Modified technique for arthroscopic Bankart repair using anchor sutures

Bankart repair, or one of its modifications, is currently the gold standard procedure for treatment of anterior traumatic shoulder instability. It is now possible to perform the operation arthroscopically with the introduction of suture anchors. As described by Eugene Wolf, arthroscopic shoulder stabilization using the Mitek (Mitek Surgical Products, Ethicon, Edinburgh, U.K.) anchors requires two anterior portals and intra-articular knot tying. However, sliding the anchor on the inside limb of a suture loop could be challenging because the other limb could get tangled in the nitinol arc of the anchor. We describe a modification of the original technique to prevent that possibility and avoid any tension on the repair tissue during anchor passage. The proposed modification involves the use of a cheap, readily available silastic feeding tube to isolate the outside limb of the suture loop and stabilize labral tissues while the anchor is being passed. This tube also serves as a stent for knot tying. By allowing the whole operation to be performed through one anterior portal, the modified technique reduces possible morbidity associated with a second portal and further reduces cost.