Purpose
To characterize the additive effect of a 6-o'clock anchor in the stabilization of
a Bankart lesion.
Methods
Twelve cadaveric shoulders were tested on a 6-df robotic musculoskeletal simulator to measure the peak resistance force due to anterior
displacement of 1 cm. The rotator cuff muscles were loaded dynamically. The test conditions
consisted of the intact shoulder, Bankart lesion, Bankart repair (3-, 4-, and 5-o'clock
anchors), and Bankart repair with the addition of a 6-o'clock anchor. A 13% anterior
bone defect was then created, and all conditions were repeated. Repeated-measures
analysis of variance was performed.
Results
In the group with no bone loss, the addition of a 6-o'clock anchor yielded the highest
peak resistance force (52.8 N; standard deviation [SD], 4.5 N), and its peak force
was significantly greater than that of the standard Bankart repair by 15.8% (7.2 N,
P = .003). With subcritical glenoid bone loss, the repair with the addition of a 6-o'clock
anchor (peak force, 52.6 N; SD, 6.1 N; P = .006) had a significantly higher peak resistance force than the group with bone
loss with a Bankart lesion (35.2 N; SD, 5.8 N). Although the 6-o'clock anchor did
increase the strength of the standard repair by 6.7%, this was not statistically significant
(P = .9) in the bone loss model.
Conclusions
The addition of a 6-o'clock suture anchor to a 3-anchor Bankart repair increases the
peak resistance force to displacement in a biomechanical model, although this effect
is lost with subcritical bone loss.
Clinical Relevance
This study provides surgeons with essential biomechanical data to aid in the selection
of the repair configuration.
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Article info
Publication history
Published online: August 05, 2019
Accepted:
May 3,
2019
Received:
January 19,
2019
Footnotes
The authors report the following potential conflicts of interest or sources of funding: Funding of this project was provided in part by DePuy Synthes. S.L.B. receives education fees from Stryker. J.J.C. receives grant support from the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award number P30GM12273 (COBRE Bio-engineering Core). B.D.O. receives grant support and personal fees from OREF and personal fees from Mitek and ConMed Linvatec/MTF. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2019 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: More Is Better? The 6-O’clock Anchor in Instability SurgeryArthroscopyVol. 35Issue 10
- PreviewPlacing an anchor at the 6-o’clock position on the glenoid when performing an arthroscopic Bankart repair has been suggested by multiple authors as a potential key step in improving the outcomes of arthroscopic repair. Placement of a 6-o’clock anchor increases the peak resistance force to displacement over a traditional 3-anchor repair. Determining what technique issues are relevant remains problematic, and the ultimate preferred technique remains elusive.
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