Abstract
Background: Several arthroscopic methods have been developed to
treat posttraumatic recurrent anterior shoulder instability in an attempt to
match the results that can be achieved with open repair. The aim of this study
was to perform an independent long-term clinical and radiographic evaluation
after extra-articular arthroscopic Bankart repair with use of absorbable tacks
(Suretac fixators).
Methods: Eighty-one consecutive patients with posttraumatic
recurrent anterior shoulder instability underwent an extra-articular
arthroscopic Bankart procedure. Seventy-one (88%) of the patients were
reexamined physically after a median duration of follow-up of 107 months by
two independent examiners and constituted the study group. Their clinical and
radiographic outcomes were documented.
Results: At the time of follow-up, twenty-seven (38%) of the
seventy-one patients had experienced some kind of shoulder instability,
although fifteen of them had had a new, clinically relevant shoulder injury.
Eleven patients had had subluxation only, and sixteen had had redislocation.
Fourteen of the twenty-seven patients had had a single episode of instability.
Seven patients had undergone additional surgery to treat shoulder instability.
The instability episodes occurred less than two years postoperatively in nine
patients, between two and five years postoperatively in twelve, and more than
five years postoperatively in six. At the time of final follow-up the median
external rotation in abduction was 90° (range, 0° to 120°)
compared with 95° (range, 70° to 125°) for the contralateral,
uninjured shoulders (p < 0.001). Before the injury, fifty-two patients
(73%) participated in overhead or contact sports, whereas thirty-four patients
(45%) participated in such activities at the time of follow-up. At the time of
follow-up, the drill holes used to implant the absorbable tacks were invisible
or hardly visible in fifty-eight (91%) of sixty-four patients for whom
radiographs had been made. A marked increase in degenerative changes was noted
when follow-up radiographs were compared with the preoperative
radiographs.
Conclusions: This long-term follow-up study of arthroscopic
extra-articular Bankart repairs revealed an unexpectedly high number of
patients with new episodes of instability. This finding led to a slight
modification of the technique. Since most instability episodes occurred after
two years, it is important to follow patients for a longer period of time
after surgical treatment of recurrent anterior shoulder instability to
identify the true recurrence rate.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.
Open repair has been regarded as the gold standard for the treatment of a
detached capsulolabral complex since Rowe et al. reported a recurrence rate of
only five (3.4%) of 145 patients in
19781. This
technique includes the use of curved drill holes and is technically demanding,
even for skilled shoulder surgeons. The introduction of suture anchors has
facilitated the procedure considerably, and the results appear to have
remained equally
good2,3.
The main drawback of the open Bankart procedure is that it often results in
the restriction of external
rotation2-4.
Arthroscopic procedures appear to result in less
restriction4,5.
One advantage of an open Bankart procedure is that, unlike most arthroscopic
procedures, its success does not rely on the quality of the labral complex.
The recurrence rates after most arthroscopic procedures have been reported to
range between 10% and
20%6-8,
although a rate as high as 49% (twenty-nine of fifty-nine) was reported in one
study9. The
extra-articular Bankart repair with use of 8-mm Suretac fixators (Smith and
Nephew Endoscopy, Andover, Massachusetts), as described by Resch et
al.5, is the
arthroscopic procedure that is technically closest to an open repair, as it
emphasizes fixation of the capsule to the anterior aspect of the glenoid and
it does not rely on the quality of the labral complex. The recurrence rate at
a minimum of eighteen months after extra-articular arthroscopic Bankart repair
was reported to be approximately 6%, after the learning curve was no longer a
factor5. The same
technique resulted in a recurrence rate of 14% at forty-two
months10, a finding
that emphasizes the importance of longer-term follow-up of these patients.
The development of degenerative changes has been reported after both
surgical and nonoperative treatment of traumatic shoulder
dislocations11-14.
Previous studies have indicated that the degenerative changes increase despite
the achievement of shoulder
stability15,16.
It was previously reported that the intraosseous implantation of absorbable
materials causes increased osmotic pressure or a foreign-body reaction,
resulting in the development of cystic changes seen on
radiographs4,17.
