Arthroscopic Bankart Reconstruction Dr. Mbugua Francis Orthopedic Surgeon AIC Cure International Hospital, Kijabe

Introduction Shoulder dislocations account for 50 percent of all major joint dislocations. Anterior dislocation - accounts for 95% - 97%. The shoulder joint is anatomically inherently unstable therefore explaining the high rate of dislocation in comparison to other joints. The commonest lesion - anteroinferior labral tear/defect and a hillsach’s lesion for recurrent dislocation. Surgical treatment of recurrent dislocations involves repair of this labral defect with either open or arthroscopic methods.

What we do Initially did all labral repairs open Recent years almost all cases done arthroscopic We looked at cases of arthroscopic Bankart repair done at our institution over a 3year period

Methods Evaluated Patterns of reconstruction – bony/soft tissue Conversion rate to open Technique – knots vs knotless Complications Return to pre-injury level of activity

Outcomes Done – 62 shoulder arthroscopies Bankart reconstruction – 29% (18) Bony bankart – 22% (4) Gender – M:F – 66.6%:33.3% (12:6) Average age – 24 Pre-op recurrent dislocation – 100%

Outcomes Soft tissue procedures – 100% Technique 3 portal technique – posterior, antero-superior, antero-inferior Knot tying and knotless techniques used interchangeably 3 anchors – 100%

Outcomes Re-dislocation rate – 0% Subluxatory episodes – 11.1 % (2) Grinding – 55.6% (10) Loss of some degree of ER – 44.4% (8) Conversion to open procedure – 11.1% (2) Return to pre-injury level of activity – 89% (16)

Rehab Arm sling – 6weeks Passive ROM – 0 - 2weeks 90 degrees flexion and abduction Active ROM – after 2 weeks Goal is for full range of motion by 6weeks Only limit is external rotation – 45degrees by 6weeks Strength training after 6 weeks Return to sports – after 4 months

Other procedures Laterjet procedure – for bony loss more than 20% Bone Graft for glenoid bone loss and humeral head defect(hillsach’s) Remplissage for hillsach’s Putti-platt, Magnusson stack - Historical

Conclusion Recurrent anterior disclocation can be successfully treated arthroscopically in our setup Watch out for multi-directional instability Rehab is key even though arthroscopic surgery has made this much easier Soft tissue procedures works in most cases High demand athletes? and 1st time dislocators less than 25yrs old?