Evaluation of glenoid capsulolabral complex insertional anatomy and restoration with single- and double-row capsulolabral repairs

doi:10.1016/j.jse.2009.03.022

Journal of Shoulder and Elbow Surgery

Volume 18, Issue 6, November–December 2009, Pages 948-954

https://doi.org/10.1016/j.jse.2009.03.022 Get rights and content

Background

The purpose of this study was to evaluate the normal glenoid insertional anatomy of the anterior-inferior capsulolabral complex and to compare the ability of a single-row repair and a double-row suture bridge repair to restore the insertional anatomy.

Methods

Eight fresh frozen cadaver shoulders were dissected and the native glenoid insertion of the anterior-inferior capsulolabral complex was digitized. Bankart lesions were created, the shoulders were randomized to receive either the standard single-row suture anchor repair or a double-row suture bridge repair, and the insertion repair sites were then digitized.

Results

The single-row repair recreated 42.3% of the native footprint surface area while the double-row repair recreated 85.9%. The double-row repair was significantly larger and recreated significantly more of the native footprint compared with single-row repair (P < .01).

Conclusion

Double-row repair of the capsulolabral complex reestablishes the native insertional footprint on the anterior inferior glenoid better than a single-row repair.

Level of evidence

Basic science study.

Section snippets

Methods and materials

Eight fresh frozen cadaver shoulders (mean age 55, 6 males, 2 females) were thawed and dissected. The humerus, acromion, and soft tissues were removed leaving the glenoid, glenoid labrum, and anterior-inferior capsule intact. The scapula was mounted in a clamp system to keep it rigid. The anterior-inferior capsulolabral complex from the level of the base of the coracoid to the 6 o'clock position was carefully dissected off the glenoid and its attachment marked with black ink (Figure 1). The

Results

The mean surface area of the native capsulolabral complex footprint was 256.0 ± 40.4 mm², whereas the native footprint of the labrum was 152.3 ± 24.4 mm² (Figure 5). Therefore, the labrum attachment comprised 59% of the overall capsulolabral complex. The mean surface area of the single-row repair was 108.3 ± 27.2 mm², while the double-row repair was 220.2 ± 39.3 mm². This represented 42.3% and 85.9% recreation of the native capsulolabral complex footprint surface area for single- and double-row

Discussion

To our knowledge, this is the first study to evaluate quantitatively the glenoid capsulolabral anatomy and its restoration with different repair techniques. Many authors advocate repair of the capsulolabral complex with emphasis on recreating the labral bumper effect by placing anchors on the glenoid articular surface, but have not attempted to restore the insertional anatomy. Most recommend abrading the anterior bony glenoid to enhance healing, but do not provide fixation in this area.14, 20,

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Cited by (37)

