Arthroscopic Bankart Repair With and Without Curettage of the Glenoid Edge: A Prospective, Randomized, Controlled Study.

PURPOSE: To determine whether curettage of the cartilage on the glenoid edge in arthroscopic Bankart repair reduces the postoperative recurrence rate compared with noncuretted glenoid. METHODS: Between January 2010 and December 2013, 134 patients underwent arthroscopy and stabilization for recurrent anterior dislocation of shoulder; 42 patients were excluded. Alternate glenoid edge was curetted in 92 patients undergoing arthroscopic Bankart repair. Twelve patients were lost to follow-up. The remaining 80 patients were divided into 2 groups of 40 patients each, curettage and noncurettage. In both groups, the Bankart lesion was repaired using ≥3 bioanchors loaded with nonabsorbable braided sutures. Postoperative rehabilitation was the same for the 2 groups. We recorded recurrence of instability, pain, and Constant and Rowe shoulder scores. Statistical analysis of data was performed using unpaired t test (significance level P < .05). RESULTS: The 2 groups were comparable in terms of age, number of dislocations, and bone loss. The average follow-up was 7 years and 9 months (range 6 to 10 years). Of the total 40 patients in the curettage group, 6 (15%) had recurrence of dislocation and none had subluxations, whereas in the noncurettage group, 13 (32.5%) had recurrence of dislocation and 3 (7.5%) had subluxations. The difference in postoperative recurrence of instability was statistically significant (P = .012). The average (standard deviation) Rowe score was 83.75 (23.28) in the curettage group and 70.13 (31.29) in the noncurettage group (P = .030). CONCLUSIONS: During arthroscopic Bankart repair, curettage of the cartilage on the anterior glenoid edge reduces the incidence of postoperative recurrence of instability. LEVEL OF EVIDENCE: II, therapeutic; prospective, randomized, controlled study.

Long Head of Biceps Tendon Pathology and Results of Tenotomy in Full-Thickness Reparable Rotator Cuff Tear.

PURPOSE: To document the incidence of long head of the biceps tendon (LHBT) pathology in full-thickness reparable rotator cuff tears and report the clinical results of arthroscopic LHBT tenotomy combined with rotator cuff repair. METHODS: Between January 2012 and January 2014, 141 shoulders with full-thickness rotator cuff tears that had undergone arthroscopic repair were included for the analysis. The LHBT was thoroughly examined during arthroscopy, and tenotomy was performed in all patients with a pathologic LHBT. Shoulder range of movement and the Constant score were recorded at an average follow-up of 2.2 years (range, 24-40 months). RESULTS: The overall incidence of LHBT pathology was 36.1% (51 of 141 shoulders). The increase in LHBT pathology with the increase in the size of the rotator cuff tear was statistically significant (P = .001). Tears involving the subscapularis had a statistically significantly higher incidence of LHBT pathology (P = .001). The duration of the rotator cuff tear showed no statistical significance regarding the incidence of LHBT pathology (P = .598). Of 141 patients with full-thickness rotator cuff tears, 89 had tears due to trauma and 52 had atraumatic tears. The difference in the incidence of LHBT pathology between the traumatic and atraumatic groups was not statistically significant (P = .412). The average Constant score in the patients who had undergone LHBT tenotomy was 82 (range, 70-90), and in those with normal tendons, it was 84 (range, 72-92). The difference was not statistically significant (P = .423). CONCLUSIONS: About one-third of patients with full-thickness reparable rotator cuff tears are likely to have LHBT pathology. Large and massive rotator cuff tears and tears involving the subscapularis are more likely to have LHBT pathology. Tenotomy of the pathologic LHBT as an adjunct to rotator cuff repair produces satisfactory results. LEVEL OF EVIDENCE: Level IV, therapeutic case series.