title: Anatomic and Biomechanical Comparison of Traditional Bankart Repair With Bone Tunnels and Bankart Repair Utilizing Suture Anchors.
abstract: BACKGROUND
  Traditional Bankart repair using bone tunnels has a reported failure rate between 0% and 5% in long-term studies. Arthroscopic Bankart repair using suture anchors has become more popular; however, reported failure rates have been cited between 4% and 18%. There have been no satisfactory explanations for the differences in these outcomes.
  
  
  OBJECTIVE
  Bone tunnels will provide increased coverage of the native labral footprint and demonstrate greater load to failure and stiffness and decreased cyclic displacement in biomechanical testing.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Twenty-two fresh-frozen cadaveric shoulders were used. For footprint analysis, the labral footprint area was marked and measured using a Microscribe technique in 6 specimens. A 3-suture anchor repair was performed, and the area of the uncovered footprint was measured. This was repeated with traditional bone tunnel repair. For the biomechanical analysis, 8 paired specimens were randomly assigned to bone tunnel or suture anchor repair with the contralateral specimen assigned to the other technique. Each specimen underwent cyclic loading (5-25 N, 1 Hz, 100 cycles) and load to failure (15 mm/min). Displacement was measured using a digitized video recording system.
  
  
  RESULTS
  Bankart repair with bone tunnels provided significantly more coverage of the native labral footprint than repair with suture anchors (100% vs 27%, P < .001). Repair with bone tunnels (21.9 ± 8.7 N/mm) showed significantly greater stiffness than suture anchor repair (17.1 ± 3.5 N/mm, P = .032). Mean load to failure and gap formation after cyclic loading were not statistically different between bone tunnel (259 ± 76.8 N, 0.209 ± 0.064 mm) and suture anchor repairs (221.5 ± 59.0 N [P = .071], 0.161 ± 0.51 mm [P = .100]).
  
  
  CONCLUSIONS
  Bankart repair with bone tunnels completely covered the footprint anatomy while suture anchor repair covered less than 30% of the native footprint. Repair using bone tunnels resulted in significantly greater stiffness than repair with suture anchors. Load to failure and gap formation were not significantly different.
authors.affiliation: University of Connecticut Health Center, Farmington, Connecticut, USA.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Judson
authors.affiliation: University of Connecticut Health Center, Farmington, Connecticut, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Charette
authors.affiliation: University of Connecticut Health Center, Farmington, Connecticut, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Cavanaugh
authors.affiliation: University of Connecticut Health Center, Farmington, Connecticut, USA.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Shea
keywords: Bankart repair; bone tunnels; footprint; shoulder instability; suture anchors