On-the-Edge Anchor Placement May Be Protective Against Glenoid Rim Erosion After Arthroscopic Bankart Repair Compared to On-the-Face Anchor Placement
2022, Arthroscopy - Journal of Arthroscopic and Related Surgery
This retrospective study aimed to compare the effects of 2 different anchoring placements on glenoid rim erosion after arthroscopic Bankart repair (ABR).
Shoulders that underwent ABR from January 2013 to July 2020 were divided into 2 groups according to anchor placement (on-the-face, group F; on-the-edge, group E). We retrospectively calculated the percent change of glenoid width (Δ) on the first postoperative computed tomography scan (CT; performed within 6 months) and second postoperative CT (performed at 6 to 12 months) relative to the width on the preoperative CT and compared percent changes between the 2 groups. Also, we investigated the influence of preoperative glenoid structures (normal, erosion, bony Bankart) and the postoperative recurrence rate.
We examined 225 shoulders in 214 patients (group F, n = 151; group E, n = 74). At first CT, anchoring placement was significantly associated with postoperative decrease of glenoid width (group F, −7.6% ± 7.9%; group E, −0.1% ± 9.7%; P < .0001). The difference between groups F and E was significant in shoulders with a preoperative glenoid defect (bony Bankart, −6.6% ± 8.8% vs 2.5% ± 11.2%, respectively; P < .0001; erosion, −6.6% ± 6.2% vs −2.6% ± 5.3%, respectively; P = .03). In 112 shoulders, CT was performed twice; Δ was −6.9% ± 7.3% in group F (n = 64) and −1.7% ± 10.1% in group E (n = 48; P = .005) at the first CT and −3.2% ± 10.0% and 1.0% ± 10.6% (P = .10), respectively, at the second CT, indicating recovery of glenoid width in both groups. The postoperative recurrence rate in patients with at least 2 years’ follow-up was 14.7% in group F and 14.6% in group E.
In the early stage after ABR, on-the-edge glenoid anchor placement was associated with less glenoid rim erosion than on-the-face anchor placement.
Level III, retrospective comparative trial.
Arthroscopic Fixation of an Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) of the Shoulder
2020, Arthroscopy Techniques
Anterior labroligamentous periosteal sleeve avulsions represent a diagnostic and treatment challenge. They are associated with a higher number of preoperative dislocations, as well as longer chronicity, and commonly result in a scarred and medialized labrum and periosteal sleeve complex. Anterior labroligamentous periosteal sleeve avulsion lesions therefore may be commonly overlooked. The complexity of the injury pattern has been associated with double the failure rate of standard Bankart lesions after arthroscopic repair. The purpose of this article is to describe our preferred arthroscopic technique for achieving full mobilization of the labral-periosteal complex and restore it to its anatomic location using a knotless, all-suture anchor construct.
Progression of Erosive Changes of Glenoid Rim After Arthroscopic Bankart Repair
2020, Arthroscopy - Journal of Arthroscopic and Related Surgery
Citation Excerpt :
However, it is believed that “on-the-edge” anchoring might prevent bone erosion if we take into account the above-mentioned stress shielding mechanism. In addition, fixation with simple sutures was used in this series, so another suturing method such as a double-row technique23-26 or use of different suture anchors might help to prevent loss of glenoid width. Minimizing tissue abrasion or extending the period of immobilization during rehabilitation might also be useful.
To evaluate changes of the glenoid after arthroscopic Bankart repair (ABR) in patients with different preoperative glenoid structures.
Patients who underwent ABR for traumatic anterior shoulder instability were retrospectively investigated. They were divided into 3 groups on the basis of preoperative glenoid structure by computed tomography (CT): normal glenoid (group N), glenoid erosion (group E), or glenoid defect associated with a bony Bankart lesion (group B). Shoulders in group B were also stratified according to the postoperative status of the bone fragment (union, nonunion, or resorbed). Postoperative changes of glenoid width (Δ) (increase: Δ ≥5%, stable: Δ >−5% to <5%, decrease: Δ ≤−5%) and the extent of glenoid bone loss were investigated by 3-dimensional CT.
A total of 186 shoulders were divided into 3 groups: group N (n = 61), group E (n = 46), and group B (n = 79). At initial postoperative CT, the glenoid width was decreased in 41 shoulders, stable in 20 shoulders, and increased in no shoulders from group N. The respective numbers were 27, 18, and 1 in group E, and 50, 22, and 7 in group B. The glenoid width was reduced in all groups (mean percent change: −8.8%, −5.9%, and −6.1%, respectively). In group B, glenoid width decreased in most of the shoulders without bone union. The glenoid bone loss on the preoperative and postoperative final CT was, respectively, 0% and 8.6% in group N (P < .0001), 9.9% and 12.4% in group E (P = .03), and 10.4% and 7.2% in group B (P = .01). Final glenoid bone loss >13.5% was recognized in 18.2% of group N, 35.7% of group E, and 21.8% of group B.
Glenoid width often decreased after ABR because of anterior glenoid rim erosion, and this change was frequent in patients with preoperative normal glenoid, glenoid erosion, or without postoperative union of a bony Bankart lesion.
Level 3, Case-control study.
The 6-O'clock Anchor Increases Labral Repair Strength in a Biomechanical Shoulder Instability Model
2019, Arthroscopy - Journal of Arthroscopic and Related Surgery
To characterize the additive effect of a 6-o'clock anchor in the stabilization of a Bankart lesion.
Twelve cadaveric shoulders were tested on a 6-df robotic musculoskeletal simulator to measure the peak resistance force due to anterior displacement of 1 cm. The rotator cuff muscles were loaded dynamically. The test conditions consisted of the intact shoulder, Bankart lesion, Bankart repair (3-, 4-, and 5-o'clock anchors), and Bankart repair with the addition of a 6-o'clock anchor. A 13% anterior bone defect was then created, and all conditions were repeated. Repeated-measures analysis of variance was performed.
In the group with no bone loss, the addition of a 6-o'clock anchor yielded the highest peak resistance force (52.8 N; standard deviation [SD], 4.5 N), and its peak force was significantly greater than that of the standard Bankart repair by 15.8% (7.2 N, P = .003). With subcritical glenoid bone loss, the repair with the addition of a 6-o'clock anchor (peak force, 52.6 N; SD, 6.1 N; P = .006) had a significantly higher peak resistance force than the group with bone loss with a Bankart lesion (35.2 N; SD, 5.8 N). Although the 6-o'clock anchor did increase the strength of the standard repair by 6.7%, this was not statistically significant (P = .9) in the bone loss model.
The addition of a 6-o'clock suture anchor to a 3-anchor Bankart repair increases the peak resistance force to displacement in a biomechanical model, although this effect is lost with subcritical bone loss.
This study provides surgeons with essential biomechanical data to aid in the selection of the repair configuration.
The effect of subscapularis muscle contraction on coaptation of anteroinferior glenohumeral ligament–labrum complex after Bankart repair
2019, Journal of Biomechanics
Citation Excerpt :
Previous cadaveric studies on this topic measured the footprint of the repaired labrum on the glenoid with no rotator-cuff muscle loading present in the model, thereby disregarding any pressure contributions that the soft tissue may provide (Ahmad et al., 2009; Kim et al., 2011). In addition, these studies reported that the footprint of the repaired labrum using a double-row repair was from 78.4% to 90.4% of the anterior native labrum’s footprint (Ahmad et al., 2009; Kim et al., 2011). Our findings suggest that this footprint size increased with the contraction of the subscapularis and was 79.1% of the native footprint using single-row repair.
Facilitation of healing is important for the anteroinferior glenohumeral ligament–labrum complex (AIGHL-LC) after Bankart repair in shoulder dislocation. The purpose of this study was to investigate the effect of subscapularis muscle loading on contact area and contact pressure between the subscapularis and AIGHL-LC and between the glenoid bone and the AIGHL-LC following Bankart repair. Twenty-two fresh-frozen cadaveric shoulders were used. They were attached to a shoulder-positioning device to which a compression force was applied. Loads applied to the supraspinatus, infraspinatus, and teres minor tendons were held constant. The loads applied to the subscapularis tendon were set at 0, 10, 20, and 30 Newton (N). Contact pressure and area between the subscapularis and the AIGHL-LC were measured with the arm at 4 rotational positions: 60° and 30° internal, neutral, and 30° external. After the Bankart lesion was created, the contact area and pressure between the AIGHL-LC and glenoid bone were measured while Bankart repair was performed with or without loading of the subscapularis. The contact area and pressures with 10, 20, and 30 N of subscapularis loadings were significantly greater than with 0 N of subscapularis loading at 60° internal rotation and 30° external rotation (P < .05). After Bankart repair, contact area and pressure with subscapularis loading between the AIGHL-LC and glenoid bone were significantly greater than without subscapularis loading (P < .01). We conclude that isometric contraction exercises of the subscapularis might facilitate healing of the AIGHL-LC after Bankart repair.
Functional outcome of arthroscopic double row repair for Bankart lesion
2018, Journal of Orthopaedics
The shoulder joint is the most common major joint to dislocate. Population aged younger than 20 years, recurrent dislocation rates have been reported to be as high as 90%. For those individuals that continue to experience dislocations surgery is often a good decision. The goal of the Bankart surgery is to reconnect the torn labrum to the glenoid fossa. Double-row Bankart repair can both achieve anatomic reduction and enhance fixation stability. The purpose of our study is to assess the clinical outcome of arthroscopic double row repair.
49 cases with Bankart lesion operated by double row repair were studied. Functional outcome and retear were assessed after at least 6 months of surgery using scores and MRI.
Significant improvement in functional outcome after repair by double row Bankart repair. No retear or redislocation seen.
Double row repair technique improves function of shoulder significantly and potentially minimizes future re-injury or recurrence risk.

