The "purse string" technique for anterior glenohumeral instability: long-term results 7-13-year follow-up

Eur J Orthop Surg Traumatol. 2023 Aug;33(6):2317-2323. doi: 10.1007/s00590-022-03426-5. Epub 2022 Nov 9.

Abstract

Purpose: The "Purse-String Technique" (PST) is an arthroscopic horizontal mattress suture technique for recurrent anterior shoulder instability that uses a single double-loaded suture anchor at the 4-o' clock position, achieving a Bankart labral repair and an infero-superior capsular shift. In this study, we describe the long-term results of the PST.

Methods: The study included 69 individuals (70 shoulders), with a mean age of 30 years, who had recurrent post-traumatic anteroinferior instability. A purse-string suture anchor at the 4-o'clock position was used to address the Bankart lesion and capsular laxity, recreating the anterior glenoid bumper. All patients were assessed via telephone interview at a mean of 116 months after surgery (7-13-year follow-up).

Results: Postoperatively, the mean Constant score was 94, mean Rowe score was 93 and mean Walch-Duplay score was 89. 89% of patients resumed their preinjury sport activities, with 61% of patients achieving preinjury levels and most professional athletes returning to full activity. Seven patients had recurrent dislocation postoperatively (10% failure rate). Of these patients, three had revision arthroscopic stabilization, one patient had revision arthroscopic stabilization with remplissage, two had a Latarjet procedure, whereas one patient decided to seek no further treatment.

Conclusion: The long-term results of PST are promising, with a low failure rate, high patient satisfaction and a high rate of return to sport.

Level of evidence: Level IV; Case series; Treatment study.

Keywords: Arthroscopic; Bankart repair; Instability; Long-term follow-up; Shoulder.

MeSH terms

  • Adult
  • Arthroscopy / methods
  • Follow-Up Studies
  • Humans
  • Joint Instability* / etiology
  • Joint Instability* / surgery
  • Recurrence
  • Retrospective Studies
  • Shoulder Dislocation* / surgery
  • Shoulder Joint* / surgery