Parallel bridge fixation for Bankart lesions: an arthroscopic technique for anatomic fixation and true restoration of the labroligamentous bumper

A rthroscopic Bankart repair for traumatic dislocation of the glenohumeral joint is becoming more common in the treatment of appropriate patients with shoulder instability associated with a detached capsulolabral complex. Current arthroscopic techniques attempt to restore the normal labral anatomy and retension the inferior glenohumeral ligament (IGHL) complex. However, the postoperative recurrence rate after this procedure has been reported to be between 4% and 21% and may be higher in chronic lesions, bony Bankart lesions, or anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions. Reports comparing arthroscopic and open techniques have indicated that the effectiveness of current arthroscopic techniques is approaching that of open techniques in preventing recurrent instability. Although several factors including patient age, lack of appreciation of bony loss and postoperative activity level are associated with higher recurrence, surgical techniques based on sound mechanical principles may be able to decrease the reported recurrence rate. Some authors have proposed that the glenoid labrum serves many different roles in maintaining the stability of the glenohumeral joint. It is known that the labrum deepens the glenoid cavity to provide stability by enhancing concavity-compression. In addition, the labrum functions as a synovial fluid container, which is important for adhesion and cohesion. Moreover, this containment is important in providing intrinsic adherence between the glenoid and humeral head. The labrum also seals the glenohumeral joint, limits joint volume and preserves the negative intra-articular pressure created between the glenoid surface and humeral head, which is important in maintaining the stability of the joint. Currently, the standard operation for arthroscopic Bankart repair includes multiple circumferential sutures overlying the labrum to retension the IGHL complex and returns the labrum to its normal anatomic position. However, with sutures threads overlying the labrum, the ‘‘bumper effect’’ can be compromised by suture fixation. While, there is no data indicating that suture materials used in conventional circumferential suture technique have a negative effect on glenoid labral function, it is theorized that circumferential techniques can lead to decreased labral height when tensioned. Matsen et al. emphasized this important stabilizing effect of the labrum by showing that injection of fresh blood to augment labral height leads to increased stability. Therefore, decreased labral height created by circumferential sutures could be another factor influencing recurrence of instability after Bankart repair. In the present paper, we demonstrate a new repair technique that uses suture threads placed parallel to the labrum. This new technique may restore the anatomic footprint of the labroligamentous complex and augment fixation through linear compression of the labrum rather than point contact (i.e. spot welding). This may ultimately improve stability and healing between the glenoid and labroligamentous complex.