Arthroscopic inferior capsular split and advancement for anterior and inferior shoulder instability: technique and results at 2- to 5-year follow-up.

Abstract

We present a modification of the arthroscopic Bankart repair that includes an inferior capsular split. This technique allows up to 2 cm of additional capsular advancement, restoring more normal capsular tension by addressing plastic elongation of the capsule. Prospective evaluations of 34 patients with 2- to 5-year follow-up are included in this report. Average patient age was 25.1 years (range, 16 to 40 years). Twenty-two patients had experienced at least 1 anterior/inferior dislocation. Ten patients had chronic anterior/inferior subluxation. Two patients were considered multidirectional. Time from dislocation or the duration of symptoms to the repair ranged from 1 month to 13 years. The first 5 repairs were performed using transglenoid suture fixation, the last 29 with suture/anchor technique. There were no neurological complications. The average postoperative Bankart score was 91.6 (range, 40-100). In 30 of 34 patients, there has been no recurrence of subluxation or dislocation. Two of the 5 transglenoid repairs had a recurrence (40% recurrence rate). Two of 29 patients in the suture anchor group had a recurrence (6.9% recurrence rate). We believe that the addition of an inferior capsular split, used in conjunction with a suture/anchor repair, restores more normal capsular tension and especially addresses the inferior component of anterior/inferior shoulder instability. We include an inferior capsular split and advancement routinely when performing arthroscopic Bankart repairs.