Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
SlideShare a Scribd company logo

Arthroscopic bankart’s repair

•Download as PPT, PDF•
•

This document describes the arthroscopic Bankart repair procedure for a 26-year-old male patient with recurrent right shoulder instability. An MRI showed a Bankart lesion and Hill-Sachs lesion. During the arthroscopic procedure, the Bankart lesion extending from the 2 to 5 o'clock position on the glenoid was repaired. Post-operatively, the patient's arm was immobilized for 3 weeks followed by a rehabilitation program. Arthroscopic stabilization allows for a complete inspection of the joint and treatment of all intra-articular lesions while preserving range of motion.

1 of 14

1

Arthroscopic Bankart’s repair

2

History  26 yrs old male , Right handed individual , computer programmer by profession , recreational sportsman , presented with Recurrent episodes of instability of Right shoulder for 6yrs.  Episodes 10/year. Last episode 1 week back. Treated with CR.

3

History  Tenderness anterior aspect . Wasting of Deltoid , Positive Hamilton ruler test. All ROM restricted and painfull . Apprehension present . No evidence of multidirection, sulcus sign present.  MRI done– Bankart’s lesion. Posteromedial Hillsach’s lesion.

4

MRArthrogram  Bankart’s lesion  Postero-medial Hillsach’s lesion

5

What is Bankart’s ?  Capsulo-labral avulsion of the Anterior capsule from the Glenoid.

6

Procedure

7

Examination underAnaesthesia  Anterior drawer’s grade 2+.  Sulcus sign grade 2.

8

Arthroscopic Bankart’s repair Bankart’s lesion extending from 2 to 5 ‘O’ clock position. Inferior capsule lax. Glenoid

9

Post-operative Radiogram  Immobilisation in arm sling for 3 wks. Passive and active assisted at 3 wks. Abduction only to 90. No ER. At 6 wks full Rom and rotator strengthening.

10

 Advantages of Ascopic stabilisation.  Smaller skin incisions.  Complete inspection of joint.  Ability to treat all intraarticular lesions.  Ability to access all areas of GH joint.  Less soft tissue dissection.  Preservation of ER.

11

 T.Neviaser identified ALPSA(anterior labroligamentous periosteal sleeve avulsion) in anterior-inferior GH instability.  High failure rates in previous ascopic repairs due to technical factors- medial repair of anterior labrum. failure to treat ALPSA, SLAP, rotator interval, capsular tensioning.

12

 Neer’s concepts  GH instability in multiple directions  Correction of all 3 symptomatic directions is necessary.  Scoring systems used- American shoulder and elbow surgeons shoulder index , constant scoring systems.

13

 Indications- persistant shoulder pain from GH instability that has not responded to 6 mnths of non-opretive treatment.  Factors to be considered; age, severity of initial trauma, reduction method, arm dominance, activity level, sports , desired level of activity, instability, radiographic finding’s.

14

 Contraindications- who demonstrate GH instability , voluntary muscular contractions , emotional instability, Glenoid defects more thyan 4 mm.  Hill-S-sach’s lesion engaging the anterior Glenoid.

More Related Content

Arthroscopic bankart’s repair

  • 2. History  26 yrs old male , Right handed individual , computer programmer by profession , recreational sportsman , presented with Recurrent episodes of instability of Right shoulder for 6yrs.  Episodes 10/year. Last episode 1 week back. Treated with CR.
  • 3. History  Tenderness anterior aspect . Wasting of Deltoid , Positive Hamilton ruler test. All ROM restricted and painfull . Apprehension present . No evidence of multidirection, sulcus sign present.  MRI done– Bankart’s lesion. Posteromedial Hillsach’s lesion.
  • 4. MRArthrogram  Bankart’s lesion  Postero-medial Hillsach’s lesion
  • 5. What is Bankart’s ?  Capsulo-labral avulsion of the Anterior capsule from the Glenoid.
  • 7. Examination underAnaesthesia  Anterior drawer’s grade 2+.  Sulcus sign grade 2.
  • 8. Arthroscopic Bankart’s repair Bankart’s lesion extending from 2 to 5 ‘O’ clock position. Inferior capsule lax. Glenoid
  • 9. Post-operative Radiogram  Immobilisation in arm sling for 3 wks. Passive and active assisted at 3 wks. Abduction only to 90. No ER. At 6 wks full Rom and rotator strengthening.
  • 10.  Advantages of Ascopic stabilisation.  Smaller skin incisions.  Complete inspection of joint.  Ability to treat all intraarticular lesions.  Ability to access all areas of GH joint.  Less soft tissue dissection.  Preservation of ER.
  • 11.  T.Neviaser identified ALPSA(anterior labroligamentous periosteal sleeve avulsion) in anterior-inferior GH instability.  High failure rates in previous ascopic repairs due to technical factors- medial repair of anterior labrum. failure to treat ALPSA, SLAP, rotator interval, capsular tensioning.
  • 12.  Neer’s concepts  GH instability in multiple directions  Correction of all 3 symptomatic directions is necessary.  Scoring systems used- American shoulder and elbow surgeons shoulder index , constant scoring systems.
  • 13.  Indications- persistant shoulder pain from GH instability that has not responded to 6 mnths of non-opretive treatment.  Factors to be considered; age, severity of initial trauma, reduction method, arm dominance, activity level, sports , desired level of activity, instability, radiographic finding’s.
  • 14.  Contraindications- who demonstrate GH instability , voluntary muscular contractions , emotional instability, Glenoid defects more thyan 4 mm.  Hill-S-sach’s lesion engaging the anterior Glenoid.