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
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
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.