However, we are not aware of any previous report on the long-term radiographic
appearance of a large number of drill holes after the extraarticular
implantation of an absorbable material, such as the polygluconate copolymer,
in the shoulder region. Some previous studies on the results after shoulder
stabilization were limited by a low (<80%) rate of clinical
follow-up1,12;
therefore, the aims of the present study were to perform an independent
long-term reexamination of patients who had undergone an arthroscopic
extra-articular Bankart repair, achieve a high follow-up rate, evaluate with
radiographs the development of degenerative changes, and evaluate the
radiographic appearance of the drill holes after implantation of the
absorbable polygluconate copolymer tacks.
The hypothesis in the present study was that the arthroscopic
extra-articular Bankart procedure would result in stable, well-functioning
shoulders in the long term. Furthermore, we hypothesized that the radiographic
assessment would show an increase in degenerative changes in the shoulders in
the long term.
Inclusion Criteria
Eighty-one patients who were living in Austria and were operated on at the
University Hospital in Salzburg between April 1994 and September 1997 were
included in the study. After one initial dislocation, each had experienced
recurrent posttraumatic anterior shoulder instability in the form of either
dislocations or subluxations. Prior to surgery, the patients had maximum
inferior instability, represented by a +1 sulcus sign. All patients had a
Bankart lesion and underwent an extra-articular arthroscopic Bankart repair
with use of Suretac fixators. The follow-up period was a minimum of
eighty-four months (seven years).
Unbiased Observers
Two independent observers—one orthopaedic surgeon (J.K.) and one
physiotherapist (C.K.) with specific interest in shoulder surgery and shoulder
conditions—performed all of the follow-up examinations. The observers
came from another country (Sweden) and were in no way involved in the
treatment of the patients. The observers were given unlimited access to
examine the patients as well as their medical files, surgical reports, and
radiographs. Prior to the start of the study, it was agreed that the observers
were going to analyze and present the results without guidance or interference
from the institution where the patients were treated.
Surgical Technique
The patient was placed in a beach-chair position. In addition to a
posterior arthroscopic portal placed 1 to 2 cm below the posterior aspect of
the acromion just medial to the deltoid muscle, two anterior portals were
used: one anterior-superior portal located between the coracoid process and
the anterior aspect of the acromion and one anterior-inferior portal located
1.5 cm inferior to the coracoid process. The last portal was utilized for the
trans-subscapular approach.
Intra-articularly, the damaged glenoid labrum and the capsule were detached
from the glenoid rim. The glenoid rim was then abraded with use of a 4.5-mm
abrader burr, and two or three shallow notches were created in it, at
approximately 5 o'clock, 3:30, and 2 o'clock (in a right shoulder).
The patient's arm was then placed in 20° to 30° of external
rotation. A metal sheath with a blunt trocar was introduced through the
inferior portal, and the "slalom
approach"18
was utilized to reach the capsule at the anterior joint line. The capsule was
then repositioned on the most inferior notch on the glenoid rim, and a
capsular shift was accomplished by bringing the capsular tissue in a superior
and medial direction. The blunt trocar was then removed, and the serrated edge
of the trocar was used to prevent the capsule from slipping. A cannulated
2.7-mm drill bit holding a 1.1-mm guidewire was introduced through the trocar.
The drill was then placed in the osseous notch close to the glenoid cartilage
under arthroscopic control. It was drilled to a maximum depth of 18 mm, the
locking mechanism was released to free the guidewire, and the drill was
extracted. A Suretac fixator was then introduced over the guidewire and was
seated with use of a cannulated driver. The procedure was then repeated with a
second and last Suretac fixator for the middle notch if the lesion did not
extend beyond the approximate midline of the glenoid cavity. If the labrum was
detached superior to the midline of the glenoid cavity and the second Suretac
fixator did not secure the whole lesion, a repair was performed with use of
one or two more intra-articularly positioned Suretac fixators at this
level5,18
(Figs. 1-A and
1-B).
