JSES International 4 (2020) 63e67

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JSES International
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Bankart repair alone in combined Bankart and superior labral

anterior-posterior lesions preserves range of motion without
compromising joint stability
Yoshiaki Itoigawa, MD, PhD a,b,*, Alexander W. Hooke a, John W. Sperling, MD c,
Scott P. Steinmann, MD c, Kristin D. Zhao, PhD d, Eiji Itoi, MD, PhD e, Kai-Nan An, PhD a
a
Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA
b
Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
c
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
d
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
e
Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan

a r t i c l e i n f o Hypothesis: The purpose was to investigate joint stability and range of motion after a Bankart repair
without superior labral anterior-posterior (SLAP) repair (termed “Bankart repair”) and after combined
Keywords: Bankart and SLAP repairs (termed “combined repair”).
Shoulder Methods: Eight fresh-frozen shoulders were used. Combined Bankart and SLAP lesions were created
glenoid labrum (10- to 6-o'clock positions). The labrum and capsule were repaired at the 2-o'clock, 3:30 clock-face, and
instability
5-o'clock positions in the Bankart repair group and at the 11-o'clock, 1-o'clock, 2-o'clock, 3:30 clock-face,
biomechanics
and 5-o'clock positions in the combined repair group. The internal- and external-rotation ranges of
Bankart repair
SLAP repair motion were determined with the arm positioned at 0
and 60
of glenohumeral abduction. The rotation
combined Bankart and SLAP angle was defined when a constant torque of 200 N-mm was applied. Joint stability was measured with a
custom stability-testing device. The peak translational force in the anterior-posterior direction was
Level of evidence: Basic Science Study; measured with the arm at the end range of external rotation.
Biomechanics Results: External rotation angles were greater at 0
and 60
of abduction in the Bankart repair group
than in the combined repair group (0
of abduction, P < .01; 60
of abduction, P < .05). The internal
rotation angle was greater at 60
of abduction in the Bankart repair group than in the combined repair
group (P < .01). The stability between the 2 groups was not significantly different (P ¼ .60).
Conclusion: In patients with combined Bankart and SLAP lesions and the need for a wide range of
motion, a Bankart repair alone may provide a greater range of motion without compromising the joint
stability at the end range compared with a combined repair.
© 2019 The Authors. Published by Elsevier Inc. on behalf of American Shoulder and Elbow Surgeons.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).

A Bankart lesion occurs after a traumatic anterior dislocation of combined Bankart and SLAP lesions ranges from 10.4% to 57% in
the shoulder in most patients,4,18 and some Bankart lesions are patients with recurrent dislocation.6,7,13,15,20,29,31,37 Therefore,
concomitant with superior labral anterior-posterior (SLAP) lesions. because these lesions are not rare, it is important to establish the
Common symptoms of SLAP lesions include pain, locking, and most effective treatment option for combined Bankart and SLAP
catching sensations. These lesions are frequent in athletes who lesions.
throw overhand, such as baseball players.6 The incidence rate of A SLAP tear is a common labral pathology that leads to shoulder
pain and instability. These lesions were categorized into 4 types by
Snyder et al.32 Type II and type IV SLAP lesions cause instability at
This study was approved by the Mayo Clinic Biospecimens Committee (no. 13-
001414). the origin of the biceps long head, requiring repair. Most SLAP le-
Portions of this article were presented in abstract form at the Orthopedic Research sions occur as isolated injuries,14 but those that occur with Bankart
Society Meeting, Orlando, Florida, USA, March 5-8, 2016. This study was chosen as lesions were classified as type V SLAP lesions by Maffet et al.21 If the
best abstract no. 16 of the Japan Shoulder Society, 2017. severity and extension of the labral lesion continue to worsen with
* Corresponding author: Yoshiaki Itoigawa, MD, PhD, Department of Orthopaedic
time, the risk of recurrent dislocation increases.7 When a SLAP
Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba,
Japan, 279-0021. lesion occurs in combination with a Bankart lesion in a patient with
E-mail address: [email protected] (Y. Itoigawa). recurrent dislocation, the shoulder joint must be stabilized with a

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2666-6383/© 2019 The Authors. Published by Elsevier Inc. on behalf of American Shoulder and Elbow Surgeons. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
64 Y. Itoigawa et al. / JSES International 4 (2020) 63e67

