**6. History of the procedure**

Bankart lesions, which are most commonly seen after recurrent shoulder dislocations, were first described in 1923 as "shearing of the fibrous capsule of the joint from its attachment to the fibro-cartilaginous glenoid ligament". For decades, open repair of Bankart lesions was considered the gold standard, with success rates reaching up to 97% (Rowe et al, 1978).

Arthroscopic techniques for the repair of these lesions were not introduced until 1982, when Johnson first described the arthroscopic use of staples as a modification of the open procedure (Johnson, 1980). However, this technique produced unacceptably high rates of recurrence along with hardware loosening or migration, which subsequently limited its use. Transosseous sutures for arthroscopic Bankart repair were introduced in 1987 (Morgan & Bodenstab, 1987). The sutures were passed through the scapular neck, exited posteriorly and were tied over the posterior fascia. Although excellent results were reported originally, they were not confirmed by follow-up studies. Disadvantages of this technique included the need for knot tying over the posterior fascia and the risk of iatrogenic injury to the suprascapular nerve. Removable arthroscopic rivets and absorbable cannulated bio-tacks have also been used with promising results but without gaining wide popularity.

Suture anchors present the latest technological advance in arthroscopic shoulder instability repair. They were first introduced in 1993 (Wolf, 1993). The advantages of their use include multiple points of fixation, no posterior glenoid penetration and increased pullout strength, which in the case of later-generation suture anchors is comparable to transosseous suture fixation. Suture anchors traditionally used for labral repairs are either push-in or screw-in anchors.

Each anchor commercially available is unique with regard to its pull-out strength, type of suture, retrievability, bioabsorbability, insertion technique and cost. The ideal characteristics include strength and sturdiness at the time of insertion, fixation strength and safe biologic replacement of the glenoid as the anchor resorbs. Various types of suture anchors are currently available, including metal, bioabsorbable, and bioinert. Metallic anchors have raised concerns of migration or potentially complicating revision surgery. Absorbable anchors were developed later, but concerns remain regarding bone giant cell reaction during the dissolving process. An additional concern is raised by the friction of the sliding knots, which may increase the temperature adjacent to the eyelet of most anchors currently available, and consequently compromise fixation.