View all citing articles on Scopus

: IRB approval was not applicable as this was a basic science laboratory study.

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Rotator CuffEvaluation of glenoid capsulolabral complex insertional anatomy and restoration with single- and double-row capsulolabral repairs

Background

Methods

Results

Conclusion

Level of evidence

Section snippets

Methods and materials

Results

Discussion

Arthroscopy

J Shoulder Elbow Surg

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Orthop Clin North Am

J Shoulder Elbow Surg

Arthroscopy

Arthroscopy

Arthroscopy

Techniques in orthopaedic sports medicine

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

J Shoulder Elbow Surg

Arthroscopy

Arthroscopy

Arthroscopy

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Biomechanical performance of rotator cuff repairs with humeral rotation: a new rotator cuff repair failure model

Am J Sports Med

The double-pulley technique for double-row rotator cuff repair

Arthroscopy

The pathology and treatment of recurrent dislocation of the shoulder-joint

Br J Surg

Tensile properties of the inferior glenohumeral ligament

J Orthop Res

Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair

J Bone Joint Surg Am

A novel double-row rotator cuff repair exceeds strengths of conventional repairs

Clin Orthop Relat Res

A biomechanical comparison of 2 technical variations of double-row rotator cuff fixation: the importance of medial row knots

Am J Sports Med

Rotator Cuff
Evaluation of glenoid capsulolabral complex insertional anatomy and restoration with single- and double-row capsulolabral repairs