Technical Difficulties during Bankart repair Tips and Tricks

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Technical Difficulties during Bankart repairTips
and Tricks

• Manos Antonogiannakis
• Director
• Center for shoulder arthroscopy
• IASO General Hospital
• Athens, Greece

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• Arthroscopic instability repair
• is considered a difficult operation
• How to make it easier ?
• Follow always standard steps

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Tips and Tricks

• Anesthesia
• Patient positioning
• Surgeons Position
• Portals
• Haemostasis
• Instrumentation
• Suture management

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FIRST Have Good Friends around !
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Light General Anesthesia with Laryngeal Mask
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Plus Local Anesthesia
Scalene Block
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Examination Under Anesthesia
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Positioning the patient
Lateral decubitus My preferred position
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Patient Positioning
Padding bony prominences Beware of the neck
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Room Set up

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

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Keep the operating room cold to avoid fogging
butKeep the patient warm
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Beach Chair position
Equally suitable but ask those who use it for
tips and secrets tomorrow !!!
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Basic Arthroscopic ToolsHave them all ready from
the beginning
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Draping
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Arm DrapingBe careful with traction
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TractionNOT more than 4 Kgrs
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Instruments in side pocket easily available
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Is everything ready BEFORE starting ?
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The arthroscopic tower opposite the surgeon
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Commonly used tools arranged by the scrub nurse
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Skin Marking
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Before Entering the Scope

• Saline Backflow

Saline in
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Making the scope portal
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30º Scope Entrance
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Anterior Superior Portal
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Changing Outflow
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Making Anterior Inferior Portal
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Three Basic Portals
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Surgeons Position
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Working Team
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Scope at Anterior Superior Portal
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Bankart Hill Sachs
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View from Anterior Superior Portal
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Inverted Pear Estimation
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Inverted Pear Hill Sachs
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Checking Hill-Sachs
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Preparing the Lesion
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Preparing the lesion
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Drilling
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Anchor Placement
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Cannulated Tools
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Using Cannulated Tools
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Using Cannulated Tools
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Penetrating the capsule
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Simple Bankart Repair
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Separate Sutures
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Sutures front and back
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Holding Cannulas
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Marking Post Sutures
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Knot Tying
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If posterior laxity exists
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Posterior Anchors
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Remplissage Portal
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If Multidirectional laxity exists
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Remplissage
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Large Hill-Sachs
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Remplissage
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Rotator Interval Closure
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Our Series

• Sept 2005 today 94
• Anchors Double Loaded
• Mean FU 17 months
• Recurrences 3
• Recurrence rate 3.19

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Handball player 23y, 1st dislocation 21y,
total 3 Dislocations
Typical Bankart
No Considerable Glen Defect
Hill-Sachs
Typical Repair
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Handball player 23y, 1st dislocation 21y,
Left shoulder, Total 3 Dislocations
Typical Rehabilitation Program return to sports
9 months later but 15 months after the
operation.
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Handball player 23y, 1st dislocation 21y,
Left shoulder, Total 3 Dislocations
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Handball player 25y, 15 months after first
Bankart Repair
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Handball player 25y, 15 months after first
Bankart Repair

• HAGL repair

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Conclusions

• Have good environment
• Check everything before you start
• Get familiar with basic tools
• Make it simple
• Use common sense to solve problems

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Thank you