Arthroscopic Bankart Repair

Indications^1-15

• First-time traumatic shoulder dislocation with Bankart lesion confirmed by MRI

• Athlete <25 years old

• High-demand athlete

• Recurrent shoulder dislocations

Contraindications^16-22

• Multidirectional instability

• Large Hill-Sachs lesion

• Humeral avulsion of the glenoid labrum (HAGL)

• Capsular deficiency

• Glenoid bone loss of 25% or more

Advantages of Arthroscopic Bankart Repair^2,23,24

• Less surgical morbidity

• Less postoperative pain

• Reduced cost

• Improved cosmetic result

• Easier/faster rehabilitation

Equipment and Instrumentation

• Patient positioning

• Balanced arm traction, 7 lb longitudinal traction, and 5 lb lateral traction

• STaR (Shoulder Traction and Rotation) sleeve (Arthrex, Naples, FL)

• Beanbag positioner, vacuum

• Sterile blanket, rolled

• Arthroscopy

• Fluid pump system

• 30-degree arthroscope with standard arthroscopic instruments

• Spinal needle

• Arthroscopic elevator/spatula

• 8.25-mm cannulas

• Repair

• Three or four double-loaded 2.0-mm suture anchors

• Three No. 0 PDS sutures

• Curved suture hook

• Suture retrieval forceps

• Suture passer

• Arthroscopic knot pusher

• Closure

• 2.0 nylon sutures

• Shoulder immobilizer with abduction pillow

Patient Positioning

• The patient is placed in the lateral decubitus position using a vacuum beanbag positioner with the operative shoulder up (Fig. 2-1).

Figure 2-1 | Patient positioning. The patient is placed in a lateral decubitus position with a vacuum beanbag positioner. A hip positioner may be useful to assist in maintaining position through augmentation of the beanbag positioner.

• A corner of the beanbag immobilizer or a gel pad is placed at the junction between the thorax and axilla of the nonoperative shoulder to prevent nerve injury during surgery.

• Sterile draping of the surgical field is performed per surgeon preference.

• The operative arm is placed in a sterile STaR sleeve and attached to the balanced arm traction device with the arm externally rotated (thumb up) and abducted 20-30 degrees. Seven pounds of longitudinal traction and five pounds of lateral traction are placed (Fig. 2-2).

Figure 2-2 | The arm is placed into a sterile STaR sleeve and attached to the traction device. Seven pounds of longitudinal traction and five pounds of lateral traction are then placed onto the traction device to allow for optimal viewing of the capsulolabral complex of the glenohumeral joint.

Surgical Approach

• Bony landmarks of the shoulder are marked with a surgical marker, including the coracoid process, clavicle, acromion, acromioclavicular joint, and spine of the scapula for orientation before portal placement (Fig. 2-3).

Figure 2-3 | Landmarks are palpated and marked with a surgical marker, including the spine of the scapula, acromion, acromioclavicular (AC) joint, and coracoid. These will be landmarks for proper portal placement.

• A standard posterior arthroscopic portal is created first (Fig. 2-4).

Figure 2-4 | The posterior portal is first placed by marking a position 1 cm distal and 1 cm medial to the posterolateral tip of the acromion. After a skin incision is made, a blunt trocar is placed directed toward the coracoid. The trocar is removed, leaving the sheath for placement of the arthroscope.

• The portal is marked 2 cm distal to the posterior angle of the acromion and more lateral to the traditional portal. This will ensure that the portal is not too medial coming into the glenoid.

• A small skin incision is made and the blunt trocar is inserted aiming toward the coracoid. The trocar is removed, leaving the sheath, and the arthroscope is inserted.

• A complete diagnostic arthroscopy is performed, and the Bankart lesion is visualized using the posterior arthroscopic portal.

• Under direct visualization, the anterosuperior and anterior portals are created using a spinal needle to allow for accurate portal placement (Fig. 2-5).

Figure 2-5 | The anterosuperior and anterior portals are created under direct visualization. The anterosuperior portal is placed just in front of the anterolateral edge of the acromion and lateral to the coracoid and should enter the joint just posterior to the biceps tendon. The anterior portal is placed halfway between the acromioclavicular joint and lateral aspect of the coracoid and should enter the joint just above the subscapularis, parallel to the glenoid surface.

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