Revision Arthroscopic Labral Repair Using All-Suture Anchors in Patients With Subcritical Glenoid Bone Loss After Failed Bankart Repair: Clinical Outcomes at 2-Year Follow-up

Abstract

Background: All-suture anchors have been used for primary arthroscopic Bankart repair because of their ability to minimize initial bone loss.

Purpose: To evaluate the clinical efficacy of using all-suture anchors in revision arthroscopic labral repair after failed Bankart repair.

Study design: Case series; Level of evidence, 4.

Methods: Enrolled in this study were 28 patients who underwent revision arthroscopic labral repair with all-suture anchors after a failed primary arthroscopic Bankart repair. Revision surgery was determined for patients who had a frank redislocation history with subcritical glenoid bone loss (<15%), nonengaged Hill-Sachs lesion, or off-track lesion. Minimum 2-year postoperative outcomes were evaluated using shoulder range of motion (ROM), the Rowe score, the American Shoulder and Elbow Surgeons (ASES) score, apprehension, and the redislocation rate. Postoperative shoulder anteroposterior radiographs were assessed to evaluate arthritic changes in the glenohumeral joint.

Results: The mean patient age was 28.1 ± 6.5 years, and the mean time between primary Bankart repair and revision surgery was 5.4 ± 4.1 years. Compared with the number of suture anchors used in the primary operation, significantly more all-suture anchors were inserted in the revision surgery (3.1 ± 0.5 vs 5.8 ± 1.3, P < .001). During the mean follow-up period of 31.8 ± 10.1 months, 3 patients (10.7%) required reoperation because of traumatic redislocation and symptomatic instability. Of patients with symptoms that did not require reoperation, 2 patients (7.1%) had subjective instability with apprehension depending on the arm position. There was no significant change between preoperative and postoperative ROM. However, ASES (preoperative: 61.2 ± 13.3 to postoperative: 81.4 ± 10.4, P < .01) and Rowe (preoperative: 48.7 ± 9.3 to postoperative: 81.7 ± 13.2, P < .01) scores were significantly improved after revision surgery. Eight patients (28.6%) showed arthritic changes in the glenohumeral joint on final plain anteroposterior radiographs.

Conclusion: Revision arthroscopic labral repair using all-suture anchors demonstrated satisfactory 2-year clinical outcomes in terms of functional improvement. Postoperative stability was obtained in 82% of patients without recurrent shoulder instability after failed arthroscopic Bankart repair.

Keywords: all-suture anchor; anterior shoulder instability; labral repair; revision arthroscopic labral repair.

Figure 1.

Images obtained from a 31-year-old male who underwent revision arthroscopic labral repair for his left shoulder with 6 all-suture anchors after a failed arthroscopic Bankart repair with 4 metal suture anchors. (A) A torn labrum with residual suture materials and cartilage defect of the glenoid rim seen through the anterosuperior portal view. (B) The repaired capsulolabral complex completely covered the decorticated glenoid rim with proper tension and suture intervals. On 1-year postoperative computed tomography scans, (C) the tunnel of the all-suture anchor adjacent to the medial side of the metal anchors was observed in the axial image (arrow), and (D) multiple tunnels of all-suture anchors with high attenuation of boundaries were seen in the sagittal image (arrows).

Figure 2.

Images obtained from a 27-year-old male who underwent revision arthroscopic labral repair for his right shoulder with 7 all-suture anchors after failed arthroscopic Bankart repair with 4 all-suture anchors. (A) The lower attenuated tunnels of 3 suture anchors previously inserted at the anteroinferior glenoid were noted, and another tunnel of a previous suture anchor at the 7-o’clock position showed similar attenuation with nearby glenoid bone in the sagittal image of the preoperative computed tomography (CT) scan. (B) An initial arthroscopic examination indicated a retorn capsulolabral complex from the glenoid rim, degeneration of cartilage of the anterior glenoid, and the presence of previous suture anchors. (C) After removal of the remnant suture materials of previous suture anchors and sufficient release of the capsulolabral complex from the glenoid along the torn or collapsed site between the anteroinferior and posterior glenoid, new all-suture anchors were inserted at the desired positions. (D) From the 3-o’clock to 8:30 clockface positions, the capsulolabral complex was repaired using a simple suture technique with 7 single-stranded all-suture anchors. (E) A healed labrum and bone absorption of the tunnel caused by the all-suture anchor were identified in the axial image of the 2-year postoperative CT arthrogram. (F) In the sagittal image of the postoperative CT arthrogram, newly developed tunnels due to all-suture anchors implanted during revision surgery were observed around previous multiple tunnels due to the all-suture anchors used in the primary surgery.