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MR Arthrography of Shoulders after Suture-Anchor Bankart Repair¹

¹ From the Department of Radiology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa-ken 227-8501, Japan (H.S., H.K.); and the Department of Orthopedics, Showa University Fujigaoka Rehabilitation Hospital, Japan (K.S., K.M., H.T.). Received June 28, 2001; revision requested August 16; revision received November 15; accepted January 7, 2002. Address correspondence to H.S. (e-mail: sugimo-h@sannet.ne.jp).

View larger version (82K): [in a new window]   Figure 1. Schematic drawing of suture-anchor Bankart repair as it is performed at our institution. The detached labrum and torn capsule (arrow) are tied to the glenoid rim with the use of anchors.

View larger version (120K): [in a new window]   Figure 2a. (a) Oblique sagittal fat-suppressed T1-weighted (440/9) MR arthrogram of the right shoulder in a 33-year-old man who underwent suture-anchor Bankart repair. Three polylactic acid anchors were inserted. The tracks of the anchors in the 3- and 5-o’clock positions are seen as parallel low-signal-intensity lines (arrowheads) in the glenoid rim. All anchor points abut the reattached capsulolabral complex (arrows), which appears as an area of low signal intensity. (b) Arthroscopic image of the anterosuperior glenoid rim shows the firmly reattached capsulolabral complex (arrowheads). No failed suture or detached labrum is seen. The left side of the image is toward the patient’s head.

View larger version (134K): [in a new window]   Figure 2b. (a) Oblique sagittal fat-suppressed T1-weighted (440/9) MR arthrogram of the right shoulder in a 33-year-old man who underwent suture-anchor Bankart repair. Three polylactic acid anchors were inserted. The tracks of the anchors in the 3- and 5-o’clock positions are seen as parallel low-signal-intensity lines (arrowheads) in the glenoid rim. All anchor points abut the reattached capsulolabral complex (arrows), which appears as an area of low signal intensity. (b) Arthroscopic image of the anterosuperior glenoid rim shows the firmly reattached capsulolabral complex (arrowheads). No failed suture or detached labrum is seen. The left side of the image is toward the patient’s head.

View larger version (118K): [in a new window]   Figure 3a. (a) Oblique sagittal fat-suppressed T1-weighted (440/9) MR arthrogram of the left shoulder in a 19-year-old male rugby player who underwent suture-anchor Bankart repair. Titanium anchors at the 2-, 3-, and 4-o’clock positions were identified as areas with marked ferromagnetic artifacts (arrowheads). No reattached capsulolabral complex is seen abutting the glenoid rim at the anchor in the 2-o’clock position. The detached capsulolabral complex (arrow) is visible in the joint cavity. (b) Arthroscopic image reveals exposure of the glenoid bone to the joint cavity and no reattachment of the capsulolabral complex (arrowheads). A failed suture (arrow) at the 2-o’clock position is apparent at the glenoid rim. The detached labrum (*) is seen in the joint cavity. The right side of the image is toward the patient’s head.

View larger version (109K): [in a new window]   Figure 3b. (a) Oblique sagittal fat-suppressed T1-weighted (440/9) MR arthrogram of the left shoulder in a 19-year-old male rugby player who underwent suture-anchor Bankart repair. Titanium anchors at the 2-, 3-, and 4-o’clock positions were identified as areas with marked ferromagnetic artifacts (arrowheads). No reattached capsulolabral complex is seen abutting the glenoid rim at the anchor in the 2-o’clock position. The detached capsulolabral complex (arrow) is visible in the joint cavity. (b) Arthroscopic image reveals exposure of the glenoid bone to the joint cavity and no reattachment of the capsulolabral complex (arrowheads). A failed suture (arrow) at the 2-o’clock position is apparent at the glenoid rim. The detached labrum (*) is seen in the joint cavity. The right side of the image is toward the patient’s head.

View larger version (139K): [in a new window]   Figure 4a. (a) Oblique sagittal fat-suppressed T1-weighted (440/9) MR arthrogram of the left shoulder in a 29-year-old man who underwent suture-anchor Bankart repair. Three polylactic acid anchors were used. Extravasation of intraarticular contrast material into the subscapularis muscle is visible at the 2- and 4-o’clock anchor points (*). (b) Arthroscopic image reveals that the anterior glenoid rim is exposed from the 2- to 4-o’clock positions and reattachment of the capsulolabral complex (arrowheads) is absent. A failed suture (arrow) is seen at the 2-o’clock anchor point. The right side of the image is toward the patient’s head.

