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The “purse string” technique for anterior glenohumeral instability: long-term results 7–13-year follow-up

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The “Purse-String Technique” (PST) is an arthroscopic horizontal mattress suture technique for recurrent anterior shoulder instability that uses a single double-loaded suture anchor at the 4-o’ clock position, achieving a Bankart labral repair and an infero-superior capsular shift. In this study, we describe the long-term results of the PST.

Methods

The study included 69 individuals (70 shoulders), with a mean age of 30 years, who had recurrent post-traumatic anteroinferior instability. A purse-string suture anchor at the 4-o'clock position was used to address the Bankart lesion and capsular laxity, recreating the anterior glenoid bumper. All patients were assessed via telephone interview at a mean of 116 months after surgery (7–13-year follow-up).

Results

Postoperatively, the mean Constant score was 94, mean Rowe score was 93 and mean Walch–Duplay score was 89. 89% of patients resumed their preinjury sport activities, with 61% of patients achieving preinjury levels and most professional athletes returning to full activity. Seven patients had recurrent dislocation postoperatively (10% failure rate). Of these patients, three had revision arthroscopic stabilization, one patient had revision arthroscopic stabilization with remplissage, two had a Latarjet procedure, whereas one patient decided to seek no further treatment.

Conclusion

The long-term results of PST are promising, with a low failure rate, high patient satisfaction and a high rate of return to sport.

Level of evidence

Level IV; Case series; Treatment study.

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Authors and Affiliations

  1. Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK

    Georgios Panagopoulos, Girolamo Picca, Aleksandra Adamczyk, Andreas Leonidou, Paolo Consigliere, Giuseppe Sforza & Ofer Levy

  2. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Ehud Atoun & Ofer Levy

  3. Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel

    Ehud Atoun & Ofer Levy

  4. Division of Orthopaedic Surgery, Tel Aviv Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Ehud Rath

Authors
  1. Georgios Panagopoulos
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  2. Girolamo Picca
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  3. Aleksandra Adamczyk
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  4. Andreas Leonidou
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  5. Paolo Consigliere
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  6. Giuseppe Sforza
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  7. Ehud Atoun
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  8. Ehud Rath
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  9. Ofer Levy
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Contributions

G. Panagopoulos participated in conception, design, literature review, data collection and analysis, manuscript writing & editing, figures & tables. G. Pica participated in conception, design, literature review & data collection. A. Leonidou, P. Consigliere, A. Adamczyk, G. Sforza, E. Atoun & E. Rath participated in conception, design & data collection. OL participated in conception, design, literature review, data collection and analysis, manuscript editing and figures. All authors approved the final manuscript.

Corresponding author

Correspondence to Georgios Panagopoulos.

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Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval from the institutional ethics committee was obtained (Clinical Governance Committee—reference: 2021–05-27).

Informed consent

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

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Panagopoulos, G., Picca, G., Adamczyk, A. et al. The “purse string” technique for anterior glenohumeral instability: long-term results 7–13-year follow-up. Eur J Orthop Surg Traumatol 33, 2317–2323 (2023). https://doi.org/10.1007/s00590-022-03426-5

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  • DOI: https://doi.org/10.1007/s00590-022-03426-5

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