Arthroscopic Suture Anchor Fixation of Bony Bankart Lesions: Clinical Outcome, Magnetic Resonance Imaging Results, and Return to Sports

doi:10.1016/j.arthro.2015.03.005

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 31, Issue 8, August 2015, Pages 1472-1481

https://doi.org/10.1016/j.arthro.2015.03.005 Get rights and content

Purpose

The purpose of this study was to evaluate the outcome, return to sporting activity, and postoperative articular cartilage and bony morphology of shoulders that underwent arthroscopic suture anchor repair of bony Bankart lesions.

Methods

The inclusion criteria for this retrospective study were anterior glenoid rim fractures after traumatic shoulder instability that were treated with arthroscopic suture anchor repair. Patients were surveyed by a questionnaire including sport-specific outcome, Rowe score, Western Ontario Shoulder Instability Index, and Oxford Instability Score. Three-tesla magnetic resonance imaging could be performed in 30 patients to assess osseous integration, glenoid reconstruction, and signs of osteoarthritis.

Results

From November 1999 to April 2010, 81 patients underwent an anterior bony Bankart repair in our department (50 arthroscopic suture anchor repairs, 5 arthroscopic screw fixations, and 26 open repairs). The 55 arthroscopic repairs comprised a consecutive cohort of patients treated by a single surgeon. Of the 50 patients in the suture anchor group, 45 (90%) were available for evaluation. At 82 ± 31 months postoperatively, the mean Rowe score was 85.9 ± 20.5 points, the mean Western Ontario Shoulder Instability Index score was 89.4% ± 14.7%, and the mean Oxford Instability Score was 13.6 ± 5.4 points. Compared with the contralateral shoulder, all scores showed a significantly reduced outcome (P < .001, P < .001, and P < .001, respectively). A redislocation occurred in 3 patients (6.6%). Regarding satisfaction, 35 patients (78%) were very satisfied, 9 (20%) were satisfied, and 1 was partly satisfied. Overall, 95% of patients returned to any sporting activity after surgery. The number of sports disciplines (P < .001), duration (P = .005), level (P = .02), and risk category (P = .013) showed a significant reduction compared with the pretrauma condition. However, only 19% of patients reported that shoulder complaints were the reason for the reduction in activity. Nonunion occurred in 16.6%, with a higher frequency in patients with chronic lesions (P = .031). Anatomic reduction was achieved in 72%, the medial step-off in patients with nonanatomic reduction averaged 1.8 ± 0.9 mm, and the remaining glenoid defect size averaged 6.8% ± 7.3%. Full-thickness cartilage defects of the anterior glenoid were detected in 70% of patients.

Conclusions

Arthroscopic suture anchor repair may enable an anatomic reduction of bony Bankart lesions with no or only minimal articular steps and provides successful midterm outcomes concerning clinical scores, recurrence, and patient satisfaction. The return to activity is limited for various, mostly non–shoulder-related causes. Chronic lesions may have an inferior healing potential; therefore early surgical stabilization of acute Bankart fragments is suggested to avoid possible nonunion.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Patient Selection

The primary inclusion criterion for this retrospective study was traumatic anterior shoulder instability with a fracture of the anterior glenoid rim of type I or II according to Bigliani et al.,² diagnosed on preoperative imaging and confirmed during arthroscopy. Only patients who had undergone all-arthroscopic suture anchor repair without a previous stabilization procedure and had a follow-up period of at least 24 months were included.

The exclusion criteria were posterior or multidirectional

Demographic Characteristics

During the period from November 1999 to April 2010, a total of 81 patients underwent surgery for an anterior bony Bankart lesion in our department (50 arthroscopic suture anchor repairs, 5 arthroscopic screw fixations, and 26 open repairs). The 55 arthroscopic repairs comprised a consecutive cohort of patients treated by a single experienced arthroscopic surgeon (A.B.I.). Arthroscopic screw fixation was chosen in cases with a large solitary fragment. All other patients were treated with suture

Discussion

As hypothesized, arthroscopic suture anchor repair for bony Bankart lesions yielded successful midterm outcomes concerning clinical scores, recurrence, and patient satisfaction. Regarding glenoid fossa reconstruction, an anatomic reduction of the fragment with no or only minimal articular steps and small persisting overall postoperative glenoid defects was achieved in most cases. The reconstruction of the articular surface did not influence the clinical outcome.

