Reverse hillsachs lesion is a defect caused by the anterior compression fracture of the humeral head in posterior shoulder dislocation. Bankart repair anterior capsulorrhaphy rehabilitation guideline. What links here related changes upload file special pages permanent. If coupled with a bankart repair, follow open bankart repair guidelines assumptions. Treatment of traumatic anterior shoulder instability through arthroscopic viewing using a technique for remove the cartilage of the anterior glenoid rim for repairing a bankart lesion provided excellent results. In repair of a slap lesion, the labralbiceps complex is reattached. The following is a guideline for progression of postoperative treatment. Media in category bankart lesion the following 5 files are in this category, out of 5 total. The arthroscopic method offers a less invasive technique of bankart repair for traumatic anterior shoulder instability. Perthes lesion a perthes lesion is a labroligamentous avulsion like a bankart, but with a medially stripped intact periosteum. Choose from 2 different sets of bankart lesion flashcards on quizlet. The physiologic groove in the humerus or cysts and erosions at the attachment site of the infraspinatus tendon can simulate a hillsachs, but usually this is not. Here we will look at the common causes, associated injuries, symptoms and treatment options, both surgical and non surgical, for a bankart lesion labrum tear.
Arthroscopic bankart repair is commonly utilized for. Treatment of chronic anterior shoulder dislocation by open reduction and simultaneous bankart lesion repair. It is an indication for surgery and often accompanied by a hillsachs lesion, damage to the posterior humeral head the bankart lesion is named after english. The bankart lesion is named after english orthopedic surgeon arthur sydney blundell bankart. Bankart lesions are named after english orthopedic surgeon arthur sydney blundell bankart, 18791951, who first described the injury and the surgical repair process. The anatomic configuration of the shoulder joint glenohumeral joint is often compared to a golf ball on a tee figure 1. This protocol provides you with general guidelines for the postoperative rehabilitation of the patient following a reverse bankart posterior capsular shift repair. This rehabilitation is generally the opposite of a bankart repair. Rehabilitation guidelines for anterior shoulder reconstruction with open bankart repair.
The clinical files of the patients were examinated in order to document findings before, during and after the surgical procedure. This injury is caused by the labrum has a poor blood supply and joint fluid within the tear interferes with healing. The coronal images shows the medially displaced labrum red arrow. This implies that intrinsic stability can be shared between the bankart repair and bone support. Additional lesions such as a bankart, slap tear, or biceps injury may also be present. The purpose of this study was to evaluate the outcome of arthroscopic capsulotenodesis of the posterior capsule and infraspinatus tendon. A hill sachs lesion occurs when the lesion to the labrum presents simultaneously. Any information contained in this pdf file is automatically generated from digital. The osseous bankart lesion is an avulsion of the humeral labral complex with an anterior rim fracture. If either a bankart lesion or a hillsachs lesion is diagnosed in a shoulder after anterior luxation, it is approximately 11 times more likely to find the second type of lesion than an isolated lesion. Primary repair avoid high 5 low 5 positions if open repair1. Repair of bankart lesions with masonallen suture provides increased labrum height.
Ninety percent of shoulder dislocations are anterior, and traumatic injuries account for 95% of them4, 5, 6, 7. Immediately postoperatively, exercises must be modified so as not to place. Glenohumeral joint in abduction and external rotation in shoulder with glenoid defect and hillsachs lesion hs bipolar bone loss. The biceps anchor has pulled away from the glenoid attachment grade iv. Bankart lesions do heal, and therefore early surgical intervention if any is not required. However, a sizable defect will engage with the anterior rim of the glenoid and cause instability even after anterior glenoid reconstruction. Evolving concept of bipolar bone loss and the hillsachs. Arthroscopic bankart repair rehab protocol this rehabilitation protocol has been developed for the patient following an arthroscopic bankart surgical procedure. There was recurrence of instability in two patients 7%. Jun 14, 2011 the arthroscopic method offers a less invasive technique of bankart repair for traumatic anterior shoulder instability. Manual reduction of the joint was carried out by hippocrates or rowe technique at least 3 times.
These factors make it unlikely that a bankart tear heals. We would like to report the 2 year clinical outcomes of bioabsorbable suture anchors used in traumatic anterior dislocations of the shoulder. Reverse bankart lesion radiology reference article. Pdf treatment of reverse hillsachs lesion by autograft. Orthopaedic surgery, sports medicine and rehabilitation bankart repair post operative rehabilitation protocol general considerations. Rotator cuff lesions were the least prevalent type, seen in only one patient 1. Current concepts in the diagnosis and management of traumatic. The incidence of these lesions in the setting of glenohumeral instability is relatively high and approaches 100% in persons with recurrent.
