title: The antero-inferior (transmuscular) approach for arthroscopic repair of the Bankart lesion: an anatomic and clinical study.
abstract: In order to find a direct approach to the antero-inferior third of the glenoid rim, an anatomic study was performed on a total of 89 shoulders (48 cadavers). To obtain defined reference points for the anterior inferior third of the glenoid cavity, it was compared with the hour markings on a clock face. The 4:30 position on the right shoulder and the 7:30 position on the left shoulder were defined as the relevant reference points. The average distance between the palpable end of the coracoid process and the 4:30 and 7:30 positions was 19 mm. The average distance to the point of intersection of the musculocutaneous nerve with the medial margin of the conjoined tendon was more than 5 cm, and was never less than 2 cm. The average distance of the axillary nerve from the 4:30 position was 2.5 cm in the horizontal plane, with a minimum of 1.5 cm. Radially, the average distance of the axillary nerve was 1.7 cm, with a minimum of 1.3 cm. The anatomic study was followed by a clinical study of 264 patients. An antero-inferior portal located maximum 2 cm distal from the palpable coracoid tip was selected for the introduction of a trocar sheath and blunt trocar, passing through the subscapularis muscle to access the antero-inferior area of the glenoid rim. As additional protection for the musculocutaneous nerve, the direction of the trocar was adjusted during introduction. Reattachment of the labrum-capsule complex was performed extra-articularly. In all cases, at least one implant was located inferior to the 4:30 or 7:30 position. No neurovascular complications arose out of the choice of portal. Out of the 264 patients, the first 100 shoulders (98 patients) were followed-up after an average time of 35 months (18 to 62 months). The recurrence rate was 9%. Excluding the first 30 shoulders (30 patients) from the development phase of the technique, the recurrence rate is only 5.7%. The rate of return to overhead sports activities was 62% and to collision sports activities 70%.
authors.affiliation: Salzburg General Hospital, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Resch
authors.forename: H F
authors.initials: HF
authors.lastname: Wykypiel
authors.forename: H
authors.initials: H
authors.lastname: Maurer
authors.forename: M
authors.initials: M
authors.lastname: Wambacher
mesh_terms: D000328:Adult; D000368:Aged; D020679:Arthroscopes; D019723:Endoscopes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009138:Musculocutaneous Nerve / Q000473:pathology / Q000601:surgery; D010525:Peripheral Nerves / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D016059:Range of Motion, Articular / Q000502:physiology; D012008:Recurrence; D012782:Shoulder / Q000294:innervation / Q000473:pathology / Q000601:surgery; D012783:Shoulder Dislocation / Q000473:pathology / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation; D016896:Treatment Outcome