability events must be considered along with examination and imaging findings. A variety of treatment options, both surgical and nonsurgical, exist to manage anterior instability, however, selecting the optimal surgical treatment is not always simple. This review will discuss the role of the arthroscopic Bankart repair in the surgical management of anterior glenohumeral instability. The preoperative evaluation, surgical techniques, outcomes, and complications will be discussed in the context of the available literature validating this approach to surgical stabilization. The outcomes of arthroscopic Bankart repair will be reviewed including recurrent instability, return to sport and patient reported outcome measures to illustrate the appropriate application of this technique.
Nanoscopic Single-Incision Anterior Labrum Repair
2020, Arthroscopy Techniques
Arthroscopy frequently has been used to treat a variety of shoulder conditions, including anterior labrum tears. Anterior labrum repair techniques have progressed from multiple incision techniques to most recently a single anterior working portal with a posterior viewing portal. With the development of the NanoScope (Arthrex, Naples, FL), we do not need to make a standard portal for viewing purposes. In this article, we describe the single-incision anterior labrum repair bypassing the need for a posterior skin incision. The removal of this incision and portal should result in less fluid needed and less swelling. We hope this leads to less pain and improved patient outcomes.
Long-term outcomes following isolated arthroscopic Bankart repair: a 9- to 12-year follow-up
2019, JSES Open Access
The long-term outcomes following arthroscopic Bankart repair have been rarely reported. Because of its relative novelty, little is known about recurrent instability, postoperative arthritis, and patient satisfaction, particularly for well-established modern procedures. The purpose of the study was to evaluate the long-term outcomes following arthroscopic Bankart repair.
Patients who underwent isolated arthroscopic Bankart repair from 2003 to 2006 were retrospectively reviewed. Recurrent instability, radiographic, and clinical scores (American Shoulder and Elbow Surgeons [ASES], Simple Shoulder Test [SST], and Rowe scores) were evaluated. Patient factors (ie, age, gender, side, number of instability episodes, contact sports, and bone loss) were analyzed to determine the correlation with outcome measures.
Among the 98 patients (102 shoulders), we were able to contact 50 patients (51 shoulders, mean age 27.0 years, mean follow-up 121.2 months). Significant bone loss in glenoid and humerus was arthroscopically observed in 16 (31.4%) and 28 (54.9%) shoulders, respectively. Sixteen shoulders (31.4%) experienced recurrent instability. Recent radiographs were obtained for 38 shoulders, 14 (36.8%) of which showed moderate to severe arthritis. Clinical outcomes at follow-up were 89.3, 10.8, and 76.0 for ASES, SST, and Rowe scores, respectively. Neither recurrent instability nor arthritis was correlated with any patient factors.
When isolated arthroscopic Bankart repair was used in all patients with shoulder instability regardless of bony defect, postoperative recurrent instability and arthritis rates were unacceptably high. Additional procedures should be chosen after careful consideration of multiple patient factors.
Outcomes of Bankart Repairs Using Modern Arthroscopic Technique in an Athletic Population
2016, Arthroscopy - Journal of Arthroscopic and Related Surgery
To report a large number of highly active patients who underwent arthroscopic Bankart repair at our institution over the last decade.
A retrospective analysis of patients who underwent primary and revision arthroscopic Bankart repairs using bioabsorbable anchors was performed. Outcome measures included recurrence of dislocation, American Shoulder and Elbow Scores (ASES), Rowe, visual analog scale (VAS), return to sports, and satisfaction scores.
A total of 94 shoulders met the inclusion criteria. The recurrence rate was 6/94 (6.4%) at a mean follow-up of 5 years (range, 3 to 8.3). The mean postoperative scores were as follows: ASES = 91.5/100; Rowe = 84.3/100; VAS = 0.8/10; satisfaction = 8.8/10. In those who attempted to return to sports, 82.5% were able to return to the same level of competition. Statistical analyses revealed a significant increase in risk of recurrence among high school and recreational athletes. No recurrences were observed among professional or college-level athletes. No significant difference in recurrence rates was observed in regards to age, time to surgery, type of athlete (collision v limited contact), repair of SLAP lesion, number of anchors, or revision surgery.
