Use of the Wilmington portal and knotless wire anchors for successful arthroscopic posterior Bankart repair

Posterior shoulder instability is a relatively uncommon condition, accounting for between 2 and 10% of all cases of shoulder instability, and predominantly affecting young men. Recurrent posterior subluxation is the most frequently encountered pattern, and a posterior labral tear is the principal structural lesion, identified in approximately half of all cases. When conservative management fails and in the absence of significant glenoid bone loss, arthroscopic posterior Bankart repair is the procedure of choice. Nevertheless, the technique is demanding: adequate visualisation of the posterior aspect of the joint and correct orientation of the working portal for anchor placement both represent recognised operative challenges. This technical note describes a reproducible, step-by-step arthroscopic approach that addresses these difficulties. The patient is positioned in the beach-chair position without traction, and three portals are employed: a standard posterior soft-spot portal, an antero-supero-lateral (ASL) viewing portal, and a posterolateral Wilmington portal placed 1 cm distal and 1 cm anterior to the posterolateral acromial border, affording a 45° angle of approach to the posterior glenoid rim. After transfer of the arthroscope to the ASL portal to optimise visualisation, the capsulolabral complex is mobilised with a curved elevator and the glenoid rim is prepared with a bone rasp and curette, avoiding thermal energy. A minimum of three knotless self-locking FiberTak® 1.8 wire anchors are then inserted through the Wilmington portal from inferior to superior, spaced 5 to 8 mm apart, with the posterior soft-spot portal reserved for suture shuttle relay and retrieval. Postoperative management comprises four weeks of sling immobilisation, hydrotherapy-based rehabilitation from the third week, and return to sport between four and six months. The combination of an ASL viewing portal, a Wilmington working portal and knotless wire anchors facilitates accurate anchor positioning, minimises iatrogenic cartilage injury, simplifies suture management, and renders the procedure more reproducible. This article will be of practical value to shoulder and arthroscopic surgeons seeking a clear, optimised operative strategy for posterior Bankart repair.