Recurrent Shoulder Instability after Arthroscopic Bankart Repair in an Elite Baseball Pitcher-A Case Report. 2022

Jo-Ting Kao, and Cheng-Pang Yang, and Huan Sheu, and Hao-Che Tang, and Yi-Sheng Chan, and Alvin Chao-Yu Chen, and Kuo-Yao Hsu, and Chun-Jui Weng, and You-Hung Cheng, and Chih-Hao Chiu
Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.

A 16-year-old right-handed male pitcher had a first-time right anterior shoulder dislocation during a baseball game. X-ray and MRI revealed no apparent glenoid bone loss or Hill-Sachs lesion, but an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion with mild posterolateral decompression of the humerus head. His instability severity index score (ISIS score) was 5 with an on-track lesion. He had an arthroscopic Bankart repair using two all-suture anchors and returned to pitching 6 months after the index surgery. However, he had an unstable sensation after 50 pitches during a game one year postoperatively. This time, he presented with a significant Hill-Sachs lesion and a recurrent APLSA lesion. His ISIS score was 6 with an on-tract lesion. During the arthroscopic examination, the previous suture was stable, while anterior capsuloligament tissues were dislodged from sutures, and a Hill-Sachs lesion was observed. This time, a revision arthroscopic Bankart repair and Remplissage procedure were done on him with four double-loaded soft tissue anchors. Pitchers often develop more external rotation in their throwing arm because of a repetitive stretch of the anterior shoulder capsule and ligaments during pitching. The decrease in external rotation after surgery may limit the pitching speed of the pitcher, making a return to play (RTP) more difficult. There is still a paucity of best evidence to revise a failed arthroscopic Bankart repair in the dominant arm of a pitcher. Arthroscopic Bankart repair and Remplissage procedure have gained increasing popularity because they can provide a stable shoulder without harvesting the coracoid. The Latarjet procedure provides a high RTP rate; however, we did not perform it in the revision surgery and decided to revise the Bankart lesion again on its own with a Remplissage procedure, even with his ISIS score being 6 before the revision surgery. A salvage Latarjet procedure is left as a bailout procedure.

UI MeSH Term Description Entries
D007593 Joint Instability Lack of stability of a joint or joint prosthesis. Hypermobility, Joint,Instability, Joint,Laxity, Joint,Hypermobilities, Joint,Instabilities, Joint,Joint Hypermobilities,Joint Hypermobility,Joint Instabilities,Joint Laxities,Joint Laxity,Laxities, Joint
D008297 Male Males
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000070896 Bankart Lesions An anterior capsulolabral injury associated with a tear of the anteroinferior GLENOID LABRUM. Bankart Fractures,Bankart Lesion,Bankart Tears,Bony Bankart Lesion,Bony Bankart Lesions,Hill-Sachs Lesion,Hill-Sachs Lesions,Osseous Bankart Lesion,Osseous Bankart Lesions,Bankart Lesion, Bony,Bankart Lesion, Osseous,Bankart Lesions, Bony,Bankart Lesions, Osseous,Fractures, Bankart,Hill Sachs Lesion,Hill Sachs Lesions,Lesion, Bankart,Lesion, Bony Bankart,Lesion, Hill-Sachs,Lesion, Osseous Bankart,Lesions, Bankart,Lesions, Bony Bankart,Lesions, Hill-Sachs,Lesions, Osseous Bankart,Tears, Bankart
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D001484 Baseball A competitive nine-member team sport including softball. Softball,Baseballs,Softballs
D012782 Shoulder Part of the body in humans and primates where the arms connect to the trunk. The shoulder has five joints; ACROMIOCLAVICULAR joint, CORACOCLAVICULAR joint, GLENOHUMERAL joint, scapulathoracic joint, and STERNOCLAVICULAR joint. Shoulders
D012785 Shoulder Joint The articulation between the head of the HUMERUS and the glenoid cavity of the SCAPULA. Glenohumeral Joint,Glenoid Labrum,Glenohumeral Joints,Joint, Glenohumeral,Joint, Shoulder,Joints, Glenohumeral,Joints, Shoulder,Labrum, Glenoid,Shoulder Joints

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