Bankart repair.6,28,31,33,34 For this surgical treatment, some authors superior and inferior aspects of the glenoid rim, while the labrum
have reported that combined Bankart and SLAP repairs had favor- was pulled up with forceps. When the wires were parallel to the
able clinical results.2,6,28,31,34 Alternatively, other investigators have floor in both directions, the glenoid articular surface was consid-
suggested that Bankart repair alone, without SLAP repair, showed ered accurately parallel to the floor.36
satisfactory results and that the combined repair might be associ-
ated with a decreased range of motion.1,7,33 However, no cadaveric Surgical procedure
studies have investigated the possible mechanical benefits of
concomitantly repairing SLAP lesions and Bankart lesions. FiberWire sutures (No. 2; Arthrex, Naples, FL, USA) were passed
The purpose of this study was to investigate the joint stability through 1 cm of the anterior labrum and capsule. A transosseous
and range of motion in cadaveric shoulders after a Bankart repair suture technique (Fig. 1) was used to repair lesions at the 2-o'clock,
without SLAP repair (termed “Bankart repair”) and after combined 3:30 clock-face, and 5-o'clock positions in the Bankart repair group
Bankart and SLAP repairs (termed “combined repair”). We hy- and at the 11-o'clock, 1-o'clock, 2-o'clock, 3:30 clock-face, and
pothesized that SLAP repair for combined lesions would decrease 5-o'clock positions in the combined repair group. All knots were
range of motion. tied with a sliding-locking knot (SMC knot), followed by 3 half-
hitches on alternating posts. Bankart repair and combined repair
Methods were performed in all 8 shoulders. After the range of motion and
joint stability were measured for 1 repair procedure, the other
Specimen preparation repair procedure was performed and the range of motion and joint
stability were again measured. The experimental procedures were
We used 8 fresh-frozen shoulders from 4 men and 4 women; the conducted in an alternating fashion; the Bankart repair was tested
mean age at death was 65 years (range, 50-81 years). The shoulders first in odd-numbered specimens, and the combined repair was
were screened for rotator cuff tears, biceps tendon injury, labral tested first in even-numbered specimens.
tears, and radiologic evidence of moderate to severe glenohumeral
osteoarthritis. The subcutaneous soft tissues were removed by Testing apparatus
dissection, whereas the rotator cuff, labrum, and joint capsule were
maintained. The Bankart lesion model was made as follows: While The testing device consisted of a 6-component load cell (JR3,
observing from outside the joint, we first separated the labrum Woodland, CA, USA) mounted on a motorized x-y table (Fig. 2). The
from the scapula at approximately the 4-o'clock position in the x- and y-axes were defined as the anterior-posterior and superior-
right shoulder. Next, the lesion was accurately spread in the su- inferior directions, respectively, and the z-axis was defined as the
perior and inferior direction while we observed the inside of the medial-lateral direction. A 50-N medial compression force was
joint. Finally, a Bankart lesion (2- to 6-o'clock positions in the right applied to the humeral head by a pneumatic cylinder. The specific
shoulder) and a SLAP lesion (10- to 2-o'clock positions in the right value of 50 N was determined based on previous studies.9,16,19,35
shoulder) were created by elevating the labrum subperiosteally
from the glenoid from the 10- to 6-o'clock positions. All procedures Measurements of range of motion
were performed by an open technique, not arthroscopically. The
scapula body was removed, and the glenoid was potted in bone The internal and external axial ranges of motion were deter-
cement that was attached to a custom mechanical testing device. To mined with the arm positioned at 0
and 60
of glenohumeral
accurately orient the glenoid articular surface parallel to the floor, 2 abduction (approximately 0
and 90
of arm abduction relative to
Kirschner wires were passed through the glenoid neck before the trunk). The range-of-motion angle was determined by the po-
testing,35 1 parallel to a line connecting the anterior and posterior sition of the arm when a constant torque of 200 N-mm was applied.
aspects of the glenoid rim and 1 parallel to a line connecting the The angles were measured with a manual goniometer and a

Figure 1 Surgical procedures used to repair combined Bankart and superior labral anterior-posterior (SLAP) lesions. BT, biceps tendon; AIGHL, anteroinferior glenohumeral ligament.
 Y. Itoigawa et al. / JSES International 4 (2020) 63e67 65

Figure 2 Measurement of joint stability. (A) The custom mechanical testing device had a load cell with 6 df that was mounted on a motorized x-y table. (B) The range of motion was
measured using a digital torque wrench. Then, after the digital torque wrench was removed, the joint stability of the mounted cadaveric shoulder was investigated using a custom
mechanical testing device.