View larger version (134K): [in a new window]   Figure 4b. (a) Oblique sagittal fat-suppressed T1-weighted (440/9) MR arthrogram of the left shoulder in a 29-year-old man who underwent suture-anchor Bankart repair. Three polylactic acid anchors were used. Extravasation of intraarticular contrast material into the subscapularis muscle is visible at the 2- and 4-o’clock anchor points (*). (b) Arthroscopic image reveals that the anterior glenoid rim is exposed from the 2- to 4-o’clock positions and reattachment of the capsulolabral complex (arrowheads) is absent. A failed suture (arrow) is seen at the 2-o’clock anchor point. The right side of the image is toward the patient’s head.

View larger version (146K): [in a new window]   Figure 5a. (a) Oblique transverse fat-suppressed T1-weighted (440/9) MR arthrogram of the left shoulder in a 27-year-old male rugby player obtained with the patient in the ABER position shows that the capsulolabral complex (arrows) abuts the anterior humeral head. The transition of the AIGHL to the glenoid rim is seamless. Note the ferromagnetic artifact (arrowhead) at the insertion point of the anchor. (b) Arthroscopic image shows that the anterior capsulolabral complex (arrowheads) is tightly attached to the glenoid rim. A suture (arrow) is seen in the reattached capsule. The right side of the image is toward the patient’s head.

View larger version (111K): [in a new window]   Figure 5b. (a) Oblique transverse fat-suppressed T1-weighted (440/9) MR arthrogram of the left shoulder in a 27-year-old male rugby player obtained with the patient in the ABER position shows that the capsulolabral complex (arrows) abuts the anterior humeral head. The transition of the AIGHL to the glenoid rim is seamless. Note the ferromagnetic artifact (arrowhead) at the insertion point of the anchor. (b) Arthroscopic image shows that the anterior capsulolabral complex (arrowheads) is tightly attached to the glenoid rim. A suture (arrow) is seen in the reattached capsule. The right side of the image is toward the patient’s head.

View larger version (119K): [in a new window]   Figure 6a. (a) Oblique transverse fat-suppressed T1-weighted (440/9) MR arthrogram of the left shoulder in a 25-year-old male snowboarder obtained with the patient in the ABER position shows a pool of contrast material (arrowheads) between the humeral head and the capsulolabral complex. The attachment point (arrow) of the capsulolabral complex to the glenoid rim is a few millimeters from the glenoid edge. (b) Arthroscopic image shows that the capsulolabral complex is attached medial to the glenoid rim and that synovial proliferation (arrow) is present. The right side of the image is toward the patient’s head.

View larger version (141K): [in a new window]   Figure 6b. (a) Oblique transverse fat-suppressed T1-weighted (440/9) MR arthrogram of the left shoulder in a 25-year-old male snowboarder obtained with the patient in the ABER position shows a pool of contrast material (arrowheads) between the humeral head and the capsulolabral complex. The attachment point (arrow) of the capsulolabral complex to the glenoid rim is a few millimeters from the glenoid edge. (b) Arthroscopic image shows that the capsulolabral complex is attached medial to the glenoid rim and that synovial proliferation (arrow) is present. The right side of the image is toward the patient’s head.

View larger version (119K): [in a new window]   Figure 7. Oblique transverse fat-suppressed T1-weighted (440/9) MR arthrogram of the right shoulder in a 29-year-old male rugby player obtained with the patient in the ABER position shows mild posterior subluxation of the humeral head. The anterior band (arrowheads) of the inferior glenohumeral ligament is straightened, and a small space (*) is visible between the humeral head and the joint capsule. Note the ferromagnetic artifacts (arrow) in the glenoid rim. Arthroscopy (not shown) revealed normal reattachment of the capsulolabral complex.

View larger version (149K): [in a new window]   Figure 8. Transverse fat-suppressed T1-weighted (440/9) MR arthrogram of the left shoulder in a 26-year-old man shows that the anterior capsule is directly reattached adjacent to the glenoid rim, indicating a type I insertion (arrow). Arthroscopy (not shown) revealed that the anterior labrum and the anterior band of the inferior glenohumeral ligament were tightly attached to the glenoid rim.

View larger version (141K): [in a new window]   Figure 9. Transverse fat-suppressed T1-weighted (440/9) MR arthrogram of the right shoulder in a 28-year-old man shows that the anterior capsule is reattached 1 cm from the base of the glenoid rim, indicating a type II insertion (arrow). Arthroscopy (not shown) revealed tight reattachment of the anterior labrum.