Arthroscopic Bankart repair with additional footprint fixation using the double-row technique at the 4 o'clock position anatomically restored the capsulolabral complex and showed good clinical results.

purposeTo investigate the clinical outcome and magnetic resonance imaging (MRI) findings after arthroscopic Bankart repair with additional double anchor footprint fixation (DAFF) at the 4 o'clock position, where the native footprint is widest anatomically, for recurrent anterior shoulder instability.

methodsForty-two patients (mean age 27.0 years) with recurrent anterior shoulder instability and without severe glenoid bone defects underwent arthroscopic Bankart repair with additional DAFF at the 4 o'clock position. Using three standard portals, single-row repair was performed at the 2, 3, and 5 o'clock positions, and DAFF with the suture bridging technique was conducted at the 4 o'clock position. MRI was performed preoperatively and at 6 months postoperatively. Patients with follow-up periods of ≥1 year were included in the present study and clinically evaluated at the final follow-up. The morphology at the 2 and 4 o'clock positions on radial MRI slices was compared between the preoperative and 6-month postoperative scans, and the footprint of the repaired capsulolabral complex at 6 months postoperatively was compared between the 2 and 4 o'clock positions.

resultsThe average follow-up period was 19.5 ± 6.2 months. The rates of dislocation recurrence and positive apprehension test results were 2.4 and 4.8%, respectively. External rotation was restricted by 3.5°. The University of California at Los Angeles and Rowe scores at the final follow-up were 34.5 ± 1.0 points and 97.2 ± 5.7 points, respectively, representing significant improvements over the preoperative scores (p < 0.01). Although the capsulolabral complex at 6 months postoperatively was firmly repaired at both the 2 and 4 o'clock positions compared to its preoperative state, the footprint of the restored capsulolabral complex was wider at the 4 o'clock position than at the 2 o'clock position (p < 0.01).

conclusionsAdditional DAFF at the 4 o'clock position improved the glenohumeral stability and function of the shoulder joint. This study suggests that this technique is a reliable and useful treatment for shoulder instability. LEVEL OF EVIDENCE: IV.