uniaxial torque cell linked to a digital torque wrench (LCM Systems, the combined repair and Bankart repair were 19.4
(SD, 10.1
) and
Newport, UK), according to a previously described method.11 The 19.6
(SD, 10.6
), respectively, at 0
of abduction and 9.4
(SD, 14.5
)
neutral orientation of the humeral shaft was determined by using and 16.7
(SD, 12.1
), respectively, at 60
of abduction. The internal-
the location of the bicipital groove. rotation range of motion between the 2 groups was not signifi-
cantly different at 0
of abduction. However, the internal-rotation
Measurements of stability range of motion was significantly greater at 60
of abduction with
the Bankart repair than with the combined repair (P < .01).
The x-y table was positioned so that the relative movement of
the humeral head against the glenoid was in the anterior-posterior Stability test
direction. The humeral shaft was positioned at 60
of glenohumeral
abduction (approximately 90
of arm abduction relative to the The peak translational forces for the Bankart repair and com-
trunk) and the maximal external rotation angle (when a constant bined repair were 82.3 N (SD, 10.9 N) and 79.1 N (SD, 14.3 N),
torque of 200 N-mm was applied). The humeral head was trans- respectively (Fig. 4). This difference was not significant (P ¼ .60).
lated in the anterior direction for 10 mm at a rate of 2.0 mm/s. All
specimens were tested with this 10-mm displacement protocol,9,36
Discussion
and only anterior stability was evaluated to avoid damaging the
repaired capsule with multiple rounds of testing. Finally, the peak
The combined repair significantly decreased the range of motion
force at maximal translation was measured.
compared with the Bankart repair alone; in addition, we observed
no difference in anterior stability between the 2 repair methods.
Statistical methods Clinically, other authors have suggested that combined Bankart and
SLAP repair might be associated with a decreased range of mo-
We used the paired t test to determine significant differences tion.33 Although a wide range of motion was needed for overhead
between the combined repair and Bankart repair. P < .05 was throwing athletes such as baseball players,22 the previous reports
considered statistically significant. Statistical analysis was per- showed that it was difficult to let the patients return to their pre-
formed with JMP software (version 10.0; SAS Institute, Cary, NC, vious level of activity after SLAP repair because of a decrease in the
USA).

Results

Range of motion

The external-rotation ranges of motion with the combined

repair and Bankart repair were 39.1
(standard deviation [SD],
20.9
) and 51.8
(SD, 23.2
), respectively, at 0
of abduction and
53.3
(SD, 26.9
) and 60.6
(SD, 28.0
), respectively, at 60
of
abduction. The external-rotation range of motion was significantly
greater at both levels of abduction with the Bankart repair than
with the combined repair (0
of abduction, P < .01; 60
of abduc- Figure 3 External- and internal-rotation ranges of motion. *Significance at P < .05.
tion, P < .05) (Fig. 3). The internal-rotation ranges of motion with **Significance at P < .01. The error bars show standard deviations.
66 Y. Itoigawa et al. / JSES International 4 (2020) 63e67