Rehabilitation
Postoperatively, the arm was immobilized to the side of the body in
internal rotation in a light shoulder bandage for three weeks. Between the
fourth and sixth weeks, up to 90° of flexion and external rotation to a
neutral position was permitted. After six weeks, exercise was permitted in all
planes, including external rotation. Sports activities were resumed from the
fourth postoperative month, except for throwing actions, which were not
allowed until the fifth month.
Radiographic Examination
Radiographs of the shoulder, including an anteroposterior view with the
patient standing and a transaxillary view with the patient sitting, were made
preoperatively and at the time of long-term follow-up. On both occasions, the
radiographs were assessed by the same independent radiologist (R.F.) with no
knowledge of the surgical reports or the number of dislocations prior to the
index procedure.
Degenerative changes were classified according to the system of Rosenberg
et al. as normal, minor, moderate, or
severe12. The
intrarater reliability of this classification system has been shown to be
excellent, with a kappa value of
0.9419.
The appearance of the drill holes on the radiographs made at the time of
final follow-up was classified as invisible, hardly visible, clearly visible
but <3 mm in diameter, or clearly visible and >3 mm in
diameter4. The
intrarater reliability of this classification system has been shown to be
good, with a kappa value of
0.7619.
Follow-up
Constant20 and
Rowe21 scores were
obtained at the final follow-up evaluation. Stability was assessed with the
apprehension test and was graded as normal, as discomfort in maximum external
rotation without signs of subluxation, or as discomfort in maximum external
rotation with signs of subluxation with muscular contraction. The diagnosis of
a frank dislocation was made on the basis of documentation in the patients'
files, available radiographs, or the patients' history at the time of
follow-up. Subluxation was diagnosed either at the time of the clinical
assessment or on the basis of a history of at least one episode of dead-arm
syndrome22.
The ranges of external rotation of both shoulders were measured, with use
of a goniometer, with the patient in the sitting position with the arm in
90° of abduction. Isometric muscular strength was assessed, with use of an
Isobex dynamometer (Cursor, Bern, Switzerland), with the shoulder in abduction
in the scapular plane (as suggested for determination of the Constant
score20).
A visual analogue scale ranging from 0 to 100 mm was used for
self-assessment of change in lifestyle due to the shoulder. Zero millimeters
indicated no change, and 100 mm indicated a total change in lifestyle.
All of the patients gave informed consent to participate in the study. The
institutional review board at the University Hospital in Salzburg approved the
study.
Statistical Methods
The Wilcoxon signed-rank test was used for comparison between the injured
and uninjured, contralateral shoulders and for longitudinal comparison of the
radiographs. Correlation analyses were performed with use of the Spearman rank
correlation test, and dichotomous variables were analyzed with use of the
Fisher exact test. A p value of <0.05 was regarded as significant. All of
the values are given as the median and range, unless the mean is
indicated.
The demographic characteristics of the patients who returned for follow-up
are shown in Table I.
Seventy-one (88%) of the eighty-one patients returned for follow-up at a
median of 107 months (range, eighty-four to 126 months) after the index
procedure. Ten patients either refused to participate or were not able to
return for follow-up during either of the two visits by the independent
observers.
At the index procedure, fifty-four (76%) of the seventy-one patients had a
Bankart lesion involving the entire or almost the entire anterior aspect of
the labrum (from under the biceps tendon to the 6 o'clock position). Ten (14%)
of the seventy-one patients had a lesion only in the inferior part of the
anterior aspect of the labrum, below the approximate midline of the glenoid,
and seven patients had a detachment of the anterior biceps tendon attachment
in addition to a lesion of the anterior aspect of the labrum. Two or three
Suretac fixators were used in sixty-nine (97%) of the seventy-one patients
(Table II) at the index
procedure.
