Abstract
Bankart repair eliminates acquired shoulder laxity in overhead throwing athletes and sometimes results in decreased maximum shoulder external rotation angle and rates of return to play at preinjury levels. The authors developed a novel surgical reconstruction of the anterior band of the inferior glenohumeral ligament (AIGHL) to maintain shoulder laxity for throwing while stabilizing the shoulder joint.
AIGHL reconstruction would stabilize the shoulder joint while not decreasing maximum external rotation, whereas Bankart repair would decrease maximum external rotation.
Controlled laboratory study.
Eight fresh-frozen cadaveric shoulders were tested in a custom shoulder-testing system. Anterior glenohumeral translation, maximum shoulder external rotation, and humeral head location relative to the glenoid were compared among the following conditions: an intact shoulder, a thrower's shoulder model created by stretching the AIGHL, a Bankart lesion, Bankart repair, and AIGHL reconstruction. In AIGHL reconstruction, a fascia lata graft was patched between the detached AIGHL laterally and glenoid medially at maximum shoulder external rotation to maintain the AIGHL's original length.
In the thrower's shoulder, external rotation and anterior translation were significantly increased (intact, 128° and 2.8 mm; thrower's shoulder, 142° and 7.3 mm;
< .05). A Bankart lesion significantly increased anterior translation (8.3 mm) when compared with the intact condition (
< .01). Bankart repair restored anterior translation (3.0 mm) to intact levels. However, maximum shoulder external rotation significantly decreased after Bankart repair (135°) when compared with the thrower's shoulder (
= .01). AIGHL reconstruction restored anterior translation (6.5 mm) to the level of the thrower's shoulder without decreasing the maximum shoulder external rotation (144°). In the simulated late cocking position, the location of the humeral head relative to the glenoid was unchanged, even after Bankart repair or AIGHL reconstruction.
Bankart repair restored anterior translation to intact levels (tighter than in the thrower's shoulder), but AIGHL reconstruction restored it to the level of the thrower's shoulder. Maximum shoulder external rotation was restored to the level of the thrower's shoulder after AIGHL reconstruction, whereas Bankart repair significantly decreased external rotation when compared with the thrower's shoulder.
AIGHL reconstruction may be useful for Bankart lesion in overhead throwing athletes to restore anterior stability while maintaining maximum shoulder external rotation.