The results of arthroscopic anterior stabilisation of the shoulder using the bioknotless anchor system

Abstract

Background: Shoulder instability is a common condition, particularly affecting a young, active population. Open capsulolabral repair is effective in the majority of cases, however arthroscopic techniques, particularly using suture anchors, are being used with increasing success.

Methods: 15 patients with shoulder instability were operated on by a single surgeon (VK) using BioKnotless anchors (DePuy Mitek, Raynham, MA). The average length of follow-up was 21 months (17 to 31) with none lost to follow-up. Constant scores in both arms, patient satisfaction, activity levels and recurrence of instability was recorded.

Results: 80% of patients were satisfied with their surgery. 1 patient suffered a further dislocation and another had recurrent symptomatic instability. The average constant score returned to 84% of that measured in the opposite (unaffected) shoulder. There were no specific post-operative complications encountered.

Conclusion: In terms of recurrence of symptoms, our results show success rates comparable to other methods of shoulder stabilisation. This technique is safe and surgeons familiar with shoulder arthroscopy will not encounter a steep learning curve. Shoulder function at approximately 2 years post repair was good or excellent in the majority of patients and it was observed that patient satisfaction was correlated more with return to usual activities than recurrence of symptoms.

Figures

Figure 1

Arthroscopic view of a Bankart lesion in a right shoulder.

Figure 2

The shuttle suture (green) is threaded through a sharp device with a slight 'cork-screw' twist.

Figure 3

The shuttle suture is passed through the capsulolabral complex at the desired position. A hook is used to catch one end of the suture and bring it out the other portal.

Figure 4

The shuttle suture (green) is used to pull the anchor suture through the capsulolabral complex.

Figure 5

The anchor suture (blue) is now visible as it passes through.

Figure 6

The BioKnotless anchor is introduced.

Figure 7

One thread of the anchor suture (blue) is caught in the teeth of the anchor.

Figure 8

The anchor plus suture is then lined up with the predrilled hole in the glenoid rim.

Figure 9

The BioKnotless anchor is gently tapped into the hole.

Figure 10

The anchor is inserted until the desired tension is achieved. The shuttle suture is then removed.

Figure 11

As many anchors as necessary to effect a complete repair are inserted (two are visible in this view). The final repair is probed to ensure good stability.