Arthroscopic Bony Bankart Repair Technique: A Technical Note

Abstract

Introduction: Labrum is a static stabilitator of the glenohumeral joint. Tear to this fibrocartilaginous structure could cause shoulder instability. Lately, anterior detachment of labrum is known as a contributor to recurrent anterior instability. Anterior labrum detachments are the classic Bankart lesion. Bankart lesion involving avulsion fracture is known as bony Bankart lesion. Management for this lesion is done operatively by doing antomical repair to return rigidity to its original state. Bankart repairs were originally done openly with coracoid osteotomy and subscapularis tenotomy. Currently, arthroscopic Bankart repair is often used as the preferred surgical management. Variations of portal placements, suture placements, suture technique and other components of Bankart repair can be found today, giving options for surgeons to achieve optimal results. Surgical Technique: In athletes, bony Bankart lesion, as an intraarticular lesion with displaced labrum and avulsion causing instability, is an absolute indication for surgical intervention to ensure function return. Nonoperative treatments have been reported on small bony Bankart lesions, but outcome on follow-up showed 25% recurrent instability. We performed arthroscopic bony Brankart repair by implementing labral repair, intraosesus tunneling and double-row suture bridge techniques. First, landmarks of incisions and portals were made. Incisions for visualisation were then done. Anterior portal and posterior portal were established before identifying bony Bankart lesion. A 5 o’ clock, trans subscapularis portal was then created. We released the bony Bankart and curatage the margin. A 6 o’clock stitch was anchored through rigid suture passage (drilled bone tunnel) in 5 o’clock direction. A 4.30 o’clock stitch was anchored in a 4 o’clock suture passage. The last stitch was a 3 o’clock stitch anchored through a 3 o’clock passage. Soft tissue release was conducted until subscapularis fibers were exposed. In the remodelling process, we performed overcorrection repair. Modifications done to the Bankart repair in this paper were done to achieve excellent post-op anterior stabilization.