The socket portion of the joint is not naturally deep. Dr peter performs arthroscopic bankart repair surgery in claremont, murdoch, dunsborough, fremantle, cooloongup, northam and perth wa. Also, most payers consider the labrum to be one structure, and do not divide it into upper or lower portions for debridement. Arthroscopic bankart repair protocol robert morgan md. You will be sent home from the surgery center with prescriptions for pain medication.
Patients with additional surgery will progress at different rates. Jul 01, 2017 do not separately report the debridement if the surgeon also repairs the debrided structures. Posterior shoulder instability with glenoid bone loss has only a fraction of the prevalence of anterior instability. The arthroscopic treatment of anteriorglenohumeral instability is becoming. The arthroscope uses a tiny camera to project a picture of your affected area onto a screen for your orthopedic surgeon to see.
Arthroscopic bankart repair with suture anchors tips for success. The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an arthroscopic anterior stabilization procedure. Slap repair portal placement posterior viewing portal. For more educational videos from nyu langone orthopedics, visit. Take out of sling for arm exercises 24 times daily. Arthroscopic bankart repair with suture orthopaedic foundation. Bankart repair results in unacceptably high rates of recurrent dislocations.
In more severe cases when the labrum is torn a portion of the glenoid may be fractured and this is referred to as bony bankart lesion. Do not separately report the debridement if the surgeon also repairs the debrided structures. Immediately postoperatively, exercises must be modified so as not to place. The pushlock anchor is designed for simple and secure arthroscopic glenohumeral joint instability repair. Guideline for arthroscopic anterior capsulolabral repair of the shoulder t.
Never miscode bankart procedures again thanks to cpt 2004. Also, do not reach your hand behind you as if to tuck in your shirt or to loop your belt. Allow soft tissue healing diminish pain and inflammation initiate protected motion retard muscle atrophy. Matthew crawford this rehabilitation protocol has been developed for the patient following an arthroscopic bankart surgical procedure. While revision arthroscopic bankart repair may be appropriate in some cases in which there is minimal glenoid bone loss and robust labral and capsular tissue is available, an open procedure such. Arthrex arthroscopic bankart repair with knotless remplissage.
Overview and recovery from a patients perspective doug letourneau is an avid basketball player in his free time. Arthroscopic bankart repair combined with remplissage technique for the treatment of anterior shoulder instability with engaging hillsachs lesion. Click here to download pdf rehabilitation after arthroscopic posterior bankart repair. The shoulder is a wonderfully complex joint that is made up of the ball and socket connection between the humerus ball and the glenoid portion of the scapula socket. Continue to avoid heavy weight lifting or manual labor. Immediate postop through 4 weeks post op therapist assisted passive range of motion prom ok immobilize full time except pendulums and stick assisted external rotation er to 30. Bankart repair, arthroscopic open revised august 2008 postop days 1 7 sling x 6 weeks even while sleeping place pillow under shoulder arm while sleeping for comfort hand squeezing exercises elbow and wrist active motion arom with shoulder in neutral position at side supported pendulum exercises. The doctors will discuss your individual surgery with you before the operation.
Arthroscopic stabilisation bankart repair this procedure involves repairing the over stretched or torn labrum and capsule deep within the shoulder joint. Pdf on jan 1, 20, xinning li and others published chapter05 arthroscopic bankart repair find, read and cite all the research you need. Bankart repair surgery is a minimally invasive surgery to repair instability and restore function of dislocated shoulders. Because the head of the humerus much larger than the. Arthroscopic rotator cuff repair rehabilitation guidelines derek plausinis, masc, md, frcsc 0 to 6 weeks postop sling use. Open bankart repair versus arthroscopic repair with transglenoid sutures or bioabsorbable tacks for recurrent anterior instability of the shoulder a metaanalysis. Functional outcome of arthroscopic double row repair for bankart.
Arthroscopic posterior bankart repair tmi sports medicine. Arthroscopic bankart repair protocol recommendations. Bankart lesion, anterior shoulder instability, arthroscopic. Brady, md, knoxville, tn discusses the arthroscopic bankart repair and knotless remplissage by presenting a case study of glenohumeral instability with arthroscopicopen this protocol was developed for patients who have had a bankart repair. Arthroscopic bankart repair this procedure accesses the front of your shoulder by inserting a thin, flexible tube called an arthroscope through a small incision. Arthroscopic posterior bankart repair phase i protection phaseimmediate motion 0 6 weeks postop note. The repair is generally done through a minimally invasive approach called arthroscopic surgery. Arthroscopy with labrum repair including slap repair or bankart repair dr. Longterm outcomes following isolated arthroscopic bankart repair.