Although several repair techniques exist for traumatic anterior shoulder instability, arthroscopic repair remains a viable option even in a highly active patient population. This study uniquely identified high school and recreational athletes at higher risk for recurrence. This is perhaps due to inferior shoulder development and technique as well as to limited access to postoperative physical therapy.
Level IV, therapeutic case series.
Metric development for an arthroscopic bankart procedure: Assessment of face and content validity
2015, Arthroscopy - Journal of Arthroscopic and Related Surgery
Citation Excerpt :
The goal was to characterize a “reference” arthroscopic Bankart repair and not one attempting to manage unusual or complex instability pathology. Procedure performance characterization (task deconstruction) was guided by (1) decades of practice and teaching experience by the Metrics Group, (2) published studies on arthroscopic Bankart repair,8-10 and (3) manufacturer guidelines on device use. Two 2.5-day face-to-face meetings and eight 1.5- to 2-hour online conferences were conducted, along with countless E-mail exchanges, to craft the procedural metrics.
To establish the metrics (operational definitions) necessary to characterize a reference arthroscopic Bankart procedure, and to seek consensus from experienced shoulder arthroscopists on the appropriateness of the steps, as well as errors identified.
Three experienced arthroscopic shoulder surgeons and an experimental psychologist (comprising the Metrics Group) deconstructed an arthroscopic Bankart procedure. Fourteen full-length videos were analyzed to identify the essential steps and potential errors. Sentinel (i.e., more serious) errors were defined as either (1) potentially jeopardizing the procedure outcome or (2) creating iatrogenic damage to the shoulder. The metrics were stress tested for clarity and the ability to be scored in binary fashion during a video review as either occurring or not occurring. The metrics were subjected to analysis by a panel of 27 experienced arthroscopic shoulder surgeons to obtain face and content validity using a modified Delphi Panel methodology (consensus opinion of experienced surgeons rendered by cyclical deliberations).
Forty-five steps and 13 phases characterizing an arthroscopic Bankart procedure were identified. Seventy-seven procedural errors were specified, with 20 designated as sentinel errors. The modified Delphi Panel deliberation created the following changes: 2 metrics were deleted, 1 was added, and 5 were modified. Consensus on the resulting Bankart metrics was obtained and face and content validity verified.
This study confirms that a core group of experienced arthroscopic surgeons is able to perform task deconstruction of an arthroscopic Bankart repair and create unambiguous step and error definitions (metrics) that accurately characterize the essential components of the procedure. Analysis and revision by a larger panel of experienced arthroscopists were able to validate the Bankart metrics.
The ability to perform task deconstruction and validate the resulting metrics will play a key role in improving surgical skills training and assessing trainee progression toward proficiency.
Arthroscopic Bankart repair by using the antero-superior portal for visualization
2021, Kuwait Medical Journal

View all citing articles on Scopus

: The authors report the following potential conflict of interest or source of funding: R.T.B. receives support from DePuy Mitek, Arthrex, Smith & Nephew.

Note: To access the supplementary material accompanying this report, visit the October issue of Arthroscopy at www.arthroscopyjournal.org.

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Original ArticleAn Analysis of Technical Aspects of the Arthroscopic Bankart Procedure as Performed in the United States

Purpose

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusions

Arthroscopy

J Shoulder Elbow Surg

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthrosc Tech

Arthroscopy

Arthroscopy

Arthroscopy

The Bankart procedure. A long-term end-result study

J Bone Joint Surg Am

Surgical trends in Bankart repair: An analysis of data from the American Board of Orthopaedic Surgery Certification Examination

Am J Sports Med

Arthroscopic Bankart suture-anchor repair

Am J Sports Med

Comparison of arthroscopic and open anterior shoulder stabilization. A two to six year follow-up study

J Bone Joint Surg Am

Arthroscopic treatment of anterior-inferior glenohumeral instability

J Bone Joint Surg Am

Original Article
An Analysis of Technical Aspects of the Arthroscopic Bankart Procedure as Performed in the United States