In athletic patients under the age of 20 years, the recurrence rates are greater than 90%. A hill sachs lesion occurs when the lesion to the labrum presents simultaneously with a. Repair of bankart lesion, which is a detachment of the aighlcapsulolabral complex from the anterior glenoid neck, usually caused by traumatic anterior dislocation. Pdf treatment of chronic anterior shoulder dislocation. There is a positive correlation between the sizes of bankart and hillsachs lesions. Arthroscopic stabilization of anterior shoulder instability.
Bankart repair bankart lesion lesion of the anterior part of the glenoid labrum of the shoulder. Arthroscopic repair of bony bankart lesions in collision athletes ncbi. Dec 08, 2015 among the associated lesions, bankart lesions had the highest prevalence and were found in all the patients. Prepa re the bankart lesion by passing sutures and placing anchors, but do not. When the anterior and inferior ligaments and labrum are damaged.
As a result of an accident in the gym, a dislocation of my left shoulder left me with pain, and also instability when my arm was raised above my head. This analogy is used because the articular surface of the round humeral head upper most part of the arm is approximately four times. Evaluation of a treatment algorithm for acute traumatic. Data from 79 shoulders in 74 patients were collected over 4 years 2004 2008. Table 1 lesions associated with the bankart lesion.
A hillsachs lesion of the humeral head after a shoulder dislocation is clinically insignificant in most cases. In more severe cases when the labrum is torn a portion of the glenoid may be fractured and this is referred to as bony bankart lesion. Most reports on arthroscopic revision bankart have included small numbers of patients who had multiple previous surgeries. Dislocation of the shoulder joint occurs in 1 to 2% of the populatio. Bankart lesion, humeral avulsion of the glenohumeral ligaments hagl lesion, and capsular rupture. The top of the arm bone head of the humerus forms the ball and the front part of the shoulder blade glenoid fossa forms the socket. Learn bankart lesion with free interactive flashcards. This rehabilitation program is designed to return the individual to their activities as quickly and safely as possible. Hillsachs lesion hsl entirely covered by the glenoid at the sxchs ramhamadany and modi noted that an isolated hillsachs lesion increases the chances of a bipolar defect by a factor of 2. A bankart lesion is an injury of the anterior glenoid labrum of the shoulder due to anterior shoulder dislocation.
Perthes lesion is variant of bankart lesion, presenting as an anterior glenohumeral injury that occurs when the scapular periosteum remains intact but is stripped. Is clinical evaluation alone sufficient for the diagnosis. Shoulder, anterior dislocation, bankart repairmen, open surgery, arthroscopic surgery. Long term results of arthroscopic bankart repair for. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it. The bony apprehension test for instability of the shoulder. A bony bankart is a bankart lesion that includes a fracture of. Involves a bucket handle tear of the superior labrum which extends into. To fully understand bankart lesions, we need to first understand the structure of the shoulder. Reverse bankart lesion is defined as the detachment of posteroinferior labrum with avulsion of posterior capsular periosteum. The incidence of hillsachs lesion is not known with certainty. Mri revealed 6 osseous bankart lesions, 26 soft tissue bankart lesions 96%, and a hillsachs lesion in 25 92. Purpose of this study is to conduct a metaanalysis comparing the results of open and arthroscopic bankart repair using suture anchors in recurrent traumatic anterior shoulder instability. Open capsular repair without bone block likely failures.
Hagl lesion occurring after successful arthroscopic bankart. From engaging nonengaging to ontrack offtrack epos. This procedure included the injection of a contrast dye directly into the shoulder joint, followed by an m. The contribution of the hillsachs lesion to glenohumeral instability depends on the. Arthroscopic view from the anterior portal in the right shoulder showing fiberwire coming from a. Rehabilitation guidelines for anterior shoulder reconstruction with arthroscopic bankart repair the anatomic configuration of the shoulder joint glenohumeral joint is often compared to a golf ball on a tee figure 1. A report of 49 cases with a minimum 2year followup. A computer search of electronic medical files at our hospital resulted in 66 consecutive patients with a shoulder stabilization revision operation performed between january 1, 2007 and december 31, 2011. The incidence of anterior glenoid rim fractures has been reported to be up to 22% after first time anterior shoulder dislocation and up to 73% after recurrent dislocations 27. Injured capsulolabral structures or bony glenoid fragments typically do not heal anatomically and can result in recurrent instability manifested by repeat dislocations or subluxations 4, 5, 8. Use inferior capsular flap to repair bankart lesion. Intraoperative findings cases posterior capsuleligament lesion 2 intraarticular free body 1 slap lesion 6 enchondroma of the humeral head 1 fracturing of the anteroinferior glenoid rim 1 total 11 source. This leads to laxity of posterior band of the inferior glenohumeral ligament with posterior displacement of the humeral head as is the case with a bankart lesion, the trauma may be severe enough to involve the bony glenoid, resulting in an accompanying small flake.
