Biomechanical Evaluation of Knotless Anterior and Posterior Bankart Repairs

Authors:

Frank Martetschläger, Max P Michalski, Kyle S Jansson, Coen A Wijdicks, Peter J Millett

Abstract:

Arthroscopic anterior shoulder stabilization using suture anchors has become a well established and highly accepted procedure, showing good and reliable clinical results. Several stabilization techniques have been reported with the capsulolabral glenoid bone anchor repair being the most popular. For this technique numerous different anchors, loaded with different kinds of sutures are available. In 2001, Thal reported a new knotless suture anchor for arthroscopic repair of the glenoid labrum (Bankart repair). Since then, this technique is widely used and has shown comparable biomechanical and clinical outcomes to normal suture anchor repairs. Typically, two to four anchors are placed into the glenoid rim for anteroinferior or posteroinferior stabilizations. However, there is limited evidence in the literature regarding the amount of anchors required for anteroinferior or posteroinferior repairs. A recent study reported two double-loaded suture anchors to be superior to three single-loaded suture anchors but did not compare double-loaded suture anchor strength versus the number of double-loaded anchors. A long-term follow-up study by van der Linde suggests that using three or more anchors might result in lower recurrence rates when compared to two anchors.

In addition to anchor pullout failure, tearing of the suture through the soft tissue is a well-recognized mode of failure. Increasing attention is being paid to modern suture materials such as new tape-like suture materials which are already in use for rotator cuff repair. A biomechanical study on bovine cadavers documented similar biomechanical properties for tape repairs compared to normal suture repairs in a setting of rotator cuff testing. The use of a suture-tape material has not been evaluated for Bankart repairs yet. Further, the biomechanical properties of the native capsulolabral complex must be defined in order to better understand how well current repair techniques are restoring stability at time zero.

The study aims were to clarify whether the use of suture-tape is advantageous for Bankart repairs compared to normal suture repairs, and whether the amount of anchors placed within the anteroinferior or posteroinferior quadrant is an important factor for stability of the repair. Additionally, the strength of the native capsulolabral complex was investigated, and the failure modes of the intact group were compared to the repair groups.

The following hypotheses were tested for glenoid labrum repairs: (1) anchors loaded with the new suture-tape mate- rial will provide higher biomechanical stability compared to anchors loaded with normal sutures, (2) four anchors will provide higher stability compared to three anchors, and (3) the stability of the native capsulolabral complex will be higher when compared to the reconstructions.

For the complete study: Biomechanical Evaluation of Knotless Anterior and Posterior Bankart Repairs

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Biomechanical Evaluation of Knotless Anterior and Posterior Bankart Repairs

Authors:

Abstract:

About the Author: Peter Millett, MD