**1. Introduction**

After traumatic first-time shoulder dislocation followed by conservative treatment, the re-dislocation rate is >70% in patients <30 years. With age, the risk of re-dislocation after traumatic shoulder dislocation and conservative treatment decreases. Surgical treatment via either open or arthroscopic stabilization minimizes the risk of re-dislocation [1–4].

In cases without severe chronic bone loss at the glenoid site, anterior shoulder stabilization by arthroscopic refixation of the labroligamentous complex with suture anchors is the standard therapeutic procedure [1, 5]. The so-called "Lassoloop stitch "was described by Lafosse et al [6–9]. This technique allows positioning of the knot away from the joint and at the same time it establishes the sought labral bump. With the "Oblique mattress lasso-loop stitch" Parnes et al. published a resembling arthroscopic technique, but without giving clinical results [10].

The goal of the surgery is refixation of the anterior labrum-capsule-ligament complex to the glenoid with positioning of the knot at distance to the joint as well as bulking up the labrum. This stabilizes the gleno-humeral joint and therefore

avoids further dislocations and associated pathologies. Using lasso-loop stitches probably leads to more bulging up of the labrum than other stitching techniques as for example the single interrupted stitch or the mattress stitch. The lasso-loop stitch accentuates the physiological bumper effect of the glenoid labrum and can therefore avoid re-dislocation.

Indications for this operation are shoulder instabilities with repairable damage to the labrum: Bankart lesion, bony Bankart lesion, ALPSA, Perthes lesion, and reversed (posterior) Bankart lesions as well as injuries to the long head biceps tendon anchor (SLAP). Contraindications for this operation are arbitrary shoulder dislocations during growth period without damage to the labrum and chronic bony glenoid defects >15% of the glenoid surface [11–13]. HAGL lesions require softtissue refixation at the humeral site [14].

Patient consent should contain the following issues apart from the standard operation risks: cartilage damage, lesion to the axillary nerve, suture rupture, switching to open surgical procedure in case of larger bony defects, standardized postoperative treatment, restriction of motion (especially external rotation), re-dislocation, anchor dislocation, osteolysis in case of resorbable anchors, posttraumatic arthritis, pain, hospitalization for 1–2 days, day surgery possible, work leave dependent on job and arm dominance 2 days to 16 weeks.

While recording the patient history, it is critical to differentiate between traumatic and habitual cause and evaluate the main symptom, either pain or instability. It is followed by a standardized clinical examination including apprehension sign and determination of the instability direction as well as evaluating an existing hyperlaxity. X-rays of the shoulder in three planes (true a.p., y-view, axial) and MRI (**Figure 1**) are performed [15, 16]. The surgical site should be shaved, if strongly covered by hair. An examination under anesthesia is performed to record the passive glenohumeral range of motion following the neutral-zero method as well as evaluation of glenohumeral stability and translation according to the modified Hawkins classification [6] and exclusion of multidirectional instability. In case of larger glenoid defects, a CT scan is necessary [17].

With this technical modification to the classic arthroscopic Bankart repair, we reliably experienced very good clinical results and high patient satisfaction. It is the aim of this work to give an illustrated instruction of the surgical technique of arthroscopic Bankart repair using the lasso-loop stitch.

#### **Figure 1.**

*MRI of the right shoulder of a 20-year-old male after primary traumatic anterior-inferior shoulder dislocation. The red arrow marks a classic Bankart lesion. The green arrow marks a concomitant hill-Sachs lesion.*
