Successful Outcomes and Return to Sport After Arthroscopic Bankart Repair in National Collegiate Athletic Association and National Football League Football Players.

OBJECTIVE: To characterize recurrent instability, return to sport (RTS), and patient-reported outcomes (PROs) after arthroscopic Bankart repair for acute traumatic anterior shoulder instability in National Collegiate Athletic Association (NCAA) and National Football League (NFL) football players. DESIGN: Case series. SETTING: Orthopaedic and sports medicine clinic. PARTICIPANTS: National Collegiate Athletic Association and NFL football athletes with traumatic anterior shoulder instability who underwent arthroscopic shoulder stabilization at a single institution with at least 2-year follow-up. INTERVENTIONS OR ASSESSMENT OF RISK FACTORS OR INDEPENDENT VARIABLES: Arthroscopic Bankart repair. MAIN OUTCOME MEASURES: Recurrent instability, RTS, patient satisfaction, the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score. RESULTS: Thirty-three players were included with a mean age of 23.8 years (range, 18-33 years) and a mean follow-up of 6.3 years (range, 4.1-9.3 years). One shoulder (3.0%) had a postoperative subluxation event, and 1 shoulder (3.0%) required revision surgery for issues other than instability; 93.3% of players were able to RTS at the same level or higher for at least 1 season. Mean satisfaction was 8.9 ± 2.3. Mean VAS was 1.0 ± 1.7, and mean ASES and Rowe scores were 90.7 ± 18.5 and 89.7 ± 15.2, respectively. CONCLUSION: Arthroscopic Bankart repair is an effective surgical intervention for traumatic anterior shoulder instability in NCAA and NFL football players. At a mean 6-year follow-up, surgery restored stability in 97% of cases and 93.3% returned to their preinjury level of sport.

Bankart Repair Using Modern Arthroscopic Technique.

As technology continues to improve, surgeons must regularly re-evaluate techniques to improve efficacy and outcomes. The Bankart repair for shoulder instability has evolved from open reconstruction to minimally invasive arthroscopic techniques, which have the benefit of less pain and morbidity. This technical description and video present a modern arthroscopic technique for Bankart repair used at our institution with high success in an athletic population.

Outcomes After Arthroscopic Bankart Repair in Adolescent Athletes Participating in Collision and Contact Sports.

BACKGROUND: Literature on arthroscopic stabilization in adolescent patients participating in collision and contact sports is limited, as most studies include adolescents within a larger sample group comprised primarily of adults. PURPOSE: To review the outcomes of arthroscopic Bankart repair for anterior shoulder instability in an adolescent population participating in collision and contact sports. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This retrospective review included 39 shoulders in 37 adolescent (≤19 years) athletes who underwent primary arthroscopic Bankart repair using suture anchors with at least 2-year follow-up. All patients had a history of trauma to their shoulder resulting in an anterior dislocation. Outcome measures included patient satisfaction, the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score. Recurrence of dislocation and return to sporting activity were also assessed. RESULTS: The mean age at the time of surgery was 16.9 years (range, 15-19 years), and the mean follow-up was 6.3 years (range, 4.3-10.0 years); 58.6% of patients participated in collision sports. Time to surgery after the initial dislocation episode was 9.2 months (range, 0.5-36.2 months). Four shoulders (10.3%) had dislocation events postoperatively. The majority (78.1%) of patients returned to sports at the same level of competition. Mean VAS was 0.49 ± 1.0, and the mean ASES and Rowe scores were 92.8 ± 12.6 and 85.0 ± 24.2, respectively. Univariate analyses demonstrated that subjective functional outcomes were negatively correlated with recurrence (ASES, P = .005; Rowe, P = .001) and failure to return to sport (ASES, P = .016; Rowe, P = .004). Independent variables shown to have no significant relationship to functional outcomes included age, follow-up, number of preoperative dislocations, time to surgery, sport classification, competition level, tear extent, number of anchors, concurrent Hill-Sachs lesion, and repair of a superior labral anterior-posterior (SLAP) lesion. CONCLUSION: Arthroscopic Bankart repair is an effective surgical option for traumatic shoulder instability in adolescents participating in collision and contact sports. At a minimum 4-year follow-up, arthroscopic Bankart repair effectively restored stability in 90% of cases; 80% returned to their preinjury level of sport.

Outcomes of Bankart Repairs Using Modern Arthroscopic Technique in an Athletic Population.

