Original Article With Video Illustration
Follow-up Computed Tomography Arthrographic Evaluation of Bony Bankart Lesions After Arthroscopic Repair

https://doi.org/10.1016/j.arthro.2011.09.008Get rights and content

Purpose

The follow-up results of bony union after an arthroscopic bony Bankart repair have not been reported. We studied follow-up computed tomography (CT) arthrograms to evaluate radiographic healing of bony Bankart fragments.

Methods

Among 41 patients who underwent arthroscopy for a bony Bankart lesion between July 2006 and May 2009, 31 cases in 30 patients who had undergone sequential follow-up CT arthrography preoperatively, at 3 months postoperatively, and at 1 year postoperatively were enrolled. Radiologic patterns of fracture healing were classified into bony healing and fibrous healing. The mean age was 23.4 years, and the mean follow-up was 30.5 months. The mean interval from the first trauma to surgery was 32.5 months, and the mean preoperative dislocation number was 12.1.

Results

The mean preoperative glenoid defect was 14.1%. The fracture healing patterns included 26 bony and 5 fibrous unions. There was a significant positive relation between the total dislocation number and the preoperative glenoid defect (P = .003). The proportion of the mean fragment dimension to a circle drawn through the outer cortex of the inferior glenoid was 8.4% preoperatively, 6.6% at 3 months postoperatively, and 6.2% at 1 year postoperatively. The fragment size decreased from that measured preoperatively to the size measured 3 months after surgery (P < .05). However, the fragment size was maintained between 3 months and 1 year postoperatively (P > .05). The mean Rowe score at 1 year postoperatively was 97.2.

Conclusions

Follow-up CT arthrographic evaluation showed that small bony Bankart fragments survived without resorption until 1 year postoperatively, even with fibrous union, and that reattached bone fragment fixation to the anatomic position with the labrum could survive.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Subjects

Before the study, we obtained informed consent from all the patients. This study complied with the World Medical Association Declaration of Helsinki and Korean Good Clinical Practice guidelines, and institutional review board approval was obtained. This study was designed retrospectively. We examined 40 patients (41 cases) who underwent surgery for a bony Bankart lesion between July 2006 and May 2009. All patients who underwent surgery complained of pain or discomfort with recurrent anterior

Results

Analysis of intraobserver reliability (ICC, 95% confidence interval) is described in Table 2. Our ICC values were interpreted as showing very good reliability (0.81 to 1).

The mean preoperative glenoid defect was 14.1% ± 8.6%. Of the patients, 11, 16, and 4 had a preoperative glenoid defect less than 10%, between 10% and 25%, and greater than 25%, respectively (Table 3). The proportion of the mean fragment surface area to a circle drawn through the outer cortex of the inferior glenoid was 8.4%

Discussion

Bigliani et al.1 suggested that an anterior glenoid bone defect greater than 25% should be treated with coracoid transfer because of the high risk of redislocation with arthroscopic repair. However, the total redislocation rate was 12%. Burkhart and De Beer4 reported that capsulolabral complex repair with excision of the bone fragment might be secure. However, they expressed concerns of serious containment problems that might result in an increased risk of redislocation. Wilson et al.16

Conclusions

Follow-up CT arthrographic evaluation showed that small bony Bankart fragments survived without resorption until 1 year postoperatively, even with fibrous union, and that reattached bone fragment fixation to the anatomic position with the labrum could survive.

References (19)

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    As a result, the degree of glenoid bone loss influences the type of surgical repair used to prevent future dislocation. Therefore accurate assessment and quantification of bone loss in anterior shoulder instability are crucial for surgical decision making [10] (see Figs. 4–7). CT scan in the pre-operative imaging for patients with recurrent anterior shoulder instability facilitates the detection of bony glenoid damage and helps to decide whether open bone augmentation surgery instead of an arthroscopic Bankart repair is needed [11].

  • Clinical Outcomes and Recurrence Rates After Arthroscopic Stabilization Procedures in Young Patients With a Glenoid Bone Erosion: A Comparative Study Between Glenoid Erosion More and Less Than 20%

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    They concluded that the presence of bony Bankart fragments and their union after surgery were important factors related to low recurrence rates. In bony Bankart lesions, the glenoid defect size usually decreased with the union of the fragment after surgery leading to a glenoid bony buttress.18,29 Because the authors aimed to evaluate the effects of arthroscopic soft tissue procedures in the treatment for shoulder instability with large glenoid defects in the present study, patients with bony Bankart lesions were excluded.

  • Arthroscopic suture anchor fixation of bony bankart lesions: Clinical outcome, magnetic resonance imaging results, and return to sports

    2015, Arthroscopy - Journal of Arthroscopic and Related Surgery
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    Overall, 5 of 30 patients (16.6%) in our series had a nonunion of the bony fragment. This is comparable with the reported nonunion rate in the literature, ranging from 8.0% to 16.1%.1,4,15,17 However, in our patient population, persisting glenoid defects due to nonunion as well as attrition were usually small, averaging 6.8% of the glenoid surface area.

  • A biomechanical analysis of a single-row suture anchor fixation of a large bony Bankart lesion

    2014, Arthroscopy - Journal of Arthroscopic and Related Surgery
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    In fact, all postoperative recovery guidelines reported in the clinical studies have an initial period of immobilization that likely allows bone healing before stress is seen at the repair site.1-3,7-9 An 83.9% healing rate for bony Bankart lesions fixed with a single-row suture anchor technique at 1 year postoperatively reported by Park et al.22 may support the idea that relative rest in the early postoperative period after suture repair of a bony Bankart lesion may promote incorporation of the bony piece. Our findings are important because they show the advantages and limitations of a single-row suture anchor repair of a bony Bankart lesion.

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The authors report no conflict of interest.

Note: To access the video accompanying this report, visit the April issue of Arthroscopy at www.arthroscopyjournal.org.

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