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

2. 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.

3. 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

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

5. 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%

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

8. 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)

9. 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

10. 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

11. 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?