A bankart lesion is an injury of the glenoid labrum due to an anteroinferior shoulder dislocation, often located in the 36 oclock position. Rehabilitation guidelines for slap lesion repair the anatomic configuration of the shoulder joint glenohumeral joint is often compared to a golf ball on a tee. Arthroscopic view from the posterior portal in the right shoulder. The american society of shoulder and elbow therapists. Bony bankart lesions have been associated with up to 30% of anterior dislocations 1 and consist of an avulsion fracture of the anterior glenoid rim. Files are available under licenses specified on their description page. It has been reported to be present in 40% to 90% of patients presenting with anterior shoulder instability, that is subluxation or dislocation. The anteriorinferior labrum is torn and frayed, which is known as a bankart lesion. The physician will make specific changes to the program as appropriate for an individual patient. Additionally, mri revealed 2 capsular stretch injuries in addition to the bankart and hillsachslesions. Arthroscopic doublepulley remplissage using a 2portal. Thirteen of fifteen patients with type iv or type v were failures in this study. Bankart repairanterior capsulorrhaphy rehabilitation guideline.
Original article arthroscopic versus open bankart repair in patients. Use superior flap to double thickness of capsule and eliminate excess capsular laxity. All structured data from the file and property namespaces is available under the creative commons cc0 license. Arthroscopic bankart repair anterior capsulorrhaphy procedure. Jul 18, 2019 perthes lesion a perthes lesion is a labroligamentous avulsion like a bankart, but with a medially stripped intact periosteum. This analogy is used because the articular surface of the round humeral head upper most part of the. Additionally, the labrum may slip off the face of the glenoid and no longer contributes to shoulder stability. Open latarjet procedure for failed arthroscopic bankart repair. It is an indication for surgery and often accompanied by a hillsachs lesion, damage to the posterior humeral head. Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension. Jul 18, 2015 the threshold of glenoid bone loss above which arthroscopic bankart repairs may fail has generally been accepted as glenoid width loss. This lesion is reported to be as high as 90% after a traumatic shoulder dislocation. The shoulder is a ball and socket joint, similar to the hip. A torn glenoid labrum results in shoulder instability.
The second most frequent type was hillsachs lesions, in 71. We detail a previously unreported case of a hagl lesion occurring in a shoulder with an intact arthrosopic bankart repair following an additional traumatic event. Grade ii or iv biceps involvement slap lesion repair grade ii. A bankart lesion is an injury to the labrum caused by shoulder dislocation 4. Anterior shoulder reconstruction with arthroscopic bankart repair. The pathology and treatment of recurrent shoulder dislocation of the shoulder. A type v lesion is a completely degenerated or absent complex.
Using medline pubmed, cochrane and embase databases we performed a search of all published articles. A hill sachs lesion occurs when the lesion to the labrum presents simultaneously puppy party. The bony lesions and glenoid bone loss was measured. The indication for revision surgery was recurrent dislocation or subluxation. In bankart repairs, the labral fragment is sutured back to the glenoid rim using suture anchors. Images were produced to provide en face views of the glenoid, allowing measurements. Hagl lesion occurring after successful arthroscopic. Furthermore, all studies excluded patients with bony pathology, often cited as 2030% glenoid loss or as an engaging hillsachs lesion, but only a few studies have described the method used to assess bony pathology in detail. Slap superior labrum, anterior and posterior is a lesion that begins posterior in the labrum and extends anteriorly, involving the anchor of the long head of the biceps brachii to the labrum. Repair of a slap lesion, which is an injury of the. A number of lesions are closely related have similar appearances, see anterior glenohumeral injury for discussion of the differences.
This is because the articular surface of the round humeral head is approximately four times greater than that of the relatively flat shoulder blade face glenoid fossa1 figure 1. Bankart ppt free download as powerpoint presentation. Pdf recurrent dislocation of the hip with a bankarttype. Each phase is adaptable based on the individual and special circumstances.
A typical feature seen in reformatted en face images of the glenoid fossa is a flattening of the anterior counter. Pdf arthroscopic bankart repair for the management of anterior. The posterior bankart procedure is performed to increase posterior stability of the shoulder. A bankart lesion is an injury of the anterior inferior glenoid labrum of the shoulder due to. Imaging methods for quantifying glenoid and hillsachs bone. Open latarjet procedure for failed arthroscopic bankart. Rehabilitation guidelines for anterior shoulder reconstruction with open bankart repair the anatomic configuration of the shoulder joint glenohumeral joint is often compared to a golf ball on a tee figure 1. It may result either from a traumatic glenohumeral dislocation or a direct trauma to the adducted arm. Technical guide and tips on the allarthroscopic latarjet. We present a 34yearold male patient with pain and limited. Video analysis of the mechanisms of shoulder dislocation in four elite rugby players. Anatomic repair of this subsequent injury resulted in an excellent outcome.