Arthroscopic Bankart Repair

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Anterior labral detachment (Bankart lesion)
  • Primary dislocation in high-risk patients involved in contact or collision sports near the end of the season
  • Dislocation of the dominant shoulder in an overhead athlete
  • Recurrent shoulder instability despite adequate conservative treatment including physical therapy
CONTRAINDICATIONS
  • Uncooperative or medically unstable patient
  • The presence of capsular deficiency, especially with a history of prior thermal capsulorrhaphy
  • Active seizure disorder
  • Primary collagen disorders
    • Ehlers-Danlos syndrome
    • Marfan syndrome
  • Voluntary dislocations with secondary gain
  • Other associated injury including:
    • 25% glenoid bone loss
    • Engaging Hill-Sachs lesion involving 30% of the humeral head
    • Humeral avulsion of the glenoid labrum (HAGL)
EQUIPMENT
  • Arthroscopy equipment
  • Arthroscopy equipment set
  • Hooded arthroscopic bur
  • Arthroscopic anchors and suture
  • Suture retrieval device
ANATOMY
  • The bony anatomy of the shoulder joint does not provide inherent stability.
    • Glenoid: flat and dishlike structure that provides little bony stability
    • Humeral head: larger with only one fourth of its surface articulating with glenoid
  • Glenoid labrum:
    • Deepens the glenoid by as much as 50%
    • Increases the amount of humeral head articulation to 75% of its surface
    • May serve as a "chock block" to prevent excessive humeral head rollback
    • The long head of the biceps tendon inserts onto the superior aspect of the glenoid labrum
  • Joint capsule: thin, providing little addition to stability itself but with three thickenings (ligaments):
    • The superior glenohumeral ligament (SGHL): primary restraint to inferior humeral subluxation in 0 degrees of abduction
    • The middle glenohumeral ligament (MGHL): limits external rotation when the arm is in the lower range of abduction but has little effect over 90 degrees
    • The inferior glenohumeral ligament (IGHL): primary stabilizer to both anterior and posterior stresses when the shoulder is abducted to 45 degrees or more
  • The muscles about the shoulder joint also serve important roles as dynamic stabilizers.
    • Deltoid: principal extrinsic muscle; produces vertical shear forces, which displace the humeral head superiorly
    • Rotator cuff: Intrinsic actions provide compressive stabilizing forces.
    • Periscapular muscles: Synchronous function maintains the scapula and glenoid articular structures in their most stable positions.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • After surgery place the arm in a sling immobilizer.
  • Physical therapy should begin 7 to 10 days after surgery.
    • Initially: passive shoulder motion and passive/active elbow motion
    • 2-8 weeks: active-assisted range of motion
    • 8-12 weeks: isometric rotator cuff strengthening
    • 3-6 months: sports- and work-related exercises
  • Return to sport: conditioning at 12 weeks but full return to contact sports at 6 months
COMPLICATIONS
  • Infection
  • Axillary nerve injury
  • Anchor loosening
  • Recurrent instability
  • Shoulder stiffness
RESULT ANALYSIS
  • Outcomes are changing as techniques and suture anchors improve.
  • Initially thought to have higher recurrence rates than open procedures, especially in contact and collision athletes.
  • Currently, it is thought that the arthroscopic procedure with plication and interval closure as indicated and repair of the capsulolabral defect is comparable to an open technique.
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