Original Articles
Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: Significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion*,**

https://doi.org/10.1053/jars.2000.17715Get rights and content

Abstract

Purpose: Our goal was to analyze the results of 194 consecutive arthroscopic Bankart repairs (performed by 2 surgeons with an identical suture anchor technique) in order to identify specific factors related to recurrence of instability. Type of Study: Case series. Materials and Methods: We analyzed 194 consecutive arthroscopic Bankart repairs by suture anchor technique performed for traumatic anterior-inferior instability. The average follow-up was 27 months (range, 14 to 79 months). There were 101 contact athletes (96 South African rugby players and 5 American football players). We identified significant bone defects on either the humerus or the glenoid as (1) “inverted-pear” glenoid, in which the normally pear-shaped glenoid had lost enough anterior-inferior bone to assume the shape of an inverted pear; or (2) “engaging” Hill-Sachs lesion of the humerus, in which the orientation of the Hill-Sachs lesion was such that it engaged the anterior glenoid with the shoulder in abduction and external rotation. Results: There were 21 recurrent dislocations and subluxations (14 dislocations, 7 subluxations). Of those 21 shoulders with recurrent instability, 14 had significant bone defects (3 engaging Hill-Sachs and 11 inverted-pear Bankart lesions). For the group of patients without significant bone defects (173 shoulders), there were 7 recurrences (4% recurrence rate). For the group with significant bone defects (21 patients), there were 14 recurrences (67% recurrence rate). For contact athletes without significant bone defects, there was a 6.5% recurrence rate, whereas for contact athletes with significant bone defects, there was an 89% recurrence rate. Conclusions: (1) Arthroscopic Bankart repairs give results equal to open Bankart repairs if there are no significant structural bone deficits (engaging Hill-Sachs or inverted-pear Bankart lesions). (2) Patients with significant bone deficits as defined in this study are not candidates for arthroscopic Bankart repair. (3) Contact athletes without structural bone deficits may be treated by arthroscopic Bankart repair. However, contact athletes with bone deficiency require open surgery aimed at their specific anatomic deficiencies. (4) For patients with significant glenoid bone loss, the surgeon should consider reconstruction by means of the Latarjet procedure, using a large coracoid bone graft.

Arthroscopy: The Journal of Arthroscopic and Related surgery, Vol 16, No 7 (October), 2000: pp 677–694

Section snippets

Materials and methods

We analyzed 194 arthroscopic Bankart repairs performed by the two of us between July 1992 and June 1998. One of us (S.S.B.) performed 43 of these surgeries between July 1992 and June 1998, and the other (J.F.DeB.) performed 151 of the surgeries between January 1994 and May 1998. This was a consecutive series of traumatic anterior instability for each author, with the following exclusions: anterior instability due to humeral avulsion of the glenohumeral ligaments (HAGL lesions) and cases with

Results

We had 21 recurrent dislocations and subluxations (14 dislocations, 7 subluxations), for a 10.8% recurrence rate. However, of those 21 recurrent dislocations and subluxations, 14 had significant bone defects (3 engaging Hill-Sachs lesions and 11 inverted-pear Bankart lesions).

We found it useful to divide our patients into 2 groups: those without significant bone defects (173 patients) and those with significant bone defects (21 patients). For the group without significant bone defects, there

Arthroscopic versus open repairs

Arthroscopic Bankart repairs remain controversial primarily because of reports of high recurrence rates, ranging up to 44% for transglenoid repairs.4, 5 However, on critical analysis of the literature, the recurrence rate is quite variable and can be very low even with transglenoid sutures.6, 7 A report on a recent series of arthroscopic suture anchor repairs8 described excellent results with only a 7% recurrence rate in an athletic population. The results in this arthroscopic suture anchor

Conclusions

  • 1.

    Arthroscopic Bankart repairs produce results equal to open Bankart repairs if there are no significant structural bone deficits (large engaging Hill-Sachs lesions or large bony Bankart lesions).

  • 2.

    Patients with significant bone deficits as defined in this study are not candidates for arthroscopic Bankart repair.

  • 3.

    A Hill-Sachs lesion that engages the anterior glenoid rim in a functional position of combined flexion-abduction–external rotation on dynamic arthroscopic examination is a contraindication

Acknowledgements

Acknowledgment: The authors acknowledge Chen Yuan, Ph.D., for his assistance in performing the statistical analysis for this report.

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  • Cited by (0)

    *

    Address correspondence and reprint requests to Stephen S. Burkhart, M.D., 540 Madison Oak Dr, Suite 620, San Antonio, TX 78258, U.S.A.

    **

    NOTE: To access the video illustration accompanying this report, visit the October on-line issue of Arthroscopy at http://www.arthroscopyjournal.org

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