At the time of follow-up, some type of instability had been experienced by
twenty-seven (38%) of the seventy-one patients, including thirteen of the
thirty-five in whom two Suretac fixators had been implanted, thirteen of the
thirty-four in whom three fixators had been implanted, and one of the two in
whom four fixators had been implanted. Eleven patients had had subluxation
only, and sixteen had had redislocation (see Appendix). Fourteen (52%) of the
twenty-seven patients had experienced a single episode of instability (seven
subluxations and seven redislocations). Seven patients (10%) had undergone
additional surgery to treat the instability. Fifteen of the twenty-seven
patients who experienced instability had sustained a new, substantial injury.
The instability episodes appeared less than two years postoperatively in nine
patients, between two and five years postoperatively in twelve, and more than
five years postoperatively in six. By two years after the surgical procedure,
eight (11%) of the seventy-one patients had had a redislocation of the
shoulder.
On physical examination at the time of follow-up, ten patients revealed
clinical subluxation during the apprehension test, and an additional eleven
patients reported discomfort with the shoulder in maximum external rotation
without signs of instability.
At the time of final follow-up, the median Rowe score was 93 points (range,
44 to 100 points) and the median Constant score was 93 points (range, 43 to
100 points). The median Constant score for the contralateral shoulder was 95
points (range, 79 to 100 points). The median external rotation in abduction
was 90° (range, 0° to 120°) compared with 95° (range, 70°
to 125°) for the uninjured shoulder (p < 0.001). Measurements with use
of the Isobex dynamometer demonstrated a mean abduction strength of 8.9 kg
(range, 0.8 to 14.4 kg) on the index side and 9.3 kg (range, 2.8 to 13.7 kg)
on the contralateral side. This difference was not significant.
Before the injury, sixty-eight (96%) of the seventy-one patients
participated in sports activities and fifty-two (73%) participated in overhead
or contact sports. At the time of follow-up, sixty-five (92%) participated in
sports activities and thirty-four (45%) participated in overhead or contact
sports. The median visual analogue scale score for change in lifestyle due to
the shoulder was 5 mm (range, 0 to 85 mm).
At the time of final follow-up, sixty-four patients underwent radiographic
examination. The drill holes were classified as invisible or hardly visible in
fifty-eight (91%) of them, and four patients had one or more drill holes that
were >3 mm in diameter.
Fifty-nine patients underwent both preoperative and postoperative
radiographic examinations. There was a significant increase in the
classification of degenerative changes between those examinations (p <
0.0001) (Table III,
Fig. 2). There was no
correlation between the number of dislocation episodes prior to the surgery
and the development of degenerative changes (rho = 0.08).
In the long term, a substantial number of patients experienced instability,
in the form of recurrent dislocations or subluxations, in the operatively
treated shoulder. Most instability episodes occurred more than two years after
the operation. The findings in the present study emphasize the importance of
performing independent long-term follow-up after shoulder stabilization
procedures with any technique.
The unique characteristic and major strength of the present study is that
independent observers performed the follow-up examinations. The observers came
from another institution from outside the country, and they had not been
involved in any way in the patients' surgical treatment or rehabilitation.
Considering the fact that the patients were asked to attend one of only two
possible appointments for reexamination at a minimum of seven years after the
surgery, a follow-up rate of 88% should be regarded as good. Potential
weaknesses of this study include its retrospective design and the lack of a
control group.
The reported redislocation rates following arthroscopic procedures,
especially those involving use of transglenoid
sutures9,23-25,
exceed those following the open Bankart
procedure1,26.
The results after the use of Suretac fixators appear to be somewhat
better4,7,27,28.
More recently, better results have been reported after arthroscopic Bankart
repairs done with suture
anchors29 and, at
the same time, there have been reports revealing that the failure rate after
open Bankart repairs might previously have been underestimated, at least in
the medium and long
term30,31.
Whether the redislocations in some of the patients in the present study
were related to the surgical procedure can be questioned, as many patients
engaged in skiing, snowboarding, and bicycling and had severe falls
postoperatively; all of these events can cause a primary shoulder dislocation.
However, these patients must still be reported as having had a failure.
Furthermore, it must be emphasized that a substantial proportion (52%) of the
patients with instability in the present study experienced only a single
episode of instability without any recurrent subluxations, dislocations, or
need for additional surgical intervention.
