AANA Lab Course 906- Técnicas Avanzadas de Cirugía de Hombro-El gold standard: Indicaciones y técnica de la reparación capsulolabral para la inestabilidad anterior de hombro-Xavier A. Duaralde, M.D.

El gold standard: Indicaciones y técnica de la reparación capsulolabral para la inestabilidad anterior de hombro-Xavier A. Duaralde, M.D.

Back to course

Pdf Summary

The Bankart repair technique, presented by Dr. Xavier A. Duralde, focuses on restoring the anteroinferior labrum to the glenoid rim and re-establishing proper tension in the inferior glenohumeral ligament (IGHL), often involving tissue advancement or plication. Comprehensive management addresses all pathology contributing to shoulder instability, including Bankart lesions, SLAP tears, capsular stretching, rotator interval lesions, HAGL injuries, posterior labral tears, and associated osteoligamentous damage such as Hill-Sachs defects, ALPSA, GLAD lesions, and glenoid bone loss.<br /><br />Surgical preparation involves diagnostic arthroscopy to evaluate labral, bony, and articular tissues, including the "drive-through" sign for instability assessment. Important tools include soft tissue resectors, bipolar electrodes, cannulas, arthroscopes (30° or 70°), suture retrievers, knot pushers, and various anchors (traditional, knotless, and all-suture types).<br /><br />Both the beach chair and lateral decubitus positions are acceptable for the procedure, with beach chair facilitating conversion to open surgery and lateral decubitus offering better inferior access. Under anesthesia, evaluation determines instability direction and severity.<br /><br />The arthroscopic technique uses multiple portals—posterior for optics, anterosuperior, anterolateral, and sometimes trans-subscapularis. The labrum is mobilized and the glenoid neck prepared to receive anchors placed at the glenoid edge. Sutures are passed around the labrum and tied with lateral, sliding, or locking knots, taking care to avoid knot contact with the articular surface.<br /><br />Complex lesions require a sequential repair approach, often starting posterior-inferiorly and moving anteroinferiorly to superiorly. For bony fragment repairs, anchors are placed similarly but incorporate the bone fragment. Successful Bankart repair restores normal anatomy and tension of the glenoid-labrum-IGHL complex, addressing all causes of instability to prevent recurrence.<br /><br />Preoperative investigation, thoughtful patient positioning, thorough evaluation, and readiness with all instruments optimize surgical outcomes in Bankart repairs.

Asset Caption

(The Gold Standard: Indications and Technique in Capsulolabral Repair for Anterior Shoulder Instability)

Keywords

Bankart repair

anteroinferior labrum

glenoid rim

inferior glenohumeral ligament

shoulder instability

arthroscopic technique

labral tears

HAGL injuries

Hill-Sachs defects

suture anchors