To The Editor:
I read with great interest the article "Arthroscopic Bankart
Repair of Anterior Detachments of the Glenoid Labrum. A Prospective
Study" (81-A: 1357-1366, Oct. 1999), by Dr. O'Neill. I congratulate
him on a well done study and on the excellent results that he obtained
with use of a transglenoid suture technique that I helped to develop
in 1989. Initially, our efforts concentrated on reattaching the
avulsed labrum without adequately addressing the lax capsule. O'Neill
correctly attributes his improved results to his emphasis on addressing
the capsular laxity and the use of multiple sutures.
With the newer methods of passing sutures through soft tissue,
one should be able to further improve these results by using this
transglenoid technique. An anterior capsulolabral repair using sutures
with interference (mulberry) knots secured to the posterior part
of the glenoid has the advantage of not requiring suture anchors and
has a low complication rate when properly performed.
Neil J. Maki, M.D.
Thibodaux Orthopaedic and Sports Medicine Clinic
525 St. Mary Street
Thibodaux, Louisiana 70301
D. B. O'Neill replies:
I read with great interest Dr. Maki's comments in regard to my
article, and I thank him for his review. He is indeed correct in
stating that he helped to develop the technique that was used in this
series1. I did not become interested
in the arthroscopic stabilization technique until I became familiar with
this method, which seemed safe and reproducible.
Dr. Maki also is correct in stating that the capsular laxity
was further addressed by placing multiple advancing sutures beginning
inferiorly and moving superiorly with the repair.
I believe that this is indeed a safe transglenoid method, as
there were no injuries to the neurological structures posteriorly
with use of the posterior interference (mulberry) knots. I believe that
this procedure will have a continued low complication rate.
Daniel B. O'Neill, M.D.
St. John Sports Medicine Center
18100 St. John Drive, Suite 300
Nassau Bay, Texas 77058