BACKGROUND:
A chronic osseous Bankart lesion has traditionally been treated with
soft-tissue repair and/or open bone-grafting for a large glenoid defect. We
developed an arthroscopic method of osseous reconstruction of the glenoid
without bone-grafting. The purpose of this study was to evaluate the
postoperative outcomes of our technique for chronic recurrent traumatic
anterior glenohumeral instability.
METHODS:
A consecutive series of forty-two shoulders in forty-one patients with
chronic recurrent traumatic glenohumeral instability underwent an arthroscopic
osseous Bankart repair. All shoulders were evaluated preoperatively with
three-dimensionally reconstructed computed tomography, which confirmed an
osseous fragment at the anteroinferior portion of the glenoid. The average
bone loss in the glenoid was 24.8% (range, 11.4% to 38.6%), and the average
fragment size was 9.2% (range, 2.1% to 20.9%) of the glenoid fossa. In all
shoulders, a displaced osseous fragment, firmly attached to the
labroligamentous complex, was separated from the glenoid neck before reduction
and fixation in the optimal position with use of suture anchors. All patients
were assessed with use of the scoring systems of Rowe et al. and the
University of California at Los Angeles preoperatively and at the final
evaluation.
RESULTS:
The mean duration of follow-up was thirty-four months. At that time,
thirty-nine of the forty-two shoulders were rated as having a good or
excellent result. The mean Rowe score improved from 33.6 points preoperatively
to 94.3 points postoperatively (p < 0.01). The mean score on the University
of California at Los Angeles system improved from 20.5 points preoperatively
to 33.6 points at the final evaluation (p < 0.01). The average passive
external rotation was 75° with the arm at the side and 93° with the
arm at 90° of abduction. Two patients had a reinjury. Eventually,
thirty-five of thirty-seven patients who were active participants in sports
returned to the sport they had played before the injury.
CONCLUSIONS:
Arthroscopic osseous Bankart repair with use of suture anchors yields a
successful outcome even in shoulders with a chronic large glenoid defect.