J Korean Orthop Assoc.  2019 Dec;54(6):574-578. 10.4055/jkoa.2019.54.6.574.

Alternative Fixation Technique for Bony Bankart Lesion with Using Suture Anchor

• Kim BK
• Lee HJ
• Kim GT
• Dan J

• KMID: 2469890
• DOI: http://doi.org/10.4055/jkoa.2019.54.6.574

Abstract

For the treatment of a bony Bankart lesion accompanied by an acute traumatic shoulder dislocation, anatomical reduction and stable fixation of the bone fragment and glenohumeral ligament are essential to avoid chronic instability or degenerative changes. If the Bankart lesion has large bony pieces or comminuted fragments, it can be difficult to perform precise and secure fixation of the big intraarticular fragment to the fracture site because of the limited visualization of the arthroscopic procedure. In addition, in the case of the open procedure, it requires an extensive surgical dissection to access the fractured fragment, which may cause surgical approach-related morbidity, such as neurovascular complications, delayed subscapularis healing, and increased risk of stiffness. This paper describes an alternative open suture anchor technique for a large bony Bankart lesion, which was secured anatomically with squared knots after a shuttle relay through bony tunnels and adjacent soft tissue and labrum. This technique can achieve anatomical and firm fixation under direct vision, and reduce the number of surgery related morbidities.

Keyword

anterior shoulder dislocation; bony Bankart lesion; open suture anchor technique

MeSH Terms

Ligaments
Shoulder Dislocation
Suture Anchors*
Sutures*

Figure

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  Figure 1 Plain radiography shows a cortical discontinuity on the anterior glenoid limb.

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  Figure 2 Three-dimensional computed tomography shows medial displacement of an anterior glenoid fragment. The size of the fragment is 25% of the anteroposterior glenoid width.

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  Figure 3 Schematic diagram of shuttle relay of the suture. After penetrating the spinal needle through the labrum and fractured bony fragment, the end of the suture was tied with No 1-0 Prolene (Ethicon, Bridgewater, NJ, USA).

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  Figure 4 Schematic diagram of suture anchor fixation with a double pulley technique. Two sutures were passed through the bone tunnels of the fragment and surrounding soft tissues. The bony fragment was compressed against the fracture site with the squarely tied knot, which was accomplished by the pulling of opposite ends of the suture.

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  Figure 5 Three months after surgery, computed tomography revealed congruency of the shoulder joint.

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  Figure 6 One year after surgery, three-dimensional computed tomography shows a well-maintained reduction and bone union.

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