It must be remembered that return to sports activity and the ability to
regain external rotation are other important factors that should be considered
when the results of shoulder stabilizing surgery are assessed. In the present
study, external rotation in abduction was less limited than it was after open
surgery in several
reports3,4,26,
and a substantial number of our patients still participated in overhead or
contact sports at a median of almost nine years after the index procedure.
Therefore, it appears that, in the present study, lifestyle contributed
substantially to the relatively high risk of recurrent shoulder instability
after the stabilizing procedures.
We wish to emphasize that, in order to report the true failure rate after
shoulder stabilizing surgery in the long term, the cumulative number of all
known dislocations and subluxations was included, regardless of whether they
were documented in the patients' files, subjectively reported by the patient
at the time of follow-up, or found clinically at the time of examination. If
we had reported only the frank redislocation rate at two years, which is
common in studies of shoulder stabilizing
surgery25, the
failure rate would have been only 11%. This clearly shows why it should be
mandatory to follow patients for longer than two years and, furthermore, to
include all subluxations in the calculation of the failure rate. Previously in
the literature,
Protzman32 and
Uhorchak et al.31
also stated that subluxations should be included in the calculation of the
failure rate.
As shown in the present study, which included prospective radiographic
assessments, it appears that radiographic signs of degenerative changes
increase in shoulders reconstructed after traumatic dislocations. This is
probably also the case if the patients are treated nonoperatively or if the
patients are treated with an open Bankart
procedure4,15,33.
One potential weakness of the study was the fact that the contralateral
shoulders were not examined radiographically. However, Samilson and
Prieto13 found no
radiographic abnormalities in the contralateral shoulders of patients with
unilateral dislocation. They also found that all of the unstable shoulders,
whether or not they had been operated on, had radiographic signs of
degenerative changes and that the arthritis was more marked if metal implants
encroached on the joint line. Correspondingly, Hawkins and
Angelo11 as well as
Rosenberg et al.12
showed that arthritis can be a late complication after both Putti-Platt and
open Bankart procedures.
Most patients in the present study had invisible or hardly visible drill
holes, a finding that supports our previous theory that these polygluconate
tacks are absorbed as healing
occurs10. Their
cannulated design and the fact that parts of the implant are positioned
extra-articularly appear to allow complete or nearly complete healing of the
drill holes. In line with this,
Böstman17
showed that a bicortical perforation by the drill holes in conjunction with
the intraosseous implantation of absorbable material results in fewer
osteolytic changes. Magnusson et
al.34, using
standard radiographic examinations, showed that the drill holes at two years
after implantation of polygluconate copolymer implants were significantly less
visible than those at two years after implantation of poly-l-lactic
acid implants (p = 0.004). The findings in the present study are therefore in
line with the findings of Magnusson et al. and indicate that the composition
of the implants is of importance in terms of the development of cystic changes
in conjunction with the drill holes.
The results of the present study led to modification of the procedure. At
present, the most inferior transmuscular extra-articularly placed Suretac
fixator is still used. However, intra-articularly placed suture anchors are
now used at the midline of the glenoid and above.
We concluded that, in the long term, a substantial number of patients
experience instability episodes in the form of subluxation and/or
redislocation after this arthroscopic extraarticular procedure. Most of these
episodes occur after two years. In the vast majority of patients, no long-term
radiographically visible bone reactions are seen after the extra-articular
implantation of the polygluconate device. Furthermore, signs of degenerative
changes can be expected to increase with continued long-term follow-up.
A table presenting details on the individual failures is available with the
electronic versions of this article, on our web site at
(go to
the article citation and click on "Supplementary Material") and on
our quarterly CD-ROM (call our subscription department, at 781-449-9780, to
order the CD-ROM). ?
Rowe CR, Patel D, Southmayd WW. The
Bankart procedure: a long-term end-result study. J Bone Joint Surg
Am.1978;60:
1-16.601
1978
[PubMed]
Levine WN, Richmond JC, Donaldson WR.
Use of suture anchor in open Bankart reconstruction. A follow-up report.