The anterior glenoid on MRI

Conclusions

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Cited by (38)

Arthroscopic repair with transosseous sling-suture technique for acute and chronic bony Bankart lesions
2023, Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology
Failure to fix the fractured fragment can result in bony fragment resorption and consequent glenoid bone loss. Current arthroscopic repair techniques might lead to insecure fixation and refracture. The purpose of this study was to evaluate the effectiveness of the transosseous sling-suture technique for bony Bankart lesions, and to compare the clinical outcomes for acute and chronic bony Bankart lesions treated with this technique.
A retrospective case series consisting of 46 patients with bony fracture of the glenoid rim following traumatic injury was identified from May 2015 to August 2020. The patients were divided into the acute lesion group and the chronic lesion group according to the time from first injury to surgery. The size of bone fragment was used to group the patients into the small and the medium sized fragment groups. All the patients underwent arthroscopic repairs using the transosseous sling-suture technique. Preoperative and postoperative evaluations including Rowe score, West Ontario Shoulder Instability Index (WOSI), Visual Analogue Scale (VAS) for pain scores, ROMs and number of dislocations were recorded. No significant differences were found in the comparisons of postoperative ROMs ang functional outcomes regarding between the small and the medium sized fragment groups.
No dislocations occurred for both groups postoperatively. At the last follow-up, all the ROMs (including anterior flexion, abduction, external rotation and internal rotation at the side), the Rowe score, the WOSI score and the VAS score for pain in the both groups were significantly improved compared to the preoperative evaluations (all Ps < 0.001). In the comparisons between the acute and the chronic lesion groups, significantly greater anterior flexion (158.9 ± 8.9° vs. 153.0 ± 6.4°, P = 0.037), abduction (167.7 ± 10.1° vs. 161.0 ± 7.0°, P = 0.035) and external rotation at the side (88.3 ± 6.4° vs. 83.5 ± 5.5°, P = 0.024) were found in the acute lesion group. The comparisons of the Rowe score (86.0 ± 7.5 vs. 87.5 ± 10.6, P = 0.319), the WOSI score (223.5 ± 56.3 vs. 185.0 ± 79.9, P = 0.062), the VAS score for pain (0.4 ± 0.2 vs. 0.3 ± 0.2, P = 0.324) and the internal rotation at the side (74.6 ± 13.2° vs. 80.5 ± 11.1°, P = 0.116) between these two groups did not demonstrate significant differences between the two groups.
This arthroscopic transosseous sling-suture repair technique for shoulder anterior instability with acute and chronic bony Bankart lesion can restore joint stability, improve clinical outcomes and range of motion postoperatively. The acute bony Bankart lesion using the current technique can produce better range of motion compared to the chronic lesion.
Retrospective case series; Level of evidence, 4.
Why do patients with anterior shoulder instability not return to sport after surgery? A systematic review of 63 studies comprising 3545 patients
2023, JSES International
To review athletes’ reasons not to return to sport (RTS) after surgical treatment of anterior shoulder instability, comparing capsulolabral repair and bony reconstruction procedures. The hypothesis is that the most common reason for patients unable to RTS is not due to physical inability of the shoulder.
A systematic review was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. PubMed, Embase/Ovid, Cochrane Database of Systematic Reviews/Wiley, Cochrane Central Register of Controlled Trials/Wiley, SPORTDiscus/Ebsco, and Web of Science/Clarivate Analytics were searched in collaboration with an information specialist up to August 11, 2022. Observational and interventional studies reporting reasons for no RTS following surgical treatment of anterior shoulder instability were included. Quality assessment of studies was conducted using the Methodological Index for Non-Randomized Studies (MINORS) criteria and Risk of Bias (RoB) assessment. Forest plots were generated to show an overview of the proportion shoulder function independent reasons for each study.
Sixty-three studies were included reporting on 3545 athletes, of which 2588 (73%) underwent capsulolabral repair versus 957 (27%) who underwent surgical treatment with bony reconstruction procedures. A total of 650 athletes (18%) were unable to RTS. The reason not to RTS was most frequently shoulder function independent (70%) compared to shoulder function dependent (30%) following both capsulolabral repair and bony reconstruction procedures. Most cited reasons for no RTS after capsulolabral repair were fear of reinjury (17%), personal reasons or change of priorities (11%) and retirement/discharge of military service or sports team (10%). Of these reasons, 106 (22%) were not specified other than being shoulder function dependent or shoulder function independent. Most cited reasons for no RTS after bony reconstruction procedures were fear of reinjury (12%), shoulder pain (10%), and retirement/discharge of military service or sports team (9%). Of these reasons, 74 (44%) were not specified other than being shoulder function dependent or shoulder function independent. Forest plots showed a variation from 0% to 100% shoulder independent reasons for both capsulolabral repair and bony reconstruction procedures.
The majority of athletes who did not RTS following surgical treatment for anterior shoulder instability did so due to shoulder function independent reasons, such as fear of reinjury. However, there was a high variety between studies and many reasons were unspecified, warranting unified definitions for reasons of patients that do not RTS.
Arthroscopic Autologous Scapular Spine Bone Graft Combined With Bankart Repair for Anterior Shoulder Instability With Subcritical (10%-15%) Glenoid Bone Loss
2021, Arthroscopy - Journal of Arthroscopic and Related Surgery
Citation Excerpt :