through the rotator cuff and scapular positions; however, they

facilitate standardization of testing and limit the number of vari-
ables tested.17 Instead of muscle force, a compression force of 50 N
was applied. According to previous cadaveric studies, 50 N of
compression force is sufficient to measure glenohumeral trans-
lation in cadaveric shoulders.9-11,19,36 Third, the combined Bankart
and SLAP lesions were created experimentally on cadaveric
shoulders. Although the anterior capsule and labrum were clini-
cally elongated after dislocation of the shoulder joint, the cadavers
had an intact labrum and capsule. However, obtaining a group of
cadaveric shoulders with anterior instability was not possible.
Fourth, all specimens were tested for stability by translating the
humeral head by 10 mm. This translation value was selected to
avoid damaging the soft tissues around the shoulder. Fifth, we used
Figure 4 Stability test results. Peak translational forces did not differ between Bankart a transosseous suture technique for the labral repair, whereas most
repair (ie, Bankart repair without superior labral anterior-posterior repair) and com- surgeons commonly use suture anchors.6,28,31,33,34 We used the
bined repair (ie, Bankart repair with superior labral anterior-posterior repair). The error
transosseous technique because we had to perform surgical pro-
bars show standard deviations.
cedures twice (Bankart repair and combined repair) and assess
outcomes twice for each specimen. The range of motion and sta-
range of motion.12,30 If a patient with combined Bankart and SLAP bility in this setting may not be the same as what would occur
lesions were an overhead throwing athlete, a Bankart repair alone under typical clinical conditions. Sixth, we did not measure the
might be preferable to avoid the decreased range of motion. range of motion and stability before the Bankart lesion or Bankart
In this study, the difference in joint stability between the and SLAP lesions were made; therefore, they could not be
Bankart repair and combined repair was not significant. Several compared with those in normal shoulders.
biomechanical studies have evaluated joint stability after SLAP
repair.24-26,29 Mihata et al26 reported that type II SLAP repair did not Conclusion
restore anterior shoulder stability at 60
of glenohumeral abduc-
tion. Excessive humeral external rotation can cause a type II SLAP Although there was no difference in anterior stability between
lesion5 and anterior capsular elongation,25 which can result in the Bankart repair group and the combined repair group at the end
shoulder instability.26 In our study, SLAP repair did not affect range, the Bankart repair group had a significantly greater range of
shoulder stability at 60
of glenohumeral abduction (90
of arm motion than the combined repair group. For patients with com-
abduction relative to the trunk) at the end-range position, where bined Bankart and SLAP lesions and the need for a wide range of
the anterior shoulder can be dislocated. In this position, the motion, a Bankart repair alone may provide greater range of motion
anterior-inferior capsule, including the inferior glenohumeral lig- without compromising the joint stability at the end range
ament, restrains the anterior translation of the humerus,11 and this compared with a combined repair.
capsule was repaired in both groups in our study. Therefore, the
Bankart repair was more important and the SLAP repair was not Disclaimer
associated with shoulder instability at the end-range position.
We noted that the SLAP repair was associated with a significant This supported by the Mayo Foundation, Juntendo University
decrease in the range of motion. Anchor placement for repair is School of Medicine Alumni Scholarship, and Grant-in-Aid for Sci-
probably the most important factor to affect the range of motion. entific Research (C) (no. 18K09081). The funders were not involved
Although postoperative stiffness after SLAP repair may be multi- in data collection, data analysis, or the preparation or editing of the
factorial, the middle glenohumeral ligament can be tightened with manuscript.
repair of the anterior and superior labrum; thus, repair of a sub- The authors, their immediate families, and any research foun-
labral hole (a normal variant of the labrum) may be associated dations with which they are affiliated have not received any
with a limited range of motion.3,8,15 In addition, the SLAP lesion financial payments or other benefits from any commercial entity
was fixed at the 11- and 1-o'clock positions, a common method of related to the subject of this article.
repair.12 Morgan et al27 recommended that 2 anchors be used to
fix the posterosuperior labrum because fixing the anterosuperior References
labrum offers no biomechanical advantage. However, McCulloch
et al23 reported that fixation of the anterosuperior labrum 1. Aydin N, Unal MB, Asansu M, Tok O. Concomitant SLAP repair does not influ-
decreased the external-rotation range of motion. On the other ence the surgical outcome for arthroscopic Bankart repair of traumatic shoul-
hand, Aydin et al,1 retrospectively comparing the clinical results of der dislocations. J Orthop Surg (Hong Kong) 2017;25: 2309499017718952.
https://doi.org/10.1177/2309499017718952.
isolated Bankart repair vs. combined Bankart and SLAP repair, 2. Baker CL III, Romeo AA. Combined arthroscopic repair of a type IV SLAP tear and
reported that there were no significant differences in the recur- Bankart lesion. Arthroscopy 2009;25:1045e50. https://doi.org/10.1016/
rence rate and the range of motion. Further studies are needed to j.arthro.2009.04.075.
3. Branch TP, Lawton RL, Iobst CA, Hutton WC. The role of glenohumeral capsular
determine a relationship between the suture anchor placement ligaments in internal and external rotation of the humerus. Am J Sports Med
and stiffness. 1995;23:632e7.
Our study has some limitations. First, because we had little in- 4. Burkart AC, Debski RE. Anatomy and function of the glenohumeral ligaments in
anterior shoulder instability. Clin Orthop Relat Res 2002:32e9. https://doi.org/
formation about the medical history or any symptoms of the pa-
10.1097/00003086-200207000-00005.
tients from whom the cadaveric shoulders were obtained, the 5. Burkhart SS, Morgan CD. The peel-back mechanism: its role in producing and
shoulders may not have been completely healthy, although extending posterior type II SLAP lesions and its effect on SLAP repair rehabil-
macroscopic and radiologic examinations did not identify any ab- itation. Arthroscopy 1998;14:637e40.
6. Cho HL, Lee CK, Hwang TH, Suh KT, Park JW. Arthroscopic repair of combined
normalities. Second, cadaveric fixed-scapula models may not fully Bankart and SLAP lesions: operative techniques and clinical results. Clin Orthop
capture the dynamic forces exerted on the glenohumeral joint Surg 2010;2:39e46. https://doi.org/10.4055/cios.2010.2.1.39.
 Y. Itoigawa et al. / JSES International 4 (2020) 63e67 67