Am J Sports Med.1994;22:
723-6.22723
1994
[PubMed][CrossRef]
Karlsson J, Järvholm U, Swärd
L, Lansing O. Repair of Bankart lesions with a suture anchor in recurrent
dislocation of the shoulder. Scand J Med Sci Sports.1995;5:
170-4.5170
1995
[PubMed][CrossRef]
Kartus J, Ejerhed L, Funck E,
Köhler K, Sernert N, Karlsson J. Arthroscopic and open shoulder
stabilization using absorbable implants. A clinical and radiographic
comparison of two methods. Knee Surg Sports Traumatol Arthrosc.1998;6:
181-8.6181
1998
[PubMed][CrossRef]
Resch H, Povacz P, Wambacher M, Sperner
G, Golser K. Arthroscopic extraarticular Bankart repair for the treatment of
recurrent anterior shoulder dislocation. Arthroscopy.1997;13:
188-200.13188
1997
[PubMed][CrossRef]
el Akad AM, Winge S, Molinari M,
Eriksson E. Arthroscopic Bankart procedures for anterior shoulder instability.
A review of the literature. Knee Surg Sports Traumatol
Arthrosc.1993;1:
113-22.1113
1993
[CrossRef]
Warner JJP, Warren RF. Arthroscopic
Bankart repair using a cannulated, absorbable fixation device. Oper
Tech Orthop.1991;1:
192-8.1192
1991
[CrossRef]
Williams MM, Snyder SJ, Strafford BB.
Instability of the glenohumeral joint. Curr Opin Orthop.1993;4:
44-55.444
1993
Walch G, Boileau P, Levigne C, Mandrino
A, Neyret P, Donell S. Arthroscopic stabilization for recurrent anterior
shoulder dislocation: results of 59 cases. Arthroscopy.1995;11:
173-9.11173
1995
[PubMed][CrossRef]
Kartus J, Kartus C, Povacz P, Forstner
R, Ejerhed L, Resch H. Unbiased evaluation of the arthroscopic extra-articular
technique for Bankart repair: a clinical and radiographic study with a 2- to
5-year follow-up. Knee Surg Sports Traumatol Arthrosc.2001;9:
109-15.9109
2001
[PubMed][CrossRef]
Hawkins RJ, Angelo RL. Glenohumeral
osteoarthrosis. A late complication of the Putti-Platt repair. J Bone
Joint Surg Am.1990;72:
1193-7.721193
1990
Rosenberg BN, Richmond JC, Levine WN.
Long-term followup of Bankart reconstruction. Incidence of late degenerative
glenohumeral arthrosis. Am J Sports Med.1995;23:
538-44.23538
1995
[PubMed][CrossRef]
Samilson RL, Prieto V. Dislocation
arthropathy of the shoulder. J Bone Joint Surg Am.1983;65:
456-60.65456
1983
[PubMed]
Rhee YG, Lee DH, Chun IH, Bae SC.
Glenohumeral arthropathy after arthroscopic anterior shoulder stabilization.
Arthroscopy.2004;20:
402-6.20402
2004
[PubMed][CrossRef]
Magnusson L, Ejerhed L, Rostgard L,
Sernert N, Kartus J. Absorbable implants for open shoulder stabilization. A
7-8-year clinical and radiographic follow-up. Knee Surg Sports
Traumatol Arthrosc.2006;14:
182-8.14182
2006
[CrossRef]
Ejerhed L, Kartus J, Funck E, Kohler K,
Sernert N, Karlsson J. Absorbable implants for open shoulder stabilization: a
clinical and serial radiographic evaluation. J Shoulder Elbow
Surg.2000;9:
93-8.993
2000
[CrossRef]
Böstman OM. Osteolytic changes
accompanying degradation of absorbable fracture fixation implants. J
Bone Joint Surg Br.1991;73:
679-82.73679
1991
Resch H, Wykypiel HF, Maurer H,
Wambacher M. The antero-inferior (transmuscular) approach for arthroscopic
repair of the Bankart lesion: an anatomic and clinical study.
