Technical Difficulties during Bankart repair

Tips and Tricks

Manos Antonogiannakis

Director

Center for shoulder arthroscopy

IASO General Hospital

Athens, Greece

Arthroscopic instability repair

is considered a difficult operation

How to make it easier ?

Follow always standard steps

Tips and Tricks

• Anesthesia

• Patient positioning

• Surgeons Position

• Portals

• Haemostasis

• Instrumentation

• Suture management

FIRST: Have Good Friends around !

Light General Anesthesia with Laryngeal Mask

Plus Local Anesthesia

Scalene Block

Examination Under Anesthesia

Positioning the patient

Lateral decubitus My preferred position

Patient Positioning

Padding bony prominences Beware of the neck

Room Set up

Lateral decubitus allows easy access to the anterior and posterior part of the joint

Keep the operating room cold to avoid fogging

butKeep the

patient warm

Beach Chair position

Equally suitable but ask those who use it for tips and secrets tomorrow !!!

Basic Arthroscopic ToolsHave them all ready from the beginning

Draping

Arm DrapingBe careful with traction

Traction:NOT more than 4 Kgrs

Instruments in side pocket –easily available

Is everything ready BEFORE starting ?

The arthroscopic tower opposite the surgeon

Commonly used tools arranged by the scrub nurse

Skin Marking

Before Entering the Scope

Saline Backflow

Saline in

Making the scope portal

30º Scope Entrance

Anterior Superior Portal

Changing Outflow

Making Anterior Inferior Portal

Three Basic Portals

Surgeons’ Position

Working Team

Scope at Anterior Superior Portal

Bankart – Hill Sachs

View from Anterior Superior Portal

Inverted Pear Estimation

Inverted Pear & Hill Sachs

Checking Hill-Sachs

Preparing the Lesion

Preparing the lesion

Drilling

Anchor Placement

Cannulated Tools

Using Cannulated Tools

Using Cannulated Tools

Penetrating the capsule

Simple Bankart Repair

Separate Sutures

Sutures front and back

Holding Cannulas

Marking Post Sutures

Knot Tying

If posterior laxity exists

Posterior Anchors

Remplissage Portal

If Multidirectional laxity exists

Remplissage

Large Hill-Sachs

Remplissage

Rotator Interval Closure

Our Series

• Sept 2005 – today: 94

• Anchors Double Loaded

• Mean FU: 17 months

• Recurrences: 3

• Recurrence rate: 3.19%

Handball player: 23y, 1st dislocation 21y, total 3 Dislocations

Typical Bankart No Considerable Glen Defect

Hill-Sachs Typical Repair

Typical Rehabilitation Program

…return to sports 9 months later

…but 15 months after the operation….

Handball player: 23y, 1st dislocation 21y, Left shoulder, Total 3 Dislocations

Handball player: 23y, 1st dislocation 21y, Left shoulder, Total 3 Dislocations

Handball player: 25y, 15 months after first Bankart Repair

HAGL repair

Handball player: 25y, 15 months after first Bankart Repair

Conclusions

• Have good environment

• Check everything before you start

• Get familiar with basic tools

• Make it simple

• Use common sense to solve problems

Thank you