- Now let's talk a little bit
on how we would repair, surgically, this Bankart lesion.
This is an arthroscopic procedure
that does the following:
Let's just look at that torn labrum, okay?
So again, bony socket,
shoulder blade,
the labrum, the middle of the socket,
again the labrum in three dimension,
and the tear now is down here.
The tear being right here,
where the labrum is pulled off the bone.
How are we going to get this to heal?
Well we have to sew it together.
What do we use to sew it together?
Well we use this very tiny screw,
it's actually less than the size
of the tip of this pen, but I'm going to draw it big
so you just understand it.
Well, screw's got a head, it's got the shaft,
and then it's got the threads.
On this type of screw,
there are stitches attached to the head.
And I should mention that these screws also
are what we call bioabsorbable,
and that is, after a number of months,
the body reabsorbs them.
We take this screw, we place it into the bone,
so we're placing it into the bone,
so we're just seeing as the screw went in,
the head of the screw.
And then we have the stitches that are protruding from them,
and we pass those stitches around the labrum
and secure the labrum tear so that it heals.
And we'll often put two, and often three
of these screws to hold and repair that labrum.
So that's the repair of a Bankart lesion,
or a Bankart
repair
and this is called a
anchor screw
because it allows us
to anchor these tissues
back to the bone.
Our patient is a 27-year-old male
male
who injured himself at work
when he was lifting a heavy object
and he's literally dislocated his shoulder.
This fellow has had some chronic instability.
You can tell, what's happened is
his ligament has peeled off and retracted
against the glenoid about a good centimeter or more,
which is a half an inch,
and that's indicative of some chronic instability.
It's not just an acute--
whereas if this had been, say,
a wrestler that tore the labrum
or a football player that dislocated his shoulder
and had a fresh tear,
this would be a lot less fibrotic.
This tissue would be sitting here off the bone
but along this edge and not retracted
up medial to the glenoid.
Pretty good.
That's getting there.
We're definitely moving that in the right direction.
This is a suture.
So that's our--
we're passing our suture.
This is not the suture we're going to tie with,
this is a suture that we are going to pass with.
Good.
Now we're going to put our suture through this
and that's going to be the suture
we're going to use to tie.
Now we are going to feed that through the loop now.
There we go. Okay.
That's what we're doing, that's our extension.
Now we're going to put our implant in,
which is a little bony implant
made of material that dissolves.
We want to be above our repair stitch,
but not too low because we're going to
probably put a second anchor in it.
So here we are, right on the edge of the glenoid,
we can even cheat up a little if we want.
Mallet.
(crisply hammering with mallet)
And now we're going to drill a little tiny socket.
(drilling)
Now we tension this.
And this is the critical part here,
because we are just about to tie this down
but we want to pull our suture up.
See how that's coming closer?
See how that's cinching in?
That's why they call it a cinch lock,
and I can control that tension beautifully.
You're looking for that pleated tissue there.
And I'm just about to set my implant tension.
I'm holding the suture in one hand
and putting the implant up,
and I'm about to--
now I'm putting that implant in.
(hammering with mallet)
This fellow has good bone.
Textbook, gang, textbook.
Again, we're doing this through three little holes,
and it's really a nice repair.
You want to see that tension of that ligament.
That's really good.
And now Reese is going to cut these sutures for me.
I'll protect the rest of the repair site.
He's going to come in over that
and just cut them flush.
Back up just a little--
Yeah that's good. That's good.
And what that--
There's not suture knots, nothing.
Knotless anchors, knotless repairs, very--
are less dangerous to causing arthritis in the shoulder.
And now we're going to put our implant in.
What do you think, about right there?
- That's perfect.
(hammering with mallet)
- And we'll cut that.
And that's the second stitch in.
So you can see we've really--
I mean, look how.
We can't, there's no drive through sign anymore,
we've definitely helped this fellow.
If we didn't do another thing,
he's definitely a lot more stable than he was.
Ready?
We'll immobilize him in the sling for six weeks,
but he'll start some therapy and start some gentle motion.
You have symptoms where
you feel like your shoulder's unstable,
it's giving out, it's catching, it's locking
or it's changing in positions
or you feel like a giving way sensation,
that usually means you are having some shoulder instability,
and you should be seen, you know,
by an orthopedic surgeon that uses arthroscopic technique
to stabilize the shoulder.
And we're going to tie this suture knot down,
and that should do it for his repair.
It's much less painful, minimally invasive,
leaves less scarring and I think that
our results are very comparable,
if not better than the open procedures.
(upbeat music)