[The role of capsulolabral complex in Bankart lesion repair using Mitek anchors].

PURPOSE OF THE STUDY The reconstructions of Bankart lesions, carried out according to the procedure recommended by the Mitek company, showed a high rate of recurrent dislocation. Therefore, based on operative experience, anatomical studies and reconstructive surgery on cadaver shoulders, we developed a new surgical technique that provided good shoulder stability and better operative outcomes. The results are reported here. MATERIAL Between 1997 and 2005, arthroscopic Bankart repair with use of Mitek anchors was performed on 368 shoulders at the Department of Orthopedics, Faculty of Medicine, Palacky University in Olomouc. The average age of the patients was 22 years (range, 16 to 56 years). The patients were allocated to two groups according to the surgical technique used. Group 1, which comprised 100 shoulders, was treated by the Bankart repair procedure recommended by the Mitek Company. Group 2, which included 268 shoulders, underwent Bankart reconstruction by the technique developed at our department. METHODS In group 1, anchors were inserted in the anterior glenoid rim, as recommended by the Mitek company. In group 2, implants were inserted into the superior region, with surface reduced to spongious bone, of the anterior glenoid rim. This allowed for creation of a more robust capsulolabral complex preventing the humeral head from dislocation. The results were assessed by the UCLA (University of California at Los Angeles) shoulder score system and statistical evaluation was performed at the Department of Medical Biophysics, Faculty of Medicine, Palacky University in Olomouc. RESULTS In group 1 (Mitek procedure), the UCLA shoulder score evaluation was as follows: 22 (22 %) excellent, 28 (28 %) good, 22 (22 %) satisfactory, and 28 (28 %) poor outcomes. In group 2 (our technique), the results included 199 (74 %) excellent, 66 (24.6 %) good, two (0.8 %) satisfactory and one (0.6 %) poor outcomes. The difference between the groups was statistically significant (Chi-square, p 0.0001). DISCUSSION The method of Bankart lesion repair has been a much discussed issue for a long time. At our department Mitek implants have been used. Although the operative procedures were faultlessly done, the results of the first 100 operations were not satisfactory. In some patients, the labrum reinserted by Mitek anchors failed to heal; it either remained loose or was attached to the scapular neck distally and thus did not provide sufficient stability that would prevent recurrent dislocation of the shoulder. In view of this, we conducted reconstructive operations on cadaver limbs, after a thorough topographic and anatomic study of the glenohumeral joint, and developed a modified method; after the labrum and capsule were freed, implants were inserted into the superior part of the anterior glenoid rim. This created a sufficient capsulolabral complex that prevented recurrent dislocation. CONCLUSION Arthroscopic Bankart lesion repair, with the insertion of anchors by our method, markedly improved surgical outcomes and provided good shoulder stability. We believe that, in the future, this method will be more widely used in arthroscopic treatment of Bankart lesions.