Arthroscopic Osseous Bankart Repair in the Treatment of Recurrent Anterior Glenohumeral Instability.

Abstract

Anterior glenohumeral instability associated with an anterior-inferior fracture of the glenoid (osseous Bankart lesion) can be treated successfully with arthroscopic, rather than open, surgical repair, or fixation of the osseous fragment. Place the patient in the beach-chair position and examine both shoulders for laxity after induction of general anesthesia with an interscalene block. Create a standard posterior viewing portal and anterior and anterosuperior working portals. Separate the displaced osseous fragment associated with the labroligamentous complex from the glenoid neck and mobilize the labroligamentous complex together with the fragment up to the 7 o'clock or 7:30 position (in a right shoulder). Perform an inferior labrum repair by inserting 2 suture anchors at the anteroinferior part of the glenoid face. Fix the osseous fragment by passing the sutures either through or around the fragment with use of a bone penetrator, or Bone Stitcher, while stabilizing the labrum and fragment with a large grasper. Rotator interval closure, done with the arm in >60° of external rotation, is the most frequently performed augmentation procedure. A consecutive series of 46 patients with an osseous Bankart lesion who demonstrated >15% glenoid bone loss underwent osseous Bankart repair, which was performed regardless of the fragment size, between January 2005 and December 20061.