Rotator cuff muscular integrity after arthroscopic revision of a Bankart repair

Johannes Buckup; Frederic Welsch; Reinhard Hoffmann; Philip P Roessler; Karl F Schüttler; Thomas Stein

doi:10.1007/s00402-017-2831-7

Rotator cuff muscular integrity after arthroscopic revision of a Bankart repair

Arch Orthop Trauma Surg. 2018 Feb;138(2):155-163. doi: 10.1007/s00402-017-2831-7. Epub 2017 Nov 3.

Authors

Johannes Buckup¹, Frederic Welsch², Reinhard Hoffmann³, Philip P Roessler⁴, Karl F Schüttler⁵, Thomas Stein^{2

6}

Affiliations

¹ Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany. buckup@me.com.
² Department of Sports traumatology, Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany.
³ Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany.
⁴ Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
⁵ Department of Orthopaedics and Rheumatology, University Hospital Marburg, Baldingerstraße, 35043, Marburg, Germany.
⁶ Department of Sports Science, University of Bielefeld, Bielefeld, Germany.

PMID: 29101541
DOI: 10.1007/s00402-017-2831-7

Abstract

Introduction: Recurrent shoulder instability after arthroscopic Bankart repair is still a common complication. For primary Bankart repair studies have shown that the rotator cuff can recover completely. The ability of muscles to regenerate after arthroscopic revision Bankart repair (ARBR) has not been studied. Does the ARBR using a three-portal method allows complete muscle integrity compared with an uninjured imaging control group (ICG)?

Materials and methods: Twenty-two (1 female, 21 males) physically active patients (mean age at follow-up 28.5 ± 7.1 years; mean follow-up 27.5 months ± 8.5) were assessed. ARBR with a three-portal method was carried out in all patients according to previous primary arthroscopic stabilization of the shoulder (revision Bankart group). Muscle atrophy of the subscapularis muscle (SSC), supraspinatus muscle (SSP) and infraspinatus muscle (ISP) was assessed by making lateral and vertical measurements by magnetic resonance imaging (MRI). Fatty infiltration was detected by standardized assessment from variations in intensity. Detailed clinical examination of the rotator cuff was carried out. MRI assessment was compared with that of a control group of 22 healthy volunteers of same age and activity level (ICG).

Results: For the SSC, no muscle impairment was noted compared with the ICG [superior atrophy index (sAI_SSC), p = 0.439; inferior atrophy index (iAI_SSC), p = 0.555; superior fatty infiltration index (sFDI_SSC), p = 0.294; inferior fatty infiltration index (iFDI_SSC), p = 0.62]. In investigation of the SSP and ISP, fatty infiltration was not shown (FDI_SSP, p = 0.454; sFDI_ISP, p = 0.504), though persistent muscle atrophy was found even > 2 years after surgery compared with the ICG (AI_SSP, p = 0.0025; sAI_ISP, p = 0.0009; iAI_ISP, p = 0.0004).

Conclusion: ARBR using a three-portal method allowed good muscular integrity compared with the ICG, but with persistent slight muscular atrophy of the SSP and ISP.

Keywords: Arthroscopic revision of Bankart repair; Muscular atrophy; Muscular integrity; Rehabilitation.

MeSH terms

Adult
Arthroscopy / adverse effects*
Female
Humans
Joint Instability / physiopathology*
Male
Muscular Atrophy / etiology
Muscular Atrophy / physiopathology
Postoperative Complications / physiopathology*
Rotator Cuff / surgery*
Rotator Cuff Injuries
Shoulder Joint / physiopathology*
Young Adult