Shoulder
Fewer anchors achieves successful arthroscopic shoulder stabilization surgery: 114 patients with 4 years of follow-up

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Background

The shoulder is the most frequently dislocated joint, with an incidence of 10 to 20 per 100,000 each year. The optimum number of anchors to use in arthroscopic stabilization is a topic of growing interest; most surgeons use 3. Our stabilization technique is to commonly use only a single suture anchor to purse-string the capsulolabral tissue up and toward the glenoid. This study aimed to ascertain whether successful stabilization can be achieved with fewer than 3 anchors.

Methods

Our study comprised 114 consecutive patients with anterior instability and a Bankart lesion undergoing arthroscopic stabilization with 4 years of follow-up. Outcome was measured by Oxford Instability Score (OIS) and recurrence of instability or dislocation. Patient demographics were 86.8% male, 13.2% female, mean age of 31 years, 76.3% Hill-Sachs lesions, 13.2% bony Bankart lesions, 13.2% glenoid defects, and 9.6% SLAP lesions. The majority of patients, 71 patients (62.3%), received only 1 anchor; 40 patients (35.1%) received 2 anchors, and 3 patients (2.6%) had 3 anchors.

Results

The mean OIS was 44.3 preoperatively and 17.3 postoperatively (P < .0001). There was no difference in OIS improvement between the patients who received a single anchor and those who received 2 or 3 anchors (P > .05). Even with minor bony Bankart lesions and glenoid defects, a single suture anchor can be sufficient. Our failure rate of 6.1% is comparable with that of other published series.

Conclusion

Successful shoulder stabilization can be achieved with fewer than 3 anchors, and a single anchor is usually sufficient.

Section snippets

Materials and methods

The study comprised 114 consecutive patients. Inclusion criteria were all patients with anterior instability and a Bankart lesion undergoing arthroscopic stabilization. Patients with bony glenoid defects >20% were excluded from the study and treated with a Latarjet procedure. All patients were followed up for a minimum of 4 years postoperatively. The Oxford Instability Score (OIS) was collected prospectively. All other data were collected retrospectively by use of patient case notes, x-ray

Results

Our series comprised 114 patients, of whom 99 (86.8%) were male and 15 (13.2%) female. The mean age was 31 years (age range, 15-71 years). In total, 10 patients were older than 50 years. There were 87 (76.3%) Hill-Sachs lesions, 15 (13.2%) bony Bankart lesions, 15 (13.2%) glenoid defects, and 11 (9.6%) SLAP lesions. The number of anchors used is shown in Figure 4. This demonstrates that the majority of patients, 71 patients (62.3%), received only 1 anchor; 40 patients (35.1%) received 2

Discussion

In our series, we have used only 1 anchor in the majority of patients. Although most surgeons commonly use 3 anchors, we have used 3 anchors only in 3 (2.6%) of our patients. Despite our smaller number of anchors, our failure rate of 6.1% compares favorably with that of other published series.1, 2, 3, 4, 5, 6, 8, 10, 11, 13, 15, 16, 17, 18, 19, 20, 21, 22, 23 Table II shows how our results compare with the literature.

Strengths of our study include a relatively large patient sample size, a

Conclusion

Although most surgeons choose to use 3 anchors as their standard practice, we found that fewer anchors can achieve successful shoulder stabilization. A single anchor was sufficient for the majority of our patients. We found no statistically significant difference in outcome for patients treated with a single anchor compared with those treated with 2 or 3 anchors. In fact, our experience shows that even in patients with minor bony Bankart lesions and minor glenoid defects, a single anchor can be

Disclaimer

The authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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  • Cited by (0)

    UK National Health Service ethics approval is not required for this work.

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