**4. Discussion**

An anatomic reconstruction of the capsulo-labral complex is one of the advantages of the described surgical technique. It is possible to address SLAP lesions (Superior labrum anterior to posterior) and rotator cuff tears at the same time. The subscapular muscle or its insertion are not compromised as in an open surgical procedure. Compared to other arthroscopic techniques, the procedure presented here leads to an accentuated labral bump and enables secure knot-tying with positioning of the knot away from the articular cartilage while avoiding the suture cutting through the tissue.

As shown, the arthroscopic Bankart repair using the lasso-loop stitch leads to very good results, which are comparable to other studies of arthroscopic shoulder stabilization with good clinical outcomes [16–18]. Possible disadvantages of the lasso-loop stitch compared to arthroscopic single interrupted or mattress sutures are a relatively demanding and slightly more time-consuming technique, and not being able to use slip knots. Iatrogenic cartilage damage, misplacement of anchors, or lesions to the axillary nerve can occur intraoperatively; the latter when too much tissue is taken while performing a capsular shift in the anterior inferior recessus.

Malcompliance by the patient with risk to the healing process of the anterior capsulo-labral complex with strong tensile forces during external rotation require extensive patient consent and education. In the event of re-dislocation, a detailed investigation of causes in the patient history and further diagnostics including MRI should be performed before possibly attempting revision surgery [23, 24]. Postoperative infection requires arthroscopic irrigation and systemic antibiotics, beginning with Ampicillin/Sulbactam and possibly changing to the antibiogram.

If a bony Bankart fragment is big enough to allow screw fixation, this should be undertaken either openly or arthroscopically. If the labrum remains partially unstable, a further labrum reconstruction following screw fixation may be necessary [25].

The arthroscopic refixation of the capsulo-labral complex with suture anchors using the lasso-loop stitch is slightly more elaborate due to the suturing technique than single interrupted sutures or mattress sutures. But this technique leads to a stronger bulging of the glenoid labrum and might therefore increase the physiological bumper effect of the labrum. At the same time, the knot can be positioned away from the joint to avoid irritation without cutting through the tissue like it is possible with mattress sutures for glenoid labrum refixation [26]. For further clarification of possible advantages and disadvantages of this technical modification, prospective studies comparing the described procedure with other stitching techniques are recommended.