7. Hantes ME, Venouziou AI, Liantsis AK, Dailiana ZH, Malizos KN. Arthroscopic 23. McCulloch PC, Andrews WJ, Alexander J, Brekke A, Duwani S, Noble P. The
repair for chronic anterior shoulder instability: a comparative study between effect on external rotation of an anchor placed anterior to the biceps in type 2
patients with Bankart lesions and patients with combined Bankart and superior SLAP repairs in a cadaveric throwing model. Arthroscopy 2013;29:18e24.
labral anterior posterior lesions. Am J Sports Med 2009;37:1093e8. https:// https://doi.org/10.1016/j.arthro.2012.06.021.
doi.org/10.1177/0363546508331139. 24. McMahon PJ, Burkart A, Musahl V, Debski RE. Glenohumeral translations are
8. Huri G, Hyun YS, Garbis NG, McFarland EG. Treatment of superior labrum increased after a type II superior labrum anterior-posterior lesion: a cadaveric
anterior posterior lesions: a literature review. Acta Orthop Traumatol Turc study of severity of passive stabilizer injury. J Shoulder Elbow Surg 2004;13:
2014;48:290e7. https://doi.org/10.3944/AOTT.2014.3169. 39e44. https://doi.org/10.1016/S1058274603002477.
9. Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on 25. Mihata T, Lee Y, McGarry MH, Abe M, Lee TQ. Excessive humeral external
anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. rotation results in increased shoulder laxity. Am J Sports Med 2004;32:
J Bone Joint Surg Am 2000;82:35e46. 1278e85. https://doi.org/10.1177/0363546503262188.
10. Itoigawa Y, Hooke AW, Sperling JW, Steinmann SP, Zhao KD, Yamamoto N, 26. Mihata T, McGarry MH, Tibone JE, Fitzpatrick MJ, Kinoshita M, Lee TQ.
et al. Repairing the capsule to the transferred coracoid preserves external Biomechanical assessment of type II superior labral anterior-posterior (SLAP)
rotation in the modified Latarjet procedure. J Bone Joint Surg Am 2016;98: lesions associated with anterior shoulder capsular laxity as seen in throwers: a
1484e9. https://doi.org/10.2106/JBJS.15.01069. cadaveric study. Am J Sports Med 2008;36:1604e10. https://doi.org/10.1177/
11. Itoigawa Y, Itoi E. Anatomy of the capsulolabral complex and rotator interval 0363546508315198.
related to glenohumeral instability. Knee Surg Sports Traumatol Arthrosc 27. Morgan RJ, Kuremsky MA, Peindl RD, Fleischli JE. A biomechanical comparison
2016;24:343e9. https://doi.org/10.1007/s00167-015-3892-1. of two suture anchor configurations for the repair of type II SLAP lesions
12. Kibler WB, Sciascia A. Current practice for the surgical treatment of SLAP le- subjected to a peel-back mechanism of failure. Arthroscopy 2008;24:383e8.
sions: a systematic review. Arthroscopy 2016;32:669e83. https://doi.org/ https://doi.org/10.1016/j.arthro.2007.09.014.
10.1016/j.arthro.2015.08.041. 28. Ozbaydar MU, Tekin C, Kocabas R, Altun M. [Arthroscopic repair of combined
13. Kim DS, Yi CH, Yoon YS. Arthroscopic repair for combined Bankart and superior superior labrum anterior posterior and Bankart lesions]. Acta Orthop Trau-
labral anterior posterior lesions: a comparative study between primary and matol Turc 2006;40:134e9 (in Turkish).
recurrent anterior dislocation in the shoulder. Int Orthop 2011;35:1187e95. 29. Panossian VR, Mihata T, Tibone JE, Fitzpatrick MJ, McGarry MH, Lee TQ.
https://doi.org/10.1007/s00264-011-1229-3. Biomechanical analysis of isolated type II SLAP lesions and repair. J Shoulder
