Arthroscopic bony Bankart repair for chronic recurrent traumatic anterior glenohumeral instability (SS-30)

Abstract

Purpose: A bony Bankart lesion associated with chronic recurrent traumatic glenohumeral instability has traditionally been treated with only soft tissue repair and/or open bone grafting if the glenoid defect was large. However, we recognized that the bony Bankart lesion could be reconstructed arthroscopically, even if it was chronic with a large osseous defect, because it is possible to separate the bony fragment from the glenoid neck together with the labroligamentous complex. The purpose of this study was to evaluate the postoperative outcome of an arthroscopic bony Bankart repair for chronic recurrent traumatic anterior glenohumeral instability, including “inverted-pear” type glenoid bone deficiency. Methods: A consecutive series of 41 shoulders with chronic recurrent traumatic glenohumeral instability underwent arthroscopic bony Bankart repair. Subjects included 37 males and 4 females with an average age of 23 years old. All shoulders were evaluated by three-dimensionally reconstructed computed tomography (3DCT) preoperatively, which confirmed a bony fragment at the anteroinferior portion of the glenoid. The average bone loss against the lower part of the circular glenoid portion was 7.3% (range, 2.1–20.9) as measured by our original calculation method using 3DCT. In all shoulders, a displaced bony fragment, firmly attached to the labroligamentous complex, was separated from the glenoid neck before a reduction and fixation to the optimal position was achieved utilizing suture anchors. All patients were assessed using the Rowe scoring system at a minimum 24 months postoperatively. Results: The Rowe score improved postoperatively in all shoulders (P < .01). The average Rowe score at the time of mean follow-up of 31 months (range, 24–47) was 94.3 (range, 40–100) with 40 out of 41 shoulders graded as excellent or good (97.6%). One noncompliant patient experienced a redislocation 3 months postoperatively during soccer play before receiving permission to return to full sports activity. Thirty-eight out of 39 active sports participants returned to their preinjury sports. Conclusions: Arthroscopic bony Bankart repair utilizing suture anchors yields a successful outcome in shoulders with chronic recurrent traumatic anterior glenohumeral instability. This study demonstrates that the bony reconstruction together with the attached labroligamentous complex can bring a favorable outcome even in athletes and also suggests that this technique might obviate the necessity of open bone-grafting in patients with “inverted pear” type glenoid.