Modern concepts in arthroscopic Bankart repair.

The purpose of this report is to review recent advances in Bankart repair that allow it to be performed arthroscopically. Metallic implants in the form of staples, screws, or rivets were used initially, but problems with loosening of implants has prompted development of alternative devices and techniques. A modified form of the transglenoid suturing technique used in open Bankart repair has been used successfully but is associated with an increased risk of soft tissue complications. The use of absorbable tacks avoids some of the complications associated with this approach, but the ability to advance the capsule to reduce the volume is limited. Recently, the use of suture anchors has been described for arthroscopic Bankart lesion repair. However, the ability of these anchoring systems to advance and reduce the capsular volume is limited, and the arthroscopic techniques are technically demanding. One particularly innovative suture anchor system uses a bioabsorbable suture anchor with an integrated suture passing system. This self-contained implant allows multiple passes with suture through the capsule, followed by attachment to the glenoid with the bioabsorbable anchor. This procedure allows the capsule to be advanced by passing suture through before it is anchored to the glenoid, thereby reducing capsular volume to help restore shoulder stability.