The “Purse String” Procedure for Recurrent Anterior Glenohumeral Instability: A Simple Technique to Achieve Bankart Repair, Capsular Shift, and a Good Labral Bumper

Abstract: Failure of arthroscopic techniques in cases of recurrent anterior glenohumeral instability may result from inadequate treatment of capsular injury. The use of few anchors has been cited as a cause of failure in arthroscopic stabilization techniques. This applies to the use of the suture anchors as spot-welding points in conventional techniques. It has been shown that horizontal mattress suture techniques restore better labral height and anatomy than simple suture techniques in the repair of acute Bankart lesions. Horizontal mattress repairs, like the one achieved with the “purse-string” technique, pushes the labrum toward the humeral side of the joint, thus providing a buttress to the glenohumeral joint. We present the purse-string technique, which involves the use of only 1 suture anchor located at the 4-o’clock position. Sutures are passed through the labrum and capsule from south to north, thus allowing the incorporation of more capsular tissue involved in the raising of the anterior labral bumper. One suture anchor at the 4-o’clock position is used to ensure a purse-string effect, with tightening of the capsule in the inferosuperior plane and repair of the Bankart lesion. The repair achieved is 3-fold: Bankart repair, south-to-north capsular shift, and creation of an anterior bumper.