Arthroscopy.1996;12:
309-22.12309
1996
[PubMed][CrossRef]
Magnusson L. Post-traumatic recurrent
anterior shoulder instability. Aspects of surgical techniques, implants
and diagnostic methods [thesis]. Göteborg, Sweden: Göteborg
University; 2005. 56 pages.56
2005
Constant CR, Murley AH. A clinical
method of functional assessment of the shoulder. Clin Orthop Relat
Res.1987;214:
160-4.214160
1987
Rowe CR. Evaluation of the shoulder. In:
Rowe CR, editor. The shoulder. New York: Churchill Livingstone;
1988. p 631-7.631
1988
Rowe CR, Zarins B. Recurrent transient
subluxation of the shoulder. J Bone Joint Surg Am.1981;63:
863-72.63863
1981
[PubMed]
Landsiedl F. Arthroscopic therapy of
recurrent anterior luxation of the shoulder by capsular repair.
Arthroscopy.1992;8:
296-304.8296
1992
[PubMed][CrossRef]
Mologne TS, Lapoint JM, Morin WD,
Zilberfarb J, O'Brien TJ. Arthroscopic anterior labral reconstruction using a
transglenoid suture technique. Results in active-duty military patients.
Am J Sports Med.1996;24:
268-74.24268
1996
[PubMed][CrossRef]
Freedman KB, Smith AP, Romeo AA, Cole
BJ, Bach BR Jr. Open Bankart repair versus arthroscopic repair with
transglenoid sutures or bioabsorbable tacks for recurrent anterior instability
of the shoulder: a meta-analysis. Am J Sports Med.2004;32:
1520-7.321520
2004
[PubMed][CrossRef]
Hovelius L, Thorling J, Fredin H.
Recurrent anterior dislocation of the shoulder. Results after the Bankart and
Putti-Platt operations. J Bone Joint Surg Am.1979;61:
566-9.61566
1979
[PubMed]
Karlsson J, Kartus J, Ejerhed L,
Gunnarsson AC, Lundin O, Swärd L. Bioabsorbable tacks for arthroscopic
treatment of recurrent anterior shoulder dislocation. Scand J Med Sci
Sports.1998;8:
411-5.8411
1998
[CrossRef]
Speer KP, Warren RF, Pagnani M, Warner
JJ. An arthroscopic technique for anterior stabilization of the shoulder with
a bioabsorbable tack. J Bone Joint Surg Am.1996;78:
1801-7.781801
1996
[PubMed]
Fabbriciani C, Milano G, Demontis A,
Fadda S, Ziranu F, Mulas PD. Arthroscopic versus open treatment of Bankart
lesion of the shoulder: a prospective randomized study.
Arthroscopy.2004;20:
456-62.20456
2004
[PubMed][CrossRef]
Magnusson L, Kartus J, Ejerhed L,
Hultenheim I, Sernert N, Karlsson J. Revisiting the open Bankart experience: a
four- to nine-year follow-up. Am J Sports Med.2002;30:
778-82.30778
2002
[PubMed]
Uhorchak JM, Arciero RA, Huggard D,
Taylor DC. Recurrent shoulder instability after open reconstruction in
athletes involved in collision and contact sports. Am J Sports
Med.2000;28:
794-9.28794
2000
Protzman RR. Anterior instability of the
shoulder. J Bone Joint Surg Am.1980;62:
909-18.62909
1980
[PubMed]
Chapnikoff D, Besson A, Chantelot C,
Fontaine C, Migaud H, Duquennoy A. [Bankart procedure: clinical and
radiological long-term outcome]. Rev Chir Orthop Reparatrice Appar
Mot.2000;86:
558-65. French.86558
2000
Magnusson L, Ejerhed L,
Rostgard-Christensen L, Sernert N, Eriksson R, Karlsson J, Kartus JT. A
prospective, randomized, clinical and radiographic study after arthroscopic
Bankart reconstruction using 2 different types of absorbable tacks.
Arthroscopy.2006;22:
143-51.22143
2006
[PubMed][CrossRef]