Bankart Lesion: Comparison between Open and Arthroscopic Techniques

The study of shoulder instability is describe in detail since Hippocrates. The anatomy, mechanisms and different forms of treatment come to the generations being modified and perfected. The gleno humeral joint is the most mobile of the human body and is thus the most susceptible to dislocations, with an incidence of 17 cases per 100,000 inhabitants per year, with the previous instability accounting for about 85% of the cases [1,2].


Introduction
The study of shoulder instability is describe in detail since Hippocrates. The anatomy, mechanisms and different forms of treatment come to the generations being modified and perfected. The gleno humeral joint is the most mobile of the human body and is thus the most susceptible to dislocations, with an incidence of 17 cases per 100,000 inhabitants per year, with the previous instability accounting for about 85% of the cases [1,2].
The congruence of this complex joint is maintained by static stabilizers: bone compliance, glenoid lip, adhesion cohesion effect, joint capsule, glenohumeral and coracoumeral ligaments. Dynamic stabilizers: cuff rotator cuff (subscapular, supraspinatus, infraespinal and minor round), scapular muscles (anterior serratus, trapezius, latus of the dorsum, rhomboids and lift of the scapula) and long biceps [3]. The importance of the stability achieved by the anterior lower edge of the glenoid lip was first described in 1906 by Phertes [4]. In 1939Bankart describes for medical community its surgical technique based on the open repair of the glenohumeral dislocation [5].
Surgical Treatment is indicate in cases of post-traumatic glenoumeral instability with open or arthroscopic technique. We specifically in cases has glenolabial injury, Hill-Sachs <25% and anteroposterior impairment Gives long Gives lower surface over one third of the overall diameter glenoidque [6,7]. The objective of this study is to evaluate the epidemiology and the postoperative results obtained after one year comparing these two techniques, open and arthroscopic.

Material and Methods
A retrospective study of 66 patients submitted to Bankart's surgery between January 2009 and December 2013 at the Rio Grande do Sul Institute of Orthopedics and Traumatology (IOT-RS). Of these, 20 were operated by open technique and 46 by arthroscopic technique. Epidemiological aspects were evaluated through the analysis of medical records and telephone contact. The results obtained after one year of postoperative were analyzed using the functional score criteria for Carter-Rowe shoulder instability. For the comparison methodology, the study was done for independent groups.  Arthroscopic technique is performed by general anesthesia associated with brachial plexus block. Patient in the beach chair position and the operated limb was submitted to traction as required in the intraoperative period. Posterior portal for intraarticular visualization with saline solution infusion. Bankart lesion is identified and debridement of the glenoid bone border and release of the medialized capsule and labrum is realized. We use multiple bio-absorbable anchors according to the extent of the lesion for capsular-labral repair. Centering of the humeral head on the glenoid must be observe after complete de repair, demonstrating good positioning. Skin incisions are close with 4-0 nylon.
Open technique is performed by general anesthesia too, associated with brachial plexus block. Deltopectoral approach is preferred. Tenotomy of the subscapular tendon is performed 1cm medial to the lesser tuberosity along with the joint capsule. Identification of the Bankart lesion, debridement of the glenoid bone and release of the medialized capsule and labrum were performed. Suture metallic anchors were used for labral reconstruction and capsular shift retencionament. Subscapular tendon repair is performed with braided non-absorbable suture. At the end performed hemostasis and suture by plans up to the skin.   e. After 1-2 weeks exercises to gain range of motion and up to 3 months to avoid exercises in zone of instability (maximum external rotation, abduction and extension of the shoulder). f. After 3 months, from the date of surgery, exercises to gain strength of the rotator cuff and scapular girdle, starting with isometric and after active.
g. Return to sports activities, depending on the degree of contact, in 6-8 months.
The work of Fabbriciani [16] Table 6: T-test correlation for independent groups, significant analysis and interpretation. Regarding the mobility criterion, the patients operated by arthroscopic presented better results. The work of Mohtadi [16] JBJS -2014 with a Level I Sample evidence how we recurrence brainy 11% and 23% open procedures That We arthroscopic procedures and Prove how brainy or functional outcome no statistical significance. In this study, the relapse in the cases operated by arthroscopy was also superior to the open surgery and the final functional result was not statistically significant difference between both techniques ( Figure 1& 2).

Conclusion
It is possible to conclude with this work that: a. Both techniques present good results, although few works in the literature compare homogeneous groups of patients.
b. The possibility of further episodes of dislocation is apparently greater in the arthroscopic technique.
c. The arthroscopic technique seems to have a better result when compared to mobility.