This is a technique paper describing the "belt-and-suspenders" arthroscopic procedure for anterior shoulder instability with a stretched or deficient capsule. It combines an arthroscopic Bankart repair (the belt) with an arthroscopic conjoined tendon transfer (the suspenders). The authors report preliminary outcomes in 36 patients at minimum 1-year follow-up.
The clinical decision rule here is about patient selection. When you face anterior instability with a stretched or deficient anteroinferior capsule, or hyperlaxity, an isolated arthroscopic Bankart repair carries a recurrence rate of 15-20% and may not hold.
This technique adds a conjoined tendon sling to reinforce a failed inferior glenohumeral ligament, borrowing the muscular locking principle of the Latarjet without relying on a bone block. The key teaching point: the authors are explicit that only the sling effect is at work here, so the Bankart repair is not optional. Two of three failures came from a poorly done Bankart.
Weight this as Level IV evidence: a case series of 36 patients, minimum 1-year follow-up, no comparison group, from a single expert surgeon. It shows feasibility and promising short-term numbers, not proof of superiority. Also appreciate the steep learning curve and screw-related risks (pseudarthrosis, osteolysis, pain) before considering this over an established open Latarjet.
This is a technique paper describing the "belt-and-suspenders" arthroscopic procedure for anterior shoulder instability with a stretched or deficient capsule. It combines an arthroscopic Bankart repair (the belt) with an arthroscopic conjoined tendon transfer (the suspenders). The authors report preliminary outcomes in 36 patients at minimum 1-year follow-up.
The clinical decision rule here is about patient selection. When you face anterior instability with a stretched or deficient anteroinferior capsule, or hyperlaxity, an isolated arthroscopic Bankart repair carries a recurrence rate of 15-20% and may not hold.
This technique adds a conjoined tendon sling to reinforce a failed inferior glenohumeral ligament, borrowing the muscular locking principle of the Latarjet without relying on a bone block. The key teaching point: the authors are explicit that only the sling effect is at work here, so the Bankart repair is not optional. Two of three failures came from a poorly done Bankart.
Weight this as Level IV evidence: a case series of 36 patients, minimum 1-year follow-up, no comparison group, from a single expert surgeon. It shows feasibility and promising short-term numbers, not proof of superiority. Also appreciate the steep learning curve and screw-related risks (pseudarthrosis, osteolysis, pain) before considering this over an established open Latarjet.