14. Kim TK, Queale WS, Cosgarea AJ, McFarland EG. Clinical features of the Elbow Surg 2005;14:529e34. https://doi.org/10.1016/j.jse.2004.11.002.
different types of SLAP lesions: an analysis of one hundred and thirty-nine 30. Provencher MT, McCormick F, Dewing C, McIntire S, Solomon D. A prospective
cases. J Bone Joint Surg Am 2003;85:66e71. analysis of 179 type 2 superior labrum anterior and posterior repairs: out-
15. Kuhn JE, Huston LJ, Soslowsky LJ, Shyr Y, Blasier RB. External rotation of the comes and factors associated with success and failure. Am J Sports Med
glenohumeral joint: ligament restraints and muscle effects in the neutral and 2013;41:880e6. https://doi.org/10.1177/0363546513477363.
abducted positions. J Shoulder Elbow Surg 2005;14:39Se48S. https://doi.org/ 31. Sayde WM, Cohen SB, Ciccotti MG, Dodson CC. Return to play after type II
10.1016/j.jse.2004.09.016. superior labral anterior-posterior lesion repairs in athletes: a systematic re-
16. Lazarus MD, Sidles JA, Harryman DT II, Matsen FA III. Effect of a chondral-labral view. Clin Orthop Relat Res 2012;470:1595e600. https://doi.org/10.1007/
defect on glenoid concavity and glenohumeral stability. A cadaveric model. s11999-012-2295-6.
J Bone Joint Surg Am 1996;78:94e102. 32. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the
17. Limpisvasti O, Yang BY, Hosseinzadeh P, Leba T-B, Tibone JE, Lee TQ. The effect shoulder. Arthroscopy 1990;6:274e9.
of glenohumeral position on the shoulder after traumatic anterior dislocation. 33. Takase K. Risk of motion loss with combined Bankart and SLAP repairs. Or-
Am J Sports Med 2008;36:775e80. https://doi.org/10.1177/03635465 thopedics 2009;32. https://doi.org/10.3928/01477447-20090624-05.
07312163. 34. Warner JJ, Kann S, Marks P. Arthroscopic repair of combined Bankart and su-
18. Lintner SA, Speer KP. Traumatic anterior glenohumeral instability: the role of perior labral detachment anterior and posterior lesions: technique and pre-
arthroscopy. J Am Acad Orthop Surg 1997;5:233e9. liminary results. Arthroscopy 1994;10:383e91.
19. Lippitt SB, Vanderhooft JE, Harris SL, Sidles JA, Harryman DT II, Matsen FA III. 35. Yamamoto N, Muraki T, An KN, Sperling JW, Cofield RH, Itoi E, et al. The sta-
Glenohumeral stability from concavity-compression: a quantitative analysis. bilizing mechanism of the Latarjet procedure: a cadaveric study. J Bone Joint
J Shoulder Elbow Surg 1993;2:27e35. Surg Am 2013;95:1390e7. https://doi.org/10.2106/JBJS.L.00777.
20. Lo IK, Burkhart SS. Triple labral lesions: pathology and surgical repair 36. Yamamoto N, Muraki T, Sperling JW, Steinmann SP, Cofield RH, Itoi E, et al.
technique-report of seven cases. Arthroscopy 2005;21:186e93. https://doi.org/ Stabilizing mechanism in bone-grafting of a large glenoid defect. J Bone Joint
10.1016/j.arthro.2004.09.022. Surg Am 2010;92:2059e66. https://doi.org/10.2106/JBJS.I.00261.
21. Maffet MW, Gartsman GM, Moseley B. Superior labrum-biceps tendon complex 37. Yiannakopoulos CK, Mataragas E, Antonogiannakis E. A comparison of the
lesions of the shoulder. Am J Sports Med 1995;23:93e8. spectrum of intra-articular lesions in acute and chronic anterior shoulder
22. Manske R, Ellenbecker T. Current concepts in shoulder examination of the instability. Arthroscopy 2007;23:985e90. https://doi.org/10.1016/j.arthro.
overhead athlete. Int J Sports Phys Ther 2013;8:554e78. 2007.05.009.