Although nonrigid fixation of the bone graft was adopted, the graft healing rate is very promising because all grafts healed at 1 year after surgery. Anterior glenoid bone graft by suture anchor fixation had been well reported with high satisfaction rate.34-37 With the twin-tunnel fixation fashion by the suture anchors, the graft can be stabilized securely and kept flush with the glenoid articular surface without rotation.
The purpose of our study is to prove that the autologous scapular spine bone graft is an alternative for the treatment of anterior shoulder instability and the clinical and radiological results are promising.
From July 2016 to August 2018, patients who were diagnosed as having anterior shoulder instability with subcritical (10%-15%) glenoid bone loss were treated by arthroscopic repair with autologous scapular spine bone graft. The inclusion criteria were (1) anterior shoulder instability underwent arthroscopic autologous scapular spine bone graft; (2) glenoid bone loss was within 10% to 15% (measured by Sugaya's method); (3) three complete sets of computed tomography (CT) scans (preoperative, 1 week after surgery, and 1 year after surgery) available; and (4) clinical follow-up time was at least 2 years. The exclusion criteria were (1) concomitant rotator cuff tear; (2) concomitant remplissage or SLAP repair; (3) previous surgery of the affected shoulder; (4) open surgery; and (5) incomplete radiological or clinical follow-up. The preoperative and postoperative Constant-Murley score, dietary approaches to stop hypertension (DASH) score, visual analog scale (VAS) score, and range of motion (ROM) were recorded. CT scans with 3-dimensional reconstruction were obtained at the first week after operation and at 1 year after operation; the graft resorption rate was consequently calculated.
Twenty-seven patients were qualified and enrolled in the study. No severe complication was recorded during follow-up. No redislocation or subluxation was found, and the apprehension tests were all negative. At the last follow-up, the mean Constant-Murley score was 89.74 ± 3.71, the mean DASH score was 9.77 ± 5.31, the mean VAS score was 0.74 ± 0.64, which are all improved significantly compared with preoperative scores (P = .00,.00,.00, respectively). At the last follow-up, the ROM including anterior flexion, external rotation by side, and the internal rotation were well restored without significant difference compared with the contralateral shoulder (P =.48, .08, .47, respectively). At 1 year after operation, the resorption rate of the bone graft was 19.4%.
This study found that anterior shoulder instability with subcritical (10%-15%) glenoid bone loss treated with arthroscopic autologous scapular spine bone graft with suture anchor fixation is safe and could achieve satisfactory result at short-term follow-up.
Therapeutic case series.
Arthroscopic Reduction and Stable Fixation of an Anterior Glenoid Fracture With 4 Buttons
2020, Arthroscopy Techniques
An arthroscopic technique for the reduction and stable fixation of an articular glenoid fracture with a 2-button compression system, originally designed for the treatment of shoulder instability with bone deficiency in the anterior glenoid, is presented. This technique allows direct visualization of the joint, reduction of the fracture, precise placement of the buttons according to the fracture line, and stable fixation. It is a safe and reproducible technique, using the standard shoulder arthroscopy portals.
Arthroscopic Transosseous Suture Button Fixation Technique for Treatment of Large Anterior Glenoid Fracture
2019, Arthroscopy Techniques
Citation Excerpt :
However, open surgery including arthrotomy with splitting or detachment of the subscapularis tendon is associated with several potential complications due to the substantial soft-tissue injury or owing to the risk of fracture fragmentation. Range of motion is poorer and the complication and reoperation rates are higher after open surgery compared with arthroscopic techniques.3,4 Arthroscopy enables perfect visualization of the articular surface, minimizes the need for soft-tissue dissection, and offers the opportunity to both detect and address concomitant intra-articular injuries.
To date, several open and arthroscopic surgical procedures are available for the treatment of anterior glenoid fractures after anterior shoulder dislocation. Open approaches require extensive soft-tissue dissection and are associated with poorer outcomes. Arthroscopic screw fixation techniques are technically challenging and related to complications as well, for example, risk of brachial plexus injury or hardware impingement. Alternative arthroscopic fixation techniques use suture anchors placed along the fracture rim with sutures passed around the fragment. However, these techniques require an intact capsulolabral complex and cannot be used effectively for large fracture fragments. This article describes a safe interfragmentary, transosseous, all-arthroscopic procedure using a double–cortical button fixation technique. This method can be used to achieve anatomic reduction and stable fixation of intermediate to large anterior glenoid fractures while minimizing the difficulties associated with previously described arthroscopic or open approaches.
All-Arthroscopic Treatment of Glenoid Rim Fractures
2019, Arthroscopy Techniques
We describe an arthroscopic technique for the management of glenoid rim fractures. It is performed with the patient placed in lateral decubitus position. The fracture is assessed through the anterosuperior portal, and the fragment is mobilized. A special glenoid guide is used from the posterior portal to reduce the fragment and to create 2 tunnels through the glenoid and through the glenoid rim fragment. Two pairs of round buttons are connected with high-strength sutures and are tightened posteriorly. This allows strong fixation of the fractured fragment and avoids all the anterior structures since all the instruments are inserted posteriorly.

