Clin Orthop Surg.  2010 Mar;2(1):39-46. 10.4055/cios.2010.2.1.39.

Arthroscopic Repair of Combined Bankart and SLAP Lesions: Operative Techniques and Clinical Results

• Cho HL
• Lee CK
• Hwang TH
• Suh KT
• Park JW

• KMID: 1110348
• DOI: http://doi.org/10.4055/cios.2010.2.1.39

Abstract

BACKGROUND: To evaluate the clinical results and operation technique of arthroscopic repair of combined Bankart and superior labrum anterior to posterior (SLAP) lesions, all of which had an anterior-inferior Bankart lesion that continued superiorly to include separation of the biceps anchor in the patients presenting recurrent shoulder dislocations.
METHODS
From May 2003 to January 2006, we reviewed 15 cases with combined Bankart and SLAP lesions among 62 patients with recurrent shoulder dislocations who underwent arthroscopic repair. The average age at surgery was 24.2 years (range, 16 to 38 years), with an average follow-up period of 15 months (range, 13 to 28 months). During the operation, we repaired the unstable SLAP lesion first with absorbable suture anchors and then also repaired Bankart lesion from the inferior to superior fashion. We analyzed the preoperative and postoperative results by visual analogue scale (VAS) for pain, the range of motion, American Shoulder and Elbow Surgeon (ASES) and Rowe shoulder scoring systems. We compared the results with the isolated Bankart lesion.
RESULTS
VAS for pain was decreased from preoperative 4.9 to postoperative 1.9. Mean ASES and Rowe shoulder scores were improved from preoperative 56.4 and 33.7 to postoperative 91.8 and 94.1, respectively. There were no specific complication and no significant limitation of motion more than 10 degree at final follow-up. We found the range of motions after the arthroscopic repair in combined lesions were gained more slowly than in patients with isolated Bankart lesions.
CONCLUSIONS
In recurrent dislocation of the shoulder with combined Bankart and SLAP lesion, arthroscopic repair using absorbable suture anchors produced favorable clinical results. Although it has technical difficulty, the concomitant unstable SLAP lesion should be repaired in a manner that stabilizes the glenohumeral joint, as the Bankart lesion can be repaired if the unstable SLAP lesion is repaired first.

Keyword

Shoulder; Arthroscopy; Repair; Combined Bankart and SLAP lesion

MeSH Terms

Adolescent
Adult
Arthroscopy/*methods
Humans
Magnetic Resonance Imaging
Male
Orthopedic Procedures/*methods
Pain Measurement
Postoperative Care
Range of Motion, Articular
Shoulder Dislocation/diagnosis/etiology/physiopathology/*surgery
Tendon Injuries/complications/diagnosis/physiopathology/*surgery
Treatment Outcome
Young Adult

Figure

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  Fig. 1 MRI findings showing the Bankart lesion (A) and the superior labrum anterior to posterior lesion (B).

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  Fig. 2 Arthroscopic portals were designed at the right shoulder. Arrow is the anterosuperior portal and arrow head is the port of Wilmington.

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  Fig. 3 Arthroscopic image of the combined Bankart and superior labrum anterior to posterior lesion showing (A) inferiorly displaced superior labrum with significant fraying (right shoulder, from posterior viewing portal) and (B) medially displaced superior and anteroinferior labral complex (right shoulder, from anterior working portal).

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  Fig. 4 The effect of the superior labrum anterior to posterior (SLAP) repair revealing (A) medially an inferiorly displaced anteroinferior labrum before the repair of the SLAP lesion (right shoulder, from posterior viewing portal) and (B) relatively anatomically reduced Bankart lesion after the repair of the SLAP lesion (right shoulder, from posterior viewing portal).

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  Fig. 5 Final arthroscopic findings after the completion of the repair of combined Bankart and superior labrum anterior to posterior lesion in right shoulder viewing from (A) posterior viewing portal and (B) anterior working portal.

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  Fig. 6 Suture relay and knot tying representing (A) intra-articular suture relay using 2-0 Nylon loop which shuttles capsular side of suture limbs and (B) sliding knot tying of the most inferior suture anchor around 5 o'clock while exerting upward tension of the anteroinferior labrum using tissue grasper (right shoulder, from posterior viewing portal).

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  Fig. 7 In type superior labrum anterior to posterior Lesion, the range of motions in (A) forward flexion and (B) external rotation at 90 degree abduction after the arthroscopic repair were gained more slowly than in patients with isolated Bankart lesion (*p < 0.05).

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