PURPOSE: To report a large number of highly active patients who underwent arthroscopic Bankart repair at our institution over the last decade. METHODS: A retrospective analysis of patients who underwent primary and revision arthroscopic Bankart repairs using bioabsorbable anchors was performed. Outcome measures included recurrence of dislocation, American Shoulder and Elbow Scores (ASES), Rowe, visual analog scale (VAS), return to sports, and satisfaction scores. RESULTS: A total of 94 shoulders met the inclusion criteria. The recurrence rate was 6/94 (6.4%) at a mean follow-up of 5 years (range, 3 to 8.3). The mean postoperative scores were as follows: ASES = 91.5/100; Rowe = 84.3/100; VAS = 0.8/10; satisfaction = 8.8/10. In those who attempted to return to sports, 82.5% were able to return to the same level of competition. Statistical analyses revealed a significant increase in risk of recurrence among high school and recreational athletes. No recurrences were observed among professional or college-level athletes. No significant difference in recurrence rates was observed in regards to age, time to surgery, type of athlete (collision v limited contact), repair of SLAP lesion, number of anchors, or revision surgery. CONCLUSIONS: Although several repair techniques exist for traumatic anterior shoulder instability, arthroscopic repair remains a viable option even in a highly active patient population. This study uniquely identified high school and recreational athletes at higher risk for recurrence. This is perhaps due to inferior shoulder development and technique as well as to limited access to postoperative physical therapy. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Biomechanical Comparison of Parallel and Crossed Suture Repair for Longitudinal Meniscus Tears.

BACKGROUND: Longitudinal meniscus tears are commonly encountered in clinical practice. Meniscus repair devices have been previously tested and presented; however, prior studies have not evaluated repair construct designs head to head. This study compared a new-generation meniscus repair device, SpeedCinch, with a similar established device, Fast-Fix 360, and a parallel repair construct to a crossed construct. Both devices utilize self-adjusting No. 2-0 ultra-high molecular weight polyethylene (UHMWPE) and 2 polyether ether ketone (PEEK) anchors. HYPOTHESIS: Crossed suture repair constructs have higher failure loads and stiffness compared with simple parallel constructs. The newer repair device would exhibit similar performance to an established device. STUDY DESIGN: Controlled laboratory study. METHODS: Sutures were placed in an open fashion into the body and posterior horn regions of the medial and lateral menisci in 16 cadaveric knees. Evaluation of 2 repair devices and 2 repair constructs created 4 groups: 2 parallel vertical sutures created with the Fast-Fix 360 (2PFF), 2 crossed vertical sutures created with the Fast-Fix 360 (2XFF), 2 parallel vertical sutures created with the SpeedCinch (2PSC), and 2 crossed vertical sutures created with the SpeedCinch (2XSC). After open placement of the repair construct, each meniscus was explanted and tested to failure on a uniaxial material testing machine. All data were checked for normality of distribution, and 1-way analysis of variance by ranks was chosen to evaluate for statistical significance of maximum failure load and stiffness between groups. Statistical significance was defined as P < .05. RESULTS: The mean maximum failure loads ± 95% CI (range) were 89.6 ± 16.3 N (125.7-47.8 N) (2PFF), 72.1 ± 11.7 N (103.4-47.6 N) (2XFF), 71.9 ± 15.5 N (109.4-41.3 N) (2PSC), and 79.5 ± 25.4 N (119.1-30.9 N) (2XSC). Interconstruct comparison revealed no statistical difference between all 4 constructs regarding maximum failure loads (P = .49). Stiffness values were also similar, with no statistical difference on comparison (P = .28). CONCLUSION: Both devices in the current study had similar failure load and stiffness when 2 vertical or 2 crossed sutures were tested in cadaveric human menisci. CLINICAL RELEVANCE: Simple parallel vertical sutures perform similarly to crossed suture patterns at the time of implantation.

Biomechanical comparison of arthroscopic repair constructs for radial tears of the meniscus.

BACKGROUND: Radial tears of the meniscus represent a challenging clinical scenario because benign neglect and partial meniscectomy have both been shown to have negative biomechanical and long-term clinical consequences. HYPOTHESIS: Complex suture repair constructs have higher failure loads and stiffness values compared with simple constructs. STUDY DESIGN: Controlled laboratory study. METHODS: After radial transection of human cadaveric menisci, simulated tears were repaired arthroscopically by use of 1 of 4 repair constructs: (1) 2 inside-out horizontal sutures, (2) 2 all-inside horizontal sutures, (3) an all-inside Mason-Allen construct consisting of 4 sutures, or (4) an all-inside construct consisting of a figure-of-8 suture plus 1 horizontal suture. Meniscus specimens were harvested and tested to failure on an Instron machine. The Kruskal-Wallis test was used to evaluate for significance of maximal failure load and stiffness between groups. RESULTS: The mean maximum failure loads were 64 ± 20 N (inside-out horizontal construct), 75 ± 16 N (all-inside horizontal construct), 86 ± 19 N (Mason-Allen construct), and 113 ± 22 N (figure-of-8 plus horizontal construct). Interconstruct comparison revealed a statistically significant difference between the figure-of-8 plus horizontal construct and all 3 remaining constructs (P < .02) as well as the Mason-Allen construct when compared with the inside-out horizontal construct (P < .01). Statistical significance was not found between the all-inside horizontal construct and the Mason-Allen construct or between the all-inside horizontal construct and the inside-out horizontal construct (P = .2 and .7, respectively). Stiffness values were lower for the inside-out construct compared with the all-inside constructs (P < .05). CONCLUSION: Complex all-inside repair constructs had significantly higher failure loads than a conventional, simple inside-out suture repair construct for repair of radial meniscal tears. Stiffness values among the all-inside groups were greater than those for the inside-out group. CLINICAL RELEVANCE: Arthroscopic techniques are presented to produce stronger radial meniscal tear repairs.

