Shoulder dislocation – arthroscopic bipolar fixation (bankart+)

Definition and indication of arthroscopic fixation surgery:

If shoulder rehabilitation is not sufficient and recurrent shoulder dislocation episodes or relocation apprehension (cocking position, external rotation position 2) causing incapacitating discomfort persist, arthroscopic stabilization surgery on the shoulder must be considered.

When there is no excessively severe bone lesion and the patient doesn't practise any contact sport (rugby, judo, handball, volleyball, basketball), shoulder stabilization surgery by direct capsulo-ligamentous repair can be performed; this is known as Bankart procedure with posterior fixation or bipolar fixation.

Principle of arthroscopic bipolar fixation

This consists in repairing the lesions caused by dislocation both in front of and behind the shoulder as anatomically as possible, the surgeon also uses the term anatomic shoulder repair. This technique is an alternative to the arthroscopic Latarjet procedure using a bone transfer.

Video of shoulder surgery by arthroscopic bipolar fixation:

Video of arthroscopic shoulder surgery showing bipolar fixation procedure / Toulouse specialist

Treatment of recurrent dislocations by arthroscopic bipolar fixation

This shoulder surgery is performed on an outpatient basis, under regional and general anaesthesia.

For this procedure, the patient is in a decubitus lateral position. The optics are introduced in the shoulder joint to evaluate the lesions to the antero-inferior labrum, identify any damage to the superior labrum and/or biceps, explore the posterior capsular lesion and confirm any associated dent in the humerus.

Bankart lesion, tear of the antero-inferior labrum, CT arthrography of the shoulderTear of the antero-inferior labrum, shoulder arthroscopyinférieur, arthroscopie de l'épaule

 

The first stage of the procedure begins with a plication of the posterior capsule, at the posterior humerus; this is the posterior fixation. The surgeon positions two anchors whose ends will be tied together so as to restore posterior capsule tension. 

Posterior dent on humerus, Hill-Sachs lesion, CT arthrography of shoulderDebridement of Hill-Sachs lesion, shoulder arthroscopy

 

 

This shoulder surgery procedure then proceeds with the repair of the anterior lesions; this is the anterior fixation or Bankart procedure. After opening the rotator space, the surgeon freshens the lesion to the labrum so as to promote healing.
An anchor is then introduced, which makes it possible to restore tension of the inferior gleno-humeral ligament, a second anchor placed higher makes it possible to restore tension of the anterior capsule whilst preserving the medial gleno-humeral ligament.

The antero-inferior labrum being reattached, arthroscopic shoulder surgeryPosterior fixation, posterior capsular plication, shoulder arthroscopy

 

When a lesion of the superior labrum is found, a tenotomy-tenodesis of the biceps can be performed. At the end of the procedure, the surgical incisions are closed with absorbable sutures.

Shoulder recuperation after arthroscopic bipolar fixation

After surgery, the shoulder must be immobilized for 5 weeks. Specialized shoulder rehabilitation must be started immediately after surgery, and follow a specific protocol.

Active shoulder rehabilitation only starts the 4th week after surgery. Driving often resumes toward the end of the 2nd postoperative month.

Normal recovery spreads over 4 to 6 months, with maximal recovery of active articular range of motion toward the end of the 6th post-operative month, and maximal shoulder strength recovery toward the end of the 9th month after surgery. Contact sports such as rugby do not resume before the 6th month.

Rugby resumes 6 months after capsulo-ligamentous repair surgery