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Arthroscopic Bankart repair: how many knotless anchors do we need for anatomic reconstruction of the shoulder?—a prospective randomized controlled study

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Abstract

Purpose

The optimal strategy for surgical repair of traumatic anterior shoulder instability remains controversial. While several study groups have reported that the clinical and radiological outcomes of arthroscopic procedures performed with two anchors are not fully adequate, these conclusions are not supported by the findings published in other studies. A prospective randomized study was conducted to compare the structural and clinical outcomes of surgical procedures involving two vs. three anchors.

Methods

Patients who underwent arthroscopic Bankart repair were randomly assigned to either Group I, which underwent procedures involving two double-loaded 3.5-mm knotless anchors, or Group II, which underwent procedures involving three single-loaded 2.9-mm knotless anchors. All patients underwent bilateral MRI assessments at a minimum of 12 months and clinical assessment at a minimum of 24 months postoperatively. To evaluate the reconstruction of the labral capsular ligamentous complex (LCLC), the labrum-glenoid height index (LGHI), restored labral height (LH), and labral slope (LS) were measured for both shoulders. For clinical assessment, the redislocation rate and functional outcome scores (Constant score (CS), American Shoulder and Elbow Surgeon score (ASES), Walch Duplay score (WDS), and Rowe score (RS)) were evaluated at follow-up visits.

Results

Bankart repair with two knotless anchors showed lower values for anterior reconstruction of the LCLC compared to the uninjured contralateral shoulder. Likewise, significant differences were noted when comparing these measurements to those from patients who underwent reconstruction with three anchors. No differences were demonstrated with regard to the reconstruction of the inferior LCLC. Clinical assessment showed good to excellent results in both groups. In total, three patients experienced redislocation of the shoulder: two in group I and one in group II. No significant differences were found with respect to clinical outcomes and redislocation rates.

Conclusion

Bankart repair with both two and three knotless anchors results in effective anatomical reconstruction of the labral capsular ligamentous complex. Although the two-anchor technique yields significantly lower values for the anterior portion compared with the contralateral side, none of these differences reach clinical relevance as per our original definition.

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Data availability

The data that support the findings of this study are available on request from the corresponding author (JB).

Code availability

The datasets generated during and/or analysed during the current study are available from the corresponding author (JB) on reasonable request.

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Funding

None of the authors received any funding or sponsorship for this study, including funds or materials.

Author information

Authors and Affiliations

  1. Department of Sports Traumatology, Knee and Shoulder Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt Am Main, Frankfurt, Germany

    Johannes Buckup & Frederic Welsch

  2. Department for Shoulder Surgery and Sports Medicine, ATOS Klinik Frankfurt Am Main, Frankfurt, Germany

    Johannes Buckup

  3. Department of Orthopaedic Surgery and Arthroplasty, Vitos Orthopaedic Clinic Kassel, Kassel, Germany

    Stanislav Petchennik

  4. Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt Am Main, Frankfurt Am Main, Germany

    Alexander Klug, Yves Gramlich & Reinhard Hoffmann

  5. SPORTHOLOGICUM Frankfurt, Medical Center for Sport and Joint Injuries, Frankfurt Am Main, Germany

    Thomas Stein

  6. Institute of Sports Sciences, Goethe University Frankfurt, Frankfurt, Germany

    Thomas Stein

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  1. Johannes Buckup
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  2. Frederic Welsch
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Contributions

All authors have contributed substantially to the conception, design, analysis, and interpretation of the data in this manuscript and will take public responsibility for the content. Each author knows that the manuscript represents honest work. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Johannes Buckup.

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Approval giving authority and the Study Number: Ethik-Kommission der Landesärztekammer Hessen (FF14/ 2013).

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Informed consent was obtained from all individual participants included in the study.

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Buckup, J., Welsch, F., Petchennik, S. et al. Arthroscopic Bankart repair: how many knotless anchors do we need for anatomic reconstruction of the shoulder?—a prospective randomized controlled study. International Orthopaedics (SICOT) 47, 1285–1293 (2023). https://doi.org/10.1007/s00264-023-05749-2

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