Anatomical parameters of subaxial percutaneous transfacet screw fixation based on the analysis of 50 computed tomography scans: Clinical article.

OBJECT: Cervical transfacet screw placement has been described in the literature. Although the technique shows promise for percutaneous application, parameters for screw placement have not been well delineated. This study used reconstructed CT scans with imaging software to assess the feasibility of percutaneous transfacet screw placement, analyzing potential entry angles, transfacet lengths, and sex differences at each subaxial level. METHODS: Fifty consecutive cervical CT scans (obtained in 26 males and 24 females [mean age 41.5 years]) were reformatted using OsiriX software, and transfacet lengths, entry angles, and potential occipital clearance were analyzed at all subaxial levels. Statistical analyses were used to determine the differences, if any, between transfacet lengths, entry angle, and occipital clearance across individual cervical levels. Repeatability was quantified by calculating the intraclass correlation coefficient and Cohen kappa value. RESULTS: A total of 200 transfacet lengths and 200 entry angles in 50 patients were analyzed. The mean transfacet lengths were 17.9 ± 2.6, 17.6 ± 3.2, 16.3 ± 3.6, and 13.1 ± 2.2 mm at C3-4, C4-5, C5-6, and C6-7, respectively, with mean entry angles at 52.7° ± 7.8°, 56.5° ± 8.0°, 55.0° ± 8.8°, and 53.0° ± 8.7°, respectively. Analysis of variance revealed a significant difference between the mean transfacet lengths, while post hoc analysis revealed significantly larger transfacet lengths in the upper 2 cervical levels (C3-4 and C4-5) than in the lower 2 cervical levels (C5-6 and C6-7). Analysis of variance demonstrated no significant difference between the entry angles. Males had significantly larger transfacet lengths at C5-6 (17.4 vs 15.1 mm) and C6-7 (13.7 vs 12.4 mm) than females. The occiput would have blocked percutaneous screw placement in 86%, 78%, 54%, and 20% of the cases at C3-4, C4-5, C5-6, and C6-7, respectively. Transfacet lengths may accommodate longer screws in the upper cervical spine, but potential screw sizes decrease in the lower subaxial levels. A transfacet entry angle of approximately 50° or greater was associated with a higher incidence of occipital clearance. Additionally, the occiput may pose a significant obstruction to percutaneous transfacet fixation in upper subaxial levels. Interrater reliability was poor for screw angle and length measurements, but was satisfactory in intrarater analysis in 6 of 8 measurements. There was moderate to good agreement of occipital clearance in all but one measurement. CONCLUSIONS: Cervical transfacet screw placement is possible from C-3 to C-7. Because occipital clearance can be difficult at C3-4 and C6-7, the use of curved or flexible instruments may be necessary to obtain the appropriate screw trajectory. Screw lengths varied with spinal level and the sex of the patient.

Intra-articular knee mass in a 51-year-old woman.

A 51-year-old woman presented with moderate knee pain refractory to conservative measures. Radiographs revealed a well-defined, but irregularly-shaped ovoid soft tissue density at the posterior superior aspect of the infrapatellar fat pad of Hoffa. On magnetic resonance imaging, the mass was mildly heterogeneous and had intermediate signal in the proton density series and mixed signal intensity on the T2-weighted images. A low-signal rim could be seen around a portion of the lesion. Arthroscopic resection was performed and a vascular stalk was encountered. The differential diagnosis included: ganglion cyst, meniscal cyst, intra-articular lipoma, villous proliferation of the synovial membrane, Hoffa disease, and intracapsular chondroma. Histologic examination revealed a fibrous capsule partially surrounding a benign lipomatous neoplasm containing an abundance of thin- and thick-walled blood vessels with periadventitial myxoid stroma. To our knowledge, this is the first reported case of an intra-articular angiomyxolipoma in the literature. At 8-month follow-up, the patient was asymptomatic with no sign of recurrence. We postulate a low recurrence rate based on the insidious growth rate and benign histological appearance of such lesions. To our knowledge, no other intra-articular lipomatous lesion of the knee has been removed solely with arthroscopic techniques. Further follow-up information is needed to better understand the natural course of these lesions.