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: The authors report that they have no conflicts of interest in the authorship and publication of this article.

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Original ArticleArthroscopic Suture Anchor Fixation of Bony Bankart Lesions: Clinical Outcome, Magnetic Resonance Imaging Results, and Return to Sports

Purpose

Methods

Results

Conclusions

Level of Evidence

Section snippets

Patient Selection

Demographic Characteristics

Discussion

Conclusions

Arthroscopy

Arthrosc Tech

Arthroscopy

Arthrosc Tech

Arthroscopy

Arthroscopy

Arthroscopy

Injury

J Shoulder Elbow Surg

Long-term outcome of acute versus chronic bony Bankart lesions managed arthroscopically

Am J Sports Med

Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder

Am J Sports Med

The “bony Bankart bridge” technique for restoration of anterior shoulder stability

Am J Sports Med

A combined transglenoid and suture anchor technique for bony Bankart lesions

Knee Surg Sports Traumatol Arthrosc

Arthroscopic screw fixation of large anterior glenoid fractures

Knee Surg Sports Traumatol Arthrosc

Arthroscopic three-point double-row repair for acute bony Bankart lesions

Knee Surg Sports Traumatol Arthrosc

Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability. Surgical technique

J Bone Joint Surg Am

Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability

J Bone Joint Surg Am

Original Article
Arthroscopic Suture Anchor Fixation of Bony Bankart Lesions: Clinical Outcome, Magnetic Resonance Imaging Results, and Return to Sports