Arthroscopic bankart repair rehab protocol this rehabilitation protocol has been developed for the patient following an arthroscopic bankart surgical procedure. Instructions for use documentation provided with individual components including. To better understand what a bankart tear or lesion is, an overview of the shoulder is needed. Rehabilitation after arthroscopic posterior bankart repair. This portal can be used for anchor placement for slap lesions with a significant anterior extension and for suture management during repair of posterior slap lesions. If procedure is performed arthroscopically strengthening of the rotator cuff. When he dislocated his shoulder during a game, he wanted to treat his injury as quickly as possible and get back on the court. Petterson, phd anterior instability treated by arthroscopic surgery is a viable option to return the athlete. Avoid any internal rotation of the glenohumeral joint. You will go to the recovery room and generally will be discharged after 12 hours.
It lines the shoulder socket and helps keep the ball of the humerus in place. Good posture is critical throughout the rehabilitation process to improve healing and decrease the risk of developing poor mechanics. No passive forceful stretching into external rotationextension for 3 months following an anterior repair and into internal rotation for a posterior repair. The bankart procedure is performed to increase anterior stability of the shoulder. This protocol is not a substitute for a physiotherapists clinical reasoning during a patients postoperative healingprogress. Rehabilitation guidelines for anterior shoulder reconstruction with arthroscopic bankart repair 333 38th st. Pnf manual resistance dr tim dwyer orthopedic surgery of the k 647 707 7805 e47 ortho 1 x. In some instances, an open procedure is performed in which the muscles are separated to expose the shoulder. As of july 1, 2016, and as further clarified in the updated national correct coding initiative ncci guidelines effective. However, it is critical to communicate with the surgeon in order to be aware. After the first day or two, as the pain lessens, you may decrease the frequency with which you take the medication. The knotless technique saves valuable time and eliminates the possibility of knot impingement. This protocol is intended to provide physiotherapists with guidelines for the postoperative management of a patient who has undergone an arthroscopic bankart repair. The labrum is a thick band of cartilage attached to the glenoid.
Surgery to repair a bankart lesion is often performed through arthroscopy. The arthroscopic technique involves identifying and repairing all pathology that contribute to glenohumeral instability, i. Bankart repairanterior capsulorrhaphy rehabilitation. Arthroscopic bankart repair is a procedure is used to repair a detached or overstretched labrum and capsule deep within the shoulder joint. Rehabilitation after arthroscopic bankart repair and anterior stabilization procedures phase 0. Encourage prom at home daily 2 3 sessions by family member for the first 6 8 weeks. Arthroscopic bankart repair surgery northam shoulder. This document is intended for information purposes only and should not replace advice that your relevant health professional would give you.
The critical point to to keep the shoulder muscles loose and relaxed. General information there may be a loss of external rotation when compared to the other side, but the motion is. A biomechanical analysis of anchor placement for bankart. Arthroscopic labrum repair of the shoulder slap anatomy.
Stay current when reporting shoulder procedures aapc. We present a novel technique for safe establishment of the accessory posterior portal using a slotted cannula. Open bankart repair versus arthroscopic repair with. It is designed for rehabilitation following arthroscopic posterior bankart repair. It is designed for rehabilitation following arthroscopic bankart repair anterior capsulorrhaphy procedure. Bankart arthroscopic anterior capsulolabral 6repair, m. Arthroscopic bankart repair is currently the most utilized technique in the surgical management of symptomatic shoulder instability. Bankart repair anterior capsulorrhaphy rehabilitation guideline this rehabilitation program is designed to return the individual to their activities as quickly and safely as possible. Arthroscopic anterior capsulolabral reconstruction phase i.
Arthroscopic bankart repair was first described in 1993, with its popularity rapidly increasing over the past several decades as arthroscopic instrumentation and techniques have improved. Ice 34 times per day as needed for 1 st week then as needed thereafter. Arthroscopy is a minimallyinvasive technique that uses tiny incisions to insert a probelike camera, allowing the surgeon to fully examine the area before performing corrections. Do not even measure internal rotation at the time of initial evaluation. When the shoulder joint is torn its common to have occurred due to a shoulder dislocation and instability. Arthroscopic anterior bankart repair rehab protocol. The unstable shoulder joint can be repaired by reattaching the torn labrum and capsule to the glenoid rim. Phase i immediate postoperative phase restrictive motion weeks 06 goals. Arthroscopic bankart repair rehabilitation guidelines. Most studies have reported good to excellent outcomes with little to no loss in range of movement and recurrence rates comparable with those of arthroscopic bankart repairs performed in.
Type 2 or 4 slap tear biceps anchor detached failure of at least 12 weeks of nonoperative treatment, including activity. Summary table post op phasegoals range of motion therapeutic exercise precautions phase i 0 6 weeks after surgery. Arthroscopic repair for initial anterior dislocation. Guidelines for weeks 0 to 6 draft university of washington. Ice 34 times per day as needed for 1st week then as needed thereafter. Immediate postoperative phase restrictive motion goals. Each phase is adaptable based on the individual and special circumstances. The american society of shoulder and elbow therapists consensus rehabilitation guideline for arthroscopic anterior capsulolabral repair of the shoulder. Arthroscopic repair of posterior bony bankart lesion and subscapularis remplissage colten luedke, d. Arthroscopic anterior capsular shiftbankart repair weeks 12 objective is to protect healing capsule, allow early, graded, protected motion, prevent stiffness, minimize atrophy, and control pain and inflammation wear sling during the day for 34 weeks sleep in your sling for 34 weeks monitor neurovascular status. Arthroscopic stabilisation bankart repair shoulderdoc by. Oct 04, 2015 arthroscopic orthopedic surgical video of bankart stabilization of anteriorinferior glenohumeral ligament of the shoulder for recurrent shoulder dislocations from san francisco orthopaedic sports. The arthroscopic bankart repair progresses more conservatively than an open procedure due to fixation methods that initially postop may not be as stable.
For this reason the shoulder is the most mobile joint in the body. The appendix contains assets consensus rehabilitation guideline for arthroscopic anterior. Aerobic conditioning throughout the rehabilitation process. You may use your hand on the operated arm as long as you do not raise the hand above your head or reach across the front of your body. Postoperative protocol anterior shoulder instability this procedure is normally the result of extreme laxity in the anterior capsule requiring surgical intervention to shrink the area. Arthroscopic bankart repair boston sports medicine. The humeral head ball of the shoulder joint is centered in the glenoid the socket of the joint, which stabilizes the shoulder.
Pnf manual resistance endurance training restricted sport activities light swimming, half golf swings. This analogy is used because the articular surface of the round humeral head upper most part of the arm is approximately four times. Location is the same as described for bankart repair. Wolf md ms congdon professor and vicechair of orthopaedic surgery director of sports medicine. Chattanooga, tn 423 6242696 postoperative instructions you will wake up in the operating room. A variety of arthroscopic techniques have been described in the literature, commonly using the posterior portal for visualization and the anterior portal with a working cannula. This arthroscopic shoulder surgery is used to repair a detached labrum. Information for patients arthroscopic bankart repair. Bankart repair protocol vanderbilt university medical center. The following is a guideline for progression of postoperative treatment.
During arthroscopic bankart repair, penetration of suture anchors through the far cortex can compromise the initial biomechanical characteristics of anchor stability and repair integrity. Arthroscopic capsular plication arthroscopic bankart anterior labral repair postop rehabilitation phase i. Sling for 4 weeks may take off swathe when good arm control elbowhand rom and hand gripping exercises aarom. Flexion to 900 pendulumrope and pulley exercises isometrics. Lacking evidence for rehabilitation following arthroscopic. Arthroscopic bankart repair in plano, frisco, mckinney and. Rate of progression based on evaluation of the patient no excessive er, extension or elevation. Instead, this document should serve as a guideline and, as such, should be used in conjunction with a thorough history and physical examination of the individual patient. Pdf chapter05 arthroscopic bankart repair researchgate.
The suture first technique allows surgeons to independently pass suture through a desired amount of tissue prior to anchor. We use cookies to make interactions with our website easy and meaningful, to better understand the use of our services, and to tailor advertising. Bankart repair rehabilitation protocol arthroscopicopen this protocol was developed for patients who have had a bankart repair. Posterior bankart repair rehabilitation guideline this rehabilitation program is designed to return the individual to their activities as quickly and safely as possible. Postoperative instructions for shoulder arthroscopy with. Arthroscopic anterior stabilization with or without bankart repair. Bankart repair can be performed surgically with an arthroscopic technique under general anaesthesia. Arthroscopic bankart repair manhattan orthopedic care. We prefer to perform the surgery arthroscopically keyhole, but some surgeons prefer an open procedure. Arthroscopic repair of posterior bony bankart lesion and. Protect the anatomic repair prevent negative effects of immobilization promote dynamic stability decrease pain and inflammation weeks 0 to 4 sling for 4 weeks sleep in immobilizer for 4 weeks elbow and hand rom exercises. Laith jazrawi performs an arthroscopic repair of a bony bankart lesion. Rehabilitation guidelines for anterior shoulder reconstruction with open bankart repair the anatomic configuration of the shoulder joint glenohumeral joint is often compared to a golf ball on a tee figure 1.
Comparison of time to recurrence of instability after open. Arthroscopic bankart repair cayman orthopaedic group. Protect the anatomic repair prevent negative effects of immobilization promote dynamic stability and proprioception diminish pain and inflammation weeks 02 sling for 23 weeks for comfort. Shoulder dislocation and bankart repair sports medicine. Anterior shoulder reconstruction with arthroscopic bankart repair. The large bony bankart fragment is mobilized, and 2 tunnels are drilled through the fragment from posterior to anterior using a 0.
A report of 49 cases with a minimum 2year followup. Bankart stabilization, ranging from 0% to 11%, establishing open stabilization as the gold standard for operative repair. Although the ama once advised coders to use 29807 arthroscopy, shoulder, surgical. Lacking evidence for rehabilitation